偏瘫患者以不同步态模式通过障碍物的生物力学特征对比分析  

Comparative Analysis of Biomechanical Characteristics in Hemiplegic Patients Passing Through Obstacles

作　　者：周鲁星 孟庆华[1,2,3] 刘文红[4] 黄旭 刘姣 李猛[4] 薛艳艳[4] ZHOU Luxing;MENG Qinghua;LIU Wenhong;HUANG Xu;LIU Jiao;LI Meng;XUE Yanyan(Tianjin Teaching Center of Sports Injury and Rehabilitation Virtual Simulation Experiment,Tianjin University of Sport,Tianjin 301617,China;Tianjin key Laboratory of Sports Physiology and Sports Medicine,Tianjin University of Sport,Tianjin 301617,China;School of Sports Economics and Management,Tianjin University of Sport,Tianjin 301617,China;Tianjin Rehabilitation and Convalescent Center of the People’s Liberation Army Joint Service Support Force,Tianjin 300110,China)

机构地区：[1]天津体育学院天津市运动损伤与康复虚拟仿真实验教学中心,天津301617 [2]天津体育学院天津市运动生理与运动医学重点实验室,天津301617 [3]天津体育学院体育经济与管理学院,天津301617 [4]中国人民解放军联勤保障部队天津康复疗养中心,天津301617

出　　处：《医用生物力学》2022年第5期805-811,共7页Journal of Medical Biomechanics

基　　金：天津市自然科学基金项目(18JCZDJC35900,17JCZDJC36000);天津市研究生创新项目(2020YJSB104)。

摘　　要：目的探讨偏瘫患者使用“健上患下”和“患上健下”步态模式通过障碍物的生物力学特征,为降低患者跌倒发生率提供理论依据。方法采用Qualisys动作捕捉系统和三维测力台采集15名偏瘫患者正常行走、健上患下、患上健下通过障碍物的运动学和动力学数据,并对数据进行处理与分析。结果与正常行走相比,健上患下和患上健下通过障碍物都不同程度增加了双侧的下肢活动幅度;与正常行走和健上患下相比,患上健下模式下患侧腿垂直地面反作用力出现较大波动,步态稳定性较差,具有较大跌倒风险。结论患者通过障碍物时,对接触障碍物的一侧肢体关节活动幅度要求较高,患侧肢适应能力较差。在触地后单腿支撑期,垂直方向地面反作用力变化较大。当身体重量完全转移到该侧时,容易导致患者跌倒。相比患上健下,患者使用健上患下方式通过障碍物时能容易保持步态稳定性,降低跌倒风险。Objective To explore biomechanical characteristics of hemiplegic patients using UOHL(up obstacles with healthy leg,down obstacles with affected leg)and UOAL(up obstacles with affected leg,down obstacles with healthy leg)to pass through obstacles,and to provide theoretical basis for reducing the incidence of falls in patients.Methods The Qualisys motion capture system and three⁃dimensional(3D)force plate were used to collect the kinematics and dynamics data of 15 hemiplegic patients passing through obstacles with normal walking mode(NWM),UOHL and UOAL,and the data were processed and analyzed.Results Compared with NWM,both UOHL and UOAL increased bilateral lower extremity range of motion(ROM)to some extent.Compared with NWM and UOHL,vertical ground reaction force(GRF)of affected leg side under UOAL fluctuated more,and gait stability was worse,indicating a greater risk of falling.Conclusions When patients pass through the obstacle,the requirements for joint ROM on the side of the obstacle are relatively high,the adaptability of the affected leg side is poor.The GRF in vertical direction changes greatly during single⁃leg support period after touching the ground.When the body weight is completely transferred to this side,it is easy for the patient to fall.Compared with UOAL,patients can easily maintain gait stability when using UOHL to pass through obstacles,and the risk of falling will be reduced.

关 键 词：偏瘫 障碍物 关节活动幅度 步态稳定性 跌倒 

分 类 号：R318.01[医药卫生—生物医学工程]