三维姿势与步态分析在不同年龄健康人群平衡评估中的应用

Application of 3D posture and gait analysis system for the balance evaluation in different ages of healthy subjects

目的采用OptiTrack三维运动捕捉系统评估不同年龄组健康人群躯体各平面的姿势调节及步态情况，探讨Opti Track三维运动捕捉系统的可用性及不同年龄组健康人群平衡的变化。方法募集3个不同年龄组健康人群，即老年组60～70岁、中年组40450岁、年轻组20～30岁各10例，采用OptiTrack三维运动捕捉系统进行检测，计算头部、躯干、髋部在pitch俯仰、Yaw偏航、Roll滚动方向的姿势调节、双侧膝关节运动协调性及步态稳定参数最大李雅谱诺夫指数λ。结果步态方面，最适行走速度、跨步宽度在组间差异具有统计学意义（F=3．23、3．87，P=0．030、0．020）；头部运动在仰俯方向的角度范围不论是在正常行走还是在本体干扰模式下，年轻组均小于中年组和老年组（F=4．01、3．72，P=0．035、0．028）；而躯干运动在仰俯方向的角度范围仅在正常行走的模式下，年轻组大于中年组和老年组（F=3．19，P=0．015）；在其他行走模式和其他方向均有差异均无统计学意义。头部、髋部及躯干三平面运动角度变异度在本体干扰时的偏航角度，年轻组均高于中年组和老年组（F=2．89、3．14、3．92，P=0．036、0．019、0．034）；在视觉干扰时滚动方向，3个运动平面在年轻组均低于中年组和老年组（F=3．90、2．56、3．28，P=0．017、0．021、0．056）；而在本体干扰时，差异仅存在髋部和躯干平面（F=3．21、4．05，P=0．046、0．032）。与年轻组比较，老年组膝关节活动时的最大活动角度较小、而最小活动角度较大。3个不同年龄组在正常行走时的最大李雅谱诺夫指数λ值均小于本体干扰及视觉干扰模式，且随着年龄的增大，3种不同行走模式间的差异逐渐减小，相关性分析结果显示λ值随着年龄的增加而增加（r=0．03，P=0．041）。结论随着年龄的增加，躯体姿势调节异常以及步态的不协调性是导致老年人群罹患跌倒风险的主要因素，OptiTrack三维评估系统可作为=种评估平衡康复的手段。

Objective To investigate the patterns of gait and locomotion in three dimension space using OptiTrack motion capture system in 30 healthy people aged 20-70 years. Methods The 3D OptiTrack motion capture system was applied in young（aged 20-30 years,n=10）,middle-aged（aged 40-50 years,n=10）and the elderly （aged 60-70 years,n= 10）to capture the gait and the rhythmic oscillations of the trunk, head, hip and kneewhen subjects walked on the treadmill under three different conditions of normal walking,walking under visual interfering and walking under proprioceptive interfering. Several markers were placed on the subject. For each locomotor trial, the preferred walking speed,stride width, stride time, the absolute angular dispersions and the stander deviation of four segments around the roll, pitch and yaw axes, and gait instability（λ）were calculated to assess the equilibrium strategies of head,trunk,pelvis and knee under different experimental conditions. Results With increasing age, there were decreases in preferring walking speed （PWS） and increases in stride width （ F = 3. 23,3. 87; P =0. 030, 0. 020,respectively）. The absolute angle of the segment of head in roll axis was significantly smaller in young group than in middle age and elderly group（F=4. 01,3. 72;P=0. 035,0. 028, respectively） under the condition of normal walking and proprioceptive interfering. The trunk sway in yaw was significantly decreased while significantly increased in roll plane either in normal walking or walking under proprioception interfering（F= 3. 19,P=0. 015） ; The standard deviation（SD）of movement of head,think and hip in yaw direction was higher in young group than inmiddle-age and elderly group （F = 2. 89,3. 14,3. 92 ; P = 0. 036,0. 019,0. 034, respectively）, but was lower in young group in roll direction than in middle-age and elderly group （F = 3. 90, 2. 56, 3. 28; P = 0. 017, 0. 021, 0. 056, respectively）, the difference existed only in hip and trunk under proprioception interfering. The SD value of movement of bilateral knee joints was increased in elderly subjects. Using mediolateral-λ（ML-λ）to predict the gait stability,the results showed a significantly increasedλ value by our small circle, and the λ value was positively correlated with age（r=0. 03,P〈0. 05）. Conclusions With aging,the abnormal adjustment of body posture and the incongruity of gait may cause a high risk for falling,and gait instability begins to increase as early as age 40-50 years. This finding supports that local dynamic stability is likely to be an indicator of falling risk. OptiTrack motion capture system can be used to evaiuate a balance for rehabilitation.