脑梗死偏瘫病人静态睁闭眼条件下压力中心与足底压力分布变化

The change of center of pressure and plantar pressure distribution in hemiplegic patients with cerebral infarction under the condition of the static opening or closing eye

目的:探讨脑梗死偏瘫病人静态睁闭眼条件下站立稳定性的变化规律,以及各种代偿机制对其的影响。方法:选择首次脑梗死后可以独立站立、行走10 m以上的左侧偏瘫病人42例作为病例组,相匹配的正常中老年人36名为对照组。采用PK254动静态平衡测试仪和PDM-THM步态训练跑台对病人进行检测。结果:在睁眼状态下,2组压力中心(COP)路径长度、移动平均速度及左侧前足、后足压力分布比例差异均无统计学意义(P>0.05);病例组左侧总体和右侧前足压力分布比例均高于对照组(P<0.05和P<0.01),右侧后足和总体压力分布比例均低于对照组(P<0.01)。闭眼状态下,病例组的COP路径和移动平均速度均大于对照组(P<0.01),右侧前足压力分布比例低于对照组(P<0.01),右侧后足和总体压力分布比例均高于对照组(P<0.05);而左侧前足、后足和总体压力分布比例2组间差异均无统计学意义(P>0.05)。结论:脑梗死偏瘫病人通过视觉代偿可以使站立稳定性有显著改善;通过前庭及本体感觉的调节,病人偏瘫侧下肢站立稳定性会得到更好地改善。偏瘫后,病人健侧下肢的站立稳定性与正常相比都会受到显著影响。

Objective： To investigate the change rule of standing stability in hemiplegic patients with cerebral infarction under the condition of the static opening or closing eye,and various compensatory mechanisms effect on lower extremity stability. Methods： Fortytwo left hemiplegic patients with first time cerebral infarction and independent standing more than 10 m,and 36 healthy middle aged and elderly people were divide into the case group and control group,respectively. Two groups were detected using PK254 equilibrium tester and PDM-THM gait training treadmill. Results： Under the condition of opening eye,the differences of the path length of center of pressure（ COP） and moving average speed between two groups were not statistically significant（ P〈0. 05）,the pressure distribution proportion of the corresponding left front foot and rear foot between two group were not statistically significant（ P〈0. 05）,the total pressure distribution proportion of left side and pressure distribution proportion of right front foot in case group were higher than those in control group（ P〈0. 05 and P〈0. 01）,and the pressure distribution proportion of right rear foot and total pressure distribution proportion of right side in case group were lower than those in control group（ P〈0. 01）. Under the condition of closing eye,the path length and moving average speed of COP in case group were higher than those in control group（ P〈0. 01）. The pressure distribution proportion of the corresponding right front foot in case group was lower than those in control group（ P〈0. 01）,the pressure distribution proportion of right rear foot and total pressure distribution proportion of right side in case group were higher than those in control group（ P〈0. 05）,and the differences of the total pressure distribution proportions of left front foot,left rear foot and left side between two groups were not statistical significance（ P〉0. 05）. Conclusions： The standing stability in hemiplegic patients with cerebral infarction can be significantly improved by visual compensation. The standing stability of lower limb in hemiplegia patients can be better improved by the regulation of vestibular and proprioception. After hemiplegia,the standing stability of healthy side lower limb of patients can be significantly affected compared with normal.