2型糖尿病患者正、倒走足底生物力学分析

Plantar Biomechanical Analysis of Patients with Type 2 Diabetes Mellitus in Forward and Backward Walk

目的研究分析2型糖尿病(T2DM)患者正、倒走足底生物力学变化,对糖尿病患者健身提出建议。方法采用Rscan平板式测试系统检测53例健康对照者(DC组)和52例2型糖尿病患者(T2DM组)自然正走及倒走时动态足底压力分布及压力中心轨迹变化,对比分析正、倒走步态特征。结果正走时与DC组比较,T2DM组M3(第3跖骨)、M4(第4跖骨)、M5(第5跖骨)区峰值压力显著增高(P<0.05,P<0.01),M2(第2跖骨)、HM(足跟内侧)区峰值压力显著降低(P<0.05,P<0.01)。与正走时比较,DM组倒走时M2、M3、M4区峰值压力显著降低(P<0.05,P<0.01),除M5区外,其余各区峰值压力显著增高(P<0.05,P<0.01);DM组足底压力中心轨迹(COP)在X轴上位移变大,在Y轴上位移减少,左右足差异不明显。结论正常人与T2DM患者正走时足底峰值压力存在差异。T2DM患者倒走可使足底各区峰值压力分布更加均匀,缓解前足受力,但加大了行走的不稳定性,提醒T2DM患者倒走锻炼时应更加注意安全。

Objective To research the plantar biomechanical changes of patients with type 2 diabetes mellitus （T2DM） in forward and backward walk so as to put forward methods for appropriate exercises in patients with diabetes. Methods Distribution of plantar pressure and changes of center of pressure path （COP） in 53 healthy people （ control group） and 52 patients with type 2 diabetes mellitus （T2DM group） during natural walking and backward walking were detected with RSsan flat test system from Belgium, and the gait features of forward and backward walking were contras- tively analyzed. Results The peak pressures in districts of M3 （the third metatarsal bone） , M4 （the fourth metatarsal bone） and M5 （ the fifth metatarsal bone） in T2DM group were significantly increased during forward walking, compared with those in control group （P 〈 0.05, P 〈 0.01 ）, and peak pressures in districts in M2 （the second metatarsal bone） and HM （ inside heel） were significantly reduced （ P 〈 0.05, P 〈 0.01 ）. The peak pressures in districts of M2 （ the sec- ond metatarsal bone）, M3 （the third metatarsal bone） and M4 （the fourth metatarsal bone） were significantly reduced during forward walking compared with those during backward walking in DM group （P 〈 0.05, P 〈 0.01 ） , and the peak pressures in other districts except the M5 districts were significantly increased （ P 〈 0. 05, P 〈 0.01 ） ; COP had a large displacement in the X-axis, and a little displacement in the Y-axis. There was no significant difference between left and right flint. Conclusion There are differences in plantar peak pressure between the healthy people and patients with T2DM during forward walking. The peak pressures of plantar districts may be distributed better in patients with T2DM during backward walking, and the forefoot pressure may be relieved, but it may increase instability of walking, so patients with T2DM should be careful when they exercise in backward walking way.