经皮内镜椎板间入路微创治疗腰椎间盘突出症前后步态分析

摘要

目的:探讨经皮内镜椎板间入路微创治疗腰椎间盘突出症(LDH)前后步态特点.方法:选取2015年9-12月四川大学华西医院骨科收治的行经皮内镜椎板间入路腰椎间盘髓核摘除术(PEID)的LDH患者80例,分为L4-5组(40例)和L5S1组(40例),按照身高、体重、年龄、性别配比20例健康志愿者作为对照组.应用三维步态分析系统取对照组步态各参数作为对照,L4-5及L5S1组患者分别在术前、术后1d、术后1个月、术后6个月行三维步态分析检查,取各个时期的步频、步速、踝关节矢状面活动度(伸/屈)(ROM)整体评价患者各个时期的步态特点.结果:L4-5组及L5S1组术前步速、步频及患侧踝关节ROM均差于对照组(P＜0.05);术后1个月:L4-5组及L5S1组步速和步频较术前明显改善(P＜0.05),但仍差于对照组(P＜0.05),L4-5组患侧踝关节ROM较术前明显改善(P＜0.05),L5S1组患侧踝关节ROM较术前无明显改善(P＞0.05);术后6个月:L4-5组及L5S1组步速、步频恢复至接近对照组(P＞0.05),L4-5组患侧踝关节ROM与对照组比较差异无统计学意义(P＞0.05),L5S1组患侧踝关节ROM较术前仍无明显改善(P＞0.05).结论:LDH患者行PEID术后步速和步频均有明显的改善,踝关节ROM改善情况因腰椎间盘突出的部位的不同而有明显差异.%Objective:To analyze the characteristics of gait before and after percutaneous endoscopic interlaminar discectomy (PEID)minimally invasive therapy in patients with lumbar disc herniation(LDH).Methods:From September 2015 to December 2015,80 LDH patients undergoing PEID in our hospital were selected and divided into L4-5 group (40 cases) and L5S1 group (40 cases).Twenty healthy volunteers were selected matching with age,height,weight and sex ratio as a control group.3-D gait analysis system was applied to take parameters of gait in the control group.3-D gait analysis review was conducted on patients in L4-5 and L5S1 groups respectively before operation,and one day,one month and six months after operation.Walking frequency,walking speed and range of motion (ROM) of ankle joint sagittal plane in various periods were taken to make an overall evaluation of the gait characteristics of the patients in various periods.Results:The preoperative walking frequency,walking speed and ankle joint ROM in affected side in L4-5 and L5S1 groups were worse than those in control group (P＜0.05).One month after operation,walking frequency and walking speed in L4-5 and L5S1 groups were significantly improved (P＜0.05),but still worse than controls (P＜0.05).Ankle joint ROM in affected side in L4-5 group was significantly improved (P＜0.05),but no significant improvement was noted in affected side ankle joint ROM in L5S1 group (P＞0.05).Six months after operation,walking frequency and walking speed in L4-5 and L5S1 groups were almost recovered to normal (P＞0.05),and there was no significant difference in ankle joint ROM in affected side between L4-5 group and control group (P＞0.05),and ankle joint ROM in affected side in L5S1 group was not obvious improved after operation (P＜0.05).Conclusion:3-D gait analysis can quantitatively evaluate the gait of LDH patients before and after PEID and postoperative recovery,which provides new theoretical reference for the evaluation of therapeutic effect and individualized precise rehabilitation scheme.