老年脑卒中偏瘫患者不同站立姿势下静态平衡特征的比较

doi:10.3969/j.issn.1006-9771.2026.09.007

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (9): 1052-1060.doi: 10.3969/j.issn.1006-9771.2026.09.007

老年脑卒中偏瘫患者不同站立姿势下静态平衡特征的比较

苏盼盼¹, 何川¹, 琼吉², 孟殿怀³()

¹ 南京医科大学附属江苏盛泽医院康复医学科，江苏苏州市 215228
² 拉萨市人民医院重症医学科，西藏拉萨市 850000
³ 南京医科大学第一附属医院康复医学中心，江苏南京市 210029

收稿日期:2026-04-21 修回日期:2026-06-24 接受日期:2026-07-01 出版日期:2026-09-25 发布日期:2026-09-20
通讯作者: 孟殿怀(1976-)，男，汉族，博士，主任医师，研究生导师，主要研究方向：运动损伤与康复、老年康复。E-mail： dhdream@126.com
作者简介:苏盼盼(1988-)，女，汉族，江苏淮安市人，硕士研究生，副主任技师，主要研究方向：神经康复。
基金资助:
江苏省重点研发项目(2021012-4);苏州市吴江区科教兴卫项目(WWK202610)

Comparison of static balance characteristics under different standing postures in older patients with post-stroke hemiplegia

Su Panpan¹, He Chuan¹, Qiongji ², Meng Dianhuai³()

¹ Department of Rehabilitation Medicine, Jiangsu Shengze Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu 215228, China
² Department of Critical Care Medicine, Lhasa Municipal People's Hospital, Lhasa, Xizang 850000, China
³ Rehabilitation Medical Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

Received:2026-04-21 Revised:2026-06-24 Accepted:2026-07-01 Published:2026-09-25 Online:2026-09-20
Contact: Meng Dianhuai, E-mail: dhdream@126.com
Supported by:
Jiangsu Provincial Key Research and Development Program(2021012-4);Wujiang Science-Education Program for Health Development of Suzhou(WWK202610)

摘要/Abstract

摘要：

目的比较老年脑卒中偏瘫患者在不同站立姿势下静态平衡特征的差异。

方法选取2022年9月至2024年8月江苏盛泽医院老年脑卒中偏瘫患者38例，采用Prokin平衡测试和训练系统评估患者在7种站立姿势下的静态平衡特征，包括双足并拢站姿(BS)、患侧半串联站姿(ASTS)、健侧半串联站姿(USTS)、患侧串联站姿(ATS)、健侧串联站姿(UTS)、健侧单腿站姿(UMS)和自选站姿(SS)。每项任务中维持姿势稳定15 s。采集静态平衡的压力中心(COP)参数，包括前后方向平均运动速度(VAP)、左右方向平均运动速度(VML)、运动面积(SA)、运动长度(SL)、前后方向标准差(SDAP)和左右方向标准差(SDML)。

结果不同站立姿势对患者的COP参数均有显著主效应(F > 39.793, χ² = 109.632, P < 0.001)。SS在多数COP指标上表现出较小的姿势摆动(P < 0.05)，UMS在VAP、VML、SA和SL方面高于其他站姿(P < 0.05)，除SDML外，UTS的COP参数均高于BS、ASTS和USTS (P < 0.05)，且UTS的VAP、SA、SL和SDAP高于ATS (P < 0.05)。除VML和SDML外，ATS的COP参数均高于BS、ASTS和USTS (P < 0.05)。USTS的VAP高于BS (P < 0.05)。

结论在具有较好独立站立能力的老年脑卒中偏瘫患者中，不同站姿下COP参数存在差异。SS的姿势摆动较小，UMS和UTS姿势摆动较大；串联站姿下双足前后位置可能影响静态平衡控制。

关键词: 老年人, 脑卒中, 偏瘫, 站立姿势, 静态平衡

Abstract:

Objective To compare static balance characteristics under different standing postures in older patients with post-stroke hemiplegia.

