脑卒中患者常用下肢辅助设备干预下步态分析的对比研究

关键词：运动贴布  弹力绷带  踝足矫形器  步态分析  脑卒中

Keywords:Kinesio taping  elastic bandage  ankle-foot orthosis  gait analysis  stroke

摘要：

      摘要 目的：探究不同下肢辅助步行设备对脑卒中患者步行能力的影响。 方法：选取脑卒中后步行功能障碍患者50例，选取GaitWatch三维步态分析与评估系统在患者独立无干预步行（independent walking without intervention， IW）、运动贴布辅助步行（Kinesio taping-assisted walking， KTW）、弹力绷带辅助步行（elastic bandage-assisted walking， EBW）及踝足矫形器辅助步行（ankle-foot orthosis assisted walking， AFOW）状态下，分别进行步态分析，最终对比各组间数据差异。 结果：在步行时空参数方面，4组间无明显差异性（P＞0.05）；在步行周期方面，EBW相比于IW及KTW在健侧支撑相百分比减小及健侧摆动相百分比增大（P＜0.05）；AFOW相比于IW及KTW在患侧支撑相百分比减小及摆动相百分比增大、健侧支撑相百分比减小及摆动相百分比增大和双足支撑相百分比减小，相比于EBW在患侧支撑相百分比减小及摆动相百分比增大和双足支撑相百分比减小（P＜0.05）；在步行关节角度方面，KTW相比于IW、EBW及AFOW在患侧踝关节背屈最大角度增大，相比于IW在患侧踝关节跖屈最大角度增大（P＜0.05）；EBW相比于AFOW在患侧踝关节背屈最大角度增大，相比于IW在患侧踝关节最大背屈及跖屈角度增大（P＜0.05）；AFOW相比于其他三组在健侧髋关节屈曲及伸展最大角度、患侧膝关节屈曲及患侧踝关节跖屈最大角度增大，相比于IW在患侧踝关节背屈最大角度增大（P＜0.05）。 结论：短时间内佩戴不同下肢辅助步行设备，踝足矫形器可作为首选辅助患者完成相关训练任务，运动贴布可在患者肌张力较高时应用，弹力绷带可在治疗条件有限时辅助使用。

Abstract:

      Abstract Objective： To explore effects of different lower limb assisted walking equipment on walking ability of stroke patients. Method： Fifty patients with walking dysfunction after stroke were selected. GaitWatch 3D gait analysis and evaluation system was selected to conduct gait analysis under the conditions of independent walking without intervention（IW），Kinesio taping-assisted walking（KTW），elastic bandage-assisted walking（EBW） or ankle-foot orthosis assisted walking（AFOW），respectively and finally the data were compared among every group. Result： There was no significant difference in walking speed among the four groups（P＞0.05）.In terms of walking cycle， compared with IW and KTW， the percentage of support phase on the healthy side decreased, while the percentage swing phase on the healthy side increased in EBW （P＜0.05）.Compared with IW and KTW， AFOW decreased the percentage of support phase, and increased the percentage of swing phase on both the affected and healthy sides，and decreased the percentage of bipedal support phase. AFOW decreased the percentage of support phase and increased the percentage of swing phase on the affected side, and increased the bipedal support phase compare to EBW（P＜0.05）. In terms of walking joint Angle， KTW increased the maximum Angle of dorsiflexion of ankle joint on the affected side when compared with IW， EBW and AFOW， and increased the maximum Angle of plantar flexion of ankle joint on the affected side when compared with IW （P＜0.05）. EBW increased the maximum Angle of dorsiflexion of ankle joint on the affected side when compared with AFOW， and increased the maximum and plantar-flexion Angle of ankle joint on the affected side when compared with IW（P＜0.05）. AFOW increased the maximum Angle of hip flexion and extension on the healthy side， the maximum Angle of knee flexion on the affected side and the maximum Angle of ankle plantar flexion on the affected side when compared with the other three groups， and increased the maximum Angle of ankle dorsiflexion on the affected side compared with IW （P＜0.05）. Conclusion： Different lower limb assisted walking equipment can be worn for a short time， ankle-foot orthosis can be used as the first choice to assist patients to complete relevant training tasks， Kinesio Taping can be applied when patients have high muscle tension， and elastic bandage can be used when treatment conditions are limited.