- 期刊
Lateral Pelvic Tilt during Ambulation in Hemiplegic Patients
偏癱病人步行時骨盆側傾之研究
摘要
左右不對稱性是偏癱病人步行時之主要問題之一。而根據Bobath之理論，骨盆腔動作之控制，是下肢動作的重點。因此本實驗目的，在研究偏癱病人步行時，骨盆側傾之左右對稱性、其與中臀肌活動之關係、以及單腳站立測驗下之最大骨盆側傾角度與步行時之最大骨盆側傾角度之關連性。八名因腦中風引起之偏癱病人參與本實驗。有四名左側、四名右側偏癱；二名女性、六名男性病人。平均年齡為58.88歲。中風後至參與實驗時間間隔為半年至13年。所有受試者皆可不使用任何副木或輔行器完成本實驗所需之步行測驗。受試者步行時骨盆側傾之角度、由－VHS攝影機記錄。此攝影機置於受試者正前方、與受試者骨盆高度相當。受試者面向攝影機、於－9公尺長之步道上走5次。選取其中三次步行速度相似之記錄，分析這三次步行記錄每一次之最中間3大步，以避免加、減速對步態造成之影響。步行時，同時以體表肌電圖記錄中臀肌之活動情形，並以足底壓力計記錄步態週期。此外亦以攝影機記錄單腳站立測驗中，最大骨盆側傾角度。骨盆側傾角度均以雙足站立時之側斜度為基準（為零度），而非以水準線為基準。結果顯示偏癱病人步行時之骨盆側傾動作左右不對稱，且相當複雜。在八名受試者中，可歸納出四種形式：(l)患側承重時，對側骨盆過度下傾（即所謂positive Trendelenburg Sign)；健側承重時，對側骨盆上揚（即pelvic hiking)；(2)患側承重時，對側骨盆腔初期持平，後過度下傾；健側承重時，對側骨盆上揚；(3)患側承重時，對側骨盆上揚；健側承重時，對側骨盆下傾；(4)二側均上揚。其次，發現單腳站立測驗之骨盆側傾角度與步行時之角度無顯著相關。步行時最大骨盆側傾角度健側承重時平均為－1.11度（上揚），患側為2.82度（下傾）。單腳站立測驗時之最大骨盆側傾角度在健側平均為－7.55度，患側為－1.00度。最後，步行時健側承重時對側之最大骨盆側傾角度可以用下列公式推算：步行最大骨盆側傾角度＝－4.99＋1.10×單腳站立測驗最大骨盆側傾角度＋0.22×中臀肌收縮時問。但患側則無此關連性。總之，本實驗證實偏癱患者骨盆側傾現像是左右不對稱的。而且不僅有過度下傾的情形，亦有過度上揚的現象。以攝影方法記錄步行時之骨盆側傾動作，為一臨床可用之客觀評估法。此外，單腳站立並非評估步行時之骨盆側傾角度之可靠方法，其相關度值得再深入研究。
並列摘要
The purposes of this study were to: (1) describe the lateral pelvic tilt (pelvic motion in the frontal plane) during gait in subjects with hemiplegia; (2) examine the relationship of the peak amplitude of lateral pelvic tilt during ambulation and during the single limb stance test; and (3) examine the relationship between the timing of the gluteus medius muscle and the peak amplitude of lateral pelvic tilt. Eight ambulatory hemiplegic subjects (4 right-and 4 left-side involvements; 2 females and 6 males) participated in this study. The average age was 58.88 years (ranging from 55 to 67 years old). The lateral pelvic tilt was monitored by a video camera positioned in front of the subjects during the single limb stance test and during ambulation. A second video camera positioned to the side of the subject recorded the stride length. Two foot switches placed under the heels recorded the gait cycle duration during walking trials. Surface electromyographic activity of bilateral gluteus medius muscles was monitored simultaneously with the kinematic data during ambulation. The results of this study revealed that the lateral pelvic tilt during ambulation for hemiplegic subjects was complex in wave form and asymmetrical between the left and right sides. The peak amplitude of lateral pelvic tilt during the single limb stance test was not related to that during ambulation in hemiplegic subjects. A multiple regression analysis showed that, on the unaffected side, the peak amplitude of lateral pelvic tilt during ambulation could be estimated by both the peak amplitude of lateral pelvic tilt during the single limb stance test and the normalized burst duration of the gluteus medius muscle. This relationship, however, was lost in the affected side of the hemiplegic subjects. The results of this study suggested that lateral pelvic tilt be complex in the hemiplegic subjects and it can be analyzed with the use of a video camera in the clinical settings.