| 涂雪灵,姜财,刘小玲,徐盼,李雅萍,林忠华.衰弱前期老年人常速行走的步态特征分析[J].中国康复,2025,40(4):229-234 |
| 衰弱前期老年人常速行走的步态特征分析 |
| Analysis on the gait characteristics of pre-frailt elderly individuals during normal speed walking |
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| DOI：10.3870/zgkf.2025.04.007 |
| 中文关键词: 衰弱前期 步态 平衡 老年人 |
| 英文关键词: pre-frailty gait balance elderly individuals |
| 基金项目:福建省社会发展科技引导性项目（2023Y0052）；中央引导地方科技发展专项（2023L0318） |
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| 中文摘要: |
| 目的：本研究利用三维步态分析系统探讨衰弱前期老年人常速行走的步态特点。方法：本研究采用倾向性匹配法，共纳入受试者68例，其中衰弱前期老年人和配对的非衰弱老年人各34例，分别纳入衰弱前期组和非衰弱组。收集受试者基本信息，进行Fried衰弱量表、简易智力状态量表（MMSE）、Berg平衡量表（BBS）、简易体能状况量表（SPPB）评估，同时利用三维步态分析系统采集动态图像，通过量化整体步态获取下肢步态运动学和髋膝踝关节矢状面运动学特征参数，包括步态偏离指数（GDI）、步态曲线评分（GPS）、步态变异分数（GVS）等，并将步态参数与MMSE、BBS、SPPB评分进行相关性分析，研究衰弱前期老年人的步态特征。结果：较之于非衰弱组，衰弱前期组老年人步速减慢、步长缩短、双支撑相时间延长(均P<0.05)；骨盆前后倾角度、髋内收外展角度、髋屈伸角度、髋旋转角度、膝屈伸角度增大(均P<0.05)，GPS评分增加(P<0.05)，GDI减小(P<0.05)；摆动相初期足趾离地时的髋屈伸角度（TOHFE）、摆动相末期足跟着地时的髋屈伸角度（HSHFE）、踝跖背屈最小值均增大(均P<0.05)，摆动相末期足跟着地时膝屈伸角度（HSKFE）、屈伸最大值，踝跖背屈最大值、踝跖背屈活动度均减小(均P<0.05)。结论：衰弱前期老年人的步态异常可能同身体平衡及足、踝、膝、髋等关节的协同运动降低有关，其在下肢步态特征方面表现出代偿现象，步态参数与MMSE、BBS、SPPB评分相关性分析结果显示衰弱前期状态导致步态出现障碍如步速减慢、步长缩短、踝关节活动度减小等的改变在行走或日常生活中可被察觉。可以将步态分析应用于临床衰弱初筛中。 |
| 英文摘要: |
| Objective: This study employed a three-dimensional gait analysis system to examine the lower extremity biomechanical characteristics associated with normal-speed walking in elderly individuals at the pre-frailty stage. Methods: This investigation was designed as a single-center, cross-sectional study involving 68 eligible participants (34 pre-frail elderly individuals and 34 matched non-frail counterparts) selected through propensity score matching. Comprehensive demographic data were collected from subjects, alongside assessments using the Fried frailty scale, mini-mental state examination (MMSE), Berg balance scale（BBS）, and simple physical performance battery (SPPB). Simultaneously, a three-dimensional gait analysis system was employed to capture dynamic images, enabling the quantification of overall gait and the extraction of corresponding lower limb kinematic parameters. A correlation analysis was subsequently performed to examine the relationship between these gait parameters and established measures such as the BBS, SPPB, and MMSE, thereby elucidating the abnormal gait characteristics observed in the elderly individuals during the pre-asthenic stage. Results: Compared to their non-frail counterparts, those in the pre-frailty group exhibited notable differences in gait parameters: (1) spatiotemporal metrics indicated reduced square step speed, shortened step length, and prolonged double support phase duration (P<0.05); (2) gait variability score (GVS), pelvic tilt angle, hip adduction/abduction angles, hip flexion/extension angles, hip rotation angle increased while gait profile score（GPS）rose and gait deviation index (GDI) decreased (P<0.05); (3) Kinematic analyses revealed that during initial swing phase toe-off there was an increase in hip flexion/extension angle at terminal swing phase foot contact there was an increase in hip flexion/extension angle while knee flexion/extension angle decreased along with maximum knee flexion/extension values. Additionally observed were decreases in maximum ankle dorsiflexion values coupled with increases in minimum plantarflexion values leading to reduced range of motion (ROM), and the difference was statistically significant (P<0.05). Conclusion: This resear-ch suggests that the abnormal gait of pre-frail elderly people might be associated with body balance and the coordinated movements of joints such as the feet, ankles, knees, and hips, and presents compensatory phenomena in temporal and spatial parameters and the kinematics of lower limb joints. Correlation analyses between identified gait parameters and fall incidents indicate that changes characteristic of a pre-asthenic state can lead to observable impairments such as slower pace or diminished ankle mobility during ambulation or daily activities. Consequently, implementing gait analysis could serve as a valuable tool for clinical frailty screening. |
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