不同足位对脑卒中偏瘫患者坐一站转移稳定性及下肢负重的影响

The impact of foot position on sit-to-stand stability and lower limb loading in hemiplegic stroke patients

目的探讨不同足位对脑卒中偏瘫患者坐-站转移稳定性及下肢负重的影响。方法选取脑卒中偏瘫患者36例（实验组）和健康人36例（对照组），2组受试者均需在双足（BF）踝背屈10°、BF踝背屈10°时患足置后（PFP）或非优势足置后（UFDP）、BF踝背屈10°时健足置后（NPFP）或优势足置后（DFP）3种足位下完成坐一站转移测试，采用AL-080型步态与平衡功能训练评估系统对受试者完成坐一站转移的时间、双下肢负重差异（ALD）、人体重心点（COG）在冠状面上的摆动幅度（COGX）进行测量，探讨其不同差异。结果BF踝背屈10°时，除坐-站转移所需的时间外，健足平均负重[（59．12±2．71）％]、患足平均负重[（40．88±2．71）％]、ALD[（18．24±5．41）％]及COGX[（3．58±0．76）cm]与PFP比较，差异均有统计学意义（P〈0．05）。NPFP时，上述所有指标与PFP比较，差异均有统计学意义（P〈0．05），与BF踝背屈10°时各指标比较，除坐-站转移所需时间外，剩余指标与其差异均有统计学意义（P〈0．05）。与对照组UDEP比较，BF踝背屈10°时所有指标均有不同程度增高或降低（P〈0．05），DFP时，除坐-站转移所需时间外，剩余指标与UDFP时比较，差异均有统计学意义（P〈0．05）。对照组3种足位下所有指标与实验组比较，差异均有统计学意义（P〈0．05）。实验组PFP时（r=0．753、P=0．00）、BF踝背屈10。时（r=0．798、P=0．00）、NPFP时（r=0．814、P=0．00）ALD与COGX之间呈高度正相关性，对照组UDFP时（r=0．764、P=0．00）、BF踝背屈10°时（r=0．824、P=0．00）、DFP时（r=0．838、P=0．00）ALD与COGX之间亦呈高度正相关性。结论不同足位对脑卒中偏瘫患者坐-站转移稳定性及下肢负重的影响较大，患者双下肢负重的对称性越高，其姿势稳定性越好。

Objective To explore the effects of different foot positions on lower limb loading and the sit- to-stand stability of hemiplegic stroke patients. Methods Thirty-six hemiplegic stroke patients were recruited as the experimental group and 36 healthy elderly as the control group. Both groups of subjects completed sit-to-stand movements with 3 different foot positions： （ 1 ） both feet （BF） placed at 10° of ankle dorsiflexion; （2） the paretic foot placed posterior （PFP） for hemiparetic subjects or the undominant foot placed posterior （UDFP） for healthy subjects; （3） the non-paretic foot placed posterior （NPFP） for hemiparetic subjects or the dominant foot placed posterior （DFP） for healthy subjects. The time required to rise from sitting, the average load difference （ALD） be- tween the left and right feet and sway of the center of gravity in the mediolateral direction （COGX） were measured. Results Comparing BF with PFP positioning, the time to rise was not significantly different but the loads on the two legs, the ALD and the COGX in were all significantly different. Comparing NPFP with PFP positioning, all the indexes were significantly different, and the time to rise was significantly different from the BF positioning. For the control group, all the indexes significantly different in the BP and PFP positions, and the time to rise was signifi- cantly different from that required with the UDFP placement. In all 3 foot positions, all of the experimental group＇ s indices differed significantly from those of the control group. In both groups there was a strong positive correlation between the average ALD and COGX values in all three foot positions. Conclusions Foot placement influences lower limb loading and stability in rising from sitting for hemiplegic stroke survivors. The greater the symmetry of lower limb loading, the better the postural stability.