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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (06) : 338 -343. doi: 10.3877/cma.j.issn.2095-123X.2022.06.004

临床研究

躯干姿势调整对脑卒中偏瘫患者步行能力的影响
张军1, 王宝军1,†(), 黄妍1, 赵海1, 梁磊1, 安旭1, 金渊媛1   
  1. 1. 014040　包头市中心医院康复医学科
  • 收稿日期:2022-03-16 出版日期:2022-12-15
  • 通信作者: 王宝军
  • 基金资助:
    包头市科技计划项目(2017S2001-4-10)

Effect of trunk posture adjustment on walking ability in stroke hemiplegic patients

Jun Zhang1, Baojun Wang1,†(), Yan Huang1, Hai Zhao1, Lei Liang1, Xu An1, Yuanyuan Jin1   

  1. 1. Department of Rehabilitation Medicine, Baotou Central Hospital, Baotou 014040, China
  • Received:2022-03-16 Published:2022-12-15
  • Corresponding author: Baojun Wang
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引用本文：

张军, 王宝军, 黄妍, 赵海, 梁磊, 安旭, 金渊媛. 躯干姿势调整对脑卒中偏瘫患者步行能力的影响[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(06): 338-343.

Jun Zhang, Baojun Wang, Yan Huang, Hai Zhao, Lei Liang, Xu An, Yuanyuan Jin. Effect of trunk posture adjustment on walking ability in stroke hemiplegic patients[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(06): 338-343.

目的

研究躯干姿态调整对脑卒中偏瘫患者行走能力的影响。

方法

选取自2018年4月到2020年10月于包头市中心医院康复医学科行康复治疗的60例脑卒中偏瘫患者，按照随机数字表分为试验组（30例）和对照组（30例）。对照组进行常规康复，试验组行常规康复联合躯干姿势调整疗法。2组的治疗频率为40 min/次，1次/d，5 d/周，共治疗4周。在治疗前和治疗4周后评估2组6 min步行距离（6 MWD）、10 m步行时间（10 MWT），使用步态分析仪测量空间、时间参数，比较骶骨倾斜角（SS）、骨盆投射角（PI）、骨盆倾斜角（PT）的变化。

结果

试验组在治疗4周后的6 MWD和10 MWT均较治疗前有显著改善，差异具有统计学意义（P<0.05）。治疗4周后，试验组步态分析仪测量的空间参数较对照组提升更为显著，差异具有统计学意义（P<0.05）。2组患者治疗4周后双支撑期时间、患健侧支撑期时间较治疗前缩短，患健侧摆动期时间较治疗前增加，且试验组双支撑期时间缩短更明显，差异均具有统计学意义（P<0.05）；2组患者患侧支撑期、摆动期时间分别与健侧比较，差异无统计学意义（P>0.05）。2组患者治疗4周后脊柱正侧位、骨盆正位X光片测量相关指标比较：PI、SS、PT的变化差异无统计学意义（P>0.05）。

结论

常规康复疗法联合躯干姿势调整在改善脑卒中偏瘫患者运动功能方面相对于单独使用常规康复疗法较优。

关键词: 躯干姿势调整, 脑卒中, 偏瘫, 步行能力, 康复治疗
Objective

To investigate the effect of postural correction on the walking ability of stroke patients.

Methods

From April 2018 to October 2020, 60 patients with stroke hemiplegia who received rehabilitation treatment in the Rehabilitation Medicine Department of Baotou Central Hospital were selected and divided into the experimental group (30 cases) and the control group (30 cases) according to the random number table. The control group received conventional rehabilitation, while the experimental group received conventional rehabilitation combined with posture correction. The treatment frequency of the two groups was 40 min/time, once a day, 5 d a week, a total of 4 weeks. The 6-min walking distance (6 MWD) and 10-m walking time (10 MWT) were assessed before treatment and 4 weeks after treatment. The spatial and temporal parameters were measured with gait analyzer, and the changes of sacral tilt angle (SS), pelvic projection angle (PI), and pelvic tilt angle (PT) were compared.

Results

After 4 weeks of treatment, the 6 MWD and 10 MWT of patients in the experimental group were significantly improved compared with those before treatment, and the differences were statistically significant (P<0.05). After 4 weeks of treatment, the spatial parameters measured by gait analyzer in the treatment group were improved more significantly than those in the control group, and the difference was statistically significant (P<0.05). After 4 weeks of treatment, the duration of double support period and the duration of contralateral support period in the two groups were lower than those before treatment, while the duration of contralateral swing period was longer than that before treatment, in addition, the duration of double support period in the experimental group was significantly shortened, and the differences were statistically significant (P<0.05). There was no significant difference in the affected side support, swing period time and the healthy side support, swing period time between the two groups (P>0.05). Four weeks after treatment, the changes of PI, SS and PT in the frontal and lateral spine as well as the frontal pelvis X-ray films were not significantly different between the two groups (P>0.05).

