臺灣博碩士論文加值系統

原發性脊椎側彎是青少年常見的骨科疾病，其原因為三維脊椎變形所導致。脊椎側彎之臨床症狀為軀幹外觀不對稱、脊椎關節角度受限、身體兩側肌力不對稱、背痛，進而導致心肺功能受限。脊椎側彎之變形與併發症對於姿勢與步態有相當程度的影響。過去研究指出，雖然脊椎側彎不致影響步行之速度、步頻、步寬等時空參數，但不對稱之脊椎側彎會影響步行時之下肢運動學。然而目前仍無探討不同分類之脊椎側彎對於步態影響之相關文獻。本研究目的在於利用Lenke分類系統，探討第五型Lenke脊椎側彎 (Lenke 5)，亦即胸腰椎型脊椎側彎之青少年在步行時之下肢運動學及力動學變化。
本研究徵招15位脊椎側彎之青少年與15位同年齡族群之控制組進行步態分析。經由三維動作分析系統與測力版之資訊，計算受試者在步行過程中之時空參數、關節角度與關節力矩，並比較兩組之間的差異。研究結果發現胸腰椎型脊椎側彎病患在步距有減少的趨勢，髖關節的角度在腳跟著地及對側腳尖離地時較內收且內轉，在力矩部分則是在對側腳尖離地及及對側腳尖著地時內轉力矩減少，與正常人比有較明顯不同；骨盆角度在步行有旋轉角度變大的現象，顯示胸腰椎型脊椎側彎病患可能有步態不穩定之趨勢。此研究結果有助於不同類型脊椎側彎之步態評估與臨床診斷。

Idiopathic scoliosis (IS) is one of the common orthopedic disease in adolescents which characterized by a three-dimensional (3D) deformity of the spine. AIS may cause uneven appearance of trunk, spine range of motion limitation, differences in muscle strength between both sides, back pain and may compromise of cardiopulmonary function. The spine deformity and these symptoms have a considerable effect on posture and gait. The previous study showed that there were no significant difference in spatial-temporal parameters including walking speed, cadence and step width when compared scoliosis patients with normal subjects, but the uneven spine curve did cause the changes of lower limb kinematics during ambulation. However, there were no studies discussed those effects in specific classification of scoliosis. The purpose of this study is to explore any asymmetries in gait kinematics and kinetics during walking in patients with thoracolumbar scoliosis which is classified as type 5 in Lenke classification system.
Fifteen adolescents with thoracolumbar scoliosis and fifteen age-matched healthy controls were recruited. All subjects walked at their self-selected speeds while their kinematic and kinetic data were measured. It was found that the step length in scoliosis patients decreased compared with the controls. Pelvis tended to rotate to concave side when walking. The hip angle increased in adduction and internal rotation during heel strike and contralateral toe off. The hip internal rotation moment decreased during contralateral toe off and contralateral heel strike. Those findings indicate that the scoliosis may result in gait instability in adolescents. The results of this study contribute to the gait assessment of different types of scoliosis and clinical diagnosis.

致謝 I
摘要 II
ABSTRACT III
目錄 IV
圖目錄 VI
表目錄 VIII
第一章 緒論 1
第一節 研究背景 1
一、 脊椎側彎成因、臨床分類與症狀 1
二、 步態研究 5
第二節 脊椎側彎患者的不正常步態 5
第三節 研究目的 6
第二章 材料與方法 7
第一節 受試者 7
第二節 實驗器材 8
第三節 生物力學與動作分析模型 9
一、 動作分析模型 9
二、 局部座標系統定義 10
三、 廣義/局部座標系統轉換 16
四、 測力板反作用力 17
五、 關節運動學 18
六、 關節力動學-逆向動力學 18
第四節 步態分期 19
第五節 施測流程 20
一、 設備準備 20
二、 受試者準備 20
三、 收取資料 20
第六節 統計方法 21
第三章 結果 22
第一節 步態時空參數 23
第二節 關節角度 24
一、 骨盆 24
二、 髖關節 27
三、 膝關節 30
四、 踝關節 33
第三節 關節力矩 36
一、 髖關節 36
二、 膝關節 39
三、 踝關節 42
第四節 地面反作用力 45
第四章 討論 48
第一節 步態時空參數 48
第二節 關節運動學與力動學 48
第三節 研究限制 49
第五章 結論 50
參考文獻 51

