下肢髋膝过伸代偿对帕金森病患者步态的影响

关键词：帕金森病  病程  步态分析  运动学参数

Keywords:Parkinson's disease  process  gait analysis  kinematics paramete

摘要：

      摘要 目的：研究下肢髋膝过伸代偿对不同病程帕金森病患者步态特点的影响。 方法：选取2020—2022年于复旦大学附属华山医院住院的157例原发帕金森病患者，根据患病时间分组，分为短病程组（病程≤5年）、中病程组（5年＜病程≤10年）及长病程组（病程＞10年），同时以健康受试者37人次为对照组，利用可穿戴式步态采集设备采集3组患者和健康对照组人群步态时空参数和运动参数，比较各组间受试者步态参数差异。 结果：随着病程增加，帕金森病患者步态参数变化明显，与健康对照组相比，帕金森病患者在步幅、步速方面损害最为显著；同时，患者步行过程中屈髋、屈膝角度随着病程的增加下降明显，并且与病程呈正比，而伸髋、伸膝在疾病早期代偿性活动角度增加，随着病程的增加，代偿功能逐渐消退（伸髋代偿消退早于伸膝代偿）并导致步态异常逐渐加重。 结论：下肢髋膝过伸代偿机制在帕金森病病程中呈现动态演变规律。在帕金森病的功能诊断、康复治疗及疾病预测等方面具有指导意义。

Abstract:

      Abstract Objective：To study the effect of lower limb hip and knee hyperextension compensation on gait characteristics of Parkinson's disease patients at different stages. Method：A total 149 patients with primary Parkinson's disease admitted to Huashan Hospital of Fudan University from 2020 to 2022 were divided into three groups based on the duration of the disease: short course group （duration≤5years），medium course group （5 years10 years）. Additionally，37 healthy subjects were selected as the control group. A wearable gait acquisition device was used to collect the temporal and spatial parameters of gait and movement parameters of the three groups of patients and the healthy control group. The differences in gait parameters among the groups were compared. Result：The gait parameters of Parkinson's disease patients changed significantly with the progression of the disease. Compared with the healthy control group, the stride length and stride speed of Parkinson's disease patients showed the most significant impairment. Additionally， the angles of hip flexion and knee flexion during walking decreased significantly with the progression of the disease and were proportional to the duration of the disease， while the angles of compensatory activity of hip extension and knee extension increased in the early stage of the disease， and the compensatory function gradually subsided with the progression of the disease （the regression of hip extension compensation was earlier than that of knee extension compensation）, leading to the gradual aggravation of abnormal gait. Conclusion：The compensatory mechanism of hip and knee hyperextension in the lower extremities presents a dynamic evolution pattern through the course of Parkinson's disease. This has guiding significance for functional diagnosis， rehabilitation treatment and disease prediction in Parkinson's disease.