踝足矫形器对脑卒中后偏瘫患者步态稳定性恢复的影响  

Effects of ankle-foot orthosis on gait stability and balance control in patients with hemiparetic stroke

作　　者：徐光青[1] 兰月[2] 黄东锋[1] 陈正宏[1] 丁明晖[1] 

机构地区：[1]中山大学附属第一医院康复医学科,广州510080 [2]中山大学附属第三医院康复医学科

出　　处：《中华医学杂志》2011年第13期890-893,共4页National Medical Journal of China

基　　金：国家自然科学基金（81071608）

摘　　要：目的 探讨佩戴踝足矫形器对脑卒中后偏瘫患者步态稳定性和平衡控制能力恢复的影响.方法 首次发病、慢性单侧偏瘫脑卒中患者25例.采用功能评定和运动解析系统评测佩戴踝足矫形器前后及4周随访时的平衡控制和步态时相参数.结果 对偏瘫患者佩戴踝足矫形器前、即刻和4周时最大步行速度[（27±11）m/min,（34±13）m/min,（39±10）m/min]、步行能力分级（4.2±0.6,4.3±0.5,4.7±0.5）、Berg平衡量表（48±4,48±4,50±4）、5次坐立试验（24.0±1.6,24.1±1.6,20.4±3.1）和步态不对称指数（0.197±0.035,0.169±0.026,0.135±0.027）进行重复测量方差分析,差异均有统计学意义（均P＜0.01）.佩戴即刻最大步行速度和步行能力分级提高,步态不对称指数减小,差异有统计学意义（P＜0.05）.使用4周后所以测量指标均有改善,差异具有显著统计学意义（P＜0.01）.结论 佩戴踝足矫形器后,步行能力和步态稳定性即刻就有明显改善;而经适应训练使用4周后,步行能力和步态稳定性继续提高,平衡控制能力也得到改善.Objective To quantitatively analyze the effects of ankle-foot orthosis （AFO） on gait stability and explore its use for walking capacity, gait stability and balance control in post-stroke patients.Methods A total of 25 inpatients with prior chronic hemiparesis from stroke who could walk at least 10meters without assistance were recruited. The maximal walking speed and gait asymmetry index were examined by a motion analysis system. Functional balance was assessed by the Functional Ambulation Categories, Berg Balance Scale and Five-Times-Sit-to-Stand Test. Results AFO had positive effects on the hemiplegic gait parameters of improving walking speed, gait stability and functional balance （ P ＜ 0. 01 ）.Pair wise comparisons suggested that there were significant differences in the maximal walking speed,Functional Ambulation Categories and gait asymmetry index after an immediate use of AFO （ P ＜ 0.05 ）. At Week 4, there were significant differences in the parameters of walking speed, gait asymmetry index and functional balance control （ P ＜ 0.01 ）. Conclusion The use of AFO may compensate the instability of gait and balance. Functional tests improve significantly with orthosis.

关 键 词：踝足矫形器 脑卒中 步态稳定 平衡 步速 

分 类 号：R743.3[医药卫生—神经病学与精神病学]