三维步态分析的研究与应用

Research and application of three-dimensional gait analysis

目的:介绍利用三维步态分析的方法定量评定人体步行功能,为颅脑损伤、中枢和周围神经系统损伤及骨关节病损的患者制定康复治疗、训练计划、评定康复疗效、定做支具和矫形器提供客观依据。资料来源:应用计算机检索Pubmed数据库1990-12/2006-06有关步态分析方面的文章,检索词“gait analysis,spinal cord injury,three dimensional gait analysis,SCI”,限定文章语言种类为English。同时计算机检索中国期刊全文数据库、万方数据库1995-06/2006-05期间的相关文章,检索词“步态分析、脊髓损伤”,限定文章语言种类为中文。资料选择:对资料进行初审,选取符合研究要求的有关文章找全文。纳入标准:①有关步态分析方面的研究。②有关三维步态分析系统在康复医学中应用的研究。排除标准:重复或类似的同一研究、Meta分析、个案报道等。资料提炼:共收集到105篇有关步态分析及三维步态分析系统在康复医学中应用的文章,排除重复或类似的同一研究,33篇符合研究要求(其中25篇为步态分析方面的文献,8篇为脊髓损伤方面的文献)。资料综合:①步态分析的方法有定性和定量两种:定性分析即通过目测的方法对步态的性质进行分析;定量分析包括运动学分析、动力学分析、时空参数的分析、动态肌电图及氧价分析等。②正常及异常步态:正常步态是指当一个健康成人用自我感觉最自然、最舒坦的姿态行进时的步态,它具有如下3个特点:身体平稳、步长适当、耗能最少;异常步态包括偏瘫步态、脑瘫步态、小脑损害步态、周围神经损伤所致异常步态、前冲步态、疼痛步态、脊柱疾患所致异常步态以及脊髓损伤的步态等。③步态分析在脊髓损伤患者中的应用:步行障碍是脊髓损伤患者的共性问题,也是患者最迫切希望解决的功能障碍;临床步态分析将为明晰脊髓损伤患者步态异常的关键因素提供有力的依据,从而协助临床诊断和治疗。结论:三维步态分析系统是目前较为先进的,能够客观、定量地评定人体步行功能的步态分析系统。在康复评定、训练与治疗的过程中,可以全面反映患者的康复功能状态,在临床步态分析中具有重要意义和不可替代的作用。

OBJECTIVE： To introduce the quantitative evaluation of human gait function with three-dimensional （3-D） gait analysis so as to design training plan of rehabilitative therapy, evaluate rehabilitative curative effect, make orthosis and provide objective evidence for patients with head injury, center and peripheral nerveous system injury and osteoarthrosis. DATA SOURCES： We searched for articles about gait analysis between December 1990 and June 2006 in Pubmed database with the key words of ＂gait analysis, spinal cord injury, three dimensional gait analysis, SCI＂ in English. Meanwhile, we also searched for correlative articles from June 1995 to May 2006 in China Journal Full-text Database （CJFD） and Wanfang Database with the key words of ＂gait analysis, spinal cord injury, SCI＂ in Chinese. STUDY SELECTION： We selected articles that were accorded with our research to lookup their full-text after first trial. Inclusive criteria： （1）research about gait analysis, （2）applied research about 3-D gait analysis in rehabilitative medicine. Exclusive criteria： repeatable or similar research, Meta analysis, case report, and so on. DATA EXTRACTION： Totally 105 articles about gait analysis and 3-D gait analysis in rehabilitation were collected. Repetitive or similar researches were excluded. There were 33 articles accorded with research （thereinto, 25 about gait analysis and 8 about spinal cord injury）. DATA SYNTHESIS： （1）There were two methods about gait analysis： qualitative analysis and quantitative analysis. Qualitative analysis was to analyze diversified gait through eyeballing; quantitative analysis involved kinematic analysis, kinetic analysis, time-spatial analysis, dynamic electromyogram （EMG） and oxygen cost analysis. （2）Normal and abnormal gait： Normal gait referred to the most natural and leisurely gait that a healthy person walked by, and it had three key points： balanced body, proper step length and the least energy cost. Abnormal gait included hemiplegia gait, brain paralysis gait, cerebella gait, peripheral nervous system injury gait, festination, pain gait and spinal column and spinal cord injury gait and so on. （3）Application of gait analysis in spinal cord injury patients： Gait obstacle was the common issue that spinal cord injury patients faced, and it was also what these patients needed to settle eagerly. Clinical gait analysis would provide convincing gists for definiting the abnormal gait of spinal cord injury patients, and help clinical doctors to diagnose diseases and treat patients. CONCLUSION： At present, 3-D gait analysis system is an advanced system that can assess human gait objectively and quantificationally. In the course of assessment, training and treatment of rehabilitation, it can reflect the functional state of patient completely, and plays a vital role and irreplaceable effect in clinical gait analysis.