脑卒中患者静态平衡的足底压力分析

doi:10.3969/j.issn.1006-9771.2021.00.001

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (3): 290-296.doi: 10.3969/j.issn.1006-9771.2021.00.001

脑卒中患者静态平衡的足底压力分析

林强^1,^2,^3,⁴,郑煜欣^1,³,廖婉晨²,罗志伟¹,黎婉颖¹,欧海宁^1,^2,⁴,梁俊杰^1,^2,³()

^1.广州医科大学附属第五医院，广东广州市 510700
^2.广州医科大学，广东广州市 511436
^3.广州医科大学康复实验室，广东广州市 510700
^4.广州市加速康复腹部外科重点实验室，广东广州市 510700

收稿日期:2020-02-17 修回日期:2020-04-27 出版日期:2021-03-25 发布日期:2021-04-02
通讯作者: 梁俊杰 E-mail:ljj88961@gzhmu.edu.cn
作者简介:林强(1981-)，女，汉族，山西太原市人，博士研究生，主治医师，主要研究方向：神经康复、运动康复|梁俊杰(1987-)，男，汉族，广东广州市人，硕士研究生，主治医师，主要研究方向：神经康复。
基金资助:
广州市卫生健康科技项目(20191A011091);2. 2019年广东省普通高校青年创新人才类项目(2019KQNCX119);广州市加速康复腹部外科重点实验室(201905010004);广州医科大学大学生科技创新项目(2019A057)

Static Balance Function in Stroke Patients: A Plantar Pressure Analysis

Qiang LIN^1,^2,^3,⁴,Yu-xin ZHENG^1,³,Wan-chen LIAO²,Zhi-wei LUO¹,Wan-ying LI¹,Hai-ning OU^1,^2,⁴,Jun-jie LIANG^1,^2,³()

^1.The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, China
^2.Guangzhou Medical University, Guangzhou, Guangdong 511436, China
^3.The Rehabilitation Laboratory of Guangzhou Medical University, Guangzhou, Guangdong 510700, China
^4.Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery, Guangzhou, Guangdong 510700, China

Received:2020-02-17 Revised:2020-04-27 Published:2021-03-25 Online:2021-04-02
Contact: Jun-jie LIANG E-mail:ljj88961@gzhmu.edu.cn
Supported by:
General Guidance Project of Guangzhou Health and Family Planning Commission(20191A011091);Guangdong Provincial Department of Education(2019KQNCX119);Guangzhou Key Laboratory Fund(201905010004);Science and Technology Innovation Project for College Students in Guangzhou Medical University(2019A057)

摘要/Abstract

摘要： 目的

通过足底压力分析脑卒中患者平衡调控机制。

方法

2019年7月至12月于本院康复科招募脑卒中受试者12例(脑卒中组)和正常人30例(对照组)。两组均进行睁、闭眼下的足底压力分析，比较运动学参数、动力学参数、足底压力中心(CoP)、相应对称性指数(SI)、对称性角度(SA)和Romberg商(RQ)。

结果

与睁眼状态比较，闭眼状态下，对照组平均Y和最大摆动明显增加(P < 0.01)；脑卒中组球长度、平均速度和最大摆动均增大(P < 0.05)。与对照组比较，脑卒中组在睁、闭眼两种状态时均表现为椭圆面积显著增大(|t| > 3.509, P < 0.001)，平均X变大(|Z| > 2.311, P < 0.05)，而在闭眼状态时最大摆动明显增大(Z = -3.118, P < 0.01)。脑卒中组球长度RQ明显大于对照组(t = -3.570, P < 0.01)。两组在睁眼和闭眼两种状态下所有参数的SI和SA比较均无显著性差异(P > 0.05)。与对照组比较，脑卒中组在睁、闭眼两种状态时均表现为负荷SI、整体负荷SI、前足负荷SI、面积SI和前足面积SI均为负值变大(t > 2.344, P < 0.05)，负荷SA、整体负荷SA、前足负荷SA、面积SA、前足面积SA增大(|t| > 2.297, P < 0.05)，后足负荷SA仅在睁眼时增大(t = -2.485, P < 0.05)，后足面积SA仅在闭眼时增大(t = -2.132, P < 0.05)。对照组在睁、闭眼两种状态下CoP主要分布在Y轴的负值方向，而脑卒中组CoP相对离散分布，在X轴上分布较对照组明显。

结论

脑卒中患者的平衡控制有赖于视觉补偿，且足底压力分析系统可有效评估脑卒中患者的平衡功能。

关键词: 脑卒中, 平衡功能障碍, 足底压力分析, Romberg商, 对称性指数, 对称性角度

Abstract: Objective

To explore the mechanism of balance control after stroke by plantar pressure analysis.

