新型油液阻尼可调式踝足矫形器的跖屈阻尼在脑卒中患者步态中对胸廓和骨盆运动的影响

doi:10.3969/j.issn.1006-9771.2021.06.003

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (6): 637-644.doi: 10.3969/j.issn.1006-9771.2021.06.003

新型油液阻尼可调式踝足矫形器的跖屈阻尼在脑卒中患者步态中对胸廓和骨盆运动的影响

凌华^1,²,山本澄子²(),蔡丽飞¹,周昊³

^1.中国康复科学所，北京市 100068
^2.日本国际医疗福祉大学，日本东京 107-8402
^3.中国康复研究中心北京博爱医院，北京市 100068

收稿日期:2021-03-15 修回日期:2021-05-11 出版日期:2021-06-25 发布日期:2021-06-21
通讯作者: 山本澄子 E-mail:sumiko-y@iuhw.ac.jp
作者简介:凌华(1986-)，男，汉族，江西南昌市人，博士，助理工程师，主要研究方向：康复工程、生物力学、步态分析。
基金资助:
中央级公益性科研院所基本科研业务费专项资金项目(2020CZ-6)

Effect of Plantarflexion Resistance of A New Adjustable Oil Damper Joint Ankle Foot Orthosis on Thorax and Pelvis in Gait after Stroke

Hua LING^1,²,Sumiko YAMAMOTO²(),Li-fei CAI¹,Hao ZHOU³

^1.China Rehabilitation Science Institute, Beijing 100068, China
^2.International University of Health and Welfare, Tokyo 107-8402, Japan
^3.Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2021-03-15 Revised:2021-05-11 Published:2021-06-25 Online:2021-06-21
Contact: Sumiko YAMAMOTO E-mail:sumiko-y@iuhw.ac.jp
Supported by:
Fundamental Research Funds for Central Public Welfare Research Institutes(2020CZ-6)

摘要/Abstract

摘要： 目的

探讨不同跖屈阻尼条件下踝足矫形器对脑卒中患者步态中胸廓和骨盆运动的影响。

方法

2020年6月至2021年1月，对中国康复研究中心北京博爱医院26例脑卒中住院患者，应用跖屈阻尼可调的油液阻尼器(OD)踝铰链的踝足矫形器，采用三维动作捕捉系统测量步态中不同跖屈阻尼(OD1、OD2.5、OD4)对胸廓(T)和骨盆(P)的即时影响。观察初始着地(IC)、对侧足离地(CFO)、对侧初始着地(CIC)、足离地(FO)各时相骨盆和胸廓角度；步态周期胸廓角度变化(T_cycle_x)、支撑期胸廓角度变化(T_ST_x)和单支撑期胸廓角度变化(T_SS_x)。在三个坐标轴上定义胸廓和骨盆运动角度：前后倾(x)、侧倾(y)、旋转(z)。

结果

三种阻尼条件下承重反应期时间有显著性差异(χ² = 7.923, P = 0.019)，且OD2.5时与OD4时相比有显著性差异(P = 0.017)。骨盆角度P_CFO_x、P_CFO_z、P_CIC_x和P_FO_x，胸廓角度T_CFO_x、T_CFO_y、T_CFO_z和T_FO_x，胸廓和骨盆相对角度TP_IC_x、TP_CFO_x和TP_CIC_x，以及T_SSx在三种阻尼条件下有显著性差异(χ² > 6.077, P < 0.05)。OD2.5时，各时相骨盆前倾减少；OD4时，骨盆前倾增加。CFO时，胸廓前后倾和侧倾幅度OD2.5时小于OD4时(P < 0.05)，胸廓旋转角度OD1时小于OD4时(P < 0.05)。

结论

跖屈阻尼在脑卒中患者的步态中对胸廓和骨盆的运动产生明显影响。中等阻尼下骨盆前倾角度减少，胸廓和骨盆姿势更为直立，侧倾减少，姿势改善；阻尼过低或过高可导致骨盆前倾增大，胸廓侧倾增大；高阻尼下代偿性旋转运动出现，姿势恶化。

关键词: 脑卒中, 偏瘫, 步态, 跖屈阻尼, 胸廓, 骨盆, 运动学

Abstract: Objectives

To investigate the effects of different plantarflexion resistance of an ankle foot orthosis (AFO) on the motion of the thorax and pelvis during the gait of stroke patients.

