脑卒中偏瘫患者步态参数与平衡功能的关系

doi:10.3969/j.issn.1006-9771.2022.01.006

摘要/Abstract

摘要：

目的探讨脑卒中偏瘫患者步态参数与平衡功能的关系。方法 2018年9月至2020年3月,北京博爱医院住院脑卒中偏瘫患者76例(Brunnstrom Ⅳ、Ⅴ期各38例),采用平衡检测仪、星状伸展平衡测试(SEBT)进行评定,采用三维步态分析系统测量步速、步频,计算双侧步长比、支撑期时间比、摆动期时间比、髋关节最大屈曲角度比、膝关节最大屈曲角度比。步态参数和平衡功能测试结果行相关性分析。结果 Brunnstrom Ⅴ期患者平衡和步态参数均优于Ⅳ期患者(|t| > 2.268, P < 0.05)。所有患者步速、步频与平衡功能多数参数相关(|r| > 0.335, P < 0.05)。Brunnstrom Ⅳ期患者步长比与SEBT测量结果负相关(r = -0.467~-0.613, P < 0.01),Brunnstrom Ⅴ期患者步长比与平衡仪内外稳定极限负相关(r = -0.356, P = 0.028)。Brunnstrom Ⅳ期患者摆动期时间比与平衡仪前后稳定极限(r = -0.335, P = 0.040)、内/外极限比(r = 0.510, P = 0.001)、星状伸展平衡测试多数结果(r = -0.330~-0.445, P < 0.05)相关。Brunnstrom Ⅳ期患者髋、膝关节屈曲比与平衡功能测试结果相关(|r| > 0.326, P < 0.05),Brunnstrom Ⅴ期患者膝关节屈曲比与多数平衡功能测试结果相关(r > 0.329, P < 0.05),髋关节屈曲比仅与平衡仪前后稳定极限相关(r = 0.369, P = 0.023)。结论步速和步频可较好反映脑卒中偏瘫患者的平衡功能;步态的时空对称性在功能较低的患者中与平衡功能相关。

关键词: 脑卒中, 步态, 平衡, 对称性

Abstract:

Objective To investigate the relationship between gait spatiotemporal parameters and balance function in stroke hemiplegic patients. Methods From September, 2018 to March, 2020, 76 stroke hemiplegic patients (38 in Brunnstrom Ⅳ and V, respectively) were assessed balance function with Active Balancer EAB-100 and Star Excursion Balance Test (SEBT), and gait parameters of speed, cadence and asymmetry, named step length asymmetry ratio (SLA), swing time asymmetry ratio (SWTA), stance time asymmetry ratio (STA), maximum flexion angle ratio (MFA) of hip and knee. The correlation among gait parameters and balance function was analysed. Results The balance and gait parameters were better in those in Brunnstrom V than in Brunnstrom Ⅳ (|t| > 2.268, P < 0.05). The speed and cadence correlated with the most balance indexes (|r| > 0.335, P < 0.05). SLA correlated with SEBT in Brunnstrom Ⅳ patients (r = -0.467~-0.613, P < 0.01), while it correlated with medial-lateral (M-L) stability limits in Brunnstrom V patients (r = -0.356, P = 0.028). SWTA correlated with stability limit of Anterior-Posterior (A-P) (r = -0.335, P = 0.040) and M-L (r = 0.510, P = 0.001), and most of SEBT (r = -0.330~ -0.445, P < 0.05) in Brunnstrom Ⅳ patients. MFA of hip and knee correlated with balance indexes in Brunnstrom Ⅳ patients (|r| > 0.326, P < 0.05), while MFA of knee correlated with most balance indexes in Brunnstrom V patients (r > 0.329, P < 0.05), and MFA of hip correlated with A-P stability limit (r = 0.369, P = 0.023). Conclusion Both speed and cadence of steps can well respond to the balance function in stroke hemiplegic patients. For the asymmetry, it is related with balance in patients with poorer recovery.

Key words: stroke, gait, balance, symmetry

中图分类号:

R743.3

王亚囡,张通,杜雪晶,朱晓敏,刘元旻. 脑卒中偏瘫患者步态参数与平衡功能的关系[J]. 《中国康复理论与实践》, 2022, 28(1): 38-43.

WANG Ya'nan,ZHANG Tong,DU Xuejing,ZHU Xiaomin,LIU Yuanmin. Correlation between gait parameters and balance in stroke hemiplegic patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 38-43.

