[足迹和步幅对痉挛性偏瘫型脑瘫患者踝关节的能量产生有影响吗？]

[Does footprint and foot progression matter for ankle power generation in spastic hemiplegic cerebral palsy?].

作者信息

Riad Jacques, Henley John, Miller Freeman

机构信息

Orthopaedic Department, Kärnsjukhuset Skövde, Skövde, Sweden.

出版信息

Acta Orthop Traumatol Turc. 2009 Mar-Apr;43(2):128-34. doi: 10.3944/AOTT.2009.128.

DOI:10.3944/AOTT.2009.128

PMID:19448353

Abstract

OBJECTIVES

We investigated how foot pressure pattern and foot progression relate to power generation from the ankle joint in children with spastic hemiplegic cerebral palsy (CP).

METHODS

The study included 35 children (13 girls, 22 boys; mean age 8.8 years; range 4 to 19.8) with CP, all having independent ambulation. The children underwent three-dimensional gait analysis and a set of pedobarographic data were obtained. The pedobarographs were analyzed by dividing the foot into five segments.

RESULTS

The mean power generation from the ankle was 7.6 watts/kg on the hemiplegic side, and 15.9 watts/kg on the uninvolved side (p=0.000). Based on the pedobarographic data, hemiplegic feet exhibited significantly less heel pressure/impulse (8.0 vs. 24.7; p=0.000), time to heel rise (32.1% of stance phase vs. 61.9%; p=0.000), and decreased pressure of the medial forefoot segment (40.8 vs. 52.2; p=0.009). The children were divided into two groups depending on the ankle power generated on the hemiplegic side (<8.0 watts/kg and =/>8.0 watts/kg). Those with an ankle power generation of =/>8.0 watts/kg had significantly longer step length (49 cm vs. 41 cm; p=0.001) and increased velocity (109 cm/sec vs. 89 cm/sec; p=0.000) in gait analysis, and in pedobarographic measurements, increased heel impulse (11.6 vs. 4.4; p=0.047), time to heel rise (46.6% vs. 17.1%; p=0.000), and less varus/valgus positioning (11.1 degrees vs. -34.6 degrees ; p=0.013). In bivariate correlation analysis, ankle power generation on the hemiplegic side demonstrated a significant association with time to heel rise (r=0.574; p=0.000) and varus/valgus positioning (r=0.420; p=0.017), and almost a significant association with heel pressure (r=0.342; p=0.052).

CONCLUSION

Deviations in the pedobarographic data are reflected in the power generation of the ankle joint and can be of help in decision making of treatment in spastic hemiplegic CP. We speculate that efforts to normalize the heel segment pattern may result in decreased power generation differences.

摘要

目的

我们研究了痉挛性偏瘫型脑瘫（CP）患儿的足部压力模式和足部前进方式与踝关节产生功率之间的关系。

方法

该研究纳入了35名CP患儿（13名女孩，22名男孩；平均年龄8.8岁；范围4至19.8岁），所有患儿均能独立行走。对患儿进行了三维步态分析，并获取了一组足底压力数据。通过将足部划分为五个部分对足底压力数据进行分析。

结果

偏瘫侧踝关节产生的平均功率为7.6瓦/千克，非受累侧为15.9瓦/千克（p = 0.000）。根据足底压力数据，偏瘫侧足部的足跟压力/冲量明显较低（8.0对24.7；p = 0.000），足跟抬起时间较短（站立期的32.1%对61.9%；p = 0.000），且前足内侧部分的压力降低（40.8对52.2；p = 0.009）。根据偏瘫侧产生的踝关节功率，将患儿分为两组（<8.0瓦/千克和≥8.0瓦/千克）。在步态分析中，踝关节功率≥8.0瓦/千克的患儿步长明显更长（49厘米对41厘米；p = 0.001），速度更快（109厘米/秒对89厘米/秒；p = 0.000），在足底压力测量中，足跟冲量增加（11.6对4.4；p = 0.047），足跟抬起时间增加（46.6%对17.1%；p = 0.000），内翻/外翻定位减少（11.1度对 -34.6度；p = 0.013）。在双变量相关性分析中，偏瘫侧的踝关节功率与足跟抬起时间（r = 0.574；p = 0.000）和内翻/外翻定位（r = 0.420；p = 0.017）显著相关，与足跟压力几乎显著相关（r = 0.342；p = 0.052）。