背屈踝足矫形器对偏瘫患者骨盆控制影响的运动学分析

The kinematic analysis of Dorsiflexion Ankle Foot Orthotics on pelvic control of hemiplegic patients

目的通过分析穿戴不同角度踝足矫形器（AFO）偏瘫患者的步态时空参数及骨盆三维运动参数，探讨不同角度AFO对偏瘫患者骨盆控制的影响。方法对15例偏瘫患者穿戴背屈5。位AFO（d-AFO）、背屈0。位AFO（f-AFO）、裸足状态进行步态对比分析，获取步态时空参数及骨盆三维运动参数，并对3种状态的空间参数及步态不对称指数进行统计学分析比较。结果与裸足相比，穿戴d-AFO时的步速是（0．54±0．05）m／s，患侧步长是（0．47±0．01）m，健侧步长是（0．44±0．03）m，步宽是（0．16±0．02）m，其能显著提高患者步速（P〈0．05），增加步长（P〈0．05），减少步宽（P〈0．01），提高步态的稳定性；佩戴d-AFO步行时，骨盆横断面上的旋转范围（10．2±3．29）°，较佩戴f-AFO步行时无明显减小（P〉0．05），但矢状面倾斜范围（6．52±0．84）°及冠状面的倾斜范围（5±0．38）。均明显减小（P〈0．05）。结论背屈d-AFO能有效地改善偏瘫患者的骨盆控制能力，提高平衡能力，改善步态的稳定性。

Objective To observe the effects of dorsiflexion ankle foot orthotics （d-AFO） on pelvic control of hemiplegic patients by analyzing the time-space gait parameters and 3D pelvic motion parameters. Methods Fifteen hemiplegic patients （14 male and 1 female） were enrolled in this study. The time-space gait parameters and pelvic 3D motion parameters were collecte with a Motion Analysis System while the patients were asked to walk under 3 conditions： wearing d-AFO （5°dorsiflexion） , f-AFO （0°dorsiflexion） or barefoot. Results It was found that, while wearing d-AFO, the velocity, the paralyzed step length and the nonparalyzed step length were significantly in- creased, and the step width was significantly decreased when compared with those while walking barefoot （P 〈 0.05）. Comparison between wearing d-AFO and f-AFO showed that the sagittal and coronal plane inclinations, but not the transverse rotation of pelvis were significantly decreased when wearing the d-AFO （ P 〈 0.05 ）. Conclusions d-AFO can significantly improve pelvis control and increase gait stability in hemiplegic patients.