骶髂关节半脱位矫正对慢性期卒中后功能障碍恢复的影响

doi:10.3969/j.issn.1673-5765.2023.01.009

摘要/Abstract

摘要： 目的初步探讨矫正骶髂关节半脱位对慢性期卒中偏瘫患者步行能力及平衡功能的影响。
方法选择2018年4月—2021年12月在包头市中心医院神经康复中心住院且符合入组标准的慢性期卒中偏瘫患者，对确定存在骶髂关节半脱位的13例患者进行手法矫正治疗。治疗前、治疗3周后进行Berg平衡量表评估、“起立-行走”计时测试、10米步行计时测试、Holden步行能力分级以及骨盆正位X线片检查，并进行比较。
结果存在骶髂关节半脱位的慢性期卒中偏瘫患者共11例纳入研究。按冈斯德分析系统进行骨盆正位X线片画线测量，其中髂骨ASIn 7例，髂骨ASEx 2例，髂骨PIIn 1例，髂骨In 1例。手法矫正治疗3周后，Berg平衡量表评分高于治疗前[（47.00±9.22）分 vs.（37.45±11.04）分，P<0.001]；“起立-行走”计时测试时间短于治疗前[（18.51±5.29）s vs.（24.94±9.50）s，P=0.003]；10米步行计时测试：步行速度较治疗前变快[（53.72±25.71）cm/s vs.（43.49±24.24）cm/s，P＜0.001]，步长较治疗前增加[（38.37±9.87）cm vs.（34.49±9.32）cm，P=0.022]；Holden步行能力分级高于治疗前（2级∶3级∶4级∶5级=0∶2∶4∶5 vs. 1∶6∶4∶0，P=0.002）。
结论对于存在骶髂关节半脱位的慢性期卒中偏瘫患者，骶髂关节半脱位手法矫正治疗有助于患者步行能力及平衡功能的改善。

文章导读： 本研究从脊柱整体姿势出发，矫正骶髂关节半脱位，使骨盆处于标准姿势，改善慢性期偏瘫患者的步行及平衡能力，有望为慢性期卒中偏瘫患者提供一种安全、有效的康复治疗新方法。

关键词: 骶髂关节; 半脱位; 卒中; 功能障碍

Abstract:

Objective To explore the effects of correcting sacroiliac joint subluxation on rehabilitation of walking ability and balance function in patients with chronic stroke hemiplegia.

Methods The inpatients with hemiplegia after chronic stroke in Neurological Rehabilitation Center of Baotou Central Hospital from April 2018 to December 2021 were selected, and 13 patients with sacroiliac joint subluxation who received manipulative treatment among them were included in this study. The Berg balance scale, the timed up and go (TUG) test, the 10 meters walk (10mW) test, Holden walking ability rating, and the pelvis AP radiographs were compared before treatment and 3 weeks after treatment.

Results A total of 11 eligible patients were included in the final analysis. According to the Gunsted analysis system, the pelvis radiographs showed 7 cases with ASIn, 2 cases with ASEx, 1 case with PIIn, and 1 case with In. Compared to before treatment, the assessment scales results at 3 weeks after treatment were as follows: the score of Berg balance scale was higher [ (47.00±9.22) points vs. (37.45±11.04) points, P<0.001], the TUG time was shorter [ (18.51±5.29) s vs. (24.94±9.50) s, P=0.003], the walking speed in 10mW test was faster [ (53.72±25.71) cm/s vs. (43.49±24.24) cm/s, P<0.001] and the step length was increased [ (38.37±9.87) cm vs. (34.49±9.32) cm, P=0.022], and the grade of Holden walking ability rating was higher (grade 2∶grade 3∶grade 4∶grade 5=0∶2∶4∶5 vs. 1∶6∶4∶0, P=0.002).

Conclusions For hemiplegia patients with chronic stroke and sacroiliac joint subluxation, manipulative treatment for sacroiliac joint subluxation can improve patients’ walking ability and balance function.

Key words: Sacroiliac joint; Subluxation; Stroke; Dysfunction

付琨燕, 项文平, 杨志刚, 何飞, 满乾坤, 王雅明, 牛翻燕, 岳雅蓉. 骶髂关节半脱位矫正对慢性期卒中后功能障碍恢复的影响 [J]. 中国卒中杂志, 2023, 18(01): 90-96.

FU Kunyan, XIANG Wenping, YANG Zhigang, HE Fei, MAN Qiankun, WANG Yaming, NIU Fanyan, YUE Yarong. Effects of Correction of Sacroiliac Joint Subluxation on Rehabilitation of Functional Impairment in Patients with Chronic Stroke[J]. Chinese Journal of Stroke, 2023, 18(01): 90-96.