Conclusion

Routine rehabilitation therapy combined with trunk posture adjustment is superior to routine rehabilitation therapy alone in improving motor function of stroke patients with hemiplegia.

Key words: Trunk posture adjustment, Stroke, Hemiplegia, Walking ability, Rehabilitation
表1 2组患者一般资料比较
组别 例数 性别（男/女） 年龄（岁，Mean±SD） 脑卒中类型[例（%）]
缺血性 出血性
试验组 30 23/7 52.4±10.9 10（33.3） 20（66.7）
对照组 30 22/8 55.6±11.4 24（80.0） 6（20.0）
t/χ2值   0.089 1.120 1.364
P值   0.766 0.267 0.243
表2 2组患者治疗前后6 MWD比较（m，Mean±SD）
组别 例数 治疗前 治疗后 t值 P值
试验组 30 104.50±16.63 356.27±28.96 41.572 <0.001
对照组 30 112.36±17.13 295.96±25.23 33.128 <0.001
t值   1.804 8.601    
P值   0.076 <0.001    
表3 2组患者治疗前后10 MWT比较（s，Mean±SD）
组别 例数 治疗前 治疗后 t值 P值
试验组 30 28.13±7.51 15.12±5.30 7.468 <0.001
对照组 30 25.95±5.61 22.46±5.62 2.306 0.028
t值   1.273 5.204    
P值   0.208 <0.001    
表4 2组患者治疗前后空间参数比较（Mean±SD）
空间参数   试验组（n=30） 对照组（n=30） t值 P值
步态周期（s） 治疗前 2.16±0.46 2.02±0.37 1.366 0.177
治疗后 1.22±0.32 1.51±0.33 3.381 0.001
t值 8.840 7.177    
P值 <0.001 <0.001    
步长（cm） 治疗前 28.46±5.73 26.98±5.41 1.030 0.307
治疗后 77.54±7.53 57.94±6.25 10.977 <0.001
t值 26.006 21.703    
P值 <0.001 <0.001    
表5 2组患者治疗前后时间参数比较（%，Mean±SD）
时间参数   试验组（n=30） 对照组（n=30） t值 P值
双支撑期时间 治疗前 47.37±8.70 48.70±7.61 -0.629 0.532
治疗后 34.11±5.24 38.23±6.20 -2.781 0.007
t值 7.019 7.632    
P值 <0.001 <0.001    
患侧支撑期时间 治疗前 67.86±8.71 71.68±8.53 -1.745 0.086
治疗后 63.67 ±7.31 65.90±5.50 -1.336 0.187
t值 2.213 3.415    
P值 0.035 0.002    
患侧摆动期时间 治疗前 30.71±6.48 29.02±5.35 1.094 0.279
治疗后 34.56±4.91 33.18±5.01 -1436 0.156
t值 -3.173 -2.967    
P值 0.004 0.006    
健侧支撑期时间 治疗前 80.56±9.66 78.79±9.70 0.707 0.482
治疗后 68.65±7.35 71.33±7.09 -1.436 0.156
t值 6.244 3.363    
P值 <0.001 0.001    
健侧摆动期时间 治疗前 22.16±4.87 20.89±5.02 0.993 0.325
治疗后 30.93±5.58 28.33±5.67 1.795 0.078
t值 -5.794 -5.322    
P值 <0.001 <0.001    
表6 2组治疗前后时脊柱正侧位参数比较（°，Mean±SD）
参数   试验组（n=30） 对照组（n=30） t值 P值
SS 治疗前 44.54±10.27 44.69±7.88 0.066 0.948
治疗后 42.66±8.39 41.71±8.95 0.424 0.673
t值 0.726 1.437    
P值 0.473 0.161    
PT 治疗前 19.13±4.90 19.48±4.90 0.275 0.784
治疗后 21.98±6.26 21.49±5.13 0.332 0.741
t值 -1.853 -1.557    
P值 0.074 0.130    
PI 治疗前 51.22±8.34 51.72±8.76 0.225 0.823
治疗后 50.37±8.76 47.74±7.18 1.271 0.209
t值 0.344 1.854    
P值 0.734 0.074    
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