股四头肌痉挛对脑卒中患者跨越障碍的影响

doi:10.3969/j.issn.1006-9771.2021.07.003

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (7): 755-759.doi: 10.3969/j.issn.1006-9771.2021.07.003

• 专题运动与平衡功能研究 • 上一篇下一篇

股四头肌痉挛对脑卒中患者跨越障碍的影响

于小明^1,²,黄尚军³,乔钧⁴,陆琰²,胡军¹()

1.上海中医药大学康复医学院,上海市 201203
2.上海中医药大学附属第七人民医院康复治疗科,上海市 200137
3.同济大学医学院康复工程与生物力学实验室,上海市 200092
4.上海市第二康复医院,上海市 200441

收稿日期:2020-02-14 修回日期:2021-05-12 出版日期:2021-07-25 发布日期:2021-07-28
通讯作者: 胡军 E-mail:jasonhwu@126.com
作者简介:于小明(1984-),男,汉族,上海市人,硕士研究生,主要研究方向：神经系统疾病康复和物理治疗。|胡军(1968-),男,汉族,博士,副教授,主要研究方向：神经系统疾病康复及老年康复研究。
基金资助:
1.上海市中医专科联盟建设项目(TY(2018-2020)FWTX-4009);2.上海市浦东新区"国家中医药发展综合改革试验区"建设项目(PDZY-2018-0401);3.上海中医药大学附属第七人民医院"启明星"项目(QMX2018-02)

Influences of Quadriceps Femoris Spasticity on Obstacle Crossing for Stroke Patients

YU Xiao-ming^1,²,HUANG Shang-jun³,QIAO Jun⁴,LU Yan²,HU Jun¹()

1. School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
2. Department of Rehabilitation, the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
3. Laboratory of Rehabilitation Engineering and Biomechanics, School of Medicine, Tongji University, Shanghai 200092, China
4. The Second Rehabilitation Hospital of Shanghai, Shanghai 200441, China

Received:2020-02-14 Revised:2021-05-12 Published:2021-07-25 Online:2021-07-28
Contact: HU Jun E-mail:jasonhwu@126.com
Supported by:
Shanghai Traditional Chinese Medicine Union Construction Project(TY(2018-2020)FWTX-4009);Shanghai Pudong New Area National Traditional Chinese Medicine Development Comprehensive Reform Pilot Zone Construction Project(PDZY-2018-0401);Talents Training Program of Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine(QMX2018-02)

摘要/Abstract

摘要：

目的观察股四头肌痉挛对脑卒中患者跨越障碍的影响。

方法 2017年10月至2018年11月,招募脑卒中患者20例,根据股四头肌改良Ashworth量表(MAS)分级分为痉挛组(n = 11)和无痉挛组(n = 9)。采用三维运动捕捉系统和测力台同步采集患者跨越高15 cm障碍时的步长、步宽、前后和内外质心速度、健侧足尖-障碍物距离、患侧足尖-障碍物垂直间距、障碍后足跟-障碍物距离、双支撑和健患侧摆动期百分比等。

结果在患侧和健侧脚尖位于障碍正上方时,痉挛组前后方向质心速度均明显小于无痉挛组(F > 10.006, P < 0.01);痉挛组足尖-障碍物距离和障碍前步长均明显小于无痉挛组(F > 13.456, P < 0.01);痉挛组障碍前双支撑百分比和障碍后步宽大于无痉挛组(F > 4.533, P < 0.05)。

结论股四头肌痉挛导致脑卒中患者跨越障碍时持更谨慎的策略,效率降低。

关键词: 脑卒中, 膝, 痉挛, 跨越障碍, 生物力学

Abstract:

Objective To observe the effect of quadriceps femoris spasticity on the movement parameters in stroke patients during obstacle crossing.

