痉挛型脑瘫儿童动态足底压力分布特征研究
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摘要
目的量化分析痉挛型脑瘫儿童足底压力分布特征,为临床诊断提供参考。方法选取12名GMFCSⅠ级或Ⅱ级的痉挛型脑瘫儿童和16名正常儿童作为研究对象,应用0. 5 m足底压力分布测试系统(Rsscan International@,比利时)对受试者进行自然行走过程的步态测试,采用独立样本t检验和配对t检验分别对脑瘫儿童和正常儿童及脑瘫儿童患侧、健侧步态参数的差异性进行检验。结果痉挛型脑瘫儿童足跟着地期、足后部所受冲量百分比、足中部和足跟中部压强峰值、第一趾骨和第一跖骨单位时间负荷率显著小于健康儿童(P<0. 001、P=0. 029、P=0. 035、P=0. 027、P=0. 017、P=0. 026),而全足支撑期、足中部所受冲量百分比、足弓指数、足底第三到第五跖骨和足中部所受冲量显著大于健康儿童(P=0. 041、P=0. 031、P=0. 034、P=0. 024、P=0. 007、P=0. 045、P=0. 046);痉挛型脑瘫儿童受累侧和非受累侧足底压力分布参数的差异无统计学意义。结论痉挛型脑瘫儿童行走过程中足底压力特征发生明显改变,并且非受累侧存在代偿作用。
Objective Quantitative analysis of the distribution of plantar pressure in children with spastic cerebral palsy can provide reference for clinical diagnosis.Methods Tweleve children with spastic cerebral palsy of GMFCSⅠ or Ⅱ and 16 healthy children were chosen as subjects. The gaits of the subjects during the natural walking were tested using 0. 5 m Footscan system( Rsscan International@,Belgium). The differences of gaitparameters between the affected and healthy sides of cerebral palsy children were examined by paired t-test,the differences of gait parameters between normal children and cerebral palsy children were examined by independent sample t-test. Results During walking,children with spastic cerebral palsy had significantly shorter period of heel strike,impulse percentage of rear foot,peak pressures under midfoot( MF) and heel medial( HL),load rates under Toe1( T1) and Meta 1( M1) compared to healthy children( P<0. 001,P = 0. 029,P =0. 035,P = 0. 027,P = 0. 017,P = 0. 026). The period of full foot support,impulse percentage under midfoot,foot arch index,load rates under toe1( T1),meta 1( M1),meta 3-5( M3-5) and midfoot( MF) are significantly higher than healthy children( P = 0. 041,P = 0. 031,P = 0. 034,P = 0. 024,P = 0. 007,P = 0. 045,P = 0. 046).There were no significant differences for plantar pressure distribution parameters between affected side and non-affected side in children with spastic cerebral palsy. Conclusions The characteristics of the plantar pressure distribution in the children with spastic cerebral palsy are changed significantly compared to normal chidlren,and there is a compensatory role on the non affected side.
Objective Quantitative analysis of the distribution of plantar pressure in children with spastic cerebral palsy can provide reference for clinical diagnosis.Methods Tweleve children with spastic cerebral palsy of GMFCSⅠ or Ⅱ and 16 healthy children were chosen as subjects. The gaits of the subjects during the natural walking were tested using 0. 5 m Footscan system( Rsscan International@,Belgium). The differences of gaitparameters between the affected and healthy sides of cerebral palsy children were examined by paired t-test,the differences of gait parameters between normal children and cerebral palsy children were examined by independent sample t-test. Results During walking,children with spastic cerebral palsy had significantly shorter period of heel strike,impulse percentage of rear foot,peak pressures under midfoot( MF) and heel medial( HL),load rates under Toe1( T1) and Meta 1( M1) compared to healthy children( P<0. 001,P = 0. 029,P =0. 035,P = 0. 027,P = 0. 017,P = 0. 026). The period of full foot support,impulse percentage under midfoot,foot arch index,load rates under toe1( T1),meta 1( M1),meta 3-5( M3-5) and midfoot( MF) are significantly higher than healthy children( P = 0. 041,P = 0. 031,P = 0. 034,P = 0. 024,P = 0. 007,P = 0. 045,P = 0. 046).There were no significant differences for plantar pressure distribution parameters between affected side and non-affected side in children with spastic cerebral palsy. Conclusions The characteristics of the plantar pressure distribution in the children with spastic cerebral palsy are changed significantly compared to normal chidlren,and there is a compensatory role on the non affected side.
