發(fā)布時(shí)間：2018-03-06 11:27

  本文選題：脊髓型頸椎病　切入點(diǎn)：步態(tài)分析　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景.·在提倡精準(zhǔn)醫(yī)學(xué)的今天,脊髓型頸椎病的評(píng)價(jià)系統(tǒng)仍顯得不夠客觀。有研究證實(shí)步態(tài)分析有助于脊髓型頸椎病的早期診斷,并可對(duì)其嚴(yán)重程度、治療效果等做出客觀、量化的評(píng)估。較傳統(tǒng)的三維步態(tài)實(shí)驗(yàn)室分析系統(tǒng)而言,便攜式步態(tài)分析系統(tǒng)具有操作簡(jiǎn)單、攜帶方便等優(yōu)點(diǎn),其更易于應(yīng)用于臨床,未來在脊髓型頸椎病中應(yīng)用前景廣闊。目前,便攜式步態(tài)分析儀應(yīng)用于脊髓型頸椎病的相關(guān)研究較少。目的:探討便攜式步態(tài)分析儀臨床應(yīng)用于脊髓型頸椎病的可行性,同時(shí)了解該病患者的步態(tài)特點(diǎn),明確步態(tài)參數(shù)變化可否作為反映病情的客觀、量化評(píng)價(jià)指標(biāo),為同類研究作出參考。方法:在嚴(yán)格遵循納入標(biāo)準(zhǔn)的前提下,選擇大連醫(yī)科大學(xué)附屬第一醫(yī)院脊柱外科2016年9月至11月期間脊髓型頸椎病住院患者15例,健康受試者15例。采用大連理工大學(xué)設(shè)計(jì)的便攜式步態(tài)分析儀在大連醫(yī)科大學(xué)附屬第一醫(yī)院脊柱外科病房?jī)?nèi)進(jìn)行步態(tài)數(shù)據(jù)檢測(cè)及收集。采用spss18.0軟件包對(duì)收集數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,應(yīng)用t檢驗(yàn)比較脊髓型頸椎病患者和健康受試者的步態(tài)參數(shù)差異。采用spearman相關(guān)分析對(duì)脊髓型頸椎病患者步態(tài)參數(shù)與改良日本骨科學(xué)會(huì)評(píng)分之間的相關(guān)性進(jìn)行統(tǒng)計(jì)學(xué)分析,全部檢驗(yàn)均行雙側(cè)檢驗(yàn),結(jié)果以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:本次實(shí)驗(yàn)中,患者組與對(duì)照組受試者在性別比例、年齡、身高、體質(zhì)量、體質(zhì)量指數(shù)差異方面均無(wú)統(tǒng)計(jì)學(xué)意義。患者組的步速、步長(zhǎng)、跨步長(zhǎng)、廓清、足跖屈角、足背屈角、足支撐相百分比和足擺動(dòng)相百分比與對(duì)照組差異存在顯著性(P0.05)。患者組足支撐相百分比較對(duì)照組明顯增加,而步速、步長(zhǎng)、跨步長(zhǎng)、足廓清、足跖屈角、足背屈角和足擺動(dòng)相百分比明顯減少。患者組的改良日本骨科學(xué)會(huì)評(píng)分與足跖屈角度、支撐相百分比、擺動(dòng)相百分比呈極強(qiáng)相關(guān),與步速、足支撐相、跨步長(zhǎng)、足廓清、步寬強(qiáng)相關(guān)。患者組的改良日本骨科學(xué)會(huì)下肢功能評(píng)分與步速呈極強(qiáng)相關(guān)、與足支撐相、步態(tài)周期、步長(zhǎng)、跨步長(zhǎng)、步寬、足廓清、足支撐相百分比、足擺動(dòng)相百分比強(qiáng)相關(guān)。結(jié)論:(1)與健康人相比脊髓型頸椎病患者等距離下步速明顯降低,步長(zhǎng)、跨步長(zhǎng)明顯縮短,最大足廓清明顯降低。足跖屈角度、足背屈角度明顯減小。足支撐相百分比明顯增加而擺動(dòng)相百分比明顯縮短。(2)脊髓型頸椎病患者隨著改良日本骨科學(xué)會(huì)評(píng)分降低其步速、跨步長(zhǎng)、廓清下降,足擺動(dòng)相百分比和跖屈角度減小,支撐相時(shí)間及百分比增加。當(dāng)改良日本骨科學(xué)會(huì)下肢功能評(píng)分降低時(shí),其步速、步長(zhǎng)、跨步長(zhǎng)、足擺動(dòng)相時(shí)間百分比和廓清隨之下降,而步態(tài)周期、支撐相時(shí)間、支撐相時(shí)間百分比隨之增長(zhǎng)。(3)便攜式步態(tài)分析儀可以對(duì)脊髓型頸椎病的嚴(yán)重程度作出客觀、量化評(píng)估。同時(shí),由于具有體積小、重量輕、便于穿戴的優(yōu)點(diǎn),未來應(yīng)用前景廣闊。
[Abstract]:Background... Today, the evaluation system of cervical Spondylotic myelopathy is still not objective. Some studies have proved that gait analysis is helpful to the early diagnosis of cervical Spondylotic myelopathy, and can make an objective view of the severity and therapeutic effect of cervical Spondylotic Spondylotic Spondylotic Myelopathy. Quantitative evaluation. Compared with the traditional three-dimensional gait laboratory analysis system, the portable gait analysis system has the advantages of simple operation and easy to carry. The application of portable gait analyzer in cervical Spondylotic myelopathy has a broad prospect in the future. At present, there are few related studies on the application of portable gait analyzer in cervical Spondylotic myelopathy. Objective: to explore the feasibility of clinical application of portable gait analyzer in cervical Spondylotic myelopathy. At the same time, we know the gait characteristics of the patients, determine whether the gait parameter change can be used as the objective and quantitative evaluation index to reflect the condition of the disease, and make reference for the similar research. Methods: under the premise of strictly following the inclusion criteria, Fifteen patients with cervical Spondylotic myelopathy from September 