脑卒中患者步行能力与下肢三维运动学及动力学相性分析

摘要

Objective:To analyze the correlation between gait function and three dimension(3D) kinematic and kinetic parameters of lower limb in stroke patients and explore the cause and kinetic characteristics of hemiparetic gait, and to find the key points of the intervention in rehabilitation therapy.rnMethod: Twenty patients after first stroke with right hermparesis were recruited. These patients were accorded with the criteria that the subjects can walk 10m independently. Sixteen healthy elder subjects were selected as control group. Vicon system with force plate was used in gait, 3D kinematic and kinetic analysis. Result: Compared to the control group, there were significant differences(P<0.05) in spatiotemporal (cadence, stride time, double support time, step time, opposite foot off, step length, stride length and walking speed) and kinematic parameters (hip extension, knee flexion and ankle dorsiflexion and plan tarflexon) of affected lower limb of stroke patients. For kinetic parameters, compared with control group there were significant differences of hip and knee joint extension Lime of unaffected side, ankle joint dorsiflexion time of affected side(P<0.05). There were significant correlation between the gait function and the stride length, lower limb kinematic and kinetic data (P<0.05) Conclusion: ① Stride length is an important reference to evaluate the gait changes in patienls after stroke. ② Hip and knee joint extension, ankle joint dorsiflexion and plantarextension are the substantial expressions in hemiparat-ic gait. ③The muscles' strength of hip joint, knee joint and dorxiflexion of ankle joint are the key factors impacting the gait functions in stroke patients.%目的:通过对脑卒中偏瘫患者下肢三维运动学和动力学的分析,寻找偏瘫患者步态特点,比较分析步行能力与运动学和动力学之间的关系,从运动力学角度探讨偏瘫患者异常步行的原因,寻找康复治疗中需解决的关键问题.方法:选择首次脑卒中后可以独立步行10m以上的右侧偏瘫患者20例为实验组,正常健康中老年人16例为对照组.采用Vicon和AMT OR6-7进行三维步态运动学和动力学检测和分析.结果:实验组与正常对照组比较,脑卒中患者与健康中老年人在步频、跨步时间、双腿支撑时间、步时、离地比率、步长、跨步长和步速同侧比较差异有显著性意义(P＜0.05),患侧离地占步态周期白分比和健侧单腿支撑时间实验组与对照组比较差异有显著性意义(P＜0.05).矢状面上同侧髋关节伸展角度、膝关节屈曲角度和踝关节背伸及跖屈角度比较差异都有显著性意义(P＜0.05).同侧髋关节屈伸力矩、同侧膝关节伸直力矩和患侧踝关节背伸力矩实验组和对照组相比差异有显著性意义(P＜0.05),步行能力(步速)与患侧髋关节伸展、健侧膝关节屈曲、双侧膝关节伸展、双侧踝关节背伸和跖屈角度相关,均有显著性意义(P＜0.05)；同时也和双侧髋关节屈伸、膝关节伸展和踝关节背伸力矩相关(P＜0.01).结论:①步长是脑卒中偏瘫患者步态异常的重要参考指数；②髋关节和膝关节伸展,踝关节背伸和跖屈是步态异常的重要表现；③下肢髋关节和膝关节屈伸肌群和踝关节背伸肌群的力量是影响步行能力的重要因素.