Trajectory of Walking Function in Late-Stage Older Individuals Managed with a Regular Exercise Program: A 5-Year Longitudinal Tracking with an IoT Gait Analysis System Using Accelerometers

Purpose: This study focused on maintaining and improving the walking function of late-stage older individuals while longitudinally tracking the effects of regular exercise programs in a day-care service specialized for preventive care over 5 years, using detailed gait function measurements with an accelerometer-based system. Methods: Seventy individuals (17 male and 53 female) of a daycare service in Tokyo participated in a weekly exercise program, meeting 1 - 2 times. The average age of the participants at the start of the program was 81.4 years. Gait function, including gait speed, stride length, root mean square (RMS) of acceleration, gait cycle time and its standard deviation, and left-right difference in stance time, was evaluated every 6 months. Results: Gait speed and stride length improved considerably within six months of starting the exercise program, confirming an initial improvement in gait function. This suggests that regular exercise programs can maintain or improve gait function even age groups that predictably have a gradual decline in gait ability due to enhanced age. In the long term, many indicators tended to approach baseline values. However, the exercise program seemingly counteracts age-related changes in gait function and maintains a certain level of function. Conclusions: While a decline in gait ability with aging is inevitable, establishing appropriate exercise habits in late-stage older individuals may contribute to long-term maintenance of gait function.

Novel Walking Stability-Based Gait Recognition Method for Functional Electrical Stimulation System Control

Gait recognition is the key question of functional electrical stimulation (FES) system control for paraplegic walking. A new risk-tendency-graph (RTG) method was proposed to recognize the stability information in FES-assisted walking gait. The main instrument was a specialized walker dynamometer system based on a multi-channel strain-gauge bridge network fixed on the walker frame. During walking process, this system collected the reaction forces between patient's upper extremities and walker and converted them into RTG morphologic curves of dynamic gait stability in temporal and spatial domains. To demonstrate the potential usefulness of RTG, preliminary clinical trials were done with paraplegic patients. The gait stability levels of two walking cases with 4- and 12-week FES training from one subject were quantified (0.43 and 0.19) from the results of temporal and spatial RTG. Relevant instable phases in gait cycle and dangerous inclinations of patient's body during walking process were also brought forward. In conclusion, the new RTG method is practical for distinguishing more useful gait stability information for FES system control.

Gait improvement after treadmill training in ischemic stroke survivors A critical review of functional MRI studies

Stroke survivors often present with abnormal gait, movement training can improve the walking performance post-stroke, and functional MRI can objectively evaluate the brain functions before and after movement training. This paper analyzes the functional MRI changes in patients with ischemic stroke after treadmill training with voluntary and passive ankle dorsiflexion. Functional MRI showed that there are some changes in some regions of patients with ischemic stroke including primary sensorimotor cortex, supplementary motor area and cingulate motor area after treadmill training. These findings suggest that treadmill training likely improves ischemic stroke patients＇ lower limb functions and gait performance and promotes stroke recovery by changing patients＇ brain plasticity; meanwhile, the novel treadmill training methods can better training effects.

Role of a wireless surface electromyography in dystonic gait in functional movement disorders: A case report

BACKGROUND Dystonic gait(DG) is one of clinical symptoms associated with functional dystonia in the functional movement disorders(FMDs). Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. There is no report for DG in FMDs caused by an abnormal pattern in the ankle muscle recruitment strategy during gait.CASE SUMMARY A 52-year-old male patient presented with persistent limping gait. When we requested him to do dorsiflexion and plantar flexion of his ankle in the standing and seating positions, we didn’t see any abnormality. However, we could see the DG during the gait. There were no evidences of common peroneal neuropathy and L5 radiculopathy in the electrodiagnostic study. Magnetic resonance imaging of the lumbar spine, lower leg, and brain had no definite finding. No specific finding was seen in the neurologic examination. For further evaluation, a wireless surface electromyography(EMG) was performed. During the gait, EMG amplitude of left medial and lateral gastrocnemius(GCM) muscles was larger than right medial and lateral GCM muscles. When we analyzed EMG signals for each muscle, there were EMG bursts of double-contraction in the left medial and lateral GCM muscles, while EMG analysis of right medial and lateral GCM muscles noted regular bursts of single contraction. We could find a cause of DG in FMDs.CONCLUSION We report an importance of a wireless surface EMG, in which other examination didn’t reveal the cause of DG in FMDs.

