57例脑小血管病患者步态及平衡障碍特征分析

Gait and Balance Disorders in 57 Patients with Cerebral Small Vessel Disease

目的探讨脑小血管病患者步态及平衡障碍的特征。方法连续纳入2013年6月至2015年2月就诊于北京协和医院神经内科门诊的脑小血管病患者57例,收集临床资料,对其日常生活能力、整体运动功能及步态和平衡功能进行评价。结果 57例患者中,男性71.9%,年龄(64.5±12.4)岁;45.6%(26/57)以步态障碍为主诉,73.7%(42/57)Barthel指数≥90分。帕金森病统一评分量表(Unified Parkinson’s Disease Rating Scale,UPDRS)评分(14.2±10.1)分,共济失调等级量表(Scale for the Assessment and Rating of Ataxia,SARA)(5.2±3.6)分;70.2%(40/57)Tinetti步态评分<12分,易累及的步态特征是步高、步宽(基)、步长对称性;50.9%(29/57)Tinetti平衡评分<16分,易受累的平衡特征是360°转身、轻推试验、座位起立;简明运动试验(Short Physical Performance Battery,SPPB)中,3米步行所需时间是(5.0±1.9)s,其中72.7%(24/33)步行时间≥3.62 s(评分≤3分)。结论半数以上患者表现出步态障碍,但对整体运动功能和日常生活能力影响较小;步态障碍主要表现为速度减慢、拖地、步基宽和双侧步长不等。步态和平衡功能障碍的早期评价对于预防跌倒和生活能力下降有重要意义。

Objective To explore the kinematic features of gait and balance disorders in patients with cerebral small vessel disease（CSVD）.Methods Clinical data were collected in consecutive patients who visited the neurological department in Peking Union Medical College Hospital and were diagnosed with CSVD. Activity of daily living, movement performance, as well as balance and gait disturbance were assessed using several semi-quantitive scales.Results Of the 57 patients included, 71.9% were male, aged 64.5±12.4 years. Twenty six（45.6%） complained of gait disorders but 42（73.7%） were doing well in daily life with Barthel index ≥90. Movement performance in both unified Parkinson＇s disease rating scale（UPDRS） and scale for the assessment and rating of ataxia（SARA） were mildly abnormal, with scores of 14.2±10.1 and 5.2±3.6 respectively. Gait dysfunction were found in 40 patients（70.2%, Tinetti-gait score12）, with stride height, stride width, and symmetry of stride length were the most affected gait characteristics. Balance function were affected in 29 patients（50.9%, Tinetti-balance score16）, especially when they were turning 360 degrees, nudged or attempting to arise. Time for walking 3 m in the test of short physical performance battery（SPPB） were 5.0±1.9 seconds, and of 33 patients who took the test battery, 24（72.7%） took more than 3.62 seconds for 3 m walking.Conclusion Gait dysfunction affects more than half of the patients, but these disorders have less impact on both activity of daily living and motor performance than expected. Gait velocity, strideheight, stride width and symmetry of stride length are the most involved gait characteristics, early detection of above disorders can provide chances for preventing falls and delaying disability.