中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
Chinese Journal of Physical Medicine and Rehabilitation
2015年
9期
668-673
,共6页
胡楠%毕胜%卢茜%邓思宇%郄淑燕%刘畅%张佳玮
鬍楠%畢勝%盧茜%鄧思宇%郄淑燕%劉暢%張佳瑋
호남%필성%로천%산사우%극숙연%류창%장가위
脑卒中%偏瘫%足底压力%足内翻
腦卒中%偏癱%足底壓力%足內翻
뇌졸중%편탄%족저압력%족내번
Hemiplegia%Stroke%Plantar pressure%Inversion%Gait
目的 探讨可描述脑卒中偏瘫患者步行支撑期足内翻的足底压力学参数.方法 选取能独立步行的脑卒中偏瘫患者22例设为病例组,另选与患者年龄、体重相匹配的中老年健康志愿者17例设为对照组,使用Footscan压力板测量受试者常速行走下的足底压力,采集双足各3次的动态足底压力,得到足内外侧压强比值,记录并分析患者行走时足底各区域的压强峰值和接触面积(本研究所呈现的数据均为某个区域参数相对于所有分区对应参数之和的百分比).并使用临床痉挛指数(CsI)评价患者患侧踝关节的痉挛程度,并比较对照组健康人与病例组患者健患侧之间上述参数的差异及其相关性.结果 ①病例组患侧前足内侧压强占所有分区之和的百分比[(23.52±10.15)％]小于对照组优势侧[(29.82±7.45)％],而前足外侧压强的百分比[(45.45±17.71)％]大于对照组优势侧[(37.47±12.60)％];病例组健侧第1趾压强的所占百分比[(9.04±7.47)％]小于对照组优势侧[(14.84±6.54)％],而病例组中足及足跟压强的所占百分比[患侧(38.17±13.57)％,健侧(49.61±26.36)％]均大于对照组优势侧[(25.05±4.92)％],且组间差异均有统计学意义(P＜0.05);病例组患侧前足外侧压强的所占百分比[(45.45±17.71)％]大于组内患者健侧[(37.04±22.09)％],且差异有统计学意义(P＜0.05).②病例组患侧第1趾接触面积占全足的百分比[(9.96±1.67)％]大于对照组优势侧[(8.57±1.17)％],前足内侧接触面积占全足的百分比[(14.71±4.64)％]小于对照组优势侧[(17.62±1.52)％],且组间差异均有统计学意义(P＜0.05);病例组其余各区域健患侧组内比较,差异无统计学意义(P＞0.05).③病例组患侧全足、前足内外侧压强比值最大值[(27.21±22.73)、(22.81±22.19)]明显小于对照组优势侧[(43.68±23.78)、(41.09±28.13)],组间差异均有统计学意义(P＜0.05),而足跟的足内外侧压强比值的最大值组间比较以及健患侧之间全足、前足及足跟足内外侧压强比值的最大值比较,差异均无统计学意义(P＞0.05),但有患侧小于对照组优势侧及患侧小于健侧的趋势(P＞0.05).④病例组健患侧足在支撑期翻转程度减小,整体呈内翻.⑤病例组经CSI评定有轻度痉挛13例,中度痉挛5例,重度痉挛4例.病例组患侧总体的踝关节CSI得分(10.26±3.38)分,95％可信区间位于8.63 ～11.89.病例组患侧全足的内外侧压强比值最大值与前足外侧压强呈中度负相关(r=-0.516,P＜0.05),与接触面积及CSI无关(P＞0.05).结论 足底压力可定量描述脑卒中偏瘫患者的足内翻,足内外侧压强比值的最大值是反映脑卒中偏瘫患者足内翻的有效指标.
