单侧小腿截肢患者穿假肢后的步态运动学参数研究

Research on gait kinematics parameters of unilateral transtibiai amputees after wearing prostheses

目的采用计算机辅助康复环境（CAREN）步态评估系统分析单侧小腿截肢患者穿假肢后的步态运动学参数，并分析其产生差异的原因。方法选取单侧小腿中段截肢但均装配假肢的受试者9例设为假肢组，同期选择健全受试者11例设为标准组，通过CAREN步态评估系统对2组受试者的步态运动学参数进行收集、处理、分析，并根据分析报告阐明产生差异原因。结果假肢组步态时相性指数为（0．88±0．04），其假肢侧的步长、支撑期百分比、髋关节支撑期最大伸展角度、膝关节支撑期最大屈曲角度、踝关节足跟着地背屈角度、踝关节支撑期最大背屈角度、踝关节支撑期最大跖屈角度与健侧比较，差异均有统计学意义（P〈O．05）。假肢组假肢侧的步行速度、步态周期、跨步长、支撑期百分比、髋关节足跟落地屈髋角度、髋关节支撑期最大伸展角度、髋关节支撑期最大屈曲角度、膝关节足跟着地屈膝角度、踝关节足跟着地背屈角度、踝关节支撑期最大跖屈角度、踝关节支撑期最大背屈角度与标准组双侧均值比较，差异均有统计学意义（P〈0．05）。结论单侧小腿截肢者穿戴假肢后步态时相对称性为（0．88±0．04），假肢侧踝关节运动学参数显著弱于自身健侧，其时空与运动学参数也显著弱于健全人。

Objective To analyze the gait kinematics parameters of patients with unilateral leg amputation after wearing prosthesis using the computer assisted rehabilitation environment （CAREN） gait assessment system, and the reasons for the differences. Methods Nine patients with unilateral mid-leg amputation were selected as the prosthesis group, and 11 healthy subjects were selected as the standard group. The gait kinematics parameters of the two groups were collected, processed and analyzed by using the CAREN gait evaluation system. Results The gait phase index of the prosthetic limb group was （0.88±0.04）. Significant differences were observed between the prosthetic and healthy limbs in terms of step length, stance phase percentage, maximum hip extension angle and maximum knee flexion angle, maximum dorsiflexion and plantar flexion angle of the ankle joint during the stance phase, as well as the dorsiflexion angle of ankle joint during heel strike to the ground （P〈0.05）. Moreover, there were significant differences between the affected limbs of the prosthetic limb group and limbs of the standard group in terms of the walking speed, gait cycle, stride length, percentage of stance phase, hip flexion angle, knee flexion and ankle dorsiflexion during heel strike, maximum hip extension and flexion angle, maximum dorsi- and plantar-flexion of ankle joint during stance phase （P〈0.05）. Conclusion The relative symmetry of the gait of the unilateral leg amputee is （0.88±0.04）, with their kinematics parameters of the prosthetic limb significantly weaker than those of the contralateral side and the healthy controls.