Methods From October, 2017 to November, 2018, 20 stroke patients were divided into spasticity group (n = 11) and non-spasticity group (n = 9) based on the score of modified Ashworth Scale (MAS) of quadriceps femoris. A 10-camera 3D motion analysis system and two force plates were used to synchronously measure the movement parameters of the patients during obstacle crossing of 15 cm high, such as step length, step width, anterior-posterior velocity of the center of mass (COMAPV) and medio-lateral velocity of the center of mass, toe-obstacle distance of unaffected limb, toe-obstacle clearance of affected limb, heel-obstacle distance, double support phase, and the swing phases of affected and unaffected limb.

Results Compared with the non-spasticity group, the COMAPV decreased as both affected and unaffected limb above the obstacle in the spasticity group (F > 10.006, P < 0.01), as well as the toe-obstacle distance and step length before obstacle crossing (F > 13.456, P < 0.01); while, the double support phase and the step width after obstacle crossing increased (F > 4.533, P < 0.05).

Conclusion The quadriceps femoris spasticity may make the strategy of obstacle crossing more carefully for stroke patients, and less efficiently.

Key words: stroke, knee, spasticity, obstacle crossing, biomechanics

中图分类号:

R743.3

于小明,黄尚军,乔钧,陆琰,胡军. 股四头肌痉挛对脑卒中患者跨越障碍的影响[J]. 《中国康复理论与实践》, 2021, 27(7): 755-759.

YU Xiao-ming,HUANG Shang-jun,QIAO Jun,LU Yan,HU Jun. Influences of Quadriceps Femoris Spasticity on Obstacle Crossing for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 755-759.

图/表 2

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特征	无痉挛组(n = 9)	痉挛组(n = 11)	χ²/F值	P值
性别(男/女, n)	6/3	9/2	0.617	0.396
年龄(岁)	61.33±7.53	60.02±8.79	0.129	0.724
身高(cm)	168.78±3.89	171.09±6.89	0.799	0.383
体质量(kg)	67.39±3.18	73.81±8.76	4.316	0.052
卒中类型(梗死/出血, n)	5/4	9/2	0.336	0.217
病程(d)	280.67±187.82	320.01±195.29	0.208	0.654
MAS	0.00±0.00	1.45±0.47	84.637	< 0.001
MMSE	28.11±2.52	27.55±2.02	0.311	0.584
Fugl-Meyer评定量表下肢部分	28.44±2.55	25.82±6.78	1.201	0.288
Berg平衡量表	48.89±3.79	45.73±3.72	3.519	0.077

参数	无痉挛组(n= 9)	痉挛组(n= 11)	F值	P值
COMAPV1 (m/s)	0.47±0.17	0.25±0.09	12.542	0.002
COMMLV1 (m/s)	0.02±0.01	0.02±0.02	0.082	0.778
COMAPV2 (m/s)	0.53±0.15	0.35±0.11	10.006	0.005
COMMLV2 (m/s)	0.04±0.03	0.04±0.04	0.098	0.758
TOD (m)	0.22±0.07	0.12±0.04	13.456	0.002
TOC (m)	0.13±0.04	0.11±0.08	0.211	0.651
HOD (m)	0.10±0.06	0.07±0.05	1.905	0.184
障碍前步长(m)	0.48±0.03	0.17±0.06	216.380	< 0.001
障碍后步长(m)	0.34±0.19	0.21±0.17	2.787	0.112
障碍前步宽(m)	0.08±0.06	0.10±0.04	0.608	0.446
障碍后步宽(m)	0.11±0.04	0.15±0.04	4.533	0.047
障碍前双支撑期(%)	9.23±2.33	13.34±14.62	5.381	0.032
患侧摆动期(%)	46.79±4.37	44.67±4.86	1.031	0.323
障碍中双支撑期(%)	8.18±2.50	10.60±4.35	2.180	0.157
健侧摆动期(%)	35.80±7.65	31.40±7.46	1.681	0.211

股四头肌痉挛对脑卒中患者跨越障碍的影响

Influences of Quadriceps Femoris Spasticity on Obstacle Crossing for Stroke Patients

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