引文
[1] Rosenbaum P,Paneth N,Leviton A,et al. A report:the definition and classification of cerebral palsy April 2006[J]. Developmental Medicine&Child Neurology Supplement,2007,49(Suppl109):8-14.
[2]唐久来,秦炯,邹丽萍,等.中国脑性瘫痪康复指南(2015):第一部分[J].中国康复医学杂志,2015,30(7):747-754.
[3]李晓捷,唐久来,马丙祥,等.脑性瘫痪的定义、诊断标准及临床分型[J].中华实用儿科临床杂志,2014,29(19):1520.Li XJ,Tang JL,Ma BX,et al. Definition,diagnostic criteria and clinical typing of cerebral palsy[J].Chinese Journal of Practical Pediatrics,2014,29(19):1520.
[4] Armand S,Decoulon G,Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy[J]. Efort Open Reviews,2016,1(12):448-460.
[5] Durkin MS,Benedict RE,Christensen D,et al. Prevalence of cerebral palsy among 8-year-old children in 2010 and preliminary evidence of trends in its relationship to low birthweight[J].Paediatric&Perinatal Epidemiology,2016,30(5):496-510.
[6]齐蒙蒙,赖秀华,李泽楷,等.我国儿童脑瘫患病率的Meta分析[J].循证护理,2015,1(2):63-67.
[7]李晓捷.实用小儿脑性瘫痪康复治疗技术[M].北京:人民卫生出版社,2009.
[8]林庆.小儿脑瘫的定义、诊断条件及分型[J].中华儿科杂志,1989,27(3):162-164.
[9] Brown CR,Hillman SJ,Richardson AM,et al. Reliability and validity of the Visual Gait Assessment Scale for children with hemiplegic cerebral palsy when used by experienced and inexperienced observers[J]. Gait&Posture,2008,27(4):648-652.
[10] Desloovere K,Molenaers G,Feys H,et al. Do dynamic and static clinical measurements correlate with gait analysis parameters in children with cerebral palsy?[J]. Gait&Posture,2006,24(3):302-313.
[11] Femery V,Moretto P,Renaut H,et al. Measurement of plantar pressure distribution in hemiplegic children:changes to adaptative gait patterns in accordance with deficiency[J].Clinical Biomechanics,2002,17(5):406-413.
[12] Church C,Lennon N,Alton R,et al. Longitudinal change in foot posture in children with cerebral palsy[J]. Journal of Childrens Orthopaedics,2017,11(3):229-236.
[13]刘奕,吴建贤.足外翻脑瘫患儿步行时的足底压力特征[J].安徽医学,2011,32(1):1-4.Liu Y,Wu J X. The planter pressure characteristics of children with talipes valgus[J].Anhui Medicine,2011,32(1):1-4.
[14]吴宝平,宋红芳,王辉,等.体质不同的大学生自然行走时足底压力特征的差异性分析[J].北京生物医学工程,2018,37(3):252-258.Wu B P,Song H f,Wang H,et al. Analysis on the differences of natural plantar pressure feature among college students with different physical condition[J].Beijing Biomedical Engineering,2018,37(3):252-258.
[15]闫松华,谢楠,刘志成.肥胖儿童平地自然行走时的步态研究[J].中国运动医学杂志,2007,26(3):286-290.Yan SH,Xie N,Liu ZC. Biomechanical study on gait of obese children[J].Chinese Journal of Sports Medicine,2007,26(3):286-290.
[16] Yan SH,Zhang K,Tan GQ,et al. Effects of obesity on dynamic plantar pressure distribution in chinese prepubescent children during walking[J]. Gait&Posture,2013,37(1):37-42.
[17]闫松华,董灿,杨进,等.性别与BMI对儿童动态足底压力分布的影响[J].医用生物力学,2010,25(5):363-368.Yan SH,Dong C,Yang J,et al. Effects of gender and BMI on dynamic plantar pressure distribution in children[J]. Medical Biomechanics,2010,25(5):363-368.
[18] Pascoe DD,Pascoe DE,Wang YT,et al. Influence of carrying book bags on gait cycle and posture of youths.[J]. Ergonomics,1997,40(6):631-640.