Methods A total of 38 older patients with post-stroke hemiplegia in Jiangsu Shengze Hospital from September, 2022 to August, 2024 were enrolled. Static balance was assessed using the ProKin Balance Testing and Training System under seven standing postures: bipedal stance (BS), affected semi-tandem stance (ASTS), unaffected semi-tandem stance (USTS), affected tandem stance (ATS), unaffected tandem stance (UTS), unaffected monopedal stance (UMS) and self-selected stance (SS). Participants were required to maintain each posture for 15 seconds. Center-of-pressure (COP) parameters were recorded, including mean sway velocity in the anteroposterior direction (VAP), mean sway velocity in the mediolateral direction (VML), sway area (SA), sway path length (SL), standard deviation in the anteroposterior direction (SDAP), and standard deviation in the mediolateral direction (SDML).

Results Main effect of standing posture was significant in all COP parameters (F > 39.793, χ² = 109.632, P< 0.001). SS showed smaller postural sway for most COP measures than the other postures (P < 0.05). VAP, VML, SA and SL were higher during UMS than during the other postures (P < 0.05). COP parameters during UTS were higher than those during BS, ASTS and USTS (P < 0.05), and VAP, SA, SL and SDAP during UTS were higher than those during ATS (P < 0.05). Except for VML and SDML, COP parameters during ATS were higher than those during BS, ASTS and USTS (P < 0.05). VAP during USTS was higher than that during BS (P < 0.05).

Conclusion In older patients with post-stroke hemiplegia who have relatively good independent standing ability, COP parameters differ across standing postures. Postural sway is relatively small during SS, and great during UMS and UTS. The anteroposterior positioning of the feet during tandem stance may influence static balance control.

Key words: older adults, stroke, hemiplegia, standing posture, static balance

中图分类号:

R743.3

苏盼盼, 何川, 琼吉, 孟殿怀. 老年脑卒中偏瘫患者不同站立姿势下静态平衡特征的比较[J]. 《中国康复理论与实践》, 2026, 32(9): 1052-1060.

Su Panpan, He Chuan, Qiongji , Meng Dianhuai. Comparison of static balance characteristics under different standing postures in older patients with post-stroke hemiplegia[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 1052-1060.

图/表 11

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特征	数值
性别(男/女)/n	32/6
年龄/岁	65.85±5.41
身高/m	1.68±0.09
体质量/kg	69.93±11.08
体质量指数/(kg·m^-2)	24.83±3.16
脑卒中类型(缺血/出血)/n	31/7
脑卒中病程/月	4.96±2.32
下肢Brunnstrom分期/n
III期	19
IV期	11
V期	8
计时起立-行走测试/s	26.25±15.03
30 s坐站测试/个	8.71±2.46
偏瘫侧(左/右)/n	21/17
过去12个月内有跌倒史/n	6

任务编号	任务名称	操作定义
任务1	BS	双足内侧缘并拢相触，双足跟并拢，双足呈平行位，脚尖向前
任务2	ASTS	患侧足在前，患足跟接触健足足弓中部
任务3	USTS	健侧足在前，健足跟接触患足足弓中部
任务4	ATS	患侧足在前，患足的足跟紧贴健足的脚尖，双足呈直线前后排列
任务5	UTS	健侧足在前，健足的足跟紧贴患足的脚尖，双足呈直线前后排列
任务6	UMS	健侧下肢单腿支撑，患侧腿抬离地面，尽量保持躯干直立，骨盆维持中立位
任务7	SS	患者选择自我感觉最稳定、最舒适的站立姿势

任务	ASTS	USTS	ATS	UTS	UMS	SS
BS	2.026	5.009^a	8.535^b	15.649^b	26.167^b	-2.105^a
ASTS		2.982	6.609^b	13.623^b	24.140^b	-4.132^a
USTS			3.526	10.640^b	21.158^b	-7.114^b
ATS				7.114^a	17.632^b	-10.640^b
UTS					10.518^a	-17.754^b
UMS						-28.272^b

