切换至 "中华医学电子期刊资源库"
高级检索
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
全文 ( ) 下载PDF ( ) 导出引用
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/OL]. 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/OL]. 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    
[1]
Gao Y, Jiang B, Sun H, et al. The burden of stroke in China: results from a nationwide population-based epidemiological survey[J]. PLoS One, 2018, 13(12): e0208398.
[2]
《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2019》概要[J].中国脑血管病杂志, 2020, 17(5): 272-281.
[3]
Kim WS, Choi H, Jung JW, et al. Asymmetry and variability should be included in the assessment of gait function in poststroke hemiplegia with independent ambulation during early rehabilitation[J]. Arch Phys Med Rehabil, 2021, 102(4): 611-618.
[4]
倪朝民.神经康复学[M].北京:人民卫生出版社, 2008: 238.
[5]
Kim KH, Leem MJ, Yi TI, et al. Balance ability in low back pain patients with lumbosacral radiculopathy evaluated with Tetrax: a matched case-control study[J]. Ann Rehabil Med, 2020, 44(3): 195-202.
[6]
吴兴华,玉海,杨学军,等.非特异性慢性腰痛患者姿势控制的性别差异[J].颈腰痛杂志, 2020, 41(2): 135-139.
[7]
张超龙,何兆辉,袁国静,等.镜像反馈训练对脑卒中后偏瘫患者运动功能血清生化指标及神经功能的影响[J].中国实用神经疾病杂志, 2020, 23(3): 255-259.
[8]
彭斌,崔丽英.中华医学会第20次全国神经病学学术会议纪要[J].中华神经科杂志, 2018, 51(3): 235-238.
[9]
Lee J, Jeon J, Lee D, et al. Effect of trunk stabilization exercise on abdominal muscle thickness, balance and gait abilities of patients with hemiplegic stroke: a randomized controlled trial[J]. NeuroRehabilitation, 2020, 47(4): 435-442.
[10]
万青,吴伟,刘慧华,等.脑卒中患者偏瘫步态的时空及关节运动学参数分析[J].中国康复医学杂志, 2014, 29(11): 1026-1030.
[11]
Tanikawa H, Inagaki K, Ohtsuka K, et al.Validity of quantitative assessment of posterior pelvic tilt and contralateral vaulting in hemiplegia using 3D treadmill gait analysis[J]. Top Stroke Rehabil, 2021, 28(2): 96-103.
[12]
Guralnik JM, Ferrucci L, Balfour JL, et al. Progressive versus catastrophic loss of the ability to walk: implications for the prevention of mobility loss[J]. J Am Geriatr Soc, 2001, 49(11): 1463-1470.
[13]
Kim NH, Park HY, Son JK, et al. Comparison of underwater gait training and overground gait training for improving the walking and balancing ability of patients with severe hemiplegic stroke: a randomized controlled pilot trial[J]. Gait Posture, 2020, 80: 124-129.
[14]
Hefter H, Rosenthal D. Improvement of upper trunk posture during walking in hemiplegic patients after injections of botulinum toxin into the arm[J]. Clin Biomech (Bristol, Avon), 2017, 43: 15-22.
[15]
张泽,王毅蓉,李建岗,等.躯干偏瘫模式观察[J].中国医药指南, 2013, 11(2): 6-7.
[16]
Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review[J]. Lancet Neurol, 2009, 8(8): 741-54.
[17]
Lou G, Fu C, Du Q, et al. TheraSling Therapy (TST) Combined with neuromuscular facilitation technique on hemiplegic gait in patients with stroke[J]. Med Sci Monit, 2019, 25: 4766-4772.
[18]
Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke[J]. Clin Rehabil, 2001, 15(4): 415-421.
[19]
Zhang Q, Lu H, Pan S, et al. 6MWT performance and its correlations with VO2 and handgrip strength in home-dwelling mid-aged and older Chinese[J]. Int J Environ Res Public Health, 2017, 14(5): 473.
[20]
张旭,邱模炎,权范善,等.步行机器人训练对慢性期脑卒中偏瘫患者步行能力的影响[J].中华物理医学与康复杂志, 2021, 43(1): 30-33.
[21]
Eng JJ, Tang PF. Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence[J]. Expert Rev Neurother, 2007, 7(10): 1417-1436.
[22]
梁亚利,余超,廖瑞松,等.动态扰动结合双跑带运动平板训练对脑卒中偏瘫患者步行能力的影响[J].中国康复医学杂志, 2017, 32(12): 1412-1414.
[23]
Yu HX, Wang ZX, Liu CB, et al. Effect of cognitive function on balance and posture control after stroke[J]. Neural Plasticity, 2021, 2021: 6636999.
