脑卒中偏瘫患者步态参数与平衡功能的关系

Correlation between gait parameters and balance in stroke hemiplegic patients

目的探讨脑卒中偏瘫患者步态参数与平衡功能的关系。方法2018年9月至2020年3月,北京博爱医院住院脑卒中偏瘫患者76例(BrunnstromⅣ、Ⅴ期各38例),采用平衡检测仪、星状伸展平衡测试(SEBT)进行评定,采用三维步态分析系统测量步速、步频,计算双侧步长比、支撑期时间比、摆动期时间比、髋关节最大屈曲角度比、膝关节最大屈曲角度比。步态参数和平衡功能测试结果行相关性分析。结果BrunnstromⅤ期患者平衡和步态参数均优于Ⅳ期患者(|t|>2.268,P<0.05)。所有患者步速、步频与平衡功能多数参数相关(|r|>0.335,P<0.05)。BrunnstromⅣ期患者步长比与SEBT测量结果负相关(r=-0.467~-0.613,P<0.01),BrunnstromⅤ期患者步长比与平衡仪内外稳定极限负相关(r=-0.356,P=0.028)。BrunnstromⅣ期患者摆动期时间比与平衡仪前后稳定极限(r=-0.335,P=0.040)、内/外极限比(r=0.510,P=0.001)、星状伸展平衡测试多数结果(r=-0.330~-0.445,P<0.05)相关。BrunnstromⅣ期患者髋、膝关节屈曲比与平衡功能测试结果相关(|r|>0.326,P<0.05),BrunnstromⅤ期患者膝关节屈曲比与多数平衡功能测试结果相关(r>0.329,P<0.05),髋关节屈曲比仅与平衡仪前后稳定极限相关(r=0.369,P=0.023)。结论步速和步频可较好反映脑卒中偏瘫患者的平衡功能;步态的时空对称性在功能较低的患者中与平衡功能相关。

Objective To investigate the relationship between gait spatiotemporal parameters and balance function in stroke hemiplegic patients.Methods From September,2018 to March,2020,76 stroke hemiplegic patients(38 in BrunnstromⅣand V,respectively)were assessed balance function with Active Balancer EAB-100 and Star Excursion Balance Test(SEBT),and gait parameters of speed,cadence and asymmetry,named step length asymmetry ratio(SLA),swing time asymmetry ratio(SWTA),stance time asymmetry ratio(STA),maximum flexion angle ratio(MFA)of hip and knee.The correlation among gait parameters and balance function was analysed.Results The balance and gait parameters were better in those in Brunnstrom V than in BrunnstromⅣ(|t|>2.268,P<0.05).The speed and cadence correlated with the most balance indexes(|r|>0.335,P<0.05).SLA correlated with SEBT in BrunnstromⅣpatients(r=-0.467~-0.613,P<0.01),while it correlated with medial-lateral(ML)stability limits in Brunnstrom V patients(r=-0.356,P=0.028).SWTA correlated with stability limit of Anterior-Posterior(A-P)(r=-0.335,P=0.040)and M-L(r=0.510,P=0.001),and most of SEBT(r=-0.330~-0.445,P<0.05)in BrunnstromⅣpatients.MFA of hip and knee correlated with balance indexes in BrunnstromⅣpatients(|r|>0.326,P<0.05),while MFA of knee correlated with most balance indexes in Brunnstrom V patients(r>0.329,P<0.05),and MFA of hip correlated with A-P stability limit(r=0.369,P=0.023).Conclusion Both speed and cadence of steps can well respond to the balance function in stroke hemiplegic patients.For the asymmetry,it is related with balance in patients with poorer recovery.