功能性踝关节不稳患者步态对称性的研究: 基于矢量编码技术

关键词：功能性踝关节不稳  步态对称性  健侧和患侧  协调模式  协调变异性

Keywords:functional ankle instability  gait symmetry  healthy side and affected side  coordination mode  coordination variability

摘要：

      摘要 目的：探索单侧功能性踝关节不稳（FAI）步态对称性。 方法：招募15例男性右侧功能性踝关节不稳受试者，运用Qualisys采集并截取左右两侧步态周期数据，运用Matlab计算耦合角及耦合角标准差并使用Cohen's d评价效果量。 结果：①健侧和患侧耦合角在矢状面内出现差异，其中髋-膝关节、髋-踝关节平均耦合角在预摆期健侧高于患侧（P<0.05， d=1.02；d=1.11）；膝-踝关节平均耦合角在支撑末期后50%健侧高于患侧（P<0.05，d=1.21），预摆期健侧高于患侧（P<0.05，d=1.07）及摆动期25%—50%健侧低于患侧（P<0.01，d=1.51）。②健侧与患侧在冠状面内仅在髋-踝关节间出现耦合角的差异，即预摆期健侧高于患侧（P<0.05， d=1.07）及步态摆动期最后部分健侧高于患侧（P<0.05， d=1.06）。③健侧矢状面膝-踝关节承重期、支撑中期耦合角标准差低于患侧（P＜0.01）以及健侧冠状面髋-踝关节支撑中期及摆动期的耦合角标准差高于患侧（P＜0.01）。 结论：①功能性踝关节不稳患者步行时患侧协调模式主要为矢状面近端支配同相与冠状面远端支配反向协调模式，即踝关节优势增加，而髋、膝关节优势减少。②矢状面内膝-踝关节及冠状面内髋-踝关节患侧较健侧分别产生的更低及更高的变异性共同提示患侧踝关节步态适应性更低致使步态不对称，使踝关节损伤风险提高。③基于上述结果建议未来康复治疗应重点加强患侧髋膝伸肌与外展肌力量，提高单侧FAI左右步态对称性，降低踝关节不稳患者复发性损伤风险。

Abstract:

      Abstract Objective： To explore gait symmetry of unilateral functional ankle instability （FAI）. Method： Fifteen male subjects with right functional ankle instability were recruited， Qualisys was used to collect and intercept gait cycle data on both sides. Coupling angle and standard deviation of the coupling angle were calculated using Matlab and the effect size was evaluated using Cohen's d. Result： ①The coupling angles of the healthy side and the affected side were different in the sagittal plane. The average coupling angles of the hip-knee joint and the hip-ankle joint were higher on the healthy side than on the affected side in the pre-swing period （P<0.05， d=1.02； d=1.11）； The average coupling angle of the knee to ankle was higher in 50% of the healthy side than the affected side after the end of support （P<0.05， d=1.21）， higher in the pre-swing stage than in the affected side （P<0.05， d=1.07）， and lower in 25%—50% of the healthy side during the swing stage than in the affected side （P<0.01， d=1.51）. ②The coupling angle between the healthy side and the affected side was different in the coronal plane only between the hip and ankle joint， that is， the healthy side was higher than the affected side in the pre-swing stage （P<0.05， d=1.07） and the healthy side was higher than the affected side in the last part of the gait swing stage （P<0.05， d=1.06）. ③The standard deviation of coupling angle of sagittal plane of healthy side was lower than that of affected side （P<0.01）， and the standard deviation of coupling angle of coronal plane of healthy side was higher than that of affected side （P<0.01）. Conclusion： ①In patients with functional ankle instability， the coordination pattern of the affected side was mainly in the same pattern of proximal sagittal domination and the reverse pattern of distal coronal domination， that is， the dominance of the ankle joint increased， while the dominance of the hip and knee joint decreased. ②The lower or higher variability of knee-ankle joint in sagittal plane or hip-ankle joint in coronal plane respectively than that of healthy side suggest that ankle joint on the affected side has lower gait adaptability， resulting in gait asymmetry and increasing the risk of ankle joint injury. ③Based on the above results， it is suggested that future rehabilitation therapy should focus on strengthening the strength of the knee extensor and abductor muscles of the affected hip， improving the symmetry of the left and right gait of unilateral FAI， and reducing the risk of recurrent injury in patients with ankle instability.