1.Xijing Hospital， the Airforce Military Medical University;2.Department of Orthopedics， Xijing Hospital， the Airforce Military Medical University
摘要：目的 研究中央型腰椎管狭窄症（Lumbar Spinal Stenosis，LSS）患者出现间歇性跛行（neurogenic intermittent claudication, NIC）症状前后的足底压力变化情况及跌倒风险，并为足底压力分析应用于LSS行走功能判定的进一步研究提供理论依据与数据参考。方法 选取12名患有腰4-5节段中央型LSS患者作为实验组，同时以12名同年龄健康成人作为对照组，采用Footscan足底压力测试系统进行动态足底压力测试，通过比较实验组运动前后与对照组运动前后站立相时间（CT）及各分期时间百分比（CT%）、步向角（foot progression angle, FPA）、足底各分区接触面积百分比（CA%）和压强时间积分（PTI），评估行走状态下患者足底压力的变化情况。结果 实验组症状出现前与对照组相比，足跟触地期的CT%减小，前足离地期的CT%增高，总接触时间、FPA、第1到第3跖骨头区的PTI和第2和第3跖骨头区CA%增加；实验组运动至NIC症状出现后，其全足触地期与前足离地期CT%、总接触时间、FPA、第1到第4跖骨头区PTI和CA%、足趾区CA%增加，足跟触地期与前足触地期CT%、足跟区PTI和CA%均减小。结论 中央型LSS患者在行走时足底压力分布向前足转移，站立相时间周期出现异常。这些异常可因NIC症状出现而进一步加重，具有更高的跌倒风险。
Abstract: Objective: To investigate the changes of plantar pressure distributions and risk of falling before and after the occurrence of neurogenic intermittent claudication (NIC) in patients with central lumbar spinal stenosis, so as to provide valuable references for walking abilities of the disease in future plantar pressure analysis studies. Methods: 12 patients with LSS at the L4/5 level were selected as the LSS group, while 12 healthy adults at the same age were selected as the control group. Footscan system was used to measure the plantar pressure of these subjects during walking. Contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI), foot progression angle (FPA), contact time percentage of the stance time (CT%) and total stance time (CT) in both LSS group and control group were compared to evaluate changes of the plantar pressures during walking．Results: Before the occurrence of NIC, compared with the control group, the LSS group has lower CT% of the forefoot push-off phase (FFPOP) and higher CT% of the initial contact phase (ICP), the total CT and FPA also increased, and the PTI of the 1st to 3rd metatarsals and the CA% of the 2nd and 3rd metatarsals were higher. After the NIC occurred, the results of the LSS group shows that the CT% of the initial contact phase (ICP) and forefoot contact phase (FFCP) decreased, the CT% of the foot flat phase (FFP) and forefoot push-off phase (FFPOP) as well as total CT and FPA increased, the PTI and CA% increased in 1st to 4th metatarsals, moreover, the CA% also increased in toe zone, both of the PTI and CA% decreased in heel zone. Conclusions: In patients with central LSS, the distribution of plantar pressure shifts forward and the abnormal phase of the stance time occurs, moreover, the abnormality could be further aggravated by NIC, which indicates a higher risk of falling.