[24]
王煜.运用步态分析系统从运动学评价醒脑开窍针刺法对中风患者偏瘫步态的疗效[J].新中医, 2010, 42(10): 90-92.
[25]
李华,姚红华,刘利辉.肌力训练对偏瘫步态的影响及下肢功能评定与步态分析间的相关性[J].中华物理医学与康复杂志, 2003, 25(1): 34-36.
[26]
徐光青,兰月,毛玉瑢,等.脑卒中患者步行时下肢运动的三维运动学研究[J].中华医学杂志, 2007, 87(41): 2889-2892.
[27]
励建安,孟殿怀.步态分析的临床应用[J].中华物理医学与康复杂志, 2006, 28(7): 500-503.
[28]
Noh HJ, Lee SH, Bang DH. Three-dimensional balance training using visual feedback on balance and walking ability in subacute stroke patients: a single-blinded randomized controlled pilot trial[J]. J Stroke Cerebrovasc Dis, 2019, 28(4): 994-1000.
[29]
Boulay C, Tardieu C, Hecquet J, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis[J]. Eur Spine J, 2006, 15(4): 415-22.
[30]
闫瑞忠,郭志坚.脊柱骨盆运动单位矢状位平衡与髋关节功能相关性的研究进展[J].中国骨与关节损伤杂志, 2021, 36(5): 555-557.
[31]
赵洪宇,钟磊,刘贺,等. X线上骨盆倾斜评估方法研究进展[J].中国实验诊断学, 2017, 21(3): 546-549.
[32]
Vrtovec T, Janssen MM, Likar B, et al. A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment[J]. Spine J, 2012, 12(5): 433-446.
[1] 郑爽, 张昕彤, 陈晨, 王思凡, 燕晓翔, 王长青, 胡雅娟. 神经重症患者气管插管拔除失败的风险因素分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 211-218.
[2] 张怡, 王宇洋, 司梦娇, 曹燕, 李欢欢. 脑卒中前白蛋白与肺炎发生风险相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 648-651.
[3] 江西省神经外科质量控制中心. 江西省心源性脑卒中多学科协作防治专家共识[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 264-277.
[4] 张洪, 杨琪, 罗静, 唐茜, 邓鸿, 巩文艳, 王丽坤, 刘静, 艾双春. 多靶点神经调控技术对卒中后上肢运动功能障碍患者的脑网络功能连接研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 278-284.
[5] 许方军, 曹晓光, 王修敏, 王婷, 陈冬冬, 余程冬, 张鹤言. 基于闭环理论的动作观察疗法联合躯干控制训练对脑卒中后下肢运动的影响[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 292-299.
[6] 张雅文, 尹昱, 陈江龙, 杨玉慧, 吕红香, 张琦, 吕佩源. Theta爆发式经颅磁刺激治疗失语症的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 306-311.
[7] 陈冬冬, 余程冬, 曹晓光. 上肢外骨骼机器人在脑卒中康复中的应用与研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 312-317.
[8] 吉莉, 苏云楠, 王斌, 沈滔, 刘团结, 毛蕾, 徐玉萍, 张婷, 王博. 急性缺血性脑卒中患者脑白质微结构改变对长期认知功能损伤的预测价值研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 193-200.
[9] 梁明, 魏珍, 祖合热·肉孜, 李金贤. 超声评估脑卒中气管切开患者膈肌功能与肺功能的相关性研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 133-139.
[10] 李璇, 邓岚, 郭微, 邓永梅, 刘杰昕. 标准化皮肤管理流程在防治脑卒中患者失禁相关性皮炎中的应用[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 479-482.
[11] 刘志超, 胡风云, 温春丽. 山西省脑卒中危险因素与地域的相关性分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 424-433.
[12] 王丽娜, 吕书霞, 李亚男. 脑卒中偏瘫患者健康焦虑元认知与疾病接受度、恐惧疾病进展的相关性[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 434-440.
[13] 周洪千, 张煜坤, 顾天舒, 胡苏涛, 姜超, 张雪, 张昊, 陶华岳, 刘行, 刘彤, 陈康寅. 既往出血性脑卒中患者行经皮冠脉介入治疗后不良事件的危险因素分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 323-329.
[14] 邓越, 白鹏, 洪秋阳, 王桂玲. 颈部七线调衡疗法探析并病例汇报一例[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 345-349.
[15] 李芳, 戴西望, 王凯, 郭廷昊, 涂江龙. 非瓣膜性心房颤动相关性卒中的治疗研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 393-397.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号