现代战创伤致脊髓损伤患者的三维步态分析

3D gait analysis in modern traumatic patients of spinal cord injury with advanced reciprocating gait orthosis

目的通过对现代战创伤致脊髓损伤(spinal cord injury,SCI)患者配戴改良往复式步行矫形器(Advanced reciprocating gait orthosis,ARGO)进行三维步态分析,比较分析SCI患者的脊髓损伤平面与其步行能力(下肢关节运动学、动力学及时空参数等)之间的关系,探讨重建SCI患者步行能力的方法。方法选择在我院住院且配戴ARGO进行步行训练的完全性SCI患者15例,采用Vicon三维步态分析系统进行步态检测与分析。应用Spearman秩和相关性检验对SCI患者的不同脊髓损伤平面与其步态的运动学、动力学和时空参数之间的相关性进行统计学分析。结果 15例患者的步频和跨步长分别为(34.9±1.97)step/min和(95.7±10.39)cm。髋关节摆动角度及髋关节伸展和屈曲时相的角速度分别为(45.28±4.84)°、(22.34±1.96)°/s和(121.35±10.54)°/s。SCI患者的步速(rs=0.914,P<0.001),跨步长(rs=0.926,P<0.001),助行架的压力均值(rs=-0.877,P=0.001),骨盆的旋转角度(rs=-0.926,P<0.001)和髋关节摆动角度(rs=0.963,P<0.01)与SCI平面之间均存在着显著的相关性。结论骨盆的异常运动、髋关节摆动幅度的受限及上肢的过度负载是完全性SCI患者步行能力受限的主要原因。SCI患者应接受一些能够降低其过度生理负荷的康复训练方法,从而改善其重建的步行功能。

Objective To evaluate the relationship between spinal cord injury level of SCI patients and ambulatory function wearing advanced reciprocating gait orthosis（ARGO） through three dimensional gait analysis, and to explore the quantizing guideline of reconstructing walking capacity of complete SCI patients.Method Fifteen paraplegic patients with complete spinal cord injury of lesion level between T2 and L1 who had experienced ARGO gait training for at least 3 months were selected into our study. We used 3D gait analysis system of Vicon Nexus to test and analyze these subjects, and examined their gait speeds, cadences,stride lengths, pelvic angles of rotation, hip ranges of motion, crutch forces, angular velocities of hip flexion and extension phases, et al. We use Pearson＇s product moment correlation coefficient and Spearman rank correlation coefficient to examine the relationship between the level of injury and the kinematic, kinetic and time-spatial values. Results The mean cadence and stride length of these subjects were（34.9±1.97） step/min and（95.7±10.39） cm. Their mean hip range of motion, angular velocities of hip flexion and extension phases were（45.28 ± 4.84）°,（22.34 ± 1.96）°/s and（121.35 ± 10.54）°/s respectively. The gait speed, stride length, peak crutch force, hip ROM, mean crutch force and angular velocity of hip extension phase of SCI patients all had significant pertinences with their spinal cord injury level. Conclusion The abnormal movement of pelvic,limitation of hip range of motion and excess upper limb load are the main reasons that lead to ambulatory disorders in higher thoracic lesion of complete SCI patients. Higher thoracic SCI patients should undertake some rehabilitative training exercises to reduce excessive physiological load, and thus help improve their ambulatory capacity.