【摘要】：目的探討中國正常成人的步行特征，為臨床步態(tài)分析提供正常值參考。進一步通過比較偏癱患者與正常人步行時空參數(shù)的差異，以及大腿截肢患者在安裝假肢后不同時期步行時空參數(shù)變化，探討步行時空參數(shù)分析在偏癱和截肢康復中的臨床應用價值。 方法365名正常受試者，按性別、年齡分為20-29歲組、30-39歲組、40-49歲組、50-59歲組、60-75歲組共10組。應用人體步態(tài)墊測量與分析系統(tǒng)，，測試受試者自由行走時的步行時空參數(shù)。同時收集26名偏癱患者與21名大腿假肢佩戴者的步行時空參數(shù)，分別比較偏癱患者與正常人、假肢佩戴者矯正過程中各時期步行時空參數(shù)的差異。 結(jié)果 1.年齡組內(nèi)平均步速，除30-39歲組，60-75歲組外，男性均大于女性(P0.05)，50歲以后，男、女步速均減慢，與50歲以前相比具有顯著性差異(P0.01)；各年齡組步長，男性均大于女性(P0.05)，女性步長在50歲以后減小，與50歲以前相比具有顯著性差異(P0.01)，男性步長在60歲以后減小，明顯小于60歲以前步長(P0.01)。 2.偏癱患者雙側(cè)步速、步長、支撐時間及支撐時間百分比與正常對照組相比均具有顯著性差異(P0.01)。偏癱患者步速、步長明顯低于對照組，兩者之間具有顯著性差異(P0.01)；而支撐時間及支撐時間百分比明顯高于對照組，差異亦具有顯著性(P0.01)。 3.穿戴假肢1月后與1周后、3月后與1月后相比，假肢使用者步速、步長均顯著增加(P0.01)，而單足支撐時間顯著減小(P0.01)。穿戴假肢3月后，假肢使用者步速、步長與正常對照組相比稍減小(P0.05)；單足支撐時間與正常對照組相比無明顯差異(P0.05)。同時，假肢使用者健、患兩側(cè)步態(tài)對稱性(健/患)在假肢矯正過程中也逐漸趨近于1。 結(jié)論 1.應用人體步態(tài)墊測量與分析系統(tǒng)，首次建立中國正常成人步行時空參數(shù)參考值范圍，初步揭示中國正常成人的步行時空特征； 2.偏癱患者與正常成人步行時空參數(shù)的差異，可為臨床制訂偏癱康復治療方案、評定康復療效提供簡單、量化的依據(jù)； 3.步行時空參數(shù)分析在截肢康復中用于假肢定型、矯正及假肢使用者步行功能評定，是一種簡便、定量、敏感的步態(tài)評定方法，具有重要的臨床應用價值。
[Abstract]:Objective to study the walking characteristics of Chinese normal adults and to provide reference for clinical gait analysis. By comparing the difference of walking time and space parameters between hemiplegic patients and normal subjects, and the changes of walking time and space parameters of patients with thigh amputation at different time after prosthesis installation, To explore the clinical application value of walking time-space parameter analysis in hemiplegia and amputation rehabilitation. Methods 365 normal subjects were divided into 10 groups according to their sex: 20-29 years old, 30-39 years old, 40-49 years old, 50-59 years old, 60-75 years old group. The measurement and analysis system of human gait pad was used to measure the parameters of walking time and space when the subjects were walking freely. At the same time, the walking time and space parameters of 26 patients with hemiplegia and 21 patients with thigh prosthesis wearer were collected to compare the time and space parameters of walking between the patients with hemiplegia and the normal persons and the prosthetic wearers. Result 1. The average walking speed in the age group was higher than that in the female except the 30-39 years old group and 60-75 years old group (P0.05). After 50 years old, the walking speed of the male and female slowed down, and there was significant difference between the male and the female before 50 years old (P0.01). The step length of each age group was larger than that of female (P0.05). The step length of female decreased after 50 years old (P0.01) compared with that before 50 years old (P0.01), and the step length of male decreased after 60 years old. The stride was obviously less than 60 years old (P0.01). 2. The bilateral step speed, step length, support time and the percentage of support time in hemiplegic patients were significantly different from those in the normal control group (P0.01). The walking speed and step length of hemiplegic patients were significantly lower than that of the control group (P0.01), while the percentage of supporting time and supporting time were significantly higher than that of the control group (P0.01). 3. After one month and one week, three months later and one month later, the walking speed and step length of the prosthesis users increased significantly (P0.01), while the support time of one foot decreased significantly (P0.01). Three months after wearing prosthetic limb, the walking speed and step length of the prosthetic user decreased slightly compared with the normal control group (P0.05); the time of single foot support was not significantly different from that of the normal control group (P0.05). At the same time, the prosthetic user's health and bilateral gait symmetry (health / disease) also gradually approach to 1. 1 in the process of prosthesis correction. Conclusion 1. By using the human gait pad measurement and analysis system, the reference range of spacetime parameters of walking for Chinese normal adults is established for the first time to reveal the space-time characteristics of walking of Chinese normal adults. 2. The difference of walking time and space parameters between patients with hemiplegia and normal adults can provide a simple and quantitative basis for clinical treatment of hemiplegia and evaluation of rehabilitation effect. 3. The analysis of time and space parameters of walking is a simple, quantitative and sensitive method to assess the gait function of amputation and rehabilitation. It has important clinical application value.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R339.4

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