不同运动功能分级脑瘫患儿步态分析中时-空与运动学参数的对比研究CSCD

目的比较2019年3月至2021年3月上海市儿童医院骨科收治的不同运动功能分级脑瘫患儿步态分析中时-空与运动学参数的差异,探索通过三维步态分析中时-空与运动学参数来定量评价痉挛型脑瘫患儿下肢运动功能,为痉挛型脑瘫的病情评估提供客观定量方法。方法选取年龄6~12岁、经粗大运动功能分级系统(gross motor function classification system,GMFCS)分级为Ⅰ、Ⅱ、Ⅲ级的痉挛型脑瘫患儿为研究对象,共90例,GMFCS分级为Ⅰ级(Ⅰ级组)、Ⅱ级(Ⅱ级组)、Ⅲ级(Ⅲ级组)各30例。选取30例正常儿童作为正常对照组。通过三维步态分析系统采集90例脑瘫患儿和正常对照组儿童步态分析中的时-空与运动学参数,利用方差分析和多样本均数间多重比较,分析不同运动功能分级脑瘫患儿之间以及与正常对照组儿童之间的差异。结果脑瘫患儿步态分析时-空参数中步长、步宽、步速、步频、跨步长较正常对照组儿童明显减小(P<0.05),且随GMFCS分级的升高而逐渐减小;脑瘫患儿步态周期和双支撑时间较正常对照组儿童明显延长(P<0.05),且随GMFCS分级的升高而逐渐延长。运动学参数中,脑瘫患儿髋关节、膝关节和踝关节活动角度较正常对照组儿童明显减小(P<0.05),髋关节最大屈曲角度、膝关节最大和最小屈曲角度、踝关节最大背屈角度明显减小,而髋关节最小屈曲角度明显增大(P<0.05);随GMFCS分级的升高,关节活动角度逐渐减小,髋关节最大屈曲角度、膝关节最大和最小屈曲角度、踝关节最大背屈角度逐渐减小,而髋关节最小屈曲角度逐渐增大;仅踝关节最大跖屈角度在不同GMFCS分级患儿中无明显差异(P>0.05)。结论步态分析中时-空参数和运动学参数可以定量评估痉挛型脑瘫患儿的下肢运动功能。GMFCS分级越高的脑瘫患儿与正常儿童之间的差异越大,下肢的运动功能越差。

Analysis of spatiotemporal and kinematic parameters in gait analysis of children with cerebral palsy with different motor function gradesCSCD

Objective To quantitatively evaluate motor function of lower extremities in children with spastic cerebral palsy by using spatiotemporal and kinematic parameters of three-dimensional gait analysis, com pare the differences in spatiotemporal and kinematic parameters of gait analysis with different motor function grades and provide quantitative method for severity assessment of spastic cerebral palsy. Methods According to the gross motor function classification system (GMFCS), 90 children aged 6-12 years with spastic cerebral palsy of grades I, II and HI were selected and divided into 3 groups (n = 30 each). And 30 normal children were selected as controls. The spatiotemporal and kinematic parameters of children with cerebral palsy and nor mal children were collected by three-dimensional gait analysis system and the differences analyzed by ANOVA and multiple comparisons between multi-sample means. Results After statistical analysis, step length/width and stride speed/frequency/length in spatiotemporal parameters of gait analysis declined statistically significant ly in children with cerebral palsy as compared with normal children (P < 0. 05). And the values further de creased with higher GMFCS grade. While gait cycle and double support time became prolonged in children with cerebral palsy (P <0.05) and further elongated with higher GMFCS grade; Motion angle of hip,knee and an kle joints in kinematic parameters in children with cerebral palsy were statistically significantly lower than those in normal children (P <0.05). Maximum flexion angle of hip,maximum/minimum flexion angles of knee and maximum dorsiflexion angle of ankle dropped markedly while minimum flexion angle of hip became obviously el evated (P < 0.05). With higher GMFCS grade, motion angle of joint gradually declined while maximum flexion angle of hip, maximum/minimum flexion angle of knee and maximum dorsiflexion angle of ankle gradually dropped and minimum flexion angle of hip gradually spiked. No statistically significant difference existed in maximum plantar flexion angle of ankle (P >0.05). Conclusion The spatiotemporal and kinematic parame ters in gait analysis can quantitatively evaluate the motor function of lower extremity in children with spastic cer ebral palsy. Correlated with a wider gap of gait parameters between spastic cerebral palsy and normal children, higher GMFCS grade indicates worse motor function of lower extremities. © 2022, Science and Technology Association of Hunan Province. All rights reserved.