人體步行動態平衡反應評估─蝴蝶狀重心晃動曲線分析比較

Assessment of Human Ambulatory Dynamic Postural Stability: Analysis and Comparison of Butterfly Curve

李明義(Ming-Yih Lee) ； 陳繼超(Chi-Chao Chen) ； 陳鍾德(Chung-Ta Chen) ； 吳基銓(Chi-Chuan Wu)

《Journal of Medical and Biological Engineering》 20卷3期 (2000/09) Pp. 58-67

摘要

骨科全人工髖／膝關節置換病患在進行臨床手術後，由於患部疼痛及手術後未恢復之傷口，會造成病患下肢運動失調，以及運動控制功能受到干擾，以致雙腳載重平衡能力發生異常或障礙。因此，醫師常建議病患在手術後利用輔行具協助訓練步行時動態雙腳載重之平衡，進而加速術後療效，改善下肢運動功能；然而臨床上如何評估病患使用輔行具之療效以及病患何時得以安全摒棄輔行具自由行動，亟需建立一套病患步行動態雙腳載重平衡定量評估工具和方法。本研究係採用自行開發之腳底壓力感測系統對骨科全人工髖／膝關節置換病人及正常人進行步行時動態雙腳載重平衡實驗，透過即時量測之雙腳腳底壓力值並計算雙腳及全身之壓力中心（center of pressure, COP），並將COP晃動軌跡描繪出butterfly curve「蝴蝶狀重心晃動曲線」，透過該曲線左、右側圖形對稱性進行比較；另外也依該曲線圖形對稱性，定義五項雙腳載重對稱性定量評估指標。本研究分析結果發現，以蝴蝶狀重心晃動曲線圖形之五項平衡定量指標進行比較，正常人族群步行動態平衡能力最好，手術後使用助行器病患族群次之，手術前病患族群最差；手術前左側開刀病患族群較手術前右側開刀病患族群好；膝關節手術前病患族群較髖關節手術前病患族群好。另外，至於手術後病患以三種不同助行器扶手高度設定策略（大股骨轉子高度、雙手下垂時手腕遠端橫紋高度與上二種高度之中間值）進行腳壓測試，所得結果證實使用雙手下垂時手腕遠端橫紋高度來設定扶手高度，能得到較佳的雙腳載重平衡效果。

關鍵字

步行 ； 動態 ； 平衡 ； 晃動曲線

並列摘要

Total hip/knee joint replacement patients tend to suffer limited motor control in their lower limbs due to unhealed, open wound. As a result, physicians often recommend patients who underwent surgery to utilize walker as aid in walking training that helps to balance the dynamic weight bearing balance, in order to speed up improving the lower limbs' motoring function. Nevertheless, there is a dire need in establishing a comprehensive set of tools and methods by which quantitative evaluation can be given to study the patients' dynamic weight bearing and walking stability in terms of how patients can be clinically evaluated for the need to prescribe walking aid treatment or when it is safe enough for them to move freely without the aid of a walker. In this paper, the dynamic foot pressure (weight bearing) from normal subject and total hip/total knee replacement patient groups during ambulation were collected and compared. The dynamic foot pressure data were collected using a home-made portable foot pressure sensing system. The sway pattern of center of pressure (COP) was displayed as a butterfly curve and used for weight bearing symmetricity assessment. Five quantitative indices were derived from butterfly curve for comparison. The results indicate that the symmetricity of butterfly curve of the normal subject group is better than the patient groups. In addition, the patient group often surgery with walking aided is better than the patient group before surgery. It also demonstrates that the total knee replacement patient group is better than that of the total hip replacement patient group. Finally, three different height setting strategies (i.e. greater trochanter height, distal wrist crease height, and the average height of previous two) of walker's handle were tested for postural stability. The results indicate that distal wrist crease height for walker's handle setting is the best strategy for the patient to regain dynamic postural stability.

並列關鍵字

Ambulatory ； Dynamic ； Stability ； Butterfly Curve