三维步态分析痉挛性脑性瘫痪儿步行中时空参数和骨盆运动特征

背景:痉挛性脑瘫患儿的步态异常很常见,如何改善步态是康复治疗的重点。目的:观察4～6岁痉挛性双瘫型脑瘫儿步行中时空参数和骨盆运动特征。方法:采用三维步态分析技术对20例扶走脑瘫儿、20例独走脑瘫儿和20例正常儿童进行步态分析。结果与结论:①时空参数:脑瘫患儿较正常儿童支撑相和双足支撑相延长、步长和复步长缩短(P<0.05);脑瘫患儿组间相比,扶走脑瘫组患儿支撑相和双足支撑相延长、复步长缩短更显著(P<0.05);3组儿童步宽差异无显著性意义(P>0.05)。②骨盆运动特征:脑瘫患儿较正常儿童骨盆上下移动变化范围值增大(P<0.05),扶走脑瘫儿较独走脑瘫儿增大更显著(P<0.05);脑瘫患儿较正常儿童在步行周期各时相均呈过度前倾(P<0.05),扶走脑瘫儿较独走脑瘫儿前倾更显著(P<0.05);脑瘫患儿较正常儿童骨盆内外旋变化范围值增大(P<0.05),扶走脑瘫儿较独走脑瘫儿增大更显著(P<0.05)。提示4～6岁痉挛性双瘫型脑瘫患儿步行中的时空参数、骨盆运动存在异常,且步行能力越差,异常越显著;骨盆过度前倾可能是影响痉挛性脑瘫患儿步行能力的重要因素。

Three-dimensional gait analysis of temporal and spatial parameters and the action of the pelvic during gait in children with spastic diplegic cerebral palsy

BACKGROUND:The gait abnormalities in the children with spastic cerebral palsy are common,and how to improve the gait has become the focus of the rehabilitation.OBJECTIVE:To investigate the temporal and spatial parameters and the action of the pelvic during gait in children of 4-6 years old with spastic diplegic cerebral palsy.METHODS:Three-dimensional gait analysis was used to get the temporal and spatial parameters and the action date of the pelvic during gait.Sixty children were involved:20 children who can walk more than three meters by themself as independent walking group;20 children who cannot walk by themself or walk the distance less than 3 meters,but in the help of one hand may walk more than 3 meters as assist walking group;at the same time to select the match age of 20 healthy children as normal control group.RESULTS AND CONCLUSION:①As for the temporal and spatial parameters,the step length and stride length of stance phase and double support phase in the normal control group was shorter than those in the independent walking group and assist walking group(P < 0.05);and the step length and stride length in the assist walking group were more longer than those in the independent walking group(P < 0.05);no significant differences were observed in step width between three groups(P > 0.05).②As for the action of the pelvic,the total excursion of pelvic obliquity in the independent walking group and assist walking group was larger than that in the normal control group(P < 0.05) and the total excursion of pelvic obliquity in the assist walking group was larger than that in the independent walking group(P < 0.05);the anterior tilt of each phase of the walk cycle in the independent walking group and assist walking group was obvious than that in the normal control group(P < 0.05) and the assist walking group was more obvious than independent walking group(P < 0.05);the total excursion of pelvic rotation in the independent walking group and assist walking group was significantly larger than that in the normal control group(P < 0.05) and the assist walking group was more larger than independent walking group(P < 0.05).The temporal and spatial parameters and the action of the pelvic during gait in children of 4-6 years old with spastic diplegic cerebral palsy are different from healthy children.The poorer the walking ability,the more obvious the abnormality was.The excessive anteversion of pelvic may be the most important factor for walking ability.