[19]闫松华,王露,梁秀桥,等.肥胖儿童背包行走时的步态特征[J].中国组织工程研究,2017,21(24):3900-3905.Yan SH,Wang L,Liang X Q,et al. Gait characteristics of obese children wearing school bags during walking[J]. China Tissue Engineering Research,2017,21(24):3900-3905.
[20]刘欣,王磊,陈先,等. Pilon骨折术后动态足底压力的分布特征[J].中国康复理论与实践,2013,19(11):1077-1079.Liu X,Wang L,Chen X,et al. Plantar dynamic pressure distribution after pilon fracture[J]. Rehabilitation Theory and Practice in China,2013,19(11):1077-1079.
[21]闫松华,杨进,刘志成.运动性疲劳对健康男大学生足底压力分布的影响[J].中国运动医学杂志,2009,28(4):372-376.Yan SH,Yang J,Liu ZC. Effects of exercise-induced fatigue on the dynamic plantar pressure distribution in healthy male college students[J].Chinese Journal of Sports Medicine,2009,28(4):372-376.
[22]梁亚利,张静,廖瑞松,等.痉挛型偏瘫脑性瘫痪患儿的步态分析[J].中华物理医学与康复杂志,2017,39(6):450-452.
[23] Park ES,Kim HW,Park CI,et al. Dynamic foot pressure measurements for assessing foot deformity in persons with spastic cerebral palsy.[J]. Archives of Physical Medicine&Rehabilitation,2006,87(5):703-709.
[24]李海,周安艳,黄东锋,等.正常学龄前儿童及痉挛型脑瘫儿童动态步行足底压力对照研究[C]//第九次全国神经病学学术大会论文汇编.广州:中华医学会神经学分会,2006.
[25]郝曼,孙栋.脑瘫足外翻儿童动静态足底压力分布情况分析研究[J].中国康复,2015,30(4):292-293.
[26] Allen PE,Jenkinson A,Stephens MM,et al. Abnormalities in the uninvolved leg in children with spastic hemiplegia. The effect of actual and functional leg length discrepancy[J]. Journal of Pediatric Orthopaedics,1999,10(1):88-92.
[27]燕晓宇,俞光荣.正常足弓的维持及临床意义[J].中国临床解剖学杂志,2005,23(2):219-221.Yan XY,Yu GR.Maintenance of the normal footarch stability and its clinical significance[J].Chinese Journal of Clinical Anatomy,2005,23(2):219-221.
[2]唐久来,秦炯,邹丽萍,等.中国脑性瘫痪康复指南(2015):第一部分[J].中国康复医学杂志,2015,30(7):747-754.
[3]李晓捷,唐久来,马丙祥,等.脑性瘫痪的定义、诊断标准及临床分型[J].中华实用儿科临床杂志,2014,29(19):1520.Li XJ,Tang JL,Ma BX,et al. Definition,diagnostic criteria and clinical typing of cerebral palsy[J].Chinese Journal of Practical Pediatrics,2014,29(19):1520.
[4] Armand S,Decoulon G,Bonnefoy-Mazure A. Gait analysis in children with cerebral palsy[J]. Efort Open Reviews,2016,1(12):448-460.
[5] Durkin MS,Benedict RE,Christensen D,et al. Prevalence of cerebral palsy among 8-year-old children in 2010 and preliminary evidence of trends in its relationship to low birthweight[J].Paediatric&Perinatal Epidemiology,2016,30(5):496-510.
[6]齐蒙蒙,赖秀华,李泽楷,等.我国儿童脑瘫患病率的Meta分析[J].循证护理,2015,1(2):63-67.
[7]李晓捷.实用小儿脑性瘫痪康复治疗技术[M].北京:人民卫生出版社,2009.
[8]林庆.小儿脑瘫的定义、诊断条件及分型[J].中华儿科杂志,1989,27(3):162-164.
[9] Brown CR,Hillman SJ,Richardson AM,et al. Reliability and validity of the Visual Gait Assessment Scale for children with hemiplegic cerebral palsy when used by experienced and inexperienced observers[J]. Gait&Posture,2008,27(4):648-652.
[10] Desloovere K,Molenaers G,Feys H,et al. Do dynamic and static clinical measurements correlate with gait analysis parameters in children with cerebral palsy?[J]. Gait&Posture,2006,24(3):302-313.
[11] Femery V,Moretto P,Renaut H,et al. Measurement of plantar pressure distribution in hemiplegic children:changes to adaptative gait patterns in accordance with deficiency[J].Clinical Biomechanics,2002,17(5):406-413.