任务	BS	ASTS	USTS	ATS	UTS	UMS
ASTS	2.149
USTS	2.232	0.175
ATS	7.702^a	5.553^a	5.377^a
UTS	6.781^a	4.632^a	4.456^a	-0.921
UMS	19.895^a	17.749^a	17.570^a	12.193^a	13.114^a
SS	-3.614^a	-5.763^a	-5.939^a	-11.316^a	-10.395^a	-23.509^a

站姿	n	SA/mm²	SL/mm
BS	38	471.12±219.11	317.11±95.83
ASTS	38	548.47±222.99	353.20±91.79
USTS	38	658.14±301.08	390.34±116.76
ATS	38	842.61±403.75	518.88±131.17
UTS	38	1074.15±522.28	631.62±207.19
UMS	38	2283.53±1405.85	914.55±253.19
SS	38	270.87±140.66	236.97±76.21
F值		53.796	112.232
P值		< 0.001	< 0.001

老年脑卒中偏瘫患者不同站立姿势下静态平衡特征的比较

Comparison of static balance characteristics under different standing postures in older patients with post-stroke hemiplegia

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站姿	n	VAP	VML
BS	38	12.46±3.93	10.12±3.35
ASTS	38	14.48±4.46	12.27±3.44
USTS	38	17.46±6.49	12.44±3.83
ATS	38	20.99±7.29	17.82±4.65
UTS	38	28.11±10.04	16.91±3.96
UMS	38	38.62±13.01	30.02±7.17
SS	38	10.35±3.33	6.51±2.36
F值		80.848	139.772
P值		< 0.001	< 0.001

站姿	ASTS	USTS	ATS	UTS	UMS	SS
BS	77.342	187.018	371.272^a	603.026^a	1812.412^a	-200.254^a
ASTS		109.675	294.149^a	525.684^a	1735.070^a	-277.596^a
USTS			184.474^b	416.008^a	1625.395^a	-387.272^a
ATS				231.535^b	1440.921^a	-571.746^a
UTS					1209.386^a	-803.281^a
UMS						-2012.667^a

站姿	BS	ASTS	USTS	ATS	UTS	UMS
ASTS	36.088
USTS	73.228	37.140
ATS	201.772^a	165.684^a	128.544^a
UTS	314.509^a	278.421^a	241.281^a	112.737^a
UMS	597.439^a	561.351^a	524.211^a	395.667^a	282.930^a
SS	-80.140^a	-116.228^a	-153.368^a	-281.912^a	-394.649^a	-677.579^a

站姿	n	SDAP/mm	SDML/mm
BS	38	5.36±1.63	4.67(3.67,6.00)
ASTS	38	5.67±2.02	4.67(3.67,5.75)
USTS	38	6.23±2.42	4.83(4.00,6.33)
ATS	38	7.55±3.57	5.00(4.33,6.41)
UTS	38	10.11±3.41	5.67(4.58,6.83)
UMS	38	11.59±3.94	9.67(6.92,17.75)
SS	38	4.81±1.46	2.83(2.00,3.67)
F/χ²值		39.793	109.632
P值		< 0.001	< 0.001

站姿	ASTS	USTS	ATS	UTS	UMS	SS
BS	0.316	0.868	2.193^a	4.746^b	6.237^b	-0.553
ASTS		0.553	1.877^a	4.430^b	5.921^b	-0.868
USTS			1.325	3.877^b	5.368^b	-1.421
ATS				2.553^b	4.044^b	-2.746^a
UTS					1.491	-5.298^b
UMS						-6.789^b

站姿	BS	ASTS	USTS	ATS	UTS	UMS
ASTS	0.133
USTS	-1.142	-1.274
ATS	-1.699	-1.832	-0.558
UTS	-3.159^a	-3.292^a	-2.018	-1.460
UMS	-6.160^b	-6.292^b	-5.018^b	-4.460^b	-3.000
SS	3.478^a	3.345^a	4.620^b	5.177^b	6.637^b	9.638^b

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