糖尿病周围神经病变患者足底压力与步态的变化

目的 了解2型糖尿病合并周围神经病变患者的足底压力与步态变化.方法 纳入住院的303例2型糖尿病患者,分为糖尿病无周围神经病变组(DC组)和糖尿病周围神经病变组(DPN组).收集患者一般资料、相关生化指标.使用FootScan系统收集足底压力及步态相关参数.采用独立样本t检验、Mann-Whitney U检验、Spearman秩相关进行数据分析.结果 与DC组相比,DPN组左足第3、4跖骨的峰值压力降低(13.15±4.22)N/cm2 vs(11.96±3.94) N/cm2,P ＜0.05;(10.21±4.22) N/cm2 vs(9.14±3.66) N/cm2,P＜0.05],右足第1、2、3跖骨峰值压力降低(6.02±2.79) N/cm2vs(5.04±2.87) N/cm2,P＜ 0.05;(9.95±2.69) N/cm2 vs(9.18±2.77) N/cm2,P ＜0.05;(10.90±3.23)N/cm2vs(9.93±3.09)N/cm2,P＜0.05],其余区域峰值压力、总应力、总接触面积、总应力-时间积分、各区域压力-时间积分的组间差异均无统计学意义(P＞0.05).与DC组相比,DPN组右足的整足接触阶段56.8％(50.22％～62.45％) vs 59.5％(54.25％～64.15％),P＜0.05]延长,离地阶段31.25％ (25.475％ ～ 35.775％)vs 29％(24.95％ ～33.65％),P＜0.05]缩短,总时间(858±12)ms vs(900±127)ms,P＜0.05]延长,步行速度(2.58±0.67) km/h vs(2.28±0.66) km/h,P＜0.05]减慢.步行速度与多个区域的足底压强呈正相关(P＜0.05),支撑相中的整足接触阶段与峰值压力呈负相关(P＜0.05),离地阶段与峰值压力呈正相关(P＜0.05).结论 糖尿病周围神经病变患者足底压力峰值、压力-时间积分未见升高,步行速度减慢,整足接触阶段延长,离地阶段缩短.对糖尿病患者足底压力进行评价同时需要对步行速度及步态进行矫正,使用压力-时间积分指标更能反映足底承受压力情况.

Plantar pressure and gait changes in type 2 diabetic patients with peripheral neuropathy

Objective To investigate the plantar pressure distribution and gait changes in type 2 diabetic patients with peripheral neuropathy.Methods A total of 303 patients with type 2 diabetes hospitalized were enrolled and divided into diabetic peripheral neuropathy (DPN) group (n =137) or diabetic control (DC,without DPN) group (n =166).Demographic characteristics and related biochemical indexes were recorded.Parameters of Plantar pressure and gait were recorded with the FootScan system.Independent t-test or Mann Whaitney U test and Spearman rank correlation analysis were applied in the data analysis.Results Compared with DC group,plantar peak pressures in third metatarsal (13.15 ± 4.22) N/cm2 vs.(11.96 ± 3.94) N/ema2,P ＜ 0.05] or forth metatarsal (10.21 ± 4.22) N/cm2 vs.(9.14 ± 3.66) N/cm2,P ＜ 0.05] on the left foot and in the first (6.02 ± 2.79) N/cm2 vs.(5.04 ± 2.87) N/cm2,P ＜ 0.05],the second (9.95 ±2.69) N/cm2 vs.(9.18 ±2.77) N/cm2,P ＜0.05],the third (10.90 ±3.23) N/cm2 vs.(9.93 ± 3.09) N/cm2,P ＜ 0.05] metatarsal on the right foot were significantly decreased.There was no significant difference in pressure-time intergrals in each region,total force,total force-time intergrals,or total contact area between the two groups (P ＞0.05).In comparison with those in DC group,foot flat phase extended 56.8％ (50.22％-62.45％) vs.59.5％ (54.25％-64.15％),P ＜ 0.05],forefoot push off phase shorten 31.25％ (25.475％-35.775％) vs.29％ (24.95％-33.65％),P＜0.05] in stance phase,and total contact time (858 ± 12)ms vs.(900 ± 127)ms,P＜ 0.05] were increased significantly,while walking speed was significantly decreased (2.58 ± 0.67) km/h vs.(2.28 ± 0.66)km/h,P ＜0.05] in DPN group.Walking speed and forefoot push off phase changes were positively correlated with peak pressure changes,while foot fiat phase changes was negative correlated with peak pressure.Conclusion In DPN patients,walking speed decreases,foot flat phase is extended,and forefoot push off phase is shorten in stance phase;however,peak pressure and pressure-time intergrals does not increase significantly.While evaluating plantar pressure in diabetic patients,walking speed and gait should be controlled and pressure-time intergral may be better reflecting the plantar loading.