Methods

From June, 2020 to January, 2021, 26 stroke inpatients in Beijing Bo'ai Hospital wore AFO with oil damper (OD) ankle hinge, and measured thorax and pelvis during stroke gait under three plantarflexion resistance (OD1, OD2.5, OD4) of the AFO with a three-dimensional motion capture system. The main parameters were pelvic (P) and thoracic (T) angles at the following time or phases: initial contact (IC), contralateral foot off (CFO), contralateral initial contact (CIC), foot off (FO); the change of thoracic angle in gait cycle (T_cycle_x), the change of thoracic angle in stance phase (T_ST_x) and the change of thoracic angle in single stance phase (T_SS_x). Thoracic and pelvic motions were defined on three coordinate axes: forward/backward tilt (x), oblique (y) and rotation (z).

Results

The loading response times were significant different among different plantarflexion resistance conditions (χ² = 7.923, P = 0.019), as well as between OD2.5 and in OD4 (P = 0.017). P_CFO_x, P_CFO_z, P_CIC_x and P_Fo_x; T_CFO_x, T_CFO_y, T_CFO_z and T_FO_x; relative angle of thorax to pelvis TP_IC_x, TP_CFO_x and TP_CIC_x; and T_SS_x were significant different among three resistance conditions (χ² > 6.077, P < 0.05). Forward tilt of pelvis decreased in condition OD2.5 and increased in condition OD4 during each timing. When CFO, the thoracic forward/backward tilt angle was less in OD2.5 than in OD4 (P < 0.05), the thoracic rotation angle was less in OD1 than in OD4 (P < 0.05).

Conclusion

Plantarflexion resistance has a significant effect on the motion of the thorax and pelvis in the gait of stroke patients. Under the middle magnitude of resistance, the pelvic and thoracic posture becomes more upright, the oblique angle is reduced, showing the improvement of the upright posture. On the contrary, the pelvic forward tilt and thoracic oblique are increased when resistance become low or high, compensation of rotational motion appeared in high resistance, posture getting worse.

Key words: stroke, hemiplegia, gait, plantarflexion resistance, thorax, pelvis, kinetics

中图分类号:

R496

凌华,山本澄子,蔡丽飞,周昊. 新型油液阻尼可调式踝足矫形器的跖屈阻尼在脑卒中患者步态中对胸廓和骨盆运动的影响[J]. 《中国康复理论与实践》, 2021, 27(6): 637-644.

Hua LING,Sumiko YAMAMOTO,Li-fei CAI,Hao ZHOU. Effect of Plantarflexion Resistance of A New Adjustable Oil Damper Joint Ankle Foot Orthosis on Thorax and Pelvis in Gait after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(6): 637-644.

图/表 5

表1

图3

表2

表3

不同阻尼条件下骨盆和胸廓角度比较(°)"