Decreased Gait and Function in Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a genetic disorder linked to chromosome Xp21, due to absence of dystrophin production. It is clinically characterized by progressive muscle weakness, fatigue, and development of joint contractures that compromise general motor functionality, mainly the gait. Objective: To characterize the motor function and decrease gait in children with DMD using the Portuguese version of the Motor Function Measure scale (MFM-P). Methods: A review of medical records including chronological age and scores from MFM-P of children with a DMD who attended at the Neuromuscular Diseases Clinic at Campinas State University (UNICAMP), Brazil was performed in this study. A total of 36 medical records of male patients with confirmed clinical diagnosis of DMD, ambulatory or not, regardless of age;excluding those with other associated diseases or other types of muscular dystrophies were selected. Data were analyzed using Kolmogorov-Smirnov and Spearman correlation statistical tests. Results: Analysis of all data collected showed that 75% of our sample had D1 scores lower than 41.02%. There was a linear relationship between the scores of D2 and D3, but no association between D2 and D1 scores was noted. D1 score was between 40% and 80% in those patients presenting D2 scores between 80% and 100%. In all cases patients with low total score presented a greater risk for loss of gait and their functionality. Conclusion: The standing posture and the postural transfers were the worst activities observed in children with DMD, with positive correlation between proximal and distal motor function. Even with high scores according MFM-P in proximal function, the children showed strong predictors for loss of gait.

The Relationship between Gait Asymmetry and Respiratory Function in Stroke Patients: A Pilot Study

INTRODUCTION: Gait asymmetry can become very pronounced in patients who have suffered a stroke. The impairment of trunk function in some stroke patients can restrict thorax mobility and cause respiratory muscle weakness. Trunk and neck dysfunction are believed to affect the gait in stroke patients. OBJECTIVE: This study aimed to investigate the relationship between gait asymmetry and respiratory function in stroke patients by measuring the step time and trunk acceleration. METHODS: This study employed a cross-sec- tional design. Thirty stroke patients participated in this study. The symmetry index (SI) and Lissajous index (LI) were used to evaluate asymmetry during walking. The respiratory function and respiratory muscle strength were evaluated by spirometry. We examined the relation between SI or LI and the respiratory function/respiratory muscle strength in patients with stroke. RE- SULTS: The results of our analysis demonstrated that the SI was significantly correlated with the inspiratory and expiratory muscle strength and the LI was significantly correlated with the percentage of the predicted vital capacity (respectively, r = ﹣0.386, r = ﹣0.392, r = ﹣0.446;p < 0.05). CONCLUSION: The present study is the first to indicate a relationship between gait asymmetry and respiratory function in stroke patients.

帕金森病患者出现冻结步态的危险因素分析

目的探讨帕金森病(PD)患者出现冻结步态(FOG)的危险因素。方法选取2019年7月至2022年7月中日友好医院收治的52例PD患者为研究对象,根据是否合并FOG将研究对象分为FOG组(合并FOG,14例)和非FOG组(未合并FOG,38例)。比较分析非FOG组与FOG组患者的临床特征与影像学特征。比较分析非FOG组与FOG组患者的基底前脑功能连接。采用多因素logistic回归方法分析PD患者出现FOG的独立影响因素。结果FOG组患者的国际运动障碍学会统一帕金森病评定量表Ⅱ(MDS-UPDRSⅡ)评分高于非FOG组,差异有统计学意义(P<0.05),且Meynert基底核(Ch4)与双侧中扣带回、中央前回及辅助运动区的功能连接低于非FOG组。多因素logistic回归分析结果显示,MDS-UPDRSⅡ评分、Ch4功能连接是PD患者出现FOG的独立影响因素(P<0.05)。结论MDS-UPDRSⅡ评分升高、Ch4功能连接减弱为PD患者出现FOG的独立影响因素。

