三维步态分析系统在强直性脊柱炎病情评价中的应用研究

目的 探讨三维步态分析系统在强直性脊柱炎(AS)患者病情评价中的价值.方法 对31例AS患者进行三维步态分析检查,收集脊柱活动度参数、时空参数、时间参数,同时评估患者生活质量(HAQ评分)、疾病活动指数(BASDI)、功能指数(BASFI)、测量指数(BASMI),并进行Spearman相关性分析.结果 ①AS患者行走时的脊柱左右侧倾幅度较正常值比较明显增大(P＜0.01),脊柱前倾幅度较正常值比较亦有增大趋势,静止状态脊柱旋转幅度较正常值比较明显减小(P＜0.01).②AS患者步长、步幅、步速与正常值相比均明显减少(P＜0.05),患侧下肢的步长、步幅、步速数据减少尤为明显(P＜0.05),健侧下肢的步长与步幅减少,步频加快(P＜0.05).③患侧下肢单支撑相时间有缩短趋势,双支撑相时间有增加趋势.④患侧下肢的步长、步幅、步速、步频均比健侧下肢减小(P＜0.05).患侧下肢单支撑相较健肢缩短,双支撑相较健肢延长,摆动相较健肢缩短(P＜0.05).⑤患侧下肢、健侧下肢的步长、步幅、步速、步频均与HAQ、BASDI、BASFI、BASMI呈负相关；时间参数中患侧下肢支撑相与HAQ、BASFI呈正相关,双支撑相与HAQ、BASFI、BASMI呈正相关,单支撑相与BASMI呈负相关,摆动相与HAQ、BASFI负相关；时间参数中健侧下肢支撑相与BASMI呈正相关,单支撑相与HAQ、BASFI呈负相关,摆动相与BASMI呈负相关；脊柱侧倾幅度与HAQ、BASDI、BASFI、BASMI均呈正相关；BASMI与行走时脊柱侧倾幅度、脊柱前倾幅度呈正相关,与静止时的脊柱旋转幅度呈负相关；而所有步态分析数据与年龄、病程、红细胞沉降率、C反应蛋白均无相关性.结论 三维步态分析系统能较好量化评估AS患者脊柱活动范围及步行功能,可作为评价AS患者疾病活动度和严重程度的有效指标.

gait analysis system in ankylosing spondylitis pathogenetic condition evaluation

Objective To investigate the value of the three-dimensional gait analysis system m evaluating ankylosing spondylitis （AS） patients＇ pathogenetic condition. Method Using the three-dimensional gait analysis, we investigated 31 patients with AS, collected spinal mobility parameters, spatial and temporal parameters, time parame-ters, and assessed patients＇ quality of life （HAQ score）, the disease activity index （BASDI）, functional index （BASFI） and measurement index （BASMI）. Then, we deal data with correlation analysis. Results ①During AS patients walk-ing, the spine roll rate has significantly increased than normal comparison （P〈0.01）; the spine forward rate has been increasing trend than normal comparison; stationary state spine rotation has obvious reduced rate than normal （P〈 0.01）. ②AS patients with lower limb step, stride, pace, data reduction is particularly evident （P〈0.05）, contralateral lower limb step length and stride are reduced （P〈0.05）. ③Ipsilateral lower limb single support phase time is decreas-ing, while double support phase time trend is increasing. ④Ipsilateral lower limb step, stride, pace, stride frequency are shorter （P〈0.05） than the contralateral lower extremity. Ipsilateral lower limb single support phrase shortened com-pared to healthy limbs. While the double support phrase extended compared to healthy limbs, the swing phrase short-ened （P〈0.05）. ⑤Ipsilateral lower limb, the contralateral lower limb step length, stride length, walking speed and step frequency are correlated negatively with HAQ, BASDI, BASFI and BASMI. The time parameter of lower limbs support phase correlated positively with HAQ and BASFI; the double support phase correlated positively with HAQ, BASFI and BASMI. The single support phase correlated negatively with BASMI, swing phase correlated negatively with HAQ and BASFI. The time parameter of the contralateral lower extremity support phase and BASMI are correlated positive-ly, while single-support phase and HAQ, BASFI are negatively correlated, swing phase is negatively correlated with BASMI. The spine roll amplitude showed a significant positive correlation with HAQ, BASDI, BASFI and BASMI; BASMI positively correlated with the walking spine roll rate and forward magnitude significantly, but it is negatively correlated with the stationary spine rotation magnitude. There are not significant correlation among the gait analysis data about ages, disease duration, erythrocyte sedimentation rate and C reactive protein levels. Conclusion The three-dimensional gait analysis system can be better quantitative assessment of AS patients＇ spinal range of activities and walking function, and be used as a valid indicator of the AS patients＇ disease activity and severity.