基于矢量编码技术研究功能性踝关节不稳者下肢协调性和变异性

Lower Limb Coordination and Variability in Patients with Functional Ankle Instability Based on Vector Coding Analysis

目的探索功能性踝关节不稳(functional ankle instability,FAI)人群在地面行走时的下肢协调性和协调变异性。方法12名右侧FAI男性受试者(FAI组)及配对招募15名健康男性受试者(对照组),以自选速度在地面上行走,运用Qualisys红外高速光学运动捕捉系统采集5 min步行的运动学数据,运用Matlab软件自编代码计算下肢关节间的耦合角及耦合角标准差。耦合角采用圆形分布资料统计,耦合角标准差采用独立样本t检验。使用Cohen’s d评价效应量。结果FAI组髋-膝关节矢状面耦合角在步态支撑中期前1/2和摆动期最后1/4均大于对照组;FAI组髋-踝关节矢状面耦合角在支撑末期前1/2也大于对照组;膝-踝关节矢状面耦合角在支撑中期后1/2和支撑末期前1/2均小于对照组。FAI组髋-踝关节冠状面耦合角在承重期FAI组比及摆动期最后1/4小于对照组。在支撑末期及预摆期,FAI组髋-踝关节冠状面和膝-踝关节矢状面耦合角标准差大于对照组。结论FAI患者与正常人群的步态模式存在差异。协调模式表现为某种代偿保护策略。支撑末期及预摆期较大的协调变异性提示FAI患者踝关节感觉知觉的变化使髋、膝、踝关节的运动控制发生适应性变化。

Objective To explore the coordination and coordination variability of lower limbs in patients with functional ankle instability(FAI)during level ground walking.Methods Twelve male subjects with right FAI(FAI group)and 15 healthy male subjects(control group)were recruited to walk on the ground at a self-selected speed.The kinematic data of 5-minute walking were collected using Qualisys infrared high-speed optical motion capture system.The coupling angle and the standard deviation of the coupling angle between the lower limb joints were calculated by using Matlab software to write codes.Circular distribution data were used for coupling angle statistics,and an independent sample t-test was used for the standard deviation of coupling angle.Cohen's d was used to evaluate the effect size.Results The coupling angle of the hip-knee joint at sagittal plane in FAI group was larger than that in control group in the first half of the middle stance and the last quarter of the swing phase.The coupling angle of the hip-ankle joint at sagittal plane in FAI group was also larger than that in control group before the terminal stance.The coupling angle of the knee-ankle joint at sagittal plane in FAI group was lower than that in control group in the second half of middle stance and the first half of the terminal stance.The coupling angle of the hip-ankle joint at coronal plane in FAI group was smaller than that in control group in the loading response stance and the last quarter of the swing stance.The standard deviations for coupling angles of the hip-ankle joint at coronal and sagittal plane in FAI group were higher than those in control group at the terminal and pre-swing stances.Conclusions The gait pattern of FAI patients differs from that of healthy people.The mode of coordination shows a compensatory protection strategy.The greater coordination variability in the terminal stance and pre-swing suggests that the changes in ankle sensory perception in FAI patients will lead to adaptive changes in motor control of the hip,knee,and ankle joints.