脑卒中偏瘫足下垂患者摆动相髋关节运动特征分析

Hip joint movement during a step's swing phase is cases of hemiplegia with foot drop

目的分析脑卒中偏瘫足下垂患者摆动相时髋关节的运动特征及代偿方式。方法选取脑卒中偏瘫足下垂患者30例纳入观察组,采用配对设计方案,招募30例健康者纳入对照组。采用三维步态分析系统比较观察组偏瘫侧与对照组相应侧(与观察组相匹配)髋关节及踝关节的运动学参数,采用Pearson检验分析观察组踝关节最大跖屈角度与髋关节角度间的相关性。结果与对照组比较,观察组偏瘫侧髋关节最大外展角度、最大外旋角度明显增加;髋关节最大伸直角度、最大屈曲角度、最大内收角度和最大内旋角度明显减小;髋关节矢状面、冠状面、水平面关节活动度均明显减小(P<0.05);踝关节最大背屈角度、矢状面关节活动度均明显减小(P<0.05)。通过相关性分析发现,观察组偏瘫侧摆动相时踝关节最大跖屈角度与髋关节最大屈曲角度(r=0.464,P=0.01)、最大外旋角度(r=0.483,P=0.007)、矢状面关节活动度(r=0.416,P=0.022)均具有正相关性,与髋关节水平面关节活动度(r=-0.364,P=0.048)具有负相关性。结论脑卒中偏瘫足下垂患者在摆动相时其髋关节运动特征在三维平面中均发生了显著改变;随着足下垂严重程度的不同,其髋关节代偿方式也发生相应变化。

Objective To analyze hip joint movement during the swing phase of the strides of stroke survivors with hemiplegia and foot drop.Methods Thirty stroke survivors with hemiplegia and foot drop formed the observation group,while thirty matched healthy counterparts were the control group.A three-dimensional gait analysis system was used to compare the hip and ankle joint kinematics on the hemiplegic side of the observation group members with those on the corresponding side of a matched control.Pearson correlation related the maximum plantar flexion angle of the ankle and hip joints in the observation group.Results Compared with the control group,there was a significant increase in the maximum abduction and external rotation of the hip joint during the swing phase,but a significant decrease in the maximum extension,flexion,adduction,internal rotation.The range of motion of the hip joint in the sagittal,frontal and horizontal planes was significantly smaller,as was the maximum dorsiflexion and sagittal range of motion of the ankle joint.The maximum plantar flexion angle of the ankle was positively correlated with the hip joint′s maximum flexion,maximum external rotation and sagittal joint motion,but negatively correlated with the hip′s horizontal motion.Conclusion In stroke survivors with hemiplegia and ptosis,significant changes are observed in the three-dimensional motion during the swing phase of a stride.The mode of hip joint compensation changes depending on the severity of the foot drop.