脑卒中患者偏瘫步态的时空及关节运动学参数分析

Kinematic analysis of temporal-spatial parameters and lower extremity motions of hemiparetic stroke patients

目的:探讨脑卒中患者偏瘫步态的时空及关节运动学参数,为临床康复评估和治疗提供客观依据。方法:脑卒中偏瘫患者和健康受试者各24例自愿参加本研究;其中脑卒中组男15例,女9例,脑出血5例,脑梗死19例,年龄(57.75±5.57)岁;对照组男12例,女12例,年龄(56.54±6.02)岁。应用Gait Watch步态分析系统评估步态的时空参数和下肢关节运动学参数。所有受试者由同一医师进行2次评估。结果:与对照组相比,脑卒中组的步频、步速显著降低,患侧步长显著缩短,步态周期和患侧支撑相均延长,患侧摆动相缩短。脑卒中组患侧髋关节的最大伸展角度明显受限(P=0.001),髋关节屈伸运动的平均角速度明显降低(P<0.001),膝关节最大屈曲角度亦明显受限(P<0.001),膝关节屈伸运动的平均角速度明显降低(P<0.001),髋关节的最大屈曲角度和足偏角与对照组比较无明显差异。患者的步行能力显著下降。结论:Gait Watch步态分析系统可定量测量脑卒中偏瘫患者的步态特征和下肢的关节运动学参数,对于脑卒中偏瘫患者步行能力的评估具有较高敏感度。

Objective：To investigate the temporal-spatial parameters and lower extremity motions of hemiparetic stroke patients using Gait Watch kinematic analysis system.Method：Two groups of subjects participated in the study. Stroke group had 24 stroke patients [（male 15, female 9, cerebral hemorrhage 5, cerebral infarction 19, age（57.75±5.57）y] and control group had 24 healthy volunteers [male 12, female 12, age（56.54 ± 6.02）y] were set as control. They were assessed twice by the same physiatrist. The subjects＇ height, weight, age and gait temporal- spatial parameters and lower extremity motions as well as walking capacity were compared.Result：There were significant differences（P〈0.05） in spatiotemporal parameters（cadence, walking speed, step length, cycle time, swing phase and support phase） of the stroke patients group. The maximum range of motion（ROM） of hip extension decreased significantly in hemiparetic stroke patients compared with control group（P=0.001）, and the mean velocity of hip flexion- extension motion decreased significantly（P〈0.001）. The maximum ROM of knee flexion and the mean velocity of knee flexion- extension motion also significantly decreased（P〈0.001）. The walking capacity of hemiparetic stroke patients significantly reduced compared with that of control group.Conclusion：Gait Watch kinematic analysis system could assess the kinematic parameters and walking capacity of hemiparetic stroke patients quantitatively. The sensitivity of walking capacity evaluation was high.