发作间歇期痛风患者步态特征研究  

Gait characteristics of patients with gout inintermittent stage

作　　者：李慧丹 李阔弟 李晓丁 魏星 张琳 刘畅格[1,2] 赵伟 黄力平[1,2] Li Huidan;Li Kuodi;Li Xiaoding;Wei Xing;Zhang Lin;Liu Changge;Zhao Wei;Huang Liping(Experimental Teaching and Training Center of Tianjin University of Sport,Tianjin 301617,China;Tianjin Key Laboratory of Exercise Physiology and Sports Medicine,Tianjin 300211,China;School of Sports and Health,Jiangxi University of Chinese Medicine,Nanchang 330004,China;Zhuhai Special Education School,Zhuhai 519000,China;Department of Rehabilitation Medicine,Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Gout,Zhu Xianyi Memorial Hospital of Tianjin Medical University,Tianjin 300381,China)

机构地区：[1]天津体育学院实验教学实训中心,天津301617 [2]天津市运动生理与运动医学重点实验室,天津300211 [3]江西中医药大学体育健康学院 [4]珠海市特殊教育学校 [5]南昌大学第二附属医院康复医学科 [6]天津医科大学朱宪彝纪念医院痛风科

出　　处：《中国运动医学杂志》2024年第2期103-110,共8页Chinese Journal of Sports Medicine

基　　金：国家重点研发计划(2020YFC2006704);天津市教委科研计划项目(2020SK161)。

摘　　要：目的:探讨发作间歇期痛风患者的步态特征,为痛风的临床康复治疗尤其是运动康复提供客观依据。方法:共纳入24例痛风患者(痛风组)和24例健康志愿者(健康对照组),并对痛风患者进行曼彻斯特足痛和残疾指数(Manchester foot pain and disability index,MFPDI)评分。利用步态录像解析法采集所有受试者的运动学参数,Novel Pedar足底压力测试系统采集受试者的足底压力参数;比较两组受试者运动学和足底压力参数的差异。结果:①痛风组步长、步幅、步速、步频、膝关节最大屈伸角度、踝关节最大跖屈角度及屈伸幅度均小于健康对照组(P<0.05,P<0.01),双支撑时间大于健康对照组(P<0.01)。②痛风组大拇趾区峰值压力和压力-时间积分小于健康对照组(P<0.05,P<0.01),足中部峰值压力和第一跖骨区压力-时间积分大于健康对照组(P<0.05,P<0.01)。③痛风患者大拇趾区峰值压力与步态运动学参数相关性分析发现:大拇趾区峰值压力与步长、步幅、步频、踝关节最大背伸角度呈正相关(P<0.05),与双支撑时间呈负相关(P<0.05)。结论:痛风间歇期患者步态存在明显异常,主要表现为步长和步幅减小,步速和步频减慢,双支撑时间延长;膝、踝关节活动幅度减小;步行中前足内侧负荷降低而足中部负荷增大,这表明了一种疼痛避免策略,这些变化有可能导致痛风患者步行模式的改变和足部功能受损。Objective To explore the gait characteristics of patients with intermittent gout,so as to provide objective evidences for its clinical rehabilitation,especially the exercise rehabilitation.Methods Twenty-four gout patients were selected into the gout group,while 24 healthy counterparts were cho⁃sen into the healthy control group.Then the gout group was evaluated using the Manchester foot pain and disability index(MFPDI).Moreover,both groups were collected the kinematic parameters and the plantar pressure parameters using the gait video analysis method,and the Novel Pedar plantar pres⁃sure test system,respectively,followed by a comparison of their results.Results①The step length,stride length,stride speed,stride frequency,maximum knee flexion and extension angles,as well as the maximum plantar flexion angle,and flexion and extension amplitude of the ankle of the gout group were smaller than the healthy control group(P<0.05,P<0.01),while the double supporting time was significantly longer than the latter(P<0.01).②The peak pressure and pressure-time integral of the big toe region in the gout group were significantly lower than the healthy control group(P<0.05,P<0.01),while those of the middle foot and the first metatarsal regions were significantly higher than the latter group(P<0.05,P<0.01).③The correlation analysis showed that the peak pressure in the big toe region was positively correlated with the step length,stride length,stride frequency and maximum dorsal extension angle of the ankle joint(P<0.05),but negatively correlated with the double supporting time(P<0.05).Conclusion The gait of patients with intermittent gout is obviously abnormal,mainly with reduced step length,stride length and movement rangeof the knee and ankle joints,slower step speed and stride frequency,and prolonged double supporting time,as well as reduced medial forefoot load and increased midfoot load during walking.The above pain-avoidance strategy and changes may lead to altered walking patterns and impaired foot function among

关 键 词：痛风 步态 时空特征 足底压力 

分 类 号：R589.7[医药卫生—内分泌] G804.2[医药卫生—内科学]