脑卒中偏瘫患者步态的不对称性与平衡功能的相关性研究

Gait asymmetry and balance in hemiplegic stroke survivors

目的研究脑卒中偏瘫患者步态时空参数的不对称性与平衡功能之间的相关性。方法选取可以独立步行10m以上的单侧偏瘫的脑卒中患者30例设为病例组，相匹配的健康中老年人30例设为对照组，采用步态与平衡功能训练评估系统（AL-600型）对受试对象进行步态测试，经分析评估软件提取各步态时空参数（站立期时间、摆动期时间、步长及步宽），其步态时空参数的不对称性评估用双侧下肢步长不对称比（SLA）、摆动期时间不对称比（SWTA）和站立期时间不对称比（STA）表示。并对30例脑卒中患者进行Berg平衡量表（BBS）评分。用两独立样本t检验分析病例组与对照组的各时空参数不对称比（SLA、SWTA、STA）及步宽的差异，用Pearson相关性分析法分析SLA、SWTA和STA分别与步宽及BBS评分之间的相关程度。结果病例组患者步行时，患侧的步长及摆动期时间均较健侧增加（P〈0．05），患侧站立期时间较健侧缩短（P〈0．05）；而对照组下肢步态分析，各时空参数左右侧之间差异无统计学意义（P〉0．05）。病例组患者的步宽及各时空参数不对称比（SLA、SWTA和STA）的比值均较对照组增大（P〈0．01）。病例组患者的步宽[（15．90±2．60）em]与BBS评分[（41．57±7．27）分]之间呈中度负相关（r=-0．564，P〈0．01），而患者的SLA与步宽呈轻度正相关（r=0．432，P〈0．05），与BBS评分呈高度负相关（r=-0．849，P〈0．01）；患者SWTA与步宽呈高度正相关（r=0．726，P〈0．01），与BBS评分呈中度负相关（r=-0．630，P〈0．01）；患者STA与步宽和BBS评分之间均未见明显相关性（r=0．352，r=-0．126，P〉0．05）。结论脑卒中偏瘫患者步态时空参数存在不对称性，其步态的不对称程度与平衡功能之间存在一定的相关性。

Objective To explore any correlation between gait asymmetry and the balance of hemiplegic stroke survivors. Methods Thirty patients with hemiplegia caused by stroke but who could walk more than 10 me- tres independently were recruited as the experimental group; 30 age-matched healthy elderly people served as the con- trol group. An AL-600 gait analyzer was used to quantify the spatial and temporal gait parameters of all subjects. Gait asymmetry ratios were calculated. The 30 stroke patients were also assessed with the Berg balance scale （ BBS）. Two independent sample t-tests were used to compare the step length asymmetry （ SLA）, swing time asymmetry （SWTA） and STA （stance time asymmetry） ratios for the two groups and their average step widths. Pearson correlation coeffi- cients were calculated relating the SLA, SWTA, STA, step width and BBS results. Results Among the experimen- tal group, swing time and step length on the affected side were significantly different from the unaffected side, and stance time on the affected side was significantly shorter. The control group showed no such signifieant differences. All of the experimental group＇s average asymmetry ratios were significantly greater than those of the control group, as was their step width. Step width and BBS score were negative correlated, but step width was positively correlated with the step length and swing time asymmetry ratios. BBS scores were negatively correlated with the step length and swing time asymmetry ratios. Stance time asymmetry and step width showed no significant correlation with the BBS scores. Conclusion The gait of hemiplegic stroke patients is both spatially and temporally asymmetric, and a certain corre- lation exists between the degree of asymmetry and balance function.