痉挛型脑瘫患者外科手术前后的三维步态特征分析及术后康复指导
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1.上海市浦东新区浦南医院;2.复旦大学附属华东医院

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Analysis of three-dimensional gait characteristics before and after FSPR surgery of patients with spastic cerebral palsy and Rehabilitation guidance
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    摘要:

    目的:采用三维步态分析系统定量评估外科手术前后痉挛型脑瘫患者的步态特征,评估手术疗效的同时为痉挛型脑瘫的综合治疗提供依据。方法:选取15名将要进行外科手术治疗的痉挛型脑瘫患者,利用采用VICON三维运动捕捉系统结合AMTI三维测力台对患者进行手术前后的步态采集,分析手术前后步态的时空参数、运动学参数及动力学参数。结果:手术之后,痉挛型脑瘫患者的左支撑相时间增大(p<0.05)、右支撑相时间增大(p<0.01)、左步长增大(p<0.05)、步高减小(p<0.05)、步速减小(p<0.01)及完整步态周期重心冠状面偏移最大值减小(p<0.05);患者的左右髋关节矢状面活动范围增大(p<0.05)、左右膝关节矢状面活动范围增大(p<0.01 p<0.05)、左右踝关节矢状面活动范围增大(p<0.05)、右踝关节冠状面活动范围增大(p<0.05),着地时左、右膝关节角度及步态周期中左、右膝关节矢状面角度最小值减小(p<0.05);步态周期左、右踝关节最大跖屈角度减小(p<0.05);患者的步态周期左、右支撑最大垂直力增大(p<0.05)结论:三维步态分析可以通过步态参数精准评估外科手术前后脑瘫患者的步行功能,且客观、有效,外科手术能在一定程度上可以改善脑瘫患者痉挛状态,提高步行能力,但对脑瘫患者的治疗不能只依靠外科手术,术后应积极进行康复训练,达到最佳治疗效果。

    Abstract:

    Objective Three dimensional gait analysis system was used to quantitatively evaluate the gait characteristics of patients with spastic cerebral palsy before and after surgery, to evaluate the efficacy of surgery and provide basis for the comprehensive treatment of spastic cerebral palsy. Methods 15 patients with spastic cerebral palsy to be treated by surgery were selected, and the gait collection before and after surgery was performed by using VICON 3D motion capture system combined with AMTI 3D force-measuring platform, to analyze the temporal and spatial parameters, kinematic parameters and dynamic parameters of the gait before and after surgery. Results After the operation, the left support phase time (p< 0.05), the right support phase time (p<0.01), the left step length (p <0.05), the step height (p < 0.05), and the maximum deviation of the COG increased (p<0.05), the step speed decreased (p< 0.01). The range of motion of the sagittal plane of the left and right hip was increased (p<0.05), the range of motion of the sagittal plane of the right and right knee was increased (p<0.01, p<0.05), the range of motion of the sagittal plane of the right and right ankle was increased (p<0.05), The range of motion on the coronal plane of the right ankle joint increased (p<0.05). When touching the ground, the Angle of left and right knee joints and the sagittal plane Angle of left and right knee joints in the gait cycle decreased (p < 0.05). The maximum plantarflexion Angle of left and right ankle joints decreased in gait cycle (p < 0.05). The maximum vertical force of left and right support was increased of gait cycle(p<0.05).

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  • 收稿日期:2020-11-09
  • 最后修改日期:2021-01-16
  • 录用日期:2021-01-19
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