图/表 3

表1

表2

表3

步态指标与平衡功能指标的相关性"

项目			Ⅳ期组(n = 38)							Ⅴ期组(n = 38)
项目			步速	步频	步长RI	支撑期RI	摆动期RI	髋关节屈曲RI	膝关节屈曲RI	步速	步频	步长RI	支撑期RI	摆动期RI	髋关节屈曲RI	膝关节屈曲RI
平衡检测仪	前后	r	0.631	0.504	-0.273	0.028	-0.335	0.575	0.666	0.608	0.357	-0.285	-0.095	0.064	0.369	0.523
		P	< 0.001	0.001	0.098	0.867	0.040	< 0.001	< 0.001	< 0.001	0.028	0.083	0.569	0.701	0.023	0.001
	内外	r	0.673	0.484	-0.313	-0.010	-0.297	0.545	0.674	0.657	0.317	-0.356	-0.245	0.288	0.222	0.124
		P	< 0.001	0.002	0.056	0.951	0.071	< 0.001	< 0.001	< 0.001	0.053	0.028	0.139	0.079	0.181	0.457
	内外	r	-0.692	-0.602	0.292	-0.130	0.510	-0.723	-0.540	-0.335	-0.229	0.104	-0.095	0.097	-0.206	-0.063
	比	P	< 0.001	< 0.001	0.075	0.438	0.001	< 0.001	< 0.001	0.040	0.166	0.533	0.570	0.563	0.215	0.705
SEBT 患侧支撑	前	r	0.775	0.656	-0.503	0.296	-0.445	0.726	0.506	0.825	0.638	-0.147	-0.112	0.161	0.145	0.422
		P	< 0.001	< 0.001	0.001	0.071	0.005	< 0.001	0.001	< 0.001	< 0.001	0.379	0.503	0.334	0.385	0.008
	后内	r	0.726	0.588	-0.467	0.251	-0.375	0.526	0.631	0.682	0.389	-0.239	-0.036	0.090	0.031	0.247
		P	< 0.001	< 0.001	0.003	0.128	0.020	0.001	< 0.001	< 0.001	0.016	0.148	0.829	0.589	0.582	0.135
	后外	r	0.740	0.644	-0.542	0.235	-0.361	0.606	0.509	0.658	0.408	-0.260	0.061	-0.103	0.126	0.329
		P	< 0.001	< 0.001	< 0.001	0.155	0.026	< 0.001	0.001	< 0.001	0.011	0.115	0.716	0.537	0.449	0.044
SEBT 健侧支撑	前	r	0.740	0.596	-0.579	0.364	-0.330	0.578	0.326	0.630	0.578	-0.039	-0.122	0.181	0.046	0.348
		P	< 0.001	< 0.001	< 0.001	0.025	0.043	< 0.001	0.045	< 0.001	< 0.001	0.817	0.466	0.278	0.783	0.032
	后内	r	0.727	0.539	-0.503	0.211	-0.260	0.537	0.525	0.674	0.432	-0.284	-0.144	0.189	0.023	0.345
		P	< 0.001	< 0.001	0.001	0.204	0.114	0.001	0.001	< 0.001	0.007	0.084	0.389	0.255	0.889	0.034
	后外	r	0.756	0.670	-0.613	0.109	-0.294	0.683	0.531	0.832	0.401	-0.330	-0.106	0.080	0.121	0.333
		P	< 0.001	< 0.001	< 0.001	0.515	0.073	< 0.001	0.001	< 0.001	0.013	0.043	0.526	0.635	0.469	0.041

表3

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项目	Ⅳ期组 (n = 38)	Ⅴ期组 (n = 38)	t/χ²值	P值
性别(男/女)/n	22/16	20/18	0.213	0.645
年龄/岁	39.45±7.50	40.66±10.07	-0.594	0.554
体质量/kg	67.97±8.80	70.18±5.59	-2.189	0.195
身高/m	1.71±0.08	1.73±0.06	-1.507	0.136
BMI/kg·m^-2	23.10±1.22	23.31±1.36	-0.735	0.464
性质(出血/梗死)/n	10/28	16/22	2.105	0.147
偏瘫侧(左/右)/n	16/22	19/19	0.477	0.490

项目		Ⅳ期组(n = 38)	Ⅴ期组(n = 38)	t值	P值
平衡检测仪	前后/mm	89.4±23.7	113.9±19.6	4.908	< 0.001
	内外/mm	118.3±26.2	152.6±19.1	4.834	< 0.001
	内外比/%	1.4±0.3	1.1±0.1	-4.088	< 0.001
SEBT患侧支撑	前/%	41.4±10.7	53.9±7.7	5.937	< 0.001
	后内/%	56.9±11.8	69.9±8.1	5.585	< 0.001
	后外/%	46.4±12.6	59.1±10.0	4.876	< 0.001
SEBT健侧支撑	前/%	52.5±8.3	63.3±6.8	6.206	< 0.001
	后内/%	70.5±11.2	79.5±8.6	3.937	< 0.001
	后外/%	57.1±10.6	68.8±12.7	4.345	< 0.001
步态分析	步速/cm·s^-1	45.7±17.5	73.5±19.1	6.630	< 0.001
	步频/min^-1	74.5±19.4	96.8±14.6	5.655	< 0.001
	步长RI	1.22±0.11	1.07±0.06	-7.422	< 0.001
	支撑期RI	0.94±0.11	0.98±0.07	2.322	0.023
	摆动期RI	1.16±0.34	1.02±0.10	-2.268	0.026
	髋屈曲RI	0.68±0.15	0.87±0.14	6.025	< 0.001
	膝屈曲RI	0.61±0.21	0.79±0.15	4.318	< 0.001