De Quervain I A, Simon S R, Leurgans S, Pease W S, McAllister D
Gait Analysis Laboratory, Division of Orthopaedics, Columbus, Ohio, USA.
J Bone Joint Surg Am. 1996 Oct;78(10):1506-14. doi: 10.2106/00004623-199610000-00008.
The gait patterns of eighteen patients who had had a single infarct due to obstruction of the middle cerebral artery were evaluated within one week after the patients had resumed independent walking and before a gait rehabilitation program had been initiated. Gait was analyzed with use of motion analysis, force-plate recordings, and dynamic surface electromyographic studies of the muscles of the lower extremities. The patterns of motion of the lower extremity on the hemiplegic side had a stronger association with the clinical severity of muscle weakness than with the degree of spasticity, balance control, or phasic muscle activity. There was a delay in the initiation of flexion of the hip during the pre-swing phase, and flexion of the hip and knee as well as dorsiflexion of the ankle progressed only slightly during the swing phase. During the stance phase, there was decreased extension of the hip that was related to decreased muscle effort and a coupling between flexion of the knee and dorsiflexion of the ankle. The abnormal patterns of motion altered the velocity, the length of the stride, the cadence, and all phases of the gait cycle. The duration of the pre-swing phase was prolonged for the patients who had the slowest gait velocities. There also were abnormal movements of the upper extremity, the trunk, the pelvis, and the lower extremity on the unaffected side in an effort to compensate for the decreased velocity on the hemiplegic side. As velocity improved, these abnormal movements decreased. Therefore, the goal of therapy should be to improve muscle strength and coordination on the hemiplegic side, especially during the pre-swing phase.
对18例因大脑中动脉阻塞而发生单一梗死的患者，在其恢复独立行走后一周内且在启动步态康复计划之前，对其步态模式进行了评估。使用运动分析、测力板记录以及下肢肌肉的动态表面肌电图研究对步态进行了分析。偏瘫侧下肢的运动模式与肌肉无力的临床严重程度的关联，比与痉挛程度、平衡控制或阶段性肌肉活动的关联更强。在摆动前期，髋部屈曲的起始出现延迟，且在摆动期，髋部和膝部的屈曲以及踝部的背屈仅稍有进展。在站立期，髋部伸展减少，这与肌肉用力减少以及膝部屈曲和踝部背屈之间的耦合有关。异常的运动模式改变了速度、步长、步频以及步态周期的所有阶段。步态速度最慢的患者，其摆动前期的持续时间延长。为了代偿偏瘫侧速度的降低，非受累侧的上肢、躯干、骨盆和下肢也出现了异常运动。随着速度的提高，这些异常运动减少。因此，治疗的目标应该是提高偏瘫侧的肌肉力量和协调性，尤其是在摆动前期。
