Kwon Oh-Yun, Minor Scott D, Maluf Katrina S, Mueller Michael J
Department of Rehabilitation, College of Health Science, Yonsei University, Wonju, South Korea.
Gait Posture. 2003 Aug;18(1):105-13. doi: 10.1016/s0966-6362(02)00166-2.
The purpose of this study was to compare muscle activity and joint moments in the lower extremities during walking between subjects with diabetic neuropathy (DN) and control subjects. Tests were performed on nine subjects with DN, and nine age, gender, and weight-matched controls. Onset and cessation times of lower extremity electromyographic (EMG) activity and joint moments were determined. Results demonstrated that subjects with DN had less ankle mobility, slower walking speeds, longer stance phases, and lower peak ankle dorsiflexion, ankle plantar flexion, and knee extension moments than control subjects. Onset times with respect to heel-strike (HS) for the soleus, medial gastrocnemius, and medial hamstring muscles were significantly earlier during the gait cycle (GC) in subjects with DN than in control subjects. The cessation times of soleus, tibialis anterior, vastus medialis, and medial hamstring muscles were significantly prolonged in subjects with DN. Subjects with DN showed more co-contractions of agonist and antagonist muscles at the ankle and knee joints during stance phase compared with control subjects. These gait changes and co-contractions may allow subjects with DN to adopt a safer, more stable gait pattern to compensate for diminished sensory information from the ankle and the foot. The premature activation of soleus and medial gastrocnemius muscles in subjects with DN could be contributing to abnormal forefoot plantar pressure distribution. Additional research is needed to clarify the relationship between the premature activation of triceps surae muscles and the forefoot plantar pressure parameters in subjects with DN.
本研究的目的是比较糖尿病神经病变（DN）患者与对照受试者在行走过程中下肢的肌肉活动和关节力矩。对9名DN患者以及9名年龄、性别和体重匹配的对照者进行了测试。确定了下肢肌电图（EMG）活动和关节力矩的起始和停止时间。结果表明，与对照受试者相比，DN患者的踝关节活动度较小、步行速度较慢、站立期较长，踝关节背屈、跖屈以及膝关节伸展力矩的峰值较低。在步态周期（GC）中，DN患者比对照受试者比目鱼肌、腓肠肌内侧头和半腱肌内侧头相对于足跟撞击（HS）的起始时间显著更早。DN患者比目鱼肌、胫骨前肌、股内侧肌和半腱肌内侧头的停止时间显著延长。与对照受试者相比，DN患者在站立期踝关节和膝关节处的主动肌和拮抗肌共同收缩更多。这些步态变化和共同收缩可能使DN患者采用更安全、更稳定的步态模式，以补偿来自踝关节和足部的感觉信息减少。DN患者比目鱼肌和腓肠肌内侧头的过早激活可能导致前足足底压力分布异常。需要进一步的研究来阐明DN患者小腿三头肌过早激活与前足足底压力参数之间的关系。