目的 探討可描述腦卒中偏癱患者步行支撐期足內翻的足底壓力學參數.方法 選取能獨立步行的腦卒中偏癱患者22例設為病例組,另選與患者年齡、體重相匹配的中老年健康誌願者17例設為對照組,使用Footscan壓力闆測量受試者常速行走下的足底壓力,採集雙足各3次的動態足底壓力,得到足內外側壓彊比值,記錄併分析患者行走時足底各區域的壓彊峰值和接觸麵積(本研究所呈現的數據均為某箇區域參數相對于所有分區對應參數之和的百分比).併使用臨床痙攣指數(CsI)評價患者患側踝關節的痙攣程度,併比較對照組健康人與病例組患者健患側之間上述參數的差異及其相關性.結果 ①病例組患側前足內側壓彊佔所有分區之和的百分比[(23.52±10.15)％]小于對照組優勢側[(29.82±7.45)％],而前足外側壓彊的百分比[(45.45±17.71)％]大于對照組優勢側[(37.47±12.60)％];病例組健側第1趾壓彊的所佔百分比[(9.04±7.47)％]小于對照組優勢側[(14.84±6.54)％],而病例組中足及足跟壓彊的所佔百分比[患側(38.17±13.57)％,健側(49.61±26.36)％]均大于對照組優勢側[(25.05±4.92)％],且組間差異均有統計學意義(P＜0.05);病例組患側前足外側壓彊的所佔百分比[(45.45±17.71)％]大于組內患者健側[(37.04±22.09)％],且差異有統計學意義(P＜0.05).②病例組患側第1趾接觸麵積佔全足的百分比[(9.96±1.67)％]大于對照組優勢側[(8.57±1.17)％],前足內側接觸麵積佔全足的百分比[(14.71±4.64)％]小于對照組優勢側[(17.62±1.52)％],且組間差異均有統計學意義(P＜0.05);病例組其餘各區域健患側組內比較,差異無統計學意義(P＞0.05).③病例組患側全足、前足內外側壓彊比值最大值[(27.21±22.73)、(22.81±22.19)]明顯小于對照組優勢側[(43.68±23.78)、(41.09±28.13)],組間差異均有統計學意義(P＜0.05),而足跟的足內外側壓彊比值的最大值組間比較以及健患側之間全足、前足及足跟足內外側壓彊比值的最大值比較,差異均無統計學意義(P＞0.05),但有患側小于對照組優勢側及患側小于健側的趨勢(P＞0.05).④病例組健患側足在支撐期翻轉程度減小,整體呈內翻.⑤病例組經CSI評定有輕度痙攣13例,中度痙攣5例,重度痙攣4例.病例組患側總體的踝關節CSI得分(10.26±3.38)分,95％可信區間位于8.63 ～11.89.病例組患側全足的內外側壓彊比值最大值與前足外側壓彊呈中度負相關(r=-0.516,P＜0.05),與接觸麵積及CSI無關(P＞0.05).結論 足底壓力可定量描述腦卒中偏癱患者的足內翻,足內外側壓彊比值的最大值是反映腦卒中偏癱患者足內翻的有效指標.
