三维步态在脑卒中足下垂患者下肢节段协调性分析的应用

目的:运用三维步态分析系统分析脑卒中偏瘫足下垂患者的下肢关节协调性。方法:选取脑卒中偏瘫足下垂患者15例作为观察组,配对设计选取15例健康者作为对照组一和对照组二。采集2组受试者行走过程中的时空参数和运动学参数,通过绘制仰角曲线图和步态环图进行协调性分析。结果:观察组偏瘫侧与非偏瘫侧比较,步频、支撑期百分比,髋、膝关节活动度(ROM),最大踝背屈角度、小腿、足部仰角范围均减小(均P<0.01),步长、最大踝跖屈角度增加(均P<0.01);观察组偏瘫侧与对照组一比较,步速减慢、步长减短、步频减小、支撑期百分比延长(均P<0.01),髋、膝、踝关节ROM,最大踝背屈角度、大腿、小腿、足部仰角范围均减小(均P<0.01);观察组非偏瘫侧与对照组二比较,步速减慢、步长减短(均P<0.01),髋、膝、踝关节ROM,最大踝跖屈角度、大腿、小腿、足部仰角范围均减小(均P<0.01),支撑期百分比延长(P<0.01)。观察组偏瘫侧与对照组一比较,大腿仰角峰值出现时间延迟(P<0.01)。观察组偏瘫侧与对照组一比较以及观察组非偏瘫侧与对照组二比较,方差百分比(PV1)和PV1/PV2均减小(均P<0.01),PV2均增大(均P<0.01)。观察组偏瘫侧与非偏瘫侧分别与对照组一、对照组二比较,步态环图偏离正常水滴形态,表现为高度降低、尾部消失、扭曲。结论:步态环图可直观反映脑卒中偏瘫足下垂患者下肢协调性障碍,其中PV值的改变可能是其协调功能障碍的标志之一。

Application of three-dimensional gait in the analysis of coordination of lower limbs in stroke patients with foot drop

Objective:To analyze the coordination of lower limb joints in stroke patients with hemiplegic foot drop by three-dimensional gait analysis system.Methods: Fifteen patients with post-stroke hemiplegic foot drop were selected in the treatment group, and 15 healthy persons served as the control group 1 and control group 2 by matching design. The spatio-temporal parameters and kinematic parameters in the two groups were collected during walking, and the elevation curve and gait loop diagram were drawn for coordination analysis.Results: In the treatment group, as compared with the non-hemiplegic side, stride frequency, the prolongation of support percentage, the range of motion (ROM) of hip and knee joint, the range of maximum ankle dorsiflexion angle, shank and foot elevation angle in the hemiplegic side decreased significantly (all P<0.01), while the step length and maximum ankle plantar flexion angle increased significantly (all P<0.01). As compared with the control group 1, step length, pace and stride frequency were significantly reduced, support percentage significantly increased, the ROM of hip, knee and ankle joints, the range of the maximum ankle dorsiflexion angle, and thigh, shank and foot elevation angles decreased significantly in the hemiplegic side of treatment group (all P<0.01). As compared with the control group 2, step length and pace were significantly decreased, the ROM of hip, knee and ankle joints, the range of the maximum ankle plantar flexion angle, thigh, shank, and foot elevation angle significantly decreased in the non-hemiplegic side of treatment group (all P<0.01). As compared with the control group 1, the peak time of thigh elevation angle in the treatment group was significantly delayed (P<0.01). The percentage of variance (PV1) and PV1/PV2 in the hemiplegic side of the treatment group were significantly decreased as compared with the control group 1, and those in the non-hemiplegic side of the treatment group were significantly decreased and PV2 increased as compared with thecontrol group 2 (all P<0.01). As compared with the control group 1 and the control group 2, the gait loop diagram of the hemiplegic side and the non-hemiplegic sides in the treatment group deviated from the normal water drop shape, showing height reduction, tail disappearance and distortion.Conclusion: The gait loop diagram can directly reflect the coordination disorder of the lower limb in stroke patients with hemiplegic foot drop, and the changes of PV values may play an important role in coordination dysfunction.