摘要
目的通过对有、无跌倒史老年人进行步态运动学和动力学同步测量,对比步态生物力学特征,为老年人跌倒预防提供理论及实践依据。方法在居民社区及老年公寓招募284名60岁以上老年人作为测试对象,严格按照纳入和排除标准,按照既往12个月跌倒史分为跌倒组(有跌倒史)和非跌倒组(无跌倒史)。采用三维录像解析和动态足底压力测量获取受试者自然行走步态的运动学和动力学参数。测试数据采用独立样本t检验进行组间各因素差异性对照分析。结果跌倒组老年人自然行走步态过程中左足第1跖骨峰值力、双足足跟外侧冲量、右足大拇趾冲量等动力学参数与非跌倒组相比,差异均有统计学意义(P<0.05);跌倒组老年人自然行走步态过程中右足第2跖骨受力面积、左足缓冲期接触时间、右足前脚掌触地时间、右足横向压力中心(center of pressure,COP)轨迹、左足触地髋角、双足峰值压力点重心位移等运动学参数与非跌倒组相比,差异均有统计学意义(P<0.05)。结论与无跌倒史老年人相比,有跌倒史老年人行走过程中第2跖骨受力面积减小,足底触地时间延长,过渡期支撑稳定性下降,COP横向位移增大,行进方向COM位移减小,意味着老年人下肢肌力下降,足侧向摆动增大,步行推进力减小,可导致姿势控制策略发生代偿性改变,潜在跌倒风险增大。在临床评估中,应重点关注有跌倒史老年人群步态足底压力及运动学特征。
Objective Through the simultaneous measurement on gait kinematics and dynamics of older adults with and without a history of falling,the biomechanical characteristics of gait were compared,so as to provide theoretical and practical basis for the prevention of falling in older adults.Methods A total of 284 older adults over 60 years old were recruited in residential communities and apartments for the elderly.According to the inclusion and exclusion criteria,the subjects were divided into falling group(with a falling history)and non-falling group(without a falling history)according to their falling history in the past 12 months.The kinematics and dynamics parameters of the subjects'natural walking gait were obtained by three-dimensional(3D)video analysis and dynamic plantar pressure measurement.The test data were analyzed by independent sample t-test for the differences of various factors between groups.Results The dynamic parameters of left foot first metatarsal peak force,lateral heel impulse,right toe impulse in falling group were significantly different from those in non-falling group(P<0.05).The force bearing area of the 2~(nd)metatarsal bone of the right foot,the contact time of the left foot in buffer period,the contact time of the right front foot,the right foot transverse COP(center of pressure)track,the left foot contact hip angle,the displacement of the peak pressure point COM(center of mass)of both feet were significantly different from those of non-falling group(P<0.05).Conclusions Compared with the older adults without a history of falling,the force area of the 2~(nd)metatarsal bone decreases during walking,the time of foot touching the ground lengthens,the support stability decreases during the transition period,the lateral displacement of COP increases,and the displacement of the center of gravity in the direction of walking decreases,indicating that muscle strength of the lower limb of the older adults decreases,the lateral swing of the foot increases,and the walking propulsion decreases,which may lead to compensatory changes in posture control strategy,with the the potential falling risk increasing.In clinical evaluation,the plantar pressure and kinematics characteristics of the gait of the older adults with a history of falling should be focused on.
作者
张庆来
孟站领
李瑞宁
王利红
ZHANG Qinglai;MENG Zhanling;LI Ruining;WANG Lihong(Physical Education College of Zhengzhou University,Zhengzhou 450044,China)
出处
《医用生物力学》
CAS
CSCD
北大核心
2023年第6期1107-1113,共7页
Journal of Medical Biomechanics
基金
国家社会科学基金项目(22BTY074)。
关键词
老年人
跌倒史
步态
生物力学
older adult
falling history
gait
biomechanics