项目	OD1	OD2.5	OD4	χ²值	P值	P值^a	P值^b	P值^c
P_IC_x	-7.096±3.180	-6.734±3.214	-8.098±2.924	5.846	0.054
P_IC_y	2.114±3.115	1.792±2.725	1.913±2.826	0.231	0.891
P_IC_z	-2.082±5.930	-2.400±5.850	-1.686±5.854	0.077	0.962
P_CFO_x	-10.241±4.463	-9.834±4.418	-10.614±4.493	8.240	0.016	0.198	0.014	0.967
P_CFO_y	-3.813±2.971	-3.745±3.004	-3.693±2.661	2.846	0.241
P_CFO_z	3.205±5.634	3.030±5.274	4.556±5.511	6.077	0.048	1.000	0.214	0.055
P_CIC_x	-11.382±4.489	-10.628±4.635	-12.049±4.674	19.760	< 0.001	0.359	< 0.001	0.014
P_CIC_y	-1.664±2.781	-1.865±2.354	-1.386±3.114	0.560	0.756
P_CIC_z	0.079±5.251	0.128±5.150	-0.031±4.724	1.040	0.595
P_FO_x	-10.966±3.659	-10.122±4.081	-11.989±4.027	29.308	< 0.001	0.038	< 0.001	0.011
P_FO_y	1.295±2.735	1.211±2.616	1.174±3.449	0.077	0.962
P_FO_z	-5.168±5.067	-5.425±5.049	-5.469±5.187	1.000	0.607
T_IC_x	1.793±4.071	1.540±4.105	1.453±3.783	2.077	0.354
T_IC_y	0.719±3.176	1.165±3.205	1.138±2.878	2.154	0.341
T_IC_z	-2.194±4.550	-2.047±4.680	-1.408±4.711	3.769	0.152
T_CFO_x	0.351±3.909	0.092±3.821	0.801±4.131	10.692	0.005	0.080	0.004	0.995
T_CFO_y	-4.202±2.775	-3.411±2.980	-4.502±2.502	12.538	0.002	0.055	0.002	0.802
T_CFO_z	2.875±4.447	3.078±4.227	4.625±4.033	14.077	0.001	0.288	0.113	0.001
T_CIC_x	-0.902±3.761	-0.320±4.051	-1.137±4.039	4.923	0.085
T_CIC_y	-3.341±2.732	-3.207±2.761	-3.148±2.719	1.000	0.607
T_CIC_z	1.637±4.236	1.755±4.283	2.401±4.531	0.538	0.764
T_FO_x	0.039±3.462	0.353±3.728	-1.008±3.885	12.000	0.001	1.000	0.001	0.029
T_FO_y	0.412±2.866	0.763±2.941	0.391±2.826	0.923	0.630
T_FO_z	-3.186±4.520	-3.310±4.665	-3.390±4.846	1.462	0.482
TP_IC_x	8.315±5.546	7.727±5.623	9.075±5.030	13.462	0.001	1.000	0.002	0.017
TP_CFO_x	10.060±5.714	9.362±5.768	11.081±5.343	22.640	< 0.001	0.967	< 0.001	0.001
TP_CIC_x	9.708±5.961	9.549±5.909	10.301±5.789	8.720	0.013	1.000	0.022	0.049
TP_FO_x	10.101±5.967	9.615±6.135	10.049±5.737	1.923	0.382
T_cycle_x	6.029±2.670	6.164±2.716	6.241±2.435	0.077	0.962
T_ST_x	5.681±2.696	5.512±2.790	5.510±2.493	1.000	0.607
T_SS_x	2.013±0.705	1.800±0.683	2.259±0.948	8.385	0.015	1.000	0.025	0.055

表3

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项目	值
性别(男/女，n)	26/0
年龄(岁)	47.1±14.2
身高(m)	1.72±0.33
体质量(kg)	74.8±9.3
体质量指数(kg/m²)	25.2±2.6
偏瘫侧(左/右，n)	11/15
病程(d)	153.8±76.4
偏瘫侧下肢Brunnstrom分期(Ⅲ/Ⅳ/Ⅴ，n)	7/17/2
功能性步行分级(2级/3级/4级，n)	6/14/6
Fugl-Meyer评定量表平衡部分	9.92±1.96
Berg平衡量表	44.73±3.99

项目	OD1	OD2.5	OD4	χ²值	P值	P值^a	P值^b	P值^c
步行速度(m/s)	0.247±0.139	0.229±0.117	0.270±0.146	4.692	0.096
步长(偏瘫侧-非瘫痪侧)(%身高)	0.158±0.053	0.151±0.050	0.156±0.049	5.615	0.060
步长(非偏瘫侧-瘫痪侧)(%身高)	0.136±0.052	0.133±0.049	0.141±0.049	2.846	0.241
步态周期(s)	2.282±0.599	2.332±0.581	2.149±0.628	3.308	0.191
LR (s)	0.823±0.375	0.871±0.382	0.799±0.364	7.923	0.019	0.214	0.017	0.995
SS (s)	0.336±0.087	0.332±0.088	0.354±0.126	2.769	0.250
PS (s)	0.560±0.257	0.553±0.233	0.557±0.275	0.077	0.962
摆动期(s)	0.563±0.134	0.582±0.116	0.561±0.131	2.583	0.275

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新型油液阻尼可调式踝足矫形器的跖屈阻尼在脑卒中患者步态中对胸廓和骨盆运动的影响

Effect of Plantarflexion Resistance of A New Adjustable Oil Damper Joint Ankle Foot Orthosis on Thorax and Pelvis in Gait after Stroke

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