Methods

From July to December, 2019, twelve stroke subjects (stroke group) and 30 normal subjects (control group) were recruited in the rehabilitation department of our hospital. Both groups were measured plantar pressure in eyes open and closed conditions. The kinematic parameters, dynamic parameters, plantar pressure center (CoP), symmetry index (SI), symmetry angle (SA) and Romberg quotient (RQ) were calculated.

Results

Compared with eyes open condition, the average Y and maximum swing of the control group increased significantly in eyes closed condition (P < 0.01); moreover, the ball length, average speed and maximum swing increased significantly in the stroke group (P <0.05). Compared with the control group, the area of the ellipse (|t| > 3.509, P < 0.001) and the average X (|Z|> 2.311, P < 0.05) significantly increased both in eyes open and closed condition, whereas the maximum swing (Z = -3.118, P < 0.01) increased significantly in eyes closed condition in the stroke group. The RQ of ball length was significantly more in the stroke group than in the control group (t = -3.570, P < 0.01). There was no significant difference in SI and SA of all parameters between the eyes open and closed condition in two groups (P > 0.05). Compared with the control group, load SI, overall load SI, forefoot load SI, area SI and forefoot area SI increased in both the eyes open and closed conditions in the stroke group (t > 2.344, P < 0.05), whereas load SA, overall load SA, forefoot load SA, area SA, forefoot area SA increased (|t|> 2.297, P < 0.05), hindfoot load SA increased only in eyes open condition (t = -2.485, P < 0.05), and hindfoot area SA increased only in eyes closed condition (t = -2.132, P < 0.05). In the control group, CoP was mainly distributed in the negative direction of Y axis when the eyes were open and closed, while CoP in the stroke group was relatively discrete, and the distribution on X axis was more obvious than that of the control group.

Conclusion

The balance control of stroke patients might depend on visual compensation, and the plantar pressure analysis system could be used to evaluate the balance function in stroke patients.

Key words: stroke, balance dysfunction, plantar pressure analysis, Romberg quotient, symmetry index, symmetry angle

中图分类号:

R743.3

林强,郑煜欣,廖婉晨,罗志伟,黎婉颖,欧海宁,梁俊杰. 脑卒中患者静态平衡的足底压力分析[J]. 《中国康复理论与实践》, 2021, 27(3): 290-296.

Qiang LIN,Yu-xin ZHENG,Wan-chen LIAO,Zhi-wei LUO,Wan-ying LI,Hai-ning OU,Jun-jie LIANG. Static Balance Function in Stroke Patients: A Plantar Pressure Analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 290-296.

图/表 5

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组别	n	性别 (男/女，n)	年龄(岁)	体质量(kg)	患肢 (左/右，n)	出血/梗死(n)	病程(月)	BBS评分	FMA-LE评分	体质量指数 (kg/m²)
对照组	30	15/15	20.400±0.621	56.700±7.657						20.396±1.781
脑卒中组	12	11/1	55.417±10.370	67.392±9.675	7/5	4/8	16.333±13.337	45.168±4.337	23.000±5.410	23.967±2.104
t/χ²值			-11.689	-3.789						-5.573
P值			< 0.001	< 0.001						< 0.001

项目	状态	对照组(n = 30)	脑卒中组(n = 12)	t值/Z值	P值
球长度(mm)	睁眼	215.122±65.769	241.460±128.522	-0.084	0.945
球长度(mm)	闭眼	204.464±52.285	290.282±163.816^a	-1.865	0.064
椭圆面积(cm²)	睁眼	42.100±23.042	120.713±79.189	-3.565	< 0.001
椭圆面积(cm²)	闭眼	34.267±21.792	160.480±154.463	-3.509	< 0.001
平均速度(mm/s)	睁眼	21.639±6.608	18.828±4.451	1.351^f	0.184
平均速度(mm/s)	闭眼	20.254±5.253	21.690±5.321^b	-0.798^f	0.430
平均X(mm)	睁眼	2.832±7.181	9.318±19.102	-2.311	0.020
平均X(mm)	闭眼	2.974±7.624	10.657±21.899	-2.534	0.010
平均Y(mm)	睁眼	-21.434±10.241	-15.441±12.215	-1.622^f	0.113
平均Y(mm)	闭眼	-18.715±10.286^c	-16.172±12.484	-0.681^f	0.500
椭圆倾斜角(°)	睁眼	95.433±37.486	80.917±51.005	-0.627	0.536
椭圆倾斜角(°)	闭眼	79.700±37.759	84.750±53.309	-0.042	0.967
椭圆偏心角(°)	睁眼	0.507±0.298	0.318±0.219	1.988^f	0.054
椭圆偏心角(°)	闭眼	0.509±0.244	0.409±0.264	1.166^f	0.250
最大摆动(mm)	睁眼	2.595±0.737	2.915±2.175	-0.627	0.536
最大摆动(mm)	闭眼	3.589±1.440^d	7.625±5.512^e	-3.118	0.001
最小摆动(mm)	睁眼	0.036±0.024	0.036±0.024	-0.057	0.967
最小摆动(mm)	闭眼	0.037±0.020	0.030±0.019	1.095^f	0.280
RQ
椭圆面积		1.071±1.044	1.634±1.626	-0.807	0.433
球长度		0.974±0.158	1.208±0.259	-3.570^f	0.001

