摘要
背景:脑卒中患者的异常步态严重影响了行走时的推进力,继发地降低了患者的行走速度、行走距离及稳定性,增加了患者的跌倒风险,严重影响患者的生活质量。目的:综述脑卒中偏瘫患者中推进力缺陷的相关研究,总结现有研究者对推进力缺陷的理解,并分析推进力与步态的关系,最后阐述并比较最新用于改善推进力缺陷的康复技术,为临床治疗提供参考。方法:通过计算机检索万方医学网、中国知网、Pub Med和Web of Science核心集数据库收录的相关文献。中文检索词为“推进力OR地面反作用力、脑卒中OR脑中风OR偏瘫、步态OR步行OR行走”,英文检索词为“propulsive force OR propulsive,Stroke OR cerebral infarction OR hemiplegia,walk*OR gait”。检索文献时限为2003-2023年,最终纳入71篇文献进行综述分析。结果与结论:(1)针对于髋、踝关节的训练可能对患者的步行功能更有效果,特别是应用柔性外骨骼机器人的训练,但以推进力作为脑卒中患者步行功能的预后指标仍然需要更加充足的证据。(2)与推进力相关的生物力学变量包括:支撑末期的髋关节后伸角度、踝关节跖屈力矩、膝关节的伸展。(3)偏瘫患者皮质脊髓束、小脑与皮质间的通路以及网状脊髓束的受损与推进力下降及步态不对称性相关。(4)推进力对正常步态的稳定性至关重要,推进力的减弱不利于步态稳定性;步态对称性与推进力、步长对称性、躯干位移以及下肢摆动能力相关,推进力是其中的关键因素;推进力可以作为量化偏瘫患者步态的指标,且以推进力评价步态利于行走的长远发展。(5)改善推进力缺陷的主要康复技术包括:下肢外骨骼机器人步行训练、结合功能性电刺激的跑步机训练、自适应速度跑步机训练、生物反馈技术以及全身振动训练,其中全身振动训练和生物反馈技术更有效。髋、膝、踝关节在推进力改善中
BACKGROUND:The abnormal gait of stroke patients seriously affects their propulsive force during walking,which subsequently reduces their walking speed,walking distance,and stability,increases their risk of falls,and seriously affects their quality of life.OBJECTIVE:To review the relevant research on propulsive force deficits in stroke patients with hemiplegia,to summarize the understanding of existing researchers on propulsive force deficits,to analyze the relationship between propulsive force and gait,and finally to explain and compare the latest rehabilitation technologies used to improve propulsive force deficits,providing reference for clinical treatment.METHODS:Relevant literature was retrieved from WanFang,CNKI,PubMed,and Web of Science Core Collection through computer search.The Chinese and English search terms were“propulsive force OR propulsive,stroke OR cerebral infarction OR hemiplegia,walk*OR gait.”The search time limit was from 2003 to 2023,and 71 articles were finally included for review and analysis.RESULTS AND CONCLUSION:Training targeting the hip and ankle joints may be more effective for patients’walking function,especially training with the application of flexible exoskeleton robots,but more sufficient evidence is still needed to use propulsion as a prognostic indicator of walking function in stroke patients.Biomechanical variables related to propulsive force include:the hip joint extension angle at terminal stance,ankle joint dorsiflexion torque,and knee joint extension.Damage to the corticospinal tract,cerebellar-cortical pathways,and the reticulospinal tract in hemiplegic patients are associated with reduced propulsive force and gait asymmetry.Propulsive force is crucial for the stability of healthy gait,and a decrease in propulsive force is unfavorable for gait stability.Gait symmetry is correlated with propulsive force,stride length symmetry,trunk displacement,and lower limb swing ability,with propulsive force being a key factor.Propulsive force can serve as a quantitative indicator
作者
支亮
王玉龙
张清芳
洪雅晴
柯美华
刘铨权
龙建军
Zhi Liang;Wang Yulong;Zhang Qingfang;Hong Yaqing;Ke Meihua;Liu Quanquan;Long Jianjun(School of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China;Department of Rehabilitation,Shenzhen Second People’s Hospital,Shenzhen 518035,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第35期5709-5715,共7页
Chinese Journal of Tissue Engineering Research
基金
深圳市第二人民医院新冠病毒感染应急临床研究项目(2023xgyj3357006),项目负责人:龙建军
深圳市三名工程“南京医科大学励建安团队”资助项目(SZSM202111010),项目负责人:王玉龙。
关键词
推进力
步态
脑卒中
偏瘫
生物力学
步行
康复
综述
propulsive force
gait
stroke
hemiplegia
biomechanics
walking
rehabilitation
review