[12] Church C,Lennon N,Alton R,et al. Longitudinal change in foot posture in children with cerebral palsy[J]. Journal of Childrens Orthopaedics,2017,11(3):229-236.
[13]刘奕,吴建贤.足外翻脑瘫患儿步行时的足底压力特征[J].安徽医学,2011,32(1):1-4.Liu Y,Wu J X. The planter pressure characteristics of children with talipes valgus[J].Anhui Medicine,2011,32(1):1-4.
[14]吴宝平,宋红芳,王辉,等.体质不同的大学生自然行走时足底压力特征的差异性分析[J].北京生物医学工程,2018,37(3):252-258.Wu B P,Song H f,Wang H,et al. Analysis on the differences of natural plantar pressure feature among college students with different physical condition[J].Beijing Biomedical Engineering,2018,37(3):252-258.
[15]闫松华,谢楠,刘志成.肥胖儿童平地自然行走时的步态研究[J].中国运动医学杂志,2007,26(3):286-290.Yan SH,Xie N,Liu ZC. Biomechanical study on gait of obese children[J].Chinese Journal of Sports Medicine,2007,26(3):286-290.
[16] Yan SH,Zhang K,Tan GQ,et al. Effects of obesity on dynamic plantar pressure distribution in chinese prepubescent children during walking[J]. Gait&Posture,2013,37(1):37-42.
[17]闫松华,董灿,杨进,等.性别与BMI对儿童动态足底压力分布的影响[J].医用生物力学,2010,25(5):363-368.Yan SH,Dong C,Yang J,et al. Effects of gender and BMI on dynamic plantar pressure distribution in children[J]. Medical Biomechanics,2010,25(5):363-368.
[18] Pascoe DD,Pascoe DE,Wang YT,et al. Influence of carrying book bags on gait cycle and posture of youths.[J]. Ergonomics,1997,40(6):631-640.
[19]闫松华,王露,梁秀桥,等.肥胖儿童背包行走时的步态特征[J].中国组织工程研究,2017,21(24):3900-3905.Yan SH,Wang L,Liang X Q,et al. Gait characteristics of obese children wearing school bags during walking[J]. China Tissue Engineering Research,2017,21(24):3900-3905.
[20]刘欣,王磊,陈先,等. Pilon骨折术后动态足底压力的分布特征[J].中国康复理论与实践,2013,19(11):1077-1079.Liu X,Wang L,Chen X,et al. Plantar dynamic pressure distribution after pilon fracture[J]. Rehabilitation Theory and Practice in China,2013,19(11):1077-1079.
[21]闫松华,杨进,刘志成.运动性疲劳对健康男大学生足底压力分布的影响[J].中国运动医学杂志,2009,28(4):372-376.Yan SH,Yang J,Liu ZC. Effects of exercise-induced fatigue on the dynamic plantar pressure distribution in healthy male college students[J].Chinese Journal of Sports Medicine,2009,28(4):372-376.
[22]梁亚利,张静,廖瑞松,等.痉挛型偏瘫脑性瘫痪患儿的步态分析[J].中华物理医学与康复杂志,2017,39(6):450-452.
[23] Park ES,Kim HW,Park CI,et al. Dynamic foot pressure measurements for assessing foot deformity in persons with spastic cerebral palsy.[J]. Archives of Physical Medicine&Rehabilitation,2006,87(5):703-709.
[24]李海,周安艳,黄东锋,等.正常学龄前儿童及痉挛型脑瘫儿童动态步行足底压力对照研究[C]//第九次全国神经病学学术大会论文汇编.广州:中华医学会神经学分会,2006.
[25]郝曼,孙栋.脑瘫足外翻儿童动静态足底压力分布情况分析研究[J].中国康复,2015,30(4):292-293.
[26] Allen PE,Jenkinson A,Stephens MM,et al. Abnormalities in the uninvolved leg in children with spastic hemiplegia. The effect of actual and functional leg length discrepancy[J]. Journal of Pediatric Orthopaedics,1999,10(1):88-92.
[27]燕晓宇,俞光荣.正常足弓的维持及临床意义[J].中国临床解剖学杂志,2005,23(2):219-221.Yan XY,Yu GR.Maintenance of the normal footarch stability and its clinical significance[J].Chinese Journal of Clinical Anatomy,2005,23(2):219-221.