正常压力脑积水患者的步态研究

Study of the gait in patients with normal pressure hydrocephalus

目的分析正常压力脑积水患者的步态变化,以帮助其临床诊断。方法选择23例正常压力脑积水患者和20名健康对照者,测量其行走时步态的各种参数并进行对比。同时比较正常压力脑积水患者行腰穿放脑脊液前后的步态变化。结果与健康对照组相比,脑积水患者的步速明显减慢,步幅、步频降低,步宽增加,足偏角增大,步高降低,支撑相延长(P<0.01,P<0.05)。与行腰穿前比较,脑积水患者步速、步幅提高,步宽下降,支撑相及双足支撑相缩短(P<0.01,P<0.05)。结论通过测量步态可帮助诊断正常压力脑积水。

Objective To quantitatively analyze the gait patterns of patients with normal pressure hydrocephalus （NPH）, and thus to provide evidences for clinical diagnosis. Methods Gait analysis was carried out in 23 patients with NPH and 20 age matched healthy controls. Various parameters of walking gait were evaluated. Patients with NPH were reinvestigated after removal of 40 mL cerebral spinal fluid （CSF）. Results Compared with healthy controls, the NPH patients exhibited specific features of the gait disturbance： the gait velocity was reduced, the stride length was shorter, the cadence was diminished, the step width was enhanced, the foot angle was enlarged, the stance cycle was prolonged and the step height was reduced （P〈0.01, P〈 0.05）. The reduction of natural walking velocity was due to the shorter stride length rather than to the slower cadence. Some gait parameters in the NPH patients improved after tapping 40 mL CSF. The improved gait velocity owed to the increased stride length and the decreased step width and the shortened stance cycle （P〈0.01, P〈 0.05 ）, whereas the cadence remained unchanged. Conclusions Patients with NPH walked significantly slower. The stride length improved following a diagnostic spinal tap. The characteristic gait patterns might help to the diagnosis of NPH.