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

doi:10.3969/j.issn.1006-9771.2024.03.013

摘要/Abstract

摘要：

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。

关键词: 功能性踝关节不稳, 地面硬度, 步态, 协调模式, 协调变异性

Abstract:

Objective To explore the influence of different hardness surfaces on gait coordination in patients with functional ankle instability (FAI).

Methods Qualisys Infrared Optical Motion Capture System was used to test the coordination and variability of 15 FAI patients on the right side at Nanjing Normal University from May to July, 2023. The gait cycle data were collected and intercepted, and coupling angle (CA) and standard deviation of coupling angle (SDCA) were calculated by Matlab to compare the differences on different hardness surfaces.

Results On coronal plane, CA of hip-ankle joint was higher on the hard surface than on the soft surface during middle stage of support and early stage of swing, and lower on its rest stages and the gait stages of hip-knee joint and knee-ankle joint than on the soft surface (P < 0.01). On sagittal plane, CA of hip-ankle joint and knee-ankle joint was smaller on the hard surface than on the soft surface during middle and late stages of support, and larger than on the soft surface during their rest stages, and the gait stages of hip-knee joint (P < 0.01). On horizontal plane, CA of hip-knee joint was lower on the hard surface than on the soft surface during the late stage of support, and higher than on the soft surface during its early stage of swing and bearing stage of hip-ankle joint (P < 0.01). Compared with the hard surface, SDCA was smaller on the soft surface than on the hard surface only in the hip-ankle on the sagittal plane and during bearing stage of hip-knee joint, and was greater than on the hard surface for the rest (P < 0.01).

Conclusion FAI patients showed more distal dominance on soft surface than on hard surface during most gait cycle on 3D plane, i.e., advantage of ankle varus and plantar flexion increased, and advantage of hip joint decreased; the coordination variability was generally higher on soft surface than on hard surface. These findings suggested that FAI patients may increase the risk of recurrent lateral ankle sprain walking on soft surface.

Key words: functional ankle instability, surface hardness, gait, coordination mode, coordination variability

中图分类号:

R684.7

马乾峰, 李立, 张伟, 丁健, 许贻林, 毛文慧. 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[J]. 《中国康复理论与实践》, 2024, 30(3): 345-351.

MA Qianfeng, LI Li, ZHANG Wei, DING Jian, XU Yilin, MAO Wenhui. Influence of different hardness surfaces on gait coordination in functional ankle instability[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 345-351.

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平面	关节	步态周期	硬地面	软地面	t值	P值
冠状面	髋-踝	支撑中期	255.9±31.3	198.6±55.7	3.122	0.017
		支撑后期	206.5±51.0	169.7±45.3	2.494	0.026
		摆动后期	144.6±59.4	216.6±56.2	3.735	0.020
	髋-膝	承重期	134.6±76.3	250.3±39.5	-5.500	< 0.001
		支撑中期	160.0±42.6	213.7±48.7	2.956	< 0.001
	膝-踝	摆动后期	161.0±43.7	212.0±50.3	3.695	0.003
矢状面	髋-踝	支撑中期	146.4±10.8	189.1±9.4	11.003	< 0.001
		支撑后期	147.3±15.2	205.8±17.0	9.478	< 0.001
		摆动后期	169.7±32.8	138.5±49.9	1.839	< 0.001
	髋-膝	承重期	247.8±23.0	156.2±22.4	11.186	< 0.001
	膝-踝	承重期	195.2±17.3	141.0±60.2	3.374	0.003
		支撑中期	70.4±23.7	270.9±77.0	8.506	< 0.001
		支撑后期	91.2±29.3	280.2±74.6	11.645	< 0.001
		摆动后期	211.0±26.2	152.0±68.0	2.746	0.020
水平面	髋-踝	承重期	241.3±43.6	201.7±32.2	2.558	0.018
	髋-膝	支撑后期	167.4±62.0	214.8±55.7	2.275	0.012
		摆动前期	207.2±45.3	138.3±58.8	4.256	< 0.001

平面	关节	步态周期	硬地面	软地面	t值	P值
冠状面	髋-踝	支撑中期	35.9±11.7	49.7±7.4	-3.301	0.006
	髋-膝	摆动前期	21.9±16.8	39.4±14.5	-5.016	< 0.001
		摆动期	30.6±7.9	41.4±11.3	-4.591	0.001
	膝-踝	支撑中期	39.3±10.2	52.8±6.7	-4.613	0.001
		摆动前期	21.8±15.9	41.4±16.4	-3.121	0.009
		摆动期	39.4±6.8	46.2±7.9	-5.259	< 0.001
矢状面	髋-膝	承重期	20.0±8.8	13.7±7.3	3.390	0.005
	膝-踝	摆动前期	18.0±17.7	29.3±14.8	-3.390	0.005
		摆动期	14.0±7.2	19.6±12.3	-2.259	0.043
水平面	髋-膝	支撑中期	49.2±8.6	56.9±4.0	-2.653	0.021
		支撑后期	48.9±5.6	57.3±6.2	-4.279	0.001
		摆动前期	41.5±12.2	54.5±8.6	-4.333	0.001
		摆动期	34.8±8.1	41.1±7.9	-2.577	0.024
	膝-踝	支撑中期	48.3±9.3	56.2±4.4	-2.990	0.011
		摆动前期	34.0±13.2	49.2±13.3	-3.256	0.007
		摆动期	33.1±10.1	43.5±8.9	-3.582	0.004