功能性踝关节不稳者步态的生物力学特征
摘要
目的：功能性踝关节不稳已经越来越受到人们的关注，但是对功能性踝关节不稳者步态的研究却较为少见。本研究从功能性踝关节不稳者步态的跨步、关节角度、时空等运动学特征以及足地接触力、足底压力等动力学特征，系统探讨功能性踝关节不稳者步态的生物力学特征，为踝关节损伤防治和康复训练提供基础理论和实验依据。
方法：本研究选取有左侧功能性踝关节不稳的受试者13名（FAI组），根据FAI组受试者的年龄、身高、体重、训练项目、下肢形态学指标等特征选取15名无功能性踝关节不稳的健康受试者（对照组）。运用Vicon-MX红外动作捕捉系统、kistler测力台以及Zebris步态分析跑台FDM-TDS系统对FAI组和对照组进行最舒适步速下的行走测试，并采集时相、跨步特征、关节角度、时-空、足地接触力、重心、足底压力等生物力学特征参数。FAI组和对照组同侧下肢步态的生物力学参数的对比，采用独立样本t检验。
结果：①步态的时相特征中，摆动末期、支撑相百分比、摆动相百分比、支撑相/摆动相在FAI组与对照组之间的差异有统计学意义（P<0.05）；②在步态的跨步特征方面，左右步长、跨步长、左右足偏角、左右步宽在FAI组与对照组之间的差异无统计学意义（P＞0.05），但左步长/腿长、跨步长/腿长在两组间差异有统计学意义（P<0.05）；③步态的关节角度特征方面，左右髋关节在X面的足跟着地时刻上角度、支撑期最大屈曲角、摆动期最大屈曲角在FAI组与对照组之间差异有统计学意义（P<0.05）；左膝关节在X面上摆动期最大屈曲角、关节活动幅度在两组间的差异有统计学意义（P<0.05）；左踝关节在X面上着地时刻背屈角、摆动期最大屈曲角两组间差异有统计学意义（P<0.05），左踝关节在Y面上足跟着地时刻角度两组间差异有统计学意义（P<0.05）；在X、Y、Z面上其他角度两组间差异无统计学意义（P＞0.05）；④FAI组与对照组步态的时空参数，仅步速在两组间的差异有统计学意义（P <0.05）；⑤左下肢X方向的力峰值、力峰值/体重、力值变化范围/体重在FAI组与对照组之间的差异有统计学意义（P<0.05）；其他足地接触力参数两组间差异无统计学意义（P＞0.05）；⑥在步态的足底压力特征方面，左右足足跟最大压力、足掌最大压力、最大压力时刻、压力作用线等参数在FAI组与对照组之间的差异无统计学意义（P＞0.05）。
结论：①功能性踝关节不稳者在常速行走时步态的运动学、动力学特征部分指标与对照组有显著性差异；②功能性踝关节不稳者步态的支撑期延长，摆动期缩短，摆动末期足跟摆动速度显著增加，左步长、跨步长、步速均显著减小；③功能性踝关节不稳者患侧髋关节、膝关节、踝关节在矢状面的屈伸运动均与对照组有显著性差异，同时也引起健侧髋关节屈伸的功能代偿；除了患侧踝关节在足跟着地时刻有更大的内翻角度外，两侧髋关节和踝关节在冠状面和水平面的运动无显著性差异；④功能性踝关节不稳者行走时足底接触力的前后方向的力峰值显著降低，表现向前的推动力不足；⑤功能性踝关节不稳者行走过程中足跟和足掌两部分的足底压力与对照组无显著性差异；⑥功能性踝关节不稳者行走时足跟着地时刻的踝关节背屈不足且内翻过多会增加踝关节再次内翻损伤的风险。
Objectives: Functional ankle instability is the commonest injury in the sports, butstudies on gait of functional instability of the ankle are relatively seldom. This studyfrom gait characteristics of functional ankle instability, angle characteristics, spatial andtemporal characteristics of kinematics of joints and foot exposure characteristics ofPlantar pressure, gravity and other forces. Basic theory and experimental basis wereprovided from the systemetic analysis Biomechanical gait characteristics of the anklewith functional instability was done for ankle injury prevention and rehabilitation.
Methods：Study of functional instability of the ankle to the left select subject13(FAI),according to the FAI Group subjects ' age, height, weight and training projects, andlower limb morphology,15subjects without functional ankle instability were selected ascontrol group. Using Vicon-MX infrared motion-capture system, Kistler forcemeasurement and gait analysis of Zebris treadmill FAI FDM-TDS systems group andcontrol groups for the most comfortable pace of walking test and acquisition phase,stride characteristics, joint angles, time-space, foot-ground contact forces, gravity, footbiomechanical parameters, such as pressure. FAI Group and the control groupcomparison of the ipsilateral lower extremity parameters, using independent samplest-test.