목적 탐토가묘술뇌졸중편탄환자보행지탱기족내번적족저압역학삼수.방법 선취능독립보행적뇌졸중편탄환자22례설위병례조,령선여환자년령、체중상필배적중노년건강지원자17례설위대조조,사용Footscan압력판측량수시자상속행주하적족저압력,채집쌍족각3차적동태족저압력,득도족내외측압강비치,기록병분석환자행주시족저각구역적압강봉치화접촉면적(본연구소정현적수거균위모개구역삼수상대우소유분구대응삼수지화적백분비).병사용림상경련지수(CsI)평개환자환측과관절적경련정도,병비교대조조건강인여병례조환자건환측지간상술삼수적차이급기상관성.결과 ①병례조환측전족내측압강점소유분구지화적백분비[(23.52±10.15)％]소우대조조우세측[(29.82±7.45)％],이전족외측압강적백분비[(45.45±17.71)％]대우대조조우세측[(37.47±12.60)％];병례조건측제1지압강적소점백분비[(9.04±7.47)％]소우대조조우세측[(14.84±6.54)％],이병례조중족급족근압강적소점백분비[환측(38.17±13.57)％,건측(49.61±26.36)％]균대우대조조우세측[(25.05±4.92)％],차조간차이균유통계학의의(P＜0.05);병례조환측전족외측압강적소점백분비[(45.45±17.71)％]대우조내환자건측[(37.04±22.09)％],차차이유통계학의의(P＜0.05).②병례조환측제1지접촉면적점전족적백분비[(9.96±1.67)％]대우대조조우세측[(8.57±1.17)％],전족내측접촉면적점전족적백분비[(14.71±4.64)％]소우대조조우세측[(17.62±1.52)％],차조간차이균유통계학의의(P＜0.05);병례조기여각구역건환측조내비교,차이무통계학의의(P＞0.05).③병례조환측전족、전족내외측압강비치최대치[(27.21±22.73)、(22.81±22.19)]명현소우대조조우세측[(43.68±23.78)、(41.09±28.13)],조간차이균유통계학의의(P＜0.05),이족근적족내외측압강비치적최대치조간비교이급건환측지간전족、전족급족근족내외측압강비치적최대치비교,차이균무통계학의의(P＞0.05),단유환측소우대조조우세측급환측소우건측적추세(P＞0.05).④병례조건환측족재지탱기번전정도감소,정체정내번.⑤병례조경CSI평정유경도경련13례,중도경련5례,중도경련4례.병례조환측총체적과관절CSI득분(10.26±3.38)분,95％가신구간위우8.63 ～11.89.병례조환측전족적내외측압강비치최대치여전족외측압강정중도부상관(r=-0.516,P＜0.05),여접촉면적급CSI무관(P＞0.05).결론 족저압력가정량묘술뇌졸중편탄환자적족내번,족내외측압강비치적최대치시반영뇌졸중편탄환자족내번적유효지표.
Objective To find the plantar pressure readings which best indicate foot inversion during the stance phase of walking among hemiplegic stroke survivors.Methods Twenty-two hemiplegic stroke survivors who were able to walk without extra aid were recruited as the experimental group, while 17 healthy elderly men of similar age and body weight were selected as the control group.Those in both groups were asked to walk at their preferred speed over a Footscan device which measured medio-lateral pressure ratios, maximum plantar pressures and the contact areas of both feet.The Clinical Spasticity Index (CSI) was used to evaluate the affected feet.Results The average medial forefoot pressure of the affected side in the experimental group was significantly lower than that of the control group, but their average mesopodium and heel pressure was significantly higher.The average pressure applied by the great toe on the uninjured side in the experimental group was significantly smaller than that of the control group, but the average mesopodium and heel pressure of both feet among the hemiplegics were significantly higher than those of the control group.Among the experimental group, the average medial forefoot pressure of the affected foot was significantly greater than that of the healthy foot.The average contact area of the great toe on the affected side was significantly bigger than was observed in the control group.That of the medial forefoot was, however, significantly smaller than in the control group.There was no significant difference in the contact area between the healthy and affected feet in the experimental group, though the maxmium medio-lateral pressure ratios of their full feet and forefeet on the affected side were significantly lower than those in the healthy group.No significant differences in the maxmium medio-lateral pressure ratios of the heel were observed between the two groups, nor of the full feet, forefeet and heels of the affected and unaffected sides in the experimental group.The patients demonstrated consistently reduced joint mobility on both sides during the stance phase, coinciding with increased inversion.A significant negative correlation was found between the maxmium medio-lateral pressure ratios of the full foot and the maximum pressure of the lateral part of forefoot in the experimental group, but there was no significant correlation with contact area or CSI.Conclusions Plantar pressure data can be used to describe the amount of foot inversion in the stance phase of walking with hemiplegic patients after stroke.The maxmium medio-lateral pressure ratios can effectively reflect their foot inversion.
