不同足型对脑梗死偏瘫患者步行能力的影响

Effect of different foot types on walking ability of patients with cerebral infarction and hemiplegia

目的观察不同足型对脑梗死偏瘫患者步行能力的影响。方法纳入2017年4月—2022年6月在北京中医药大学东直门医院和北京中医医院怀柔医院就诊的脑梗死偏瘫患者100例,按照足弓指数分为高弓足组17例、正常足弓组16例和平足组67例,3组均接受4周的现代常规康复治疗。治疗前后分别进行RSSCAN步态系统检测(包括步态时空参数和生物力学参数)以评估步行能力。结果①步态时空参数:治疗后3组步长、步速、步宽、步幅、患侧支撑时间、患侧摆动时间、患侧步态周期、患侧足轴角均有所改善,其中步长和患侧步态周期的恢复疗效依次为正常足弓组>平足组>高弓足组。②生物力学参数:患者治疗后足跟内侧区与足跟外侧区的最大压力减小,其余分区的最大压力均增大;第1趾区、第2~5趾区、第1跖骨冲量增加,其余分区冲量均减小;3组足底十分区最大压强均有增加(第5跖骨除外)。治疗后与同组治疗前比较,高弓足组足中部的最大压力、足中部冲量、足中部触地面积均明显增大(P<0.05),足跟外侧区触地面积明显减小(P<0.05);平足组足中部冲量、足中部触地面积均明显减少(P均<0.05)。3组治疗后足中部与足跟外侧区的最大压力,第2跖骨、足中部、足跟外侧区冲量,足中部和足跟外侧区触地面积比较差异均有统计学意义(P均<0.05),其中正常足弓组足中部的最大压力明显低于平足组(P<0.05),足中部冲量明显低于高弓足组(P<0.05);高弓足组第2跖骨、足跟外侧区冲量和足跟外侧区触地面积均明显高于平足组(P均<0.05),足中部触地面积明显小于平足组(P<0.05)。结论脑梗死偏瘫患者经系统康复治疗后步行能力明显改善,但足部畸形(高弓足与平足)的患者整体步行能力恢复程度不如正常足型的患者。

Objective It is to observe the effect of different foot types on walking ability of patients with cerebral infarction and hemiplegia.Methods One hundred patients with cerebral infarction and hemiplegia who were treated in Dongzhimen Hospital of Beijing University of Chinese Medicine and Huairou Hospital of Beijing Hospital of Traditional Chinese Medicine from April 2017 to June 2022 were included.According to the arch index,they were divided into high arch group(17 cases),normal arch group(16 cases)and peaceful foot group(67 cases).All the three groups received 4 weeks of modern routine rehabilitation treatment.The RSSCAN gait system(including temporal and biomechanical parameters of gait)was tested before and after treatment to assess walking ability.Results①Gait temporal and spatial parameters:after treatment,the step length,stride speed,stride width,stride length,affected side support time,affected side swing time,affected side gait cycle and affected side axis angle were all improved in the three groups,the recovery efficacy of stride length and affected side gait cycle was in order of normal arch group>flat foot group>high arch foot group.②Biomechanical parameters:after treatment,the maximum pressure in medial and lateral heel regions of the patients was decreased,and the maximum pressures in other regions were increased;the impulses in the 1st digit region,the 2 nd-5 th digit region and the 1st metatarsal bone were increased,while the impulses in other regions were decreased;the maximum pressure was increased in all 10 plantar regions in the three groups(except the 5th metatarsal bone).After treatment,compared with before treatment,the maximum pressure,impulse and ground contact area of the middle foot in the high arch foot group were increased significantly(all P<0.05),while the ground contact area of the lateral heel area was decreased significantly(P<0.05);the midfoot impulse and the midfoot touchdown area in the flat foot group were significantly reduced(all P<0.05).After treatment,there were significant differences in the maximum pressures in the middle foot and lateral calcaneal area,impulses in the second metatarsal bone,middle foot,lateral calcaneal area,and the ground contact areas in the middle foot and lateral calcaneal area among the three groups(all P<0.05),and the maximum pressure in the middle foot in the normal arch group was significantly lower than that in the flat foot group(P<0.05),while the midfoot impulse was significantly lower than that of high arch foot group(P<0.05);the impulse of the second metatarsal bone,lateral calcaneal area and lateral calcaneal area in the high arched foot group were significantly higher than those in the flat foot group(all P<0.05),while the ground contact areas in the middle foot was significantly lower than that in the flat foot group(P<0.05).Conclusion The walking ability of patients with cerebral infarction hemiplegia was improved significantly after systematic rehabilitation,but the overall walking ability of patients with foot deformity(high arch foot and flat foot)was not as good as that of patients with normal foot type.