不同测试条件下儿童和青少年特发性脊柱侧凸的静态足底负荷分布与姿势描记：一项初步研究

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中文摘要

背景/目的： 青少年特发性脊柱侧凸（AIS）不仅与结构性脊柱畸形相关，还与姿势控制和感觉运动整合的改变相关。对平衡和足底负荷分布的客观评估可能有助于进一步了解功能性损害，尤其是在轻度和中度弯曲的患者中。本研究旨在比较儿童和青少年特发性脊柱侧凸在不同感觉和姿势条件下的静态足底负荷分布与姿势描记参数。方法：这项初步研究纳入了19名被诊断为轻度和中度AIS的儿童和青少年（18名女性，1名男性）。使用电容式平台在三种测试条件下评估负荷分布和姿势描记参数：睁眼、闭眼和头部后仰。评估的参数包括足底各区域的负荷分布以及与压力中心相关的稳定性指标。在不同条件之间进行比较，以评估视觉和前庭调节对姿势控制的影响。结果：左右足的总足底负荷没有差异，并且整体相对足底负荷分布在三种测试条件下保持稳定。在第五跖骨头处存在一致的左右不对称，左侧负荷在每个条件下均显著低于右侧，并且在Holm多重比较校正后仍具有显著性（p = 0.001-0.002；|r| = 0.94-0.99）。在第一跖骨头和足跟处也观察到左侧负荷较高；足跟不对称仅在睁眼条件下经校正后仍具有显著性（Holm p = 0.044），而其余差异未能在校正后保留，故作为探索性结果报告。左侧对应于腰椎凸侧。不同条件之间的姿势稳定性差异显著：闭眼和头部后仰条件下的压力中心轨迹长度、90%置信椭圆面积和最大压力中心速度均大于睁眼条件，表明在去除视觉输入或改变头部位置时姿势稳定性降低。两种挑战条件之间没有显著差异。结论：在这项无对照的初步研究中，患有轻至中度特发性脊柱侧凸的儿童和青少年在左侧第五跖骨头下表现出持续性的负荷降低，而除仅在睁眼时具有显著性的左侧足跟负荷较高外，其他区域不对称均为探索性结果。姿势描记参数在视觉剥夺和头部后仰两种条件下均恶化，而两种挑战条件之间没有统计学显著差异。由于姿势变化主要在视觉或头部位置条件改变时才显现，在此类条件下进行评估可能揭示该AIS队列中与条件相关的姿势控制变化。然而，由于未纳入健康对照组，这些发现不应被解释为AIS特异性感觉整合缺陷的证据。这些初步发现需要在纳入健康年龄匹配参与者的更大规模对照研究中得到证实。

英文摘要

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is associated not only with structural spinal deformities but also with alterations in postural control and sensorimotor integration. Objective assessment of balance and plantar-load distribution may provide additional insight into functional impairments, particularly in patients with mild and moderate curves. The aim of this study was to compare static plantar-load distribution and stabilometry parameters in children and adolescents with idiopathic scoliosis under different sensory and postural conditions. Methods: This pilot study included 19 children and adolescents (18 female, 1 male) diagnosed with mild and moderate AIS. Load distribution and stabilometric parameters were assessed using a capacitive platform under three testing conditions: eyes open, eyes closed, and head extension. Parameters evaluated included load distribution across plantar regions and center-of-pressure-related stability measures. Comparisons were performed between conditions to evaluate the influence of visual and vestibular modulation on postural control. Results: Total plantar load did not differ between the right and left foot, and global relative plantar-load distribution remained stable across the three testing conditions. A consistent side-to-side asymmetry was present at the fifth metatarsal head, where load on the left side was significantly lower than on the right in every condition and remained significant after Holm correction for multiple comparisons (p = 0.001-0.002; |r| = 0.94-0.99). Higher left-sided load was also observed at the first metatarsal head and heel; the heel asymmetry remained significant after correction only in the eyes-open condition (Holm p = 0.044), whereas the remaining differences did not survive correction and are reported as exploratory. The left side corresponded to the side of lumbar convexity. Postural stability differed markedly between conditions: center-of-pressure path length, 90% confidence-ellipse area and maximum center-of-pressure speed were greater under the eyes-closed and head-extension conditions than with eyes open, indicating reduced postural stability when visual input was removed or head position was altered. The two challenge conditions did not differ significantly from each other. Conclusions: In this uncontrolled pilot study, children and adolescents with mild-to-moderate idiopathic scoliosis showed a consistent reduction in load under the left fifth metatarsal head, whereas, apart from a higher left heel load that was significant only with eyes open, other regional asymmetries were exploratory. Stabilometric parameters deteriorated under both visual deprivation and head extension, with no statistically significant difference between the two challenge conditions. Because postural changes became apparent mainly when visual or head-position conditions were altered, assessment under such conditions may reveal condition-related changes in postural control within this AIS cohort. However, because no healthy control group was included, these findings should not be interpreted as evidence of AIS-specific sensory-integration deficits. These preliminary findings require confirmation in larger controlled studies including healthy age-matched participants.