胸段完全性脊髓损伤患者的三维步态分析

Relationship between Level of Thoracic Complete Spinal Cord Injury and Ambulatory Function with Reciprocating Gait Orthosis through 3D Gait Analysis

目的通过对胸段完全性脊髓损伤(TCSCI)患者配戴交互式步行矫形器(RGO)的三维步态分析,比较分析脊髓损伤(SCI)平面与步行能力之间的关系,探讨重建SCI患者步行能力的量化指标。方法选择在本中心住院且配戴RGO进行步行训练3个月以上的TCSCI患者10例,采用Vicon三维步态分析系统进行步态检测与分析。应用Spearman秩和相关系数对TCSCI患者的不同SCI平面与其步态的运动学和时空参数等的相关性进行统计学检验。结果步频和跨步长分别为(37.4±2.15)步/min和(91.6±9.09)cm;髋关节摆动角度及髋关节伸展和屈曲时相的角速度分别为(42.57°±5.43°)、(20.88°±2.18°)/s和(124.75°±9.31°)/s。步速(r=0.80,P<0.01)、跨步长(r=0.78,P<0.01)、助行架的压力峰值(r=0.82,P<0.01)、髋关节摆动角度(r=0.77,P<0.01)、助行架的压力均值(r=-0.67,P<0.05)和髋关节伸展的角速度(r=0.75,P<0.05)与SCI平面之间均有显著的相关性。结论TCSCI患者双上肢过度负载和髋关节摆动幅度受限是其步行能力受限的主要原因;降低过度负载的康复训练方法有助于改善重建的步行功能。

Objective To evaluate the relationship between the level of thoracic complete spinal cord injury（SCD and ambulatory function wearing Reciprocating Gait Orthosis（RGO） through three dimentional gait analysis, and to explore the quantitative indica tors of reconstructing walking capacity of thoracic complete SCI patients. Methods 10 patients with thoracic complete spinal cord injury of lesion level from T4 to T12 who had experienced RGO gait training for at least 3 months. Three dimentional gait analysis system of Vicon Nexus 1.2 was used to test and examine the gait speed, cadence, stride length, pelvic angle of rotation, hip range of motion（ROM）, crutch force, angular velocity of hip flexion and extension phases, etc. Pearsoffs product moment correlation coeffi- cient and Spearman rank correlation coefficient were used to examine the relationship between the level of spinal cord injury and the kinematic and kinetic values. ResuLts The mean cadence and stride length were （37.4±2.15） steps/min and （91.6±9.09） cm. The mean hip ROM, angular velocity of hip flexion and extension phases were （42.57°±5.43 °）, （20.88 °±2.18 °）/s and （124.75°±k 9.31 °）/s respectively. The gait speed, stride length, peak crutch force, hip ROM, mean crutch force and angular velocity of hip ex tension phase all had significant pertinence with the level of spinal cord injury. ConcLusion The limitation of hip ROM and excessive load of upper limbs mainly result in ambulatory disorder in higher thoracic complete SCI patients who should be undertaken some rehabilitation training to reduce excessive physiological load in order to improve their ambulatory capacity.