双侧中重度拇外翻患者的步态特征及下肢运动链分析

关键词：拇外翻  双侧  中重度  下肢运动链  步态特征

Keywords:hallux valgus  bilateral  moderate to severe  lower limb kinetic chain  gait characteristics

摘要：

      摘要 目的：观察并分析双侧中重度拇外翻（hallux valgus， HV）患者以自适应步速行进过程中的异常步态特征与下肢运动链情况。 方法：于2022年9月至2023年8月在中国中医科学院望京医院关节科选取33例中重度HV患者入观察组，并匹配选取29例健康受试者入对照组。应用DC-G-150-F2三维步态分析系统分别采集两组在10m自适应步速行进过程的步态特征与下肢运动链情况，观察并分析所获取的步态时-空参数与髋、膝、踝等下肢关节的运动学参数变化。 结果：观察组患者左侧与右侧支撑相、总双支撑相、左侧足偏角、步长、步幅及步速等步态时-空参数均显著低于对照组受试者（P＜0.05）。观察组患者左侧与右侧摆动相及步频等步态时-空参数均显著高于对照组受试者（P＜0.05）。两组的右侧足偏角及步宽不存在显著差异（P＞0.05）。观察组患者右侧髋关节屈伸、左侧髋关节旋转、左侧与右侧膝关节旋转及左侧与右侧踝关节屈伸活动范围均显著低于对照组受试者（P＜0.05）。两组在左侧髋关节屈伸、右侧髋关节旋转、左侧与右侧髋关节展收、左侧与右侧膝关节屈伸及左侧与右侧踝关节翻转活动范围上均不存在显著性差异（P＞0.05），但观察组患者右侧髋关节旋转与右侧膝关节屈伸活动范围明显低于对照组受试者（P=0.084，P=0.093）。 结论：双侧中重度拇外翻患者步态改变表现为步态周期中单、双支撑相缩短，摆动相延长，步频增加，步长与步幅减小，以“碎步慢赶”的特征行进，下肢各关节在矢状面与水平面的活动范围降低，整个下肢运动链呈僵硬、绞扭的状态。

Abstract:

      Abstract Objective：To observe and analyze the abnormal gait characteristics and lower limb kinematic chain in patients with bilateral moderate-to-severe hallux valgus (HV) during adaptive walking. Method：From September 2022 to August 2023，33 patients with moderate-and-severe HV were selected from the department of arthrology， Wangjing Hospital， Chinese Academy of Traditional Chinese Medicine and enrolled in the observation group. A group of 29 healthy subjects were matched and enrolled in the control group. DC-G-150-F2 three-dimensional gait analysis system was used to collect gait characteristics and lower limb motion chain of two groups during a 10m adaptive walking test. Temporal-spatial gait parameters and kinematic changes in the hip, knee, and ankle joints were observed and analyzed. Result：The gait time-space parameters of left and right support phase， total double support phase， left lateral foot deviation angle， step length， stride length and pace in the observation group were significantly lower than those in the control group （P＜0.05）. In contrast, the time-space parameters of left and right swing phase and stride frequency in the observation group were significantly higher than those in the control group （P＜0.05）. The two groups had no significant difference in right lateral foot deviation angle and step width （P＞0.05）. The range of flexion and extension of the right hip joint， rotation of the left hip joint， rotation of the left and right knee joint and flexion and extension of the left and right ankle joint in the observation group were significantly lower than those in the control group （P＜0.05）. There were no significant differences between the two groups in the range of motion of left hip flexion and extension， right hip rotation， left versus right hip spreading， left versus right knee flexion and extension， and left versus right ankle rotation （P＞0.05）. However， the range of motion of right hip rotation and right knee flexion and extension was lower than that of the control subjects （P=0.084， P=0.093）. Conclusion：Gait changes in patients with bilateral moderate-to-severe bunions are characterized by shortened single and double support phases， prolonged swing phase， increased step frequency， reduced step length and stride length， and a "broken stride and slow catching up" walking pattern. The range of motion of each lower limb joint in the sagittal plane and horizontal plane is reduced， resulting in a rigid and twisted state throughout the lower limb kinematic chain.