脑卒中偏瘫患者膝过伸步态运动学特点分析

The kinematic characteristics of the knee hyperextension gait in stroke patients with hemiplegia

目的:探讨脑卒中偏瘫患者膝过伸步态的三维运动学特点及其与步行速度的相关性,从运动学角度探讨影响膝过伸患者步行速度的主要因素。方法:利用三维步态分析系统对15例伴有膝过伸步态的脑卒中偏瘫患者和15例健康老年人进行运动学定量比较,并将其与步行速度进行相关性分析。结果:与正常对照组相比,膝过伸患者的步长、步频减小,步速减慢,支撑期百分比延长(均P<0.05);膝过伸患者髋、膝、踝关节活动范围减小,最大伸髋、屈膝、踝背屈角度减小,最大伸膝角度增加(均P<0.05)。步行速度与步频、支撑相百分比、膝踝关节活动范围、最大屈膝角度和最大踝跖屈角度均相关(均P<0.05)。结论:脑卒中偏瘫膝过伸患者下肢关节活动不同程度受限,步行速度下降,其中屈膝和踝跖屈异常是影响膝过伸患者步行速度的主要因素。

Objective: Using three-dimensional gait analysis system to analyze the kinematic parameters and the correlation with walking speed,so as to explore the main kinematic factors influencing the walking speed of stroke patients with knee hyperextension. Methods: The kinematic parameters were compared between 15 stroke patients with knee hyperextension and 15 healthy elderly people,and the correlation between walking speed and kinematic parameters was analyzed. Results: Compared to the healthy elderly people,step length,stride frequency and walking speed in the stroke patients were significantly reduced,but the supporting period percentage was increased( P < 0. 05). The joint range of motion( ROM)of hip,knee and ankle in stroke patients was reduced and the maximal angle of hip extension,knee flexion and ankle dorsiflexion was also reduced,but the maximal angle of knee extension was increased significantly as compared with those in the healthy elderly( P < 0. 05 for all). The gait function was correlated with kinematic parameters( steps per minute,stance percent,the ROM of knee and the maximal angle of knee flexion and ankle plantar flexion) in stroke patients( P < 0. 05).Conclusion: Because of the motor dysfunction of lower extremities,the walking speed of stroke patients was decreased.The dysfunction of knee flexion and ankle plantar flexion was the important factors that influenced the walking speed in stroke patients with knee hyperextension.