Effects of Water Weight-Loss Walking Training on Lower Limb Motor Function and Gait in Stroke Patients

Background: Water weight-loss walking training is an emerging physical therapy technique, which provides new ideas for improving the motor function of stroke patients and improving the quality of life of patients. However, the rehabilitation effect of water weight-loss training in stroke patients is currently unclear. Objective: To analyze the effect of water weight loss walking training in stroke patients. Methods: A total of 180 stroke patients admitted to our hospital from January 2019 to December 2021 were selected and randomly divided into two groups. The control group received routine walking training, and the research group performed weight loss walking training in water on this basis. The lower limb motor function, muscle tone grade, daily living ability, gait and balance ability were compared between the two groups before and after treatment. Results: Compared with the control group, the FMA-LE score (Fugl-Meyer motor assessment of Lower Extremity), MBI score (Modified Barthel Index) and BBS score (berg balance scale) of the study group were higher after treatment, and the muscle tone was lower (P Conclusion: Water weight loss walking training can enhance patients’ muscle tension, correct patients’ abnormal gait, improve patients’ balance and walking ability, and contribute to patients’ motor function recovery and self-care ability improvement.

北京社区55~75岁高、低痴呆风险人群身体素质及其认知功能特点

目的分析预测社区中处于生命中期健康老年人痴呆风险因素。方法2021年7月至2023年4月招募北京市两个社区常住1年以上的55~75岁中老年人175例,收集心血管危险因素、衰老和痴呆(CAIDE)相关危险因素和其他一般人口资料,CAIDE风险评分≥9分为高危组,<9分为低危组。采用Stroop色词测验(SCWT)、两元素1-back任务范式、连线测验(TMT)进行评估;测量握力、30 s前臂屈曲测验和5次坐站试验;记录平地步行10 m的平均步速和步长。结果高危组CAIDE总分平均9.86分,低危组4.95分。两组年龄无显著性差异(P=0.188)。男性,受教育程度<7年、收缩压>140 mmHg、胆固醇>6.5 mmol/L、体质量指数>30 kg/m^(2)和缺乏体力活动人群CAIDE痴呆风险评分更高(χ^(2)>3.116,P<0.05)。高危组握力(t=-4.174)、步速(t=-2.414)、SCWT正确率(Z=-2.684)均差于低危组(P<0.05)。Logistic回归分析显示,步速(OR=25.483)、握力(OR=1.133),SCWT正确率(OR=37.430)是痴呆的独立危险因素(P<0.05)。结论握力弱、步速慢、抑制控制能力差可能预示痴呆风险增加。

Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability

The corticoreticular tract （CRT） is known to be involved in walking and postural control. Using diffusion tensor tractography （DTT）, we investigated the relationship between the CRT and gait dysfunction, includ- ing trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed （TD） children were recruited. Fifteen patients with gait dysfunction （bilateral trunk instability） were included in the group A, and the other 15 patients with gait dysfunction （unilateral trunk instability） were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical mani- festations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.

