中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (35): 5709-5715.doi: 10.12307/2024.580

• 组织构建综述 tissue construction review • 上一篇    下一篇

脑卒中患者偏瘫步态中的推进力缺陷

支  亮1,王玉龙2,张清芳1,洪雅晴1,柯美华1,刘铨权2,龙建军2   

  1. 1山东中医药大学康复医学院,山东省济南市  250355;2深圳市第二人民医院康复医学科,广东省深圳市  518035
  • 收稿日期:2023-11-09 接受日期:2023-12-14 出版日期:2024-12-18 发布日期:2024-03-15
  • 通讯作者: 龙建军,副教授,硕士生导师,深圳市第二人民医院康复医学科,广东省深圳市 518035
  • 作者简介:支亮,男,2001年生,江西省南昌市人,汉族,山东中医药大学在读硕士,主要从事神经康复方面研究。
  • 基金资助:
    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

Propulsion deficits in hemiplegic gait of stroke patients

Zhi Liang1, Wang Yulong2, Zhang Qingfang1, Hong Yaqing1, Ke Meihua1, Liu Quanquan2, Long Jianjun2   

  1. 1School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China; 2Department of Rehabilitation, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
  • Received:2023-11-09 Accepted:2023-12-14 Online:2024-12-18 Published:2024-03-15
  • Contact: Long Jianjun, Associate professor, Master’s supervisor, Department of Rehabilitation, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
  • About author:Zhi Liang, Master candidate, School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Supported by:
    Emergency Clinical Research Project on New Coronavirus Infection at Shenzhen Second People’s Hospital, No. 2023xgyj3357006 (to LJJ); The Sanming Project of Medicine in Shenzhen, No. SZSM202111010 (to WYL)

摘要:


文题释义:

推进力:是指步行时下肢带来的前地面反作用力,与行走时支撑末期的髋关节后伸角度以及踝关节跖屈力矩相关。
偏瘫步态:是指由于失去高位中枢神经的调控,原始的、被抑制的皮质下中枢运动反射得以释放,导致肌群间协调功能紊乱及肌张力异常而出现的运动功能障碍,主要表现为摆动期足下垂及内翻,髋关节外展外旋呈划圈步态。


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、PubMed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的具体贡献及作用机制仍存在争议,但预计髋、踝关节的贡献更大。⑥以改善推进力作为康复的目标会有更加长远的行走功能发展,然而,脑卒中患者推进力缺陷的神经学研究基础、目前改善推进力的康复技术的长期疗效以及改善推进力的主要康复技术应用于何种病情的患者更合适,还需要未来的研究者来探索。

https://orcid.org/0009-0005-7002-3843(支亮);https://orcid.org/0009-0009-6058-8946(龙建军)

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程

关键词: 推进力, 步态, 脑卒中, 偏瘫, 生物力学, 步行, 康复, 综述

Abstract: 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 for assessing the gait of hemiplegic patients, and evaluation of gait using propulsive force is beneficial for the long-term development of walking ability. Main rehabilitation techniques for improving propulsive force include: lower limb exoskeleton robot walking training, treadmill training combined with functional electrical stimulation, adaptive speed treadmill training, biofeedback technology, and whole-body vibration training. Among them, whole-body vibration training and biofeedback technology are more effective. The specific contributions and mechanisms of the hip, knee, and ankle joints in improving propulsive force are still controversial, but it is expected that the contributions of the hip and ankle joints are greater. Focusing on the improvement of propulsive force as a rehabilitation goal may yield more sustainable advancements in walking function. However, several current challenges persist in this field: understanding the neurobiological basis of propulsive force deficits in stroke patients, assessing the long-term efficacy of current rehabilitation techniques for enhancing propulsive force, and determining the most suitable patient populations for the application of major rehabilitation techniques aiming at improving propulsive force. These areas require further exploration by subsequent researchers.

Key words: propulsive force, gait, stroke, hemiplegia, biomechanics, walking, rehabilitation, review

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