项目	状态	对照组(n = 30)	脑卒中组(n = 12)	t/Z值	P值
最大压强SI	睁眼	0.013±0.987	-0.118±0.210	-1.854^a	0.068
最大压强SI	闭眼	0.014±0.085	-0.146±0.288	-1.906^a	0.060
平均压强SI	睁眼	-0.025±0.112	-0.138±0.261	1.446	0.173
平均压强SI	闭眼	-0.022±0.110	-0.106±0.235	1.190	0.255
负荷SI	睁眼	0.000±0.176	-0.348±0.454	2.579	0.024
负荷SI	闭眼	0.005±0.187	-0.331±0.482	2.344	0.037
整体负荷SI	睁眼	0.001±0.177	-0.347±0.445	2.608	0.022
整体负荷SI	闭眼	0.005±0.185	-0.340±0.474	2.451	0.030
前足负荷SI	睁眼	-0.036±0.231	-0.444±0.517	2.633	0.021
前足负荷SI	闭眼	-0.017±0.239	-0.449±0.582	2.487	0.028
后足负荷SI	睁眼	-0.005±0.273	-0.309±0.530	1.892	0.080
后足负荷SI	闭眼	0.006±0.260	-0.277±0.529	1.767	0.100
面积SI	睁眼	0.024±0.123	-0.221±0.233	3.447	0.004
面积SI	闭眼	0.027±0.130	-0.228±0.253	3.322	0.005
前足面积SI	睁眼	0.058±0.159	-0.313±0.332	3.713	0.003
前足面积SI	闭眼	0.065±0.155	-0.331±0.339	3.615	0.003
后足面积SI	睁眼	-0.011±0.160	-0.139±0.242	2.012	0.051
后足面积SI	闭眼	-0.011±0.174	-0.153±0.243	1.846	0.084

项目	状态	对照组(n = 30)	脑卒中组(n = 12)	t/Z值	P值
最大压强SA	睁眼	0.004±0.031	0.037±0.066	-1.489^a	0.146
最大压强SA	闭眼	0.004±0.027	0.045±0.088	-1.542^a	0.130
平均压强SA	睁眼	-0.008±0.036	0.043±0.082	-2.094	0.057
平均压强SA	闭眼	-0.007±0.035	0.033±0.074	-1.820	0.092
负荷SA	睁眼	-0.000±0.056	0.106±0.138	-2.593	0.023
负荷SA	闭眼	0.001±0.059	0.100±0.144	-2.297	0.040
整体负荷SA	睁眼	-0.000±0.056	0.106±0.135	-2.634	0.021
整体负荷SA	闭眼	0.014±0.106	0.103±0.141	-2.223	0.032
前足负荷SA	睁眼	-0.011±0.073	0.133±0.155	-3.091	0.009
前足负荷SA	闭眼	-0.005±0.075	0.133±0.174	-2.654	0.020
后足负荷SA	睁眼	-0.002±0.084	0.092±0.159	-1.933	0.074
后足负荷SA	闭眼	0.002±0.081	0.082±0.156	-1.685	0.115
面积SA	睁眼	0.008±0.039	0.069±0.073	-2.766	0.016
面积SA	闭眼	0.009±0.041	0.071±0.079	-2.606	0.021
前足面积SA	睁眼	0.018±0.050	0.097±0.102	-2.542	0.024
前足面积SA	闭眼	0.020±0.049	0.094±0.105	-2.332	0.036
后足面积SA	睁眼	-0.004±0.051	0.044±0.076	-2.361	0.023
后足面积SA	闭眼	0.011±0.106	0.048±0.076	-1.097	0.279

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脑卒中患者静态平衡的足底压力分析

Static Balance Function in Stroke Patients: A Plantar Pressure Analysis

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