تحليل كينتيك راه رفتن در بيماران مبتلا به اسكوليوز نوجواني ناشناخته

Kinetic Gait analysis in Patients with Adolescent Idiopathic Scoliosis and Normal Control Subjects

درناهنجاري اسكوليوز نوجواني ناشناخته، هنوز تعامل بين انحراف ستون ­مهره­اي با جنبه­هاي كينتيكي راه رفتن به خوبي شناسايي نشده است. هدف از مطالعه حاضر تحليل نيروي عكس‌العمل زمين در مرحله استقرار راه رفتن در بيماران اسكوليوز نوجواني ناشناخته و مقايسه آنها با نوجوانان سالم بود. روش بررسي: تعداد 19 دختر 11 تا 16 ساله مبتلا به اسكوليوز و 18 دختر سالم همگن با سن، قد و جرم مشابه مورد مطالعه قرار گرفتند. نيروهاي عكس ­العمل زمين در جهت ها­ي عمودي (Fz) (GRF force in Z axis) ، قدامي­ـخلفي (Fy) (GRF force in Y axis) ، و داخلي­ـخارجي (Fx) (GRF force in Z axis) و نيز جنبه ­هاي كينماتيكي بدن هنگام راه رفتن با استفاده از دو تخته نيروي Kistler ((1000 Hz و يك دستگاه Vicon با 4 دوربين سري T، اندازه ­گيري شدند. پس از پردازش داد ه­ها و همگ ن­سازي آنها بر حسب وزن، متغيرهاي اوج نيروهاي عكس ­العمل زمين، نرخ بارگذاري، اندازه ضربه، متغيرهاي زماني نيروي عكس ­العمل و شاخص عدم تقارن در متغيرهاي مختلف محاسبه گرديدند. اطلاعات با استفاده از آزمون آزمون آناليز واريانس چند متغيره و آناليز واريانس اندازه‌هاي تكراري در سطح معني ­داري 0/05 پردازش شدند. يافته ها: در هر سه جهت عمودي، قدامي ـ خلفي و داخلي­ ـ خارجي، نيروي عكس ­العمل زمين پاي راست بيماران اسكوليوز و افراد سالم مشابه بودند (0/05

Purpose: In deformed spine of adolescent patients with idiopathic scoliosis, the interaction between the deformity and kinetic aspects during gait has not been well understood. The aim of this study was to analyze the ground reaction force (GRF) during gait in adolescent idiopathic scoliosis (AIS) and healthy control group. Methods: Nineteen adolescent female patients with right thoracic idiopathic scoliosis of between 11-16 years of ages as well as 18 healthy females with similar age-matched, height and mass were studied. Using two Kistler force plates (1000 Hz) and a Vicon system with 4 T series cameras (100 Hz), the GRF and kinematic aspects of subjects’ gait were simultaneously recorded. GRF forces in x (Fx), y (Fy), and z axes (Fz), together with impulse, loading rate, and the asymmetry index (AI) for all variables were evaluated. AI index was calculated with [(Right X – Left X)/ ((Right X + Left X)*0.5)]*100. MANOVA was used to assess the between group differences, Also, repeated measure analysis of variance was used for within group comparisons. Significance level was set at p<0.05. Results: In the right foot, all parameters of GRF were similar in AIS and control groups (p>0.05). In the left foot also, Fy and Fx components of GRF were similar between groups (P>0.05). However, the Fz1 parameter of the left foot in scoliosis group was significantly smaller than that of in control group (p=0.03). In the right and left feet, the impulses, loading rate and time related GRF variables were not different between two groups (p>0.05). The AI for all variables were similar in both groups (p<0.05). Conclusion: AIS patients demonstrated reduced vertical GRF in left heel contact phase with respect to the control group. Unilateral alteration of the muscle function in the lower limb might be a possible explanation to this abnormality. Further more complex studies are needed to evaluate the origin and consequence of this observation.