Results：①In the Gait characteristics, terminal swing,support phase percentage,swingphase percentage,and the difference in percentage of the standing phase/swing phasebetween the FAI group and the control group was statistically significant.②In thecharacteristics of gait stride, the difference in the left and right step length, stride length,left and right foot the declination, around step width between FAI and control groupswas not statistically significant (P>0.05), but the difference in the left step/leg length,stride length/leg length between the two groups was statistically significant (P <0.05);③As to the joint angle of gait characteristics the difference between FAI andcontrol groups in foot followed the the ground moments angle,maximum flexion angleof support phase, maximum flexion angle of the swing phase at left and right hipenough in X-plane were statistically significant (P <0.05); the difference at left kneein the X-plane swing phase the maximum flexion angle, range of motion between thetwo groups was statistically significant (P <0.05); the difference in left ankle jointsurface in X the ground moments dorsiflexion angle, swing phase.the flexion anglebetween the two groups was statistically significant (P <0.05), the difference in the leftankle joint foot in the Y plane followed the ground moments angle between the twogroups was statistically significant (P <0.05); the difference in the other angle X, Y, Zplane between the two groups was not statistically significant (P>0.05);④Spatial andtemporal parameters between gait FAI group and the control group, only the differenceof thepace between the two groups was statistically significant (P <0.05).⑤Thedifference in the force of the left lower limb peak, peak force/body weight, the forcevalue range/weight in X-direction between the FAI group and the control group wasstatistically significant (P <0.05); the other foot contact force parameters between thetwo groups has no statistic significance(P>0.05);⑥In the characteristics of Gait ofplantar pressure, the difference in the maximum pressure of left and right feet heel,paws maximum pressure, the moment of maximum pressure, the line pressureparameters between the FAI and control groups showed no statistical significance (P>0.05).
Conclusions：Gait kinematics and kinetics were different with and without functionalankle instability walking in normal speed;②Gait support with functional ankleinstability significantly increase and decrease either in the swing phase or walking speed;speed of late heel swing phase increased significantly; left step length, stride length andwalking speed were significantly reduced;③Ipsilateral hip, knee and ankle’s flexionand extension of people with functional ankle instability have different degrees ofchange in the sagittal plane,also cause contralateral hip’s flexion and extension have thecompensatory changes; greater varus angle in addition to the ipsilateral ankle foot heelmoment, both sides of the hip and ankle in the coronal plane and the horizontal movement hardly changes;④The plantar contact force in the longitudinal direction ofthe peak force was significantly smaller, which led to an insufficient performance inforward thrust;⑤the foot plantar pressure study were divided into the two parts of theheel and paws,we couldn’t not draw the conclution that whether plantar pressure of thegait with functional ankle instability was different from that of the control group, somore detailed plantar pressure interval division was needed;⑥About the ipsilateralankle foot heel moment, people with functional ankle instability ankle dorsiflexion waslack and had too much varus, the injury risk of ankle varus would be increased duringtheir walking.
方法：本研究选取有左侧功能性踝关节不稳的受试者13名（FAI组），根据FAI组受试者的年龄、身高、体重、训练项目、下肢形态学指标等特征选取15名无功能性踝关节不稳的健康受试者（对照组）。运用Vicon-MX红外动作捕捉系统、kistler测力台以及Zebris步态分析跑台FDM-TDS系统对FAI组和对照组进行最舒适步速下的行走测试，并采集时相、跨步特征、关节角度、时-空、足地接触力、重心、足底压力等生物力学特征参数。FAI组和对照组同侧下肢步态的生物力学参数的对比，采用独立样本t检验。
结果：①步态的时相特征中，摆动末期、支撑相百分比、摆动相百分比、支撑相/摆动相在FAI组与对照组之间的差异有统计学意义（P<0.05）；②在步态的跨步特征方面，左右步长、跨步长、左右足偏角、左右步宽在FAI组与对照组之间的差异无统计学意义（P＞0.05），但左步长/腿长、跨步长/腿长在两组间差异有统计学意义（P<0.05）；③步态的关节角度特征方面，左右髋关节在X面的足跟着地时刻上角度、支撑期最大屈曲角、摆动期最大屈曲角在FAI组与对照组之间差异有统计学意义（P<0.05）；左膝关节在X面上摆动期最大屈曲角、关节活动幅度在两组间的差异有统计学意义（P<0.05）；左踝关节在X面上着地时刻背屈角、摆动期最大屈曲角两组间差异有统计学意义（P<0.05），左踝关节在Y面上足跟着地时刻角度两组间差异有统计学意义（P<0.05）；在X、Y、Z面上其他角度两组间差异无统计学意义（P＞0.05）；④FAI组与对照组步态的时空参数，仅步速在两组间的差异有统计学意义（P <0.05）；⑤左下肢X方向的力峰值、力峰值/体重、力值变化范围/体重在FAI组与对照组之间的差异有统计学意义（P<0.05）；其他足地接触力参数两组间差异无统计学意义（P＞0.05）；⑥在步态的足底压力特征方面，左右足足跟最大压力、足掌最大压力、最大压力时刻、压力作用线等参数在FAI组与对照组之间的差异无统计学意义（P＞0.05）。
结论：①功能性踝关节不稳者在常速行走时步态的运动学、动力学特征部分指标与对照组有显著性差异；②功能性踝关节不稳者步态的支撑期延长，摆动期缩短，摆动末期足跟摆动速度显著增加，左步长、跨步长、步速均显著减小；③功能性踝关节不稳者患侧髋关节、膝关节、踝关节在矢状面的屈伸运动均与对照组有显著性差异，同时也引起健侧髋关节屈伸的功能代偿；除了患侧踝关节在足跟着地时刻有更大的内翻角度外，两侧髋关节和踝关节在冠状面和水平面的运动无显著性差异；④功能性踝关节不稳者行走时足底接触力的前后方向的力峰值显著降低，表现向前的推动力不足；⑤功能性踝关节不稳者行走过程中足跟和足掌两部分的足底压力与对照组无显著性差异；⑥功能性踝关节不稳者行走时足跟着地时刻的踝关节背屈不足且内翻过多会增加踝关节再次内翻损伤的风险。
Objectives: Functional ankle instability is the commonest injury in the sports, butstudies on gait of functional instability of the ankle are relatively seldom. This studyfrom gait characteristics of functional ankle instability, angle characteristics, spatial andtemporal characteristics of kinematics of joints and foot exposure characteristics ofPlantar pressure, gravity and other forces. Basic theory and experimental basis wereprovided from the systemetic analysis Biomechanical gait characteristics of the anklewith functional instability was done for ankle injury prevention and rehabilitation.
