脑卒中后偏瘫足下垂患者廓清障碍的步态特征分析

Analysis of the gait of stroke survivors with foot drop

目的运用三维步态系统观察脑卒中后偏瘫足下垂患者的廓清策略。方法选取脑卒中后偏瘫足下垂患者30例作为观察组,另选取30例健康者作为对照组。采用三维动作捕捉系统观察并比较观察组和对照组的最小足廓清(MTC)及其变异性,绘制摆动相足趾运动轨迹,并对脑卒中后偏瘫足下垂患者的步态参数与MTC的相关性进行分析。结果观察组偏瘫侧和非偏瘫侧的MTC分别为(12.01±3.36)mm和(22.38±5.51)mm,均显著小于对照组的(26.94±3.08)mm,差异均有统计学意义(P<0.05)。观察组偏瘫侧和非偏瘫侧的MTC变异性均显著大于对照组,差异均有统计学意义(P<0.05)。观察组偏瘫侧的MTC和MTC变异性与组内非偏瘫侧比较,差异均有统计学意义(P<0.05)。观察组偏瘫侧的MTC与其步速、步长、摆动相百分比、最大伸髋角度、最大屈膝角度、最大踝背屈角度、膝关节和踝关节的关节活动范围(ROM)均呈显著正相关(P<0.05)。结论脑卒中后偏瘫足下垂患者廓清能力显著下降,步行稳定性降低,需要针对髋、膝、踝等多个因素进行干预,以减轻其廓清障碍程度。

Objective To observe the clearance strategies of hemiplegic stroke survivors with foot drop.Methods Thirty hemiplegic stroke survivors with foot drop formed the observation group and 30 healthy counterparts constituted the control group.A three-dimensional motion capture system was used to observe and compare the minimum toe clearance(MTC)and its variability between the two groups to draw the motion trajectory of the toe in the swing phase of their gaits.The gait parameters were correlated with the toe clearance.Results The average MTC of the observation group subjects on both the hemiplegic and non-hemiplegic side(12.01±3.36 and 22.38±5.51mm)was significantly smaller than the control group′s averages.The variability of their MTCs on both sides was also significantly greater.Clearance on the hemiplegic side was significantly less and its variability was significantly greater.Among the observation group,MTC on the hemiplegic side was positively correlated with walking speed,step length,swing phase percentage,maximum angle of hip extension,maximum angle of knee flexion,maximum angle of ankle dorsiflexion,and the range of motion of the knee and ankle joints.Conclusions Hemiplegic stroke survivors with foot drop walk unstably with little toe clearance.It is necessary to intervene at the hip,knee and ankle to improve their obstacle clearance.