康复外骨骼机器人对脑卒中下肢运动功能障碍疗效的Meta分析

目的:运用Meta分析方法系统评价康复外骨骼机器人对脑卒中患者下肢运动功能的康复疗效,并比较不同下肢外骨骼机器人的疗效差异,为脑卒中下肢运动功能障碍患者选择适合的外骨骼机器人提供科学理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国知网、维普和万方数据库的相关文献,收集从建库至2022年11月发表的关于探讨下肢康复外骨骼机器人改善脑卒中患者下肢运动功能的随机对照临床试验。由2名研究人员进行文献检索与筛选,使用Cochrane 5.1.0偏倚风险评估工具和Jadad量表对纳入文献进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入22篇文献,Jadad评分显示均为高质量文献,共865例患者,试验组436例、对照组429例。②Meta分析结果显示,与对照组相比,外骨骼机器人可显著提高脑卒中患者下肢运动功能(Fugl-Meyer Assessment of Lower Extremity,FMA-LE)评分(MD=2.63,95%CI:1.87-3.38,P<0.05)、平衡功能(Berg Balance Scale,BBS)评分(MD=3.62,95%CI:1.21-6.03,P<0.05)、站起-走测试量表(Timed Up and Go,TUG)评分(MD=-2.77,95%CI:-4.48至-1.05,P<0.05)和步频(MD=3.15,95%CI:1.57-4.72,P<0.05),但对功能性步行量表(Functional Ambulation Category Scale,FAC)评分(MD=0.30,95%CI:-0.01-0.61,P>0.05)和6 min步行测试(6-minute walk test,6MWT)评分(MD=3.77,95%CI:-6.60-14.14,P>0.05)的提高不明显。③网状Meta分析结果显示,FMA-LE评分:平地行走式外骨骼(MD=10.23,95%CI:3.81-27.49,P<0.05)和减重式外骨骼(MD=33.66,95%CI:11.49-98.54,P<0.05)与常规康复治疗相比均能改善FMA-LE评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;BBS评分:减重式外骨骼(MD=79.86,95%CI:2.34-2725.99,P<0.05)与常规康复治疗相比能显著改善BBS评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;FAC评分:平地行走式外骨骼(MD=1.38,95%CI:1.00-1.90,P<0.05)与常规康复治疗相比能显著改善FAC评分,排序结果为平地行走式外骨骼>减重式外骨骼>常规康复治疗;TUG评分:减重式外骨骼与常规康复治疗相比(MD=0.07,95%CI:0.01-0.51,P<0.05)能显著改善TUG评分,排序结果为平地行走式外骨骼>减重式外骨骼>常规康复治疗。结论:康复外骨骼机器人可以改善脑卒中患者平衡、步行以及日常生活活动能力,其中减重式外骨骼在提高下肢运动功能和平衡功能方面疗效更优,平地行走式外骨骼在提高功能性步行和转移能力方面疗效更佳。

基于改进SSA优化PID的下肢康复机器人控制

针对下肢康复机器人训练过程中步态跟踪误差大的问题,提出一种改进麻雀搜索算法(ISSA)优化PID的控制策略。首先,利用拉格朗日方程对下肢机器人进行动力学分析,得到动力学模型;然后,通过引入Kent映射混沌初始化种群、Tent混沌扰动和柯西变异扰动,以及改变探索者-跟随者比例系数和探索者位置更新公式等方面对麻雀搜索算法进行改进,通过8种测试函数证实了算法改进的有效性;最后,在Matlab/Simulink中建立下肢机器人PID控制器和ISSA-PID控制器系统的仿真模型,以正常人体步态数据进行拟合得到的函数曲线作为系统实际输入进行跟踪实验。结果表明:相比于传统PID控制,ISSA-PID控制髋关节和膝关节的误差分别降低了63.3%和72.5%,实现了精准的步态跟踪,验证了该控制策略的有效性。