Methods：Study of functional instability of the ankle to the left select subject13(FAI),according to the FAI Group subjects ' age, height, weight and training projects, andlower limb morphology,15subjects without functional ankle instability were selected ascontrol group. Using Vicon-MX infrared motion-capture system, Kistler forcemeasurement and gait analysis of Zebris treadmill FAI FDM-TDS systems group andcontrol groups for the most comfortable pace of walking test and acquisition phase,stride characteristics, joint angles, time-space, foot-ground contact forces, gravity, footbiomechanical parameters, such as pressure. FAI Group and the control groupcomparison of the ipsilateral lower extremity parameters, using independent samplest-test.
Results：①In the Gait characteristics, terminal swing,support phase percentage,swingphase percentage,and the difference in percentage of the standing phase/swing phasebetween the FAI group and the control group was statistically significant.②In thecharacteristics of gait stride, the difference in the left and right step length, stride length,left and right foot the declination, around step width between FAI and control groupswas not statistically significant (P>0.05), but the difference in the left step/leg length,stride length/leg length between the two groups was statistically significant (P <0.05);③As to the joint angle of gait characteristics the difference between FAI andcontrol groups in foot followed the the ground moments angle,maximum flexion angleof support phase, maximum flexion angle of the swing phase at left and right hipenough in X-plane were statistically significant (P <0.05); the difference at left kneein the X-plane swing phase the maximum flexion angle, range of motion between thetwo groups was statistically significant (P <0.05); the difference in left ankle jointsurface in X the ground moments dorsiflexion angle, swing phase.the flexion anglebetween the two groups was statistically significant (P <0.05), the difference in the leftankle joint foot in the Y plane followed the ground moments angle between the twogroups was statistically significant (P <0.05); the difference in the other angle X, Y, Zplane between the two groups was not statistically significant (P>0.05);④Spatial andtemporal parameters between gait FAI group and the control group, only the differenceof thepace between the two groups was statistically significant (P <0.05).⑤Thedifference in the force of the left lower limb peak, peak force/body weight, the forcevalue range/weight in X-direction between the FAI group and the control group wasstatistically significant (P <0.05); the other foot contact force parameters between thetwo groups has no statistic significance(P>0.05);⑥In the characteristics of Gait ofplantar pressure, the difference in the maximum pressure of left and right feet heel,paws maximum pressure, the moment of maximum pressure, the line pressureparameters between the FAI and control groups showed no statistical significance (P>0.05).
Conclusions：Gait kinematics and kinetics were different with and without functionalankle instability walking in normal speed;②Gait support with functional ankleinstability significantly increase and decrease either in the swing phase or walking speed;speed of late heel swing phase increased significantly; left step length, stride length andwalking speed were significantly reduced;③Ipsilateral hip, knee and ankle’s flexionand extension of people with functional ankle instability have different degrees ofchange in the sagittal plane,also cause contralateral hip’s flexion and extension have thecompensatory changes; greater varus angle in addition to the ipsilateral ankle foot heelmoment, both sides of the hip and ankle in the coronal plane and the horizontal movement hardly changes;④The plantar contact force in the longitudinal direction ofthe peak force was significantly smaller, which led to an insufficient performance inforward thrust;⑤the foot plantar pressure study were divided into the two parts of theheel and paws,we couldn’t not draw the conclution that whether plantar pressure of thegait with functional ankle instability was different from that of the control group, somore detailed plantar pressure interval division was needed;⑥About the ipsilateralankle foot heel moment, people with functional ankle instability ankle dorsiflexion waslack and had too much varus, the injury risk of ankle varus would be increased duringtheir walking.
引文
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