廓清障碍对脑卒中偏瘫足下垂患者平衡及步行功能的影响

Analysis of gait characteristics of swing phase clearance disorder in stroke patients with foot drop

目的运用三维步态系统研究廓清障碍对脑卒中偏瘫足下垂患者平衡及步行功能的影响。方法选取合肥市第二人民医院康复医学科自2019年11月至2021年3月收治的30例脑卒中偏瘫足下垂患者为观察组,按照与偏瘫侧和非偏侧下肢左右一致的原则,配对设计选取30名健康志愿者作为对照组,按照与偏瘫侧左右下肢相对应的原则分为对照组1和对照组2。比较2组研究对象的步态参数、最小足廓清(MTC)、平衡及下肢运动功能参数,并将MTC与平衡及下肢运动功能进行相关性分析。结果与非偏瘫侧比较,观察组偏瘫侧的步频,最大屈髋、伸髋、屈膝、踝背屈角度,髋、膝、踝关节活动范围(ROM)及MTC减小,摆动相百分比、最大伸膝和踝跖屈角度增大(P<0.05);与对照组1比较,步速,步长,步频,摆动相百分比、最大屈髋、伸髋、屈膝、踝背屈角度,髋、膝、踝ROM及MTC减小,最大伸膝、踝跖屈角度增大(P<0.05)。与对照组2比较,观察组非偏瘫侧的步速,步长,步频,摆动相百分比,最大伸髋、屈膝、踝跖屈角度,髋、膝、踝ROM及MTC减小,最大伸膝角度增大(P<0.05)。观察组偏瘫侧MTC与Berg、FMA评分均相关(P<0.05)。结论足下垂患者廓清能力、平衡功能及下肢运动功能均降低;偏瘫侧MTC与平衡及下肢运动功能的具有一定相关性。

Objective To study the effect of clearance disorder on balance and walking function in stroke patients with hemiplegic foot drop by using three-dimensional gait system.Methods Thirty cases of stroke patients with hemiplegic foot drop in the Department of Rehabilitation Medicine of the Affiliated Hefei Hospital of Anhui Medical University from November 2019 to March 2021 were selected as the observation group.According to the principle of consistent with the left and right sides of the lower limbs on the hemiplegic side and unbiased side,30 healthy volunteers were selected as the control group.According to the principle corresponding to the left and right lower limbs of hemiplegic side,they were divided into control group 1 and control group 2.The gait parameters,minimum toe clearance(MTC),balance and lower limb motor function parameters of the two groups were compared,and the correlation between MTC and balance and lower limb motor function was analyzed.Results In the observation group,as compared with the non-hemiplegic side,stride frequency,maximum hip flexion,hip extension,knee flexion,ankle dorsiflexion angle,the range of motion(ROM)of hip,knee and ankle,MTC in the hemiplegic side decreased significantly(P<0.05),while the percentage of swing phase,maximum knee extension and ankle planter flexion angle increased significantly(P<0.05).Compared with the control group 1,step speed,length and stride frequency,percentage of swing phase,maximum hip flexion,hip extension,knee flexion,ankle dorsiflexion angle,the ROM of hip,knee and ankle,MTC decreased significantly of the hemiplegic side in the observation group,while maximum knee extension and ankle planter flexion angle increased significantly(P<0.05).Compared with the control group 2,step speed,length and stride frequency,percentage of swing phase,maximum hip extension,knee flexion,ankle planter flexion angle,ROM of hip,knee and ankle,MTC decreased significantly(P<0.05),while maximum knee extension increased significantly(P<0.05).MTC of hemiplegic side in the observation group was correlated with Berg and FMA scores(P<0.05).Conclusion In patients with foot drop,the clearance ability,balance function and lower limb motor function are decreased.MTC of hemiplegic side was correlated with balance and lower limb motor function.