健康孕婦與下背和骨盆疼痛孕婦的步態

Gait in healthy pregnant women and pregnant women with low back and pelvic pain - A narrative review

孕婦在懷孕時身體會面臨許多變化及症狀，其中下背痛(low back pain)及骨盆疼痛(pelvic girdle pain)是最常見的肌肉骨骼症狀，導致步態行為與身體姿勢改變。步態檢測快速、簡單、安全和溫合，比起抽血或是照射檢測，是對孕婦身體影響最小的方式。因此本研究目的為探討健康孕婦與下背和骨盆疼痛孕婦的步態表現，並以論述性方式分為兩大部分：一、健康孕婦步態相關研究，其中包括步態參數(gait parameters)、足底壓力(plantar pressure)與壓力中心(center of pressure, COP)；二、下背和骨盆疼痛對孕婦步態表現的影響。文獻分析結果發現一：步態參數方面，與正常婦女相比，孕婦走路的速度、步長及步頻下降，步寬和跨步時間則上升。步態速度則會隨著懷孕期間逐漸下降。足底壓力部分，孕婦在第一至第三孕期，足跟、大腳趾、第一和第五蹠骨下的足壓有顯著增加。與正常婦女相比，孕婦表現出明顯更低的最大前足壓力、較高的後足壓力、較高的雙腳中足、較高的右前足外側峰值壓力與較低的前腳內側峰值壓力。壓力中心方面，第一孕期時，孕婦的壓力中心晃動面積與正常婦女並沒有差異。到了第二孕期，有些孕婦的平衡能力下降，造成其晃動面積增加。結果發現二：針對下背痛和骨盆疼痛對孕婦步態表現的影響，患有骨盆疼痛的孕婦在步態速度上較無症狀孕婦慢18%，且患有骨盆疼痛的孕婦表現出更長的雙腳支撐與更短的步長。然而在比較壓力中心差異時，下背及骨盆疼痛對孕婦的影響極小。有了孕婦在整個懷孕期間，包括產後與發生下背及骨盆疼痛與未發生時之步態、足底壓力及壓力中心晃動面積的數據，能讓孕婦在整個懷孕過程中更了解自身步態的變化。

During pregnancy, pregnant women face many changes and symptoms in their bodies that lead to changes in gait behavior and body posture. Among them, low back pain and pelvic girdle pain are the most common musculoskeletal symptoms, resulting in changes in gait behavior and body posture. Gait testing is quick, simple, safe and gentle. Compared to blood draws or radiation testing, this is the best way to minimize the negative impacts on pregnant women. The purpose of this study is to discuss the gait performance of pregnant women. This study was divided into two parts in an expository manner: 1. Research on gait in healthy pregnant women, including gait parameters, plantar pressure and center of pressure (COP); 2. The effect of low back and pelvic girdle pain on gait performance in pregnant women. Literature analysis result 1: In terms of gait parameters, in order to develop the static and dynamic balance ability, when comparing to normal women, the walking speed, step length and step frequency of pregnant women decreased, while the step width and stride time increased. Gait speed gradually decreased during pregnancy. In terms of plantar pressure, during the first to third trimester of pregnancy, the foot pressure under the heel, big toe, first and fifth metatarsals of pregnant women increased significantly, which was speculated to be related to the increase in weight during pregnancy. Compared with normal women, pregnant women at 39 weeks' gestation showed significantly lower maximum forefoot pressure, higher rearfoot pressure, higher midfoot, higher right forefoot lateral peak pressure, and lower forefoot medial peak pressure. In terms of COP, during the first trimester, there was no difference in the center of pressure sway area between pregnant women and normal women. In the second trimester, some women's balance ability decreased, resulting in an increase in the area of the center of pressure. Result 2: Regarding the influence of low back pain and pelvic pain on pregnant women's gait performance, pregnant women with pelvic pain had 18% slower gait speed than asymptomatic pregnant women, and pregnant women with pelvic pain showed longer double support phase and shorter stride length. However, when comparing differences in COP, low back and pelvic pain had little effect on pregnant women. With the data of gait, plantar pressure and COP of pregnant women during the entire pregnancy, including postpartum and whether low back and pelvic pain occurs, pregnant women can understand their own gait throughout the pregnancy better.