脑卒中偏瘫患者坐-站转移时足位、躯干运动及下肢负重间的关系

Interactions among Foot Placement, Trunk Control and Weight-bearing during Sit-to-stand Movement in Hemiplegic Stroke Patients

目的探讨脑卒中偏瘫患者在不同足位下完成坐-站转移时躯干运动及下肢负重。方法选取脑卒中偏瘫患者32例(实验组)和健康人32名(对照组),在双足踝背屈10°(BF)、健侧(优势侧)踝背屈10°时患足置后(PFP)或非优势足置后(UFDP)、患侧(非优势侧)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-站转移测试;采用平衡功能训练评估系统对受试者坐-站转移时下肢负重、下肢负重的不对称性(WBasym)以及臀部压力中心点(Co P)在冠状面和矢状面上的摆动幅度(Co Px,Co Py)进行测量。结果对照组在BF时,双下肢负重基本对称,躯干几乎无侧方移动,与DFP或UDFP时比较均有显著性差异(P<0.05)。实验组双下肢负重对称性较差,躯干偏向健侧;与NPFP比较,除Co Py外,均有显著性差异(P<0.05);与PFP比较,除Co Px及Co Py外,均有显著性差异(P<0.05)。PFP时,躯干先偏向患侧,再向健侧移动;与NPFP比较,除Co Py外,均有显著性差异(P<0.05)。实验组BF与对照组BF以及实验组NPFP与对照组DFP比较,所有指标均有非常显著性差异(P<0.01);实验组PFP与对照组UDFP比较,Co Px及Co Py均增大(P<0.05)。实验组Co Px与WBasym之间呈中度负相关(r=-0.626,P<0.001),而在对照组呈高度负相关(r=-0.776,P<0.001)。结论脑卒中偏瘫患者坐-站转移时,躯干侧方运动影响下肢负重的对称性;足位可以调节躯干运动及下肢负重。

Objective To explore the interaction of foot placement, trunk control and weight- bearing（WB） during sit- to- stand（STS）movement. Methods 32 hemiplegic stroke patients（experimental group） and 32 healthy people（control group） were recruited and completed STS movement with 3 different foot positions： ankle dorsiflexed 10° of both feet（BF）, with the paretic foot posterior（PFP） or the undominant foot posterior（UDFP）, with the non-paretic foot posterior（NPFP） or the dominant foot posterior（DFP）. Balance function assessment system（model AL-080） was used for collecting the WB, WB asymmetry（WBasym）, and the center of pressure of the buttocks in medial-lateral（CoPx） and anterior-posterior（CoPy） sway during STS movement. Results The control group had the mostly WB symmetry, and little trunk side movement in BF, and there was significant difference in all indicators compared with in DFP or UDFP. For the experiment group,the WB, WBasym and CoPx were different as BF from as NPFP（P〈0.05）; while all the indicators except CoPx were different from PFP.When PFP, the trunk moved to the non- paretic side, and then to paretic side, all the indicators were different from NPFP. When BF and NPFP of the experiment group compared with BF and DFP of the control group, all the indicators were different（P〈0.05）. CoPx and CoPy increased in the experiment group compared with the control group. CoPx negatively correlate with WBasym in the experiment group（r=-0.626, P〈0.001） and in the control group（r=-0.776, P〈0.001）. Conclusion The trunk side movement affects weight-bearing symmetry,and foot placement can modify weight-bearing distribution during the STS movement in hemiplegic stroke patients.