2016 to November in the first affiliated Hospital of Dalian Medical University were selected. A portable gait analyzer designed by Dalian University of Technology was used to detect and collect gait data in the spinal surgery ward of the first affiliated Hospital of Dalian Medical University. The collected data were statistically analyzed by spss18.0 software package. T test was used to compare the gait parameters between patients with cervical Spondylotic myelopathy and healthy subjects. The correlation between gait parameters and the score of the modified Japanese Orthopaedic Association was analyzed statistically by spearman correlation analysis in patients with cervical Spondylotic myelopathy. Results: in this experiment, the sex ratio, age, height, body weight, sex ratio, age, height, body weight of the patients and the control group were significantly higher than that of the control group. There was no significant difference in body mass index. The step speed, step length, stride length, clearance, plantar flexion angle, dorsal flexion angle of foot, The percentage of foot support phase and the percentage of foot swing phase were significantly different from those of the control group (P 0.05). The percentage of foot support phase in the patient group was significantly higher than that in the control group, while the step speed, step length, stride length, foot clearance and plantar flexion angle were significantly increased in the patient group. The score of the modified Japanese Orthopedic Society in the patient group was significantly correlated with the angle of plantar flexion, the percentage of the supporting phase, the percentage of the swing phase, and the step speed, the foot support phase, the stride length, and the foot clearance. The score of lower limb function of the modified Japanese Orthopedic Society in the patient group was strongly correlated with the walking speed, and was associated with the foot support phase, gait cycle, gait length, stride length, step width, foot clearance, and percentage of foot support phase. Conclusion compared with the healthy people, the walking speed, step length and stride length of the patients with cervical Spondylotic myelopathy at the same distance were significantly decreased, the maximal clearance of the foot was obviously decreased, and the angle of plantar flexion of the foot was obviously decreased. The percentage of foot support phase and swing phase were significantly increased and the percentage of cervical Spondylotic myelopathy decreased with the improved Japanese Orthopedic Association score. The percentage of swing phase and the angle of metatarsal flexion decreased, the time and percentage of supporting phase increased. When the score of lower limb function of the modified Japanese orthopedic society decreased, the step speed, step length, stride length, percentage of time and clearance of foot swing phase decreased. And the gait period, the support phase time, and the percentage of the support phase time increase with it.) the portable gait analyzer can make an objective and quantitative evaluation of the severity of cervical Spondylotic myelopathy. At the same time, because of its small size and light weight, Easy to wear the advantages of the future application prospects.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.55
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本文編號(hào)：1574644