应用ByGait-G6060-5压感步态测试仪分析中老年单侧膝关节滑膜炎患者的步态特征

目的应用ByGait-G6060-5压感步态测试仪观察中老年单侧膝关节滑膜炎患者的步态特征,为后续康复评估及治疗提供依据。方法选择2018年1月至2019年12月安徽医科大学第二附属医院康复运动医学科住院的20例单侧膝关节滑膜炎中老年患者(观察组),其中男性6例,女性14例;年龄51~68岁,平均年龄59.20岁;身高151~174 cm,平均身高161.45 cm;体质量52~98 kg,平均体质量66.90 kg;平均日本骨科协会(JOA)评分45.60分;左侧8例,右侧12例。同期选择20例年龄相匹配的健康中老年人(对照组),其中男性9例,女性11例;年龄54~68岁,平均年龄61.45岁;身高155~171 cm,平均身高162.50 cm;体质量51~74 kg,平均体质量63.15 kg;平均JOA评分53.35分。采用中国科学院合肥物质研究院研发的ByGait-G6060-5压感步态测试仪进行步态分析数据采集。比较两组静态站立姿势下双足压力中心(BPC)轨迹、双侧足底压力比值(ROP),以及行走时的步长、步速、触地时长、足底各分区压力占比和负重面积占比,获得滑膜炎患者的步态特征。结果观察组BPC轨迹较对照组明显增加[(59.60±15.68)mm vs(34.10±9.94)mm],差异有显著统计学意义(t=6.152,P<0.01);而ROP低于对照组(0.88±0.07 vs 0.98±0.04),差异有显著统计学意义(t=-5.329,P<0.01)。观察组步长明显短于对照组[(0.38±0.08)m vs(0.59±0.09)m;t=-7.756,P<0.01];步速明显低于对照组[(1.10±0.17)m/s vs(1.33±0.20)m/s;t=-3.924,P<0.01];而触地时长明显多于对照组[(0.81±0.09)s vs(0.68±0.06)s;t=5.293,P<0.01]。观察组与对照组比较,足底第四跖骨、第五跖骨、足中部区域所受压力占比相对较高,踇趾受力较小(P<0.05);第四跖骨、足中部和足后跟外侧负重面积增大(P<0.05),踇趾区受力面积减小(P<0.05)。结论中老年单侧膝关节滑膜炎患者静态平衡能力降低,行走能力减退,与健康中老年人对比有明显差异。

不同频率下全身振动疗法对不随意运动型脑瘫患儿下肢粗大运动及步行功能的影响

目的基于不同频率下全身振动疗法(whole body vibration,WBV)对不随意运动型脑瘫粗大运动及步行功能的影响,为后续WBV临床推广提供参考意义。方法选取2021年10月至2022年11月在西南医科大学附属医院康复医学科门诊和/或入院6~12岁不随意运动型脑瘫60例,按随机数字表法分为对照组(n=20)、(25±5)Hz组(n=20)及(35±5)Hz组(n=20)。3组均进行常规康复训练,(25±5)Hz组额外接受振动频率为(25±5)Hz的WBV,(35±5)Hz组接受(35±5)Hz的WBV,3组均治疗8周。在治疗前后对3组患儿使用Berg平衡量表(Berg Balance Scale,BBS)、起立-行走计时测试(Time to Up and Go Test,TUGT)、粗大运动功能测试量表(Gross Motor Function Measure-88,GMFM-88)及足印分析法评定疗效。结果治疗后3组患儿各项评分指标均优于治疗前(P<0.001);其中(35±5)Hz组BBS评分(F=12.502)、TUGT(F=8.211)、GMFM-88的D区、E区评分(F=12.802、8.505)、跨步长(F=12.279)、步宽(F=13.582)及1 min步行距离(F=12.619)均优于(25±5)Hz组及对照组(P<0.05或P<0.01);(25±5)Hz组疗效优于对照组(P<0.05或P<0.01)。结论WBV可提高不随意运动型脑瘫儿童躯干控制、改善其下肢粗大运动及步行功能,且(35±5)Hz的WBV疗效优于(25±5)Hz的WBV。

