腰椎脊柱管狭窄症患者における神経原性間欠性跛行の発生前後における動的足底圧の分析。観察的研究

Analysis of Dynamic Plantar Pressure before and after the Occurrence of Neurogenic Intermittent Claudication in Patients with Lumbar Spinal Stenosis: An Observational Study.

• Wei Wei
• Chao Xu
• Xiao-Jiang Yang
• Chang-Bo Lu
• Wei Lei
• Yang Zhang

抄録

腰部脊柱管狭窄症（LSS）は高齢者に多い疾患であり，神経原性間欠性跛行（NIC）などの症状による歩行パターンの異常が報告されているが，NICを有する腰部脊柱管狭窄症患者の足底圧分布については詳細な報告がない．今回、LSS患者の足底圧特性を解析するために、Footscan®圧力システムを用いて、NIC発症前後のLSS患者20名（年齢、69.5±7.2歳）を対象に動的足底圧測定を行った。各測定において、接触時間(CT)、足進行角(FPA)、圧力時間積分(PTI)、接触面積(CA)を収集し、LSS患者と年齢をマッチさせた健常者との間で比較した。LSS群は対照群と比較して前足部CT％、PTI、CA％の増加を示した。LSS群ではNIC発生後、NIC発生前に比べて前足部のCT％、PTI、CA％がさらに増加した。また、NIC発生後、前足部のPTI、CA%は内側足部から外側足部にシフトしていた。この結果から、LSS患者の足底圧分布は、腰椎前屈で起床する姿勢により健常者とは異なり、前足部の相対的な負荷が高くなっていることが示唆された。また、NICの発生はLSS患者の足底圧分布に影響を与え、患者の転倒リスクを前方向と症状側に予測する可能性があることが示唆された。

Lumbar spinal stenosis (LSS) is a common disease in the elderly population; it has been reported that patients with LSS have an abnormal gait pattern due to symptom such as neurogenic intermittent claudication (NIC); however, no detailed reports exist on the plantar pressure distributions in LSS patients with NIC. To analysis the plantar pressure characteristics of LSS patients, the Footscan® pressure system was used to perform dynamic plantar pressure measurements in 20 LSS patients (age, 69.5 ± 7.2 years) before and after the occurrence of NIC. The contact time (CT), foot progression angle (FPA), pressure-time integral (PTI), and contact area (CA) were collected and compared between the LSS patients and age-matched healthy subjects in each measurement. The LSS group showed an increase in forefoot CT%, PTI, and CA% in both measurements compared with those in the control group. After the occurrence of NIC in the LSS group, CT%, PTI, and CA% of the forefoot increased further compared with those before the occurrence of NIC. In addition, after the occurrence of NIC, the PTI and CA% of the forefoot shifted from the medial foot to the lateral foot. The results suggested that the plantar pressure distributions of patients with LSS differs from normal subjects due to the posture of waking with lumbar forward flexion, and the forefoot bears a higher relative load. In addition, the occurrence of NIC could affect the plantar pressure distribution of the patients with LSS, predicting the patient's risk of falling to the anterior direction and to the symptomatic side.

Copyright © 2020 Wei Wei et al.