参考文献

[1] FEIGIN V L，NORRVING B，MENSAH G A. Global burden of stroke[J]. Circ Res，2017，120（3）：439-448.
[2] OSTWALD S K，DAVIS S，HERSCH G，et al. Evidence-based educational guidelines for stroke survivors after discharge home[J]. J Neurosci Nurs，2008，40（3）：173-179，191.
[3] GOLDIE P A，MATYAS T A，EVANS O M. Deficit and change in gait velocity during rehabilitation after stroke[J]. Arch Phys Med Rehabil，1996，77（10）：1074-1082.
[4] DE QUERVAIN I A，SIMON S R，LEURGANS S，et al. Gait pattern in the early recovery period after stroke[J]. J Bone Joint Surg Am，1996，78（10）：1506-1514.
[5] CHANG C C，KU C H，CHANG S T. Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke：a role of crossed cerebellar diaschisis in left side[J]. Brain Inj，2017，31（1）：90-97.
[6] MCCAW S T，BATES B T. Biomechanical implications of mild leg length inequality[J]. Br J Sports Med，1991，25（1）：10-13.
[7] KNUTSON G A. Anatomic and functional leg-length inequality：a review and recommendation for clinical decision-making. PartⅡ. The functional or unloaded leg-length asymmetry[J/OL]. Chiropr Osteopat，2005，13：12[2022-03-10]. https://doi.org/10.1186/1746-1340-13-12.
[8] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志，2019，52（9）：710-715.
[9] GONSTEAD C S. 科学&艺术的脊柱矫正[M]. 曹修悌，译. 北京：中国协和医科大学出版社，2018：3-55，86-87，169-170，207-222.
[10] GIBBONS J. 骨盆和骶髂关节功能解剖：手法操作指南[M]. 朱毅，王雪强，李长江，等，译. 北京：北京科学技术出版社，2018：24-36.
[11] MAO H F，HSUEH I P，TANG P F，et al. Analysis and comparison of the psychometric properties of three balance measures for stroke patients[J]. Stroke，2002，33（4）：1022-1027.
[12] HAFSTEINSDÓTTIR T B，RENSINK M，SCHUURMANS M. Clinimetric properties of the timed up and go test for patients with stroke：a systematic review[J]. Top Stroke Rehabil，2014，21（3）：197-210.
[13] 王陇德，刘建民，杨弋，等. 《中国脑卒中防治报告2017》概要[J]. 中国脑血管病杂志，2018，15（11）：611-616，封三.
[14] 任惠明，袁海，王小同，等. 脑的可塑性与卒中后运动功能康复相关研究的Meta分析[J]. 中国康复医学杂志，2011，26（2）：182-184.
[15] DUBEY L，KARTHIKBABU S，MOHAN D. Effects of pelvic stability training on movement control，hip muscles strength，walking speed and daily activities after stroke：a randomized controlled trial[J]. Ann Neurosci，2018，25（2）：80-89.
[16] 黄竹青，石岩，闫文佼，等. 运动想象疗法联合PNF躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响[J]. 现代生物医学进展，2021，21（19）：3728-3732.
[17] GARTENBERG A，NESSIM A，CHO W. Sacroiliac joint dysfunction：pathophysiology，diagnosis，and treatment[J]. Eur Spine J，2021，30（10）：2936-2943.
[18] FEENEY D F，CAPOBIANCO R A，MONTGOMERY J R，et al. Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking[J/OL]. J Electromyogr Kinesiol，2018，43：95-103[2022-03-10]. https://doi.org/10.1016/j.jelekin.2018.09.009.
[19] LIN S I. Motor function and joint position sense in relation to gait performance in chronic stroke patients[J]. Arch Phys Med Rehabil，2005，86（2）：197-203.
[20] SEO M，SHIN M J，PARK T S，et al. Clinometric gait analysis using smart insoles in patients with hemiplegia after stroke：pilot study[J/OL]. JMIR Mhealth Uhealth，2020，8（9）：e22208[2022-03-10]. https://doi.org/10.2196/22208.
[21] 杨先文. 骶髂关节的基础与临床研究[D]. 广州：南方医科大学，2014.
[22] HERZOG W，SCHEELE D，CONWAY P J. Electromyographic responses of back and limb muscles associated with spinal manipulative therapy[J]. Spine（Phila Pa 1976），1999，24（2）：146-153.