穿戴式外骨骼康复机器人结合Bobath技术对脑卒中偏瘫患者的影响

目的探讨穿戴式外骨骼康复机器人结合Bobath技术对脑卒中偏瘫患者步态、平衡能力、下肢运动Fugl-Meyer功能量表(FMA)评分的影响。方法纳入2020年11月—2022年11月我院收治的78例脑卒中偏瘫患者,按照数字列表法随机分为观察组与对照组,每组39例,对照组予以Bobath技术训练,观察组在对照组基础上予以穿戴式外骨骼康复机器人训练,干预8周。比较两组干预前后的步态参数(步频、步速、跨步长比率)、平衡能力[Berg平衡量表(BBS)]、下肢运动功能FMA评分、日常生活活动能力[改良Barthel指数(MBI)]、下肢肌力恢复情况(屈髋肌力、伸膝肌力)。结果干预前,两组各指标差异无统计学意义(P>0.05);干预后,两组步频、步速、跨步长比率、BBS评分、下肢FMA评分、MBI评分、屈髋肌力、伸膝肌力较干预前显著升高(均P<0.05),观察组步频、步速、跨步长比率、BBS评分、下肢FMA评分、MBI评分、屈髋肌力、伸膝肌力高于对照组(均P<0.05)。结论穿戴式外骨骼康复机器人结合Bobath技术可改善脑卒中偏瘫患者步态和平衡能力,促进下肢运动功能恢复,提高日常生活活动能力,增强患者下肢肌力。

基于步态事件和sEMG的功能性电刺激起始点研究

足下垂患者步行过程中进行功能性电刺激可以帮助其恢复正常行走能力,而准确确定功能性电刺激的开启时间至关重要。文章针对该问题,利用步行过程中下肢的角速度和表面肌电信号(surface electromyography,sEMG),提出一种以步态事件与肌肉动作点之间延时关系为控制策略的足下垂步行过程中功能性电刺激准确开启的方法。根据步态信息和sEMG电信号特征对大腿处的角速度数据进行步态事件划分,试验结果表明步态事件划分得具有良好一致性;利用模糊熵算法对去噪后的sEMG信号进行肌肉运动起始点T muscle的判定,确定T muscle与脚尖离地(toe off,TO)之间的延时时间关系;结合所划分的步态事件特征点,确定电刺激起始点T on。该文为足下垂治疗中功能性电刺激开启时间点的确定提供了一种新的辨识方法。

经颅磁刺激联合康复训练对帕金森病患者冻结步态功能的影响

目的 考察对帕金森病(PD)患者行经颅磁刺激联合康复训练后其冻结步态功能的变化。方法 回顾性分析徐州医科大学附属医院于2020年3月至2022年6月期间收治的80例PD患者的临床资料,根据护理方案的不同进行分组,将接受常规治疗联合康复训练的患者纳入对照组(40例),将接受对照组干预方案联合经颅磁刺激的患者纳入观察组(40例)。对比2组患者在干预前和干预3个月后的冻结步态功能、认知功能、生活质量以及平衡能力变化。结果 干预1个月和3个月后,2组的步速均快于干预前,步长均大于干预前,起立-行走计时均短于干预前,且干预3个月后的上述变化均优于干预1个月后(P均<0.05);观察组在干预1个月和3个月后的上述变化均较同期对照组更优(P均<0.05)。干预1个月和3个月后,2组的Berg平衡量表评分、蒙特利尔认知评估量表评分和简易精神状态量表评分均高于干预前,PD患者生活质量自测问卷评分均低于干预前,且干预3个月后的上述量表评分均优于干预1个月后(P均<0.05);观察组在干预1个月和3个月后的上述量表评分均较同期对照组更优(P均<0.05)。结论 经颅磁刺激联合康复训练有助于改善PD患者的冻结步态功能和平衡能力,促进其生活质量和认知功能提升。

