视神经脊髓炎谱系疾病患者步态分析及跌倒风险评价

Gait analysis and evaluation of fall risk in patients with neuromyelitis optica spectrum disorders

目的比较视神经脊髓炎谱系疾病患者与正常对照者的步态、平衡功能和行走能力,评价视神经脊髓炎谱系疾病患者的跌倒风险。方法共12例视神经脊髓炎谱系疾病患者和9例性别、年龄相匹配的正常对照者,采用德国Reha Watch步态分析系统测定步态周期参数(包括步频、步时、步长、步速、步行各时相对称性),Berg平衡量表(BBS)评价平衡功能,起立-行走计时测验(TUGT)、站起测验和走直线步态测验(TGT)评价行走能力。结果与正常对照者相比,视神经脊髓炎谱系疾病患者步态周期中步频减慢(t=-5.354,P=0.000)、步时延长(t=4.045,P=0.005)、步长减小(t=-7.243,P=0.000)、步速减慢(t=-10.161,P=0.000)、支撑相对称性(t=-2.220,P=0.050)和单脚支撑对称性(t=-2.359,P=0.020)降低,以及TUGT测验计时增加(t=3.197,P=0.024),TGT测验步数减少(Z=-1.544,P=0.049)。BBS量表中静态平衡相关项目(包括无支持站立、无靠背坐位等)评分较高比例明显高于动态平衡相关项目(包括站立位从地面捡起物品等)。结论视神经脊髓炎谱系疾病患者步态周期参数异常,平衡功能下降,尤以动态平衡显著,存在跌倒风险,可以通过增强下肢肌力和平衡功能等予以改善。

Objective To investigate the time.distance parameters of gait, balance function and mobility performance in patients with neuromyelitis optica spectrum disorders（NMOSDs） compared with healthy subjects, so as to evaluate the fall risk in NMOSDs patients. Methods Twelve patients with NMOSDs and 9 healthy subjects with matched age and sex were enrolled in this study. The time.distance parameters of gait（including cadence, stride duration, stride length, gait velocity, symmetry of phases） were assessed using RehaWatch Gait Analysis System. The fall risk was evaluated by Berg Balance Scale（BBS）,Timed Up and Go Test（TUGT）, Chair Rising Test（CRT） and Tandem Gait Test（TGT）. Results Compared with control group, patients in NMOSDs group had slower cadence（t =. 5.354, P = 0.000）,prolonged stride duration（t = 4.045, P = 0.005）, lower stride length（t =. 7.243, P = 0.000）, slower gait velocity（t =. 10.161, P = 0.000）, decreased symmetry of stance phase（t =. 2.220, P = 0.050） and symmetry of single support phase（t =. 2.359, P = 0.020）, spent more seconds in performing TUGT（t = 3.197, P =0.024） and finished fewer numbers of steps on TGT（Z =. 1.544, P = 0.049）. In BBS, items related to static balance（including nonsupported stand and sit） got higher scores than items related to dynamic balance（including picking up something on the floor when standing）. Conclusions NMOSDs patients had abnormal time.distance parameters in gait cycle, decreased balance function, especially dynamic balance,and higher fall risk. They can be improved by enhancing muscle force of lower limb and balance function.