脑卒中偏瘫患者膝过伸步态与下肢肌肉激活功能的相关性  

Correlation between knee hyperextension gait and lower limb muscle activation in stroke patients with hemiplegia

作　　者：徐翰林 胡国炯 郑绍城 曾晓文 曾宪华[1] 邵文启 XU Hanlin;HU Guojiong;ZHENG Shaocheng;ZENG Xiaowen;ZENG Xianhua;SHAO Wenqi(Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center),Tongji University,Shanghai 201613,China;Zhejiang Rehabilitation Medical Center,Hangzhou,Zhejiang 310052,China)

机构地区：[1]同济大学附属养志康复医院(上海市阳光康复中心),上海市201613 [2]浙江康复医疗中心,浙江杭州市310052

出　　处：《中国康复理论与实践》2023年第2期151-155,共5页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的观察脑卒中膝过伸患者步行时膝关节过伸角度与下肢各关节运动学参数及下肢主要肌肉激活情况的相关性。方法2020年8月至2021年9月,在同济大学附属养志康复医院选择伴膝过伸的脑卒中患者24例,以及性别、年龄、身高及体质量匹配并伴膝过伸的健康人24例,采用三维运动捕捉系统和无线表面肌电采集系统进行分析,记录骨盆、髋、膝、踝关节在矢状面上的角度,以及双侧臀大肌、股二头肌、股内侧肌、腓肠肌内侧头肌电数据。结果脑卒中患者单腿支撑相的最大膝过伸角度时,各关节角度和各肌肉激活度均与健康人有非常显著性差异(|t|>3.080,P<0.01)。脑卒中患者单腿支撑相的最大膝过伸角度与臀大肌激活度明显负相关(r=-0.532,P<0.01);两组膝过伸最大角度与踝跖屈角度呈显著正相关(r>0.686,P<0.001)。结论脑卒中患者膝过伸步态的矫正不仅需要关注膝关节控制,还需要关注踝关节控制和臀肌功能。Objective To explore the correlation among knee hyperextension angle,lower limb joints kinematics parameters and the activation of main muscles of lower limb in stroke hemiplegic patients with knee hyperextension during walking.Methods From August,2020 to September,2021,24 stroke hemiplegic patients with knee hyperextension and 24 healthy subjects matched with sex,age,height and body mass with knee hyperextension were analyzed with three-dimensional gait analysis system and the wireless surface electromyography acquisition system,to record the range of motion of pelvis,hip,knee and ankle joints in sagittal plane,and the activation of bilateral gluteus maximus,biceps femoris,vastus medialis and gastrocnemius medialis.Results As the maximum of knee hyperextension,range of motion of the joints in sagittal plane and the activation of the muscles were different between the patients and the healthy subjects during the single-support phase of walking(|t|>3.080,P<0.01),and the maximum of knee hyperextension correlated with the activation of gluteus maximus in the patients(r=-0.532,P<0.01),and the range of motion of ankle plantar flexion in both the patients and the healthy subjects(r>0.686,P<0.001).Conclusion The correction for knee hyperextension gait in stroke hemiplegic patients may not only need to pay attention to knee joint control,but also need further treatment of ankle control and hip muscle function.

关 键 词：脑卒中 偏瘫 膝过伸 关节活动度 肌肉激活 

分 类 号：R743.3[医药卫生—神经病学与精神病学]