骨痛灵酊联合美洛昔康片治疗对膝骨关节炎患者预后的影响

目的:探讨骨痛灵酊联合美洛昔康片治疗对膝骨关节炎患者预后的影响。方法:回顾性选取2020年2月—2023年2月临邑县中医院临盘院区收治的100例膝骨关节炎患者,依据用药方法分为联合治疗组、单独治疗组,各50例。联合治疗组给予骨痛灵酊联合美洛昔康片治疗,单独治疗组给予单独美洛昔康片治疗。统计分析两组中医症候积分、疼痛程度、膝关节功能、步态功能、健康状况、生活质量、骨代谢指标、氧化应激指标、炎症因子、临床疗效。结果:治疗后,联合治疗组各项中医症候积分及总分、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数各项评分及总分、奎森运动功能指数(Lequesne评分)、视觉模拟评分法(VAS)评分、健康评价调查表(HAQ)评分、丙二醛(MDA)、一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)均低于单独治疗组,6分钟步行试验(6MWT)距离长于单独治疗组,Berg平衡量表(BBS)评分、生活质量评价简表(SF-36)评分、骨钙素(BGP)、骨保护素(OPG)、谷胱甘肽(GSH)、超氧化物歧化酶(SOD)均高于单独治疗组,差异有统计学意义(P<0.05)。联合治疗组治疗总有效率为96.00%,高于单独治疗组的78.00%,差异有统计学意义(P<0.05)。结论:膝骨关节炎患者采用骨痛灵酊联合美洛昔康片治疗效果更好,可缓解疼痛,改善膝关节功能、步态功能,提高生活质量、优化健康状况,调节骨代谢指标、氧化应激指标及炎症因子。

应用步态分析评价足趾缺损对足功能的影响研究

目的 研究应用步态分析评价足趾缺损对足功能的影响。方法 基于成人足部标本,制作不同跖骨缺损的模型并分为A、B、C、D、E、F组,应用万能生物力学试验机和F-scan足底压力鞋垫式传感器对足底应力分布进行测量,获得六组足底应力分布图像数据进行分析对比。结果 跖骨的缺损均会对足底压力变化与平衡性造成影响,除D、E、F组外,其余三组前足负重均出现下降(P<0.05),A组T1、M2、M3区峰压强较健足增加(P<0.05);C组M1、M2区峰压强较健足增加(P<0.05);D组T1、M2、M3-M4区峰压强较健足增加(P<0.05);E组、F组T1区峰压强较健足增加(P<0.05)。结论 跖骨的缺损均会对足功能产生不同程度影响,但第1跖骨、第2跖骨和多跖骨的缺损对足底重心分布影响最甚,临床选择手指再造术式应给予保留。

不同硬度地面对功能性踝关节不稳患者步态协调性的影响

目的 探索不同硬度地面对功能性踝关节不稳(FAI)患者步态协调性的影响。方法 2023年5月至7月,采用Qualisys红外光学运动捕捉系统对南京师范大学15例右侧FAI患者协调性和变异性进行测试。采集并截取步态周期数据,运用Matlab计算耦合角和耦合角标准差,比较在不同硬度地面上的差异。结果 在冠状面,髋-踝关节耦合角在支撑中期和支撑后期硬地面大于软地面,其他步态阶段以及髋-膝关节、膝-踝关节各步态阶段均小于软地面(P <0.05);在矢状面,髋-踝关节和膝-踝关节耦合角在支撑中期和支撑后期硬地面小于软地面,其他步态阶段以及髋-膝关节各步态阶段均大于软地面(P <0.01);在水平面,髋-膝关节耦合角在支撑后期硬地面小于软地面,摆动前期和髋-踝关节承重期均大于软地面(P <0.05)。与硬地面相比,软地面上耦合角标准差仅在矢状面髋-膝关节承重期小于硬地面,其余均大于硬地面(P <0.05)。结论 FAI患者在三维面内各步态阶段在软地面上表现出更多的远端主导,即踝关节内翻跖屈优势增加,髋关节优势减少;协调变异性普遍高于硬地面。表明FAI患者在软地面上步行时会增加复发性外踝扭伤风险。