1.Choudhry, M.N., Z. Ahmad, and R. Verma, Adolescent Idiopathic Scoliosis. Open Orthop J, 2016. 10: p. 143-54.
2.Konieczny, M.R., H. Senyurt, and R. Krauspe, Epidemiology of adolescent idiopathic scoliosis. J Child Orthop, 2013. 7(1): p. 3-9.
3.Morais, T., M. Bernier, and F. Turcotte, Age- and sex-specific prevalence of scoliosis and the value of school screening programs. Am J Public Health, 1985. 75(12): p. 1377-80.
4.Soucacos, P.N., et al., School-screening for scoliosis - A prospective epidemiological study in northwestern and central Greece. Journal of Bone and Joint Surgery-American Volume, 1997. 79A(10): p. 1498-1503.
5.Negrini, S., et al., 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis, 2012. 7(1): p. 3.
6.Lenke, L.G., et al., Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am, 2001. 83-a(8): p. 1169-81.
7.Edgar, M., A new classification of adolescent idiopathic scoliosis. The Lancet, 2002. 360(9329): p. 270-271.
8.Asher, M.A. and D.C. Burton, Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis, 2006. 1(1): p. 2.
9.Burwell, R.G., Aetiology of idiopathic scoliosis: current concepts. Pediatr Rehabil, 2003. 6(3-4): p. 137-70.
10.Eyvazov, K., D. Samartzis, and J.P. Cheung, The association of lumbar curve magnitude and spinal range of motion in adolescent idiopathic scoliosis: a cross-sectional study. BMC Musculoskelet Disord, 2017. 18(1): p. 51.
11.Theroux, J., et al., Prevalence and management of back pain in adolescent idiopathic scoliosis patients: A retrospective study. Pain Res Manag, 2015. 20(3): p. 153-7.
12.Sato, T., et al., Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Eur Spine J, 2011. 20(2): p. 274-9.
13.Johari, J., et al., Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients. Singapore Med J, 2016. 57(1): p. 33-8.
14.Schwender, J.D. and F. Denis, Coronal plane imbalance in adolescent idiopathic scoliosis with left lumbar curves exceeding 40 degrees: the role of the lumbosacral hemicurve. Spine (Phila Pa 1976), 2000. 25(18): p. 2358-63.
15.Karimi, M., M. Kavyani, and M. Etemadifar, Gait analysis in adolescent idiopathic scoliosis walking with Boston brace. Scoliosis, 2014. 9(Suppl 1): p. O24.
16.Syczewska, M., et al., Does the gait pathology in scoliotic patients depend on the severity of spine deformity? Preliminary results. Acta Bioeng Biomech, 2010. 12(1): p. 25-8.
17.Ko, K.-J. and S.-J. Kang, Effects of 12-week core stabilization exercise on the Cobb angle and lumbar muscle strength of adolescents with idiopathic scoliosis. Journal of Exercise Rehabilitation, 2017. 13(2): p. 244-249.
18.Negrini, S., et al., Braces for Idiopathic Scoliosis in Adolescents. Spine (Phila Pa 1976), 2016. 41(23): p. 1813-1825.
19.Hebela, N.M. and P.J. Tortolani, Idiopathic Scoliosis in Adults: Classification, Indications, and Treatment Options. Seminars in Spine Surgery, 2009. 21(1): p. 16-23.
20.Kiely, P.J. and M.P. Grevitt, Recent developments in scoliosis surgery. Current Orthopaedics, 2008. 22(1): p. 42-47.
21.Chockalingam, N., et al., Kinematic differences in lower limb gait analysis of scoliotic subjects. Stud Health Technol Inform, 2002. 91: p. 173-7.
22.Mahaudens, P., et al., Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis. Eur Spine J, 2009. 18(4): p. 512-21.
23.Schizas CG, K.-d.Q.I., Stüssi E, Grob D., Gait asymmetries in patients with idiopathic scoliosis using vertical forces measurement only. Eur Spine J, 1998. 7(2): p. 95-8.
24.Chockalingam, N., et al., Assessment of ground reaction force during scoliotic gait. Eur Spine J, 2004. 13(8): p. 750-4.
25.Yang, J.H., et al., Asymmetrical gait in adolescents with idiopathic scoliosis. Eur Spine J, 2013. 22(11): p. 2407-13.
26.Giakas, G., et al., Comparison of gait patterns between healthy and scoliotic patients using time and frequency domain analysis of ground reaction forces. Spine, 1996. 21(19): p. 2235-2242.
27.Kramers-de Quervain, I.A., et al., Gait analysis in patients with idiopathic scoliosis. Eur Spine J, 2004. 13(5): p. 449-56.
28.Park, H.J., et al., Analysis of coordination between thoracic and pelvic kinematic movements during gait in adolescents with idiopathic scoliosis. Eur Spine J, 2016. 25(2): p. 385-93.
29.Dalleau, G., et al., Horizontal body and trunk center of mass offset and standing balance in scoliotic girls. Eur Spine J, 2011. 20(1): p. 123-8.
30.Bruyneel, A.V. and S. Mesure, Learning effect on the dynamical strategies in sitting position on seesaw motion for idiopathic scoliosis patients. Neurosci Lett, 2013. 534: p. 264-8.
31.Lu, T.W., Geometric and Mechanical Modelling of the Human Locomotor System. 1997: University of Oxford.
32.Lu, T.-W., Geometric and mechanical modelling of the human locomotor system. 1997, University of Oxford.
33.Schmid, S., et al., Quantifying spinal gait kinematics using an enhanced optical motion capture approach in adolescent idiopathic scoliosis. Gait Posture, 2016. 44: p. 231-7.
34.Mahaudens, P., J.L. Thonnard, and C. Detrembleur, Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis. Spine J, 2005. 5(4): p. 427-33.
35.Haber, C.K. and M. Sacco, Scoliosis: lower limb asymmetries during the gait cycle. Archives of Physiotherapy, 2015. 5(1).
36.Kotwicki, T., A. Walczak, and A. Szulc, Trunk rotation and hip joint range of rotation in adolescent girls with idiopathic scoliosis: does the "dinner plate" turn asymmetrically ? Scoliosis, 2008. 3: p. 1.