减重靴步行训练对踝关节骨折术后患者步态的影响

Body weight support boots can promote gait rehabilitation after ankle fracture surgery

目的探讨减重靴步行训练对踝关节骨折术后患者步态的影响。方法选取踝关节骨折术后患者38例, 按照随机数字表法将其分为对照组和观察组, 每组19例。两组患者均接受常规康复训练, 在此基础上, 对照组进行传统步态训练, 观察组佩戴减重靴进行步行训练, 每周3次, 连续训练6周。干预前和干预2周、4周、6周后, 采用GaitWatch三维步态动作捕捉与训练系统进行步态数据的收集, 并对各项步态数据进行分析。结果干预2周、4周、6周后, 两组患者的步频、步态周期、步幅、步速、患侧步长、健侧步长、步长偏差均较组内干预前改善(P<0.05)。干预6周后, 观察组的步频[(111.47±5.69)步/分钟]、步态周期[(1.08±0.06)s]、步幅[(137.74±6.87)cm]、步速[(127.89±10.07)cm/s]均较对照组改善优异(P<0.05), 患侧步长[(70.05±4.03)cm]和健侧步长[(67.68±4.16)cm]较对照组大(P<0.05), 步长偏差虽较对照组小, 但差异无统计学意义(P>0.05)。干预前, 两组患者的健侧支撑期占比高于患侧支撑期占比(P<0.05), 健侧摆腿期占比低于患侧摆腿期占比(P<0.05), 干预2周、4周、6周后上述指标的差异均无统计学意义(P>0.05)。与组内干预前比较, 观察组患者干预6周后的患侧支撑期占比、健侧支撑期占比均降低(P<0.05), 患侧摆腿期占比、健侧摆腿期占比均增加(P<0.05);对照组干预6周后健侧支撑期占比降低(P<0.05), 健侧摆腿期占比增加(P<0.05)。两组干预2周、4周、6周后双侧支撑期占比均降低(P<0.05)。结论利用减重靴进行步行训练能显著改善踝关节骨折术后患者的步态功能, 其效果优于常规步态训练。

Objective:To explore the effectiveness of body weight support in gait training after surgery for an ankle fracture.Methods:Thirty-eight ankle fracture patients who received surgery were divided at random into an observation group and a control group,each of 19.In addition to 3 sessions of routine gait rehabilitation training a week for 6 weeks,only those in the observation group received body weight support training with body weight support boots.Gait data were collected using the GaitWatch three-dimensional gait action capture and training system before the training and after 2,4 and 6 weeks of the training.Results:At each assessment the gait frequency,gait cycle,stride length,stride rate,bilateral step length,step length deviation,bilateral support phase and bilateral swing phase of both groups had improved significantly.After 6 weeks the average stride frequency,gait cycle,stride length on both sides and speed of the observation group had improved significantly more than among the control group.Step length deviation was not significantly different,however.At each evaluation the proportions of affected and healthy side support had decreased significantly in both groups,but affected and healthy side swing had increased and the proportion of bilateral support had decreased significantly.Conclusion:Body weight support training with body weight support boots can significantly improve gait after ankle fracture surgery.Its effect is superior to that of conventional gait training.