基于ICF的青年女性“内八字”步态生物力学分析

doi:10.3969/j.issn.1006-9771.2022.12.011

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (12): 1459-1465.doi: 10.3969/j.issn.1006-9771.2022.12.011

基于ICF的青年女性“内八字”步态生物力学分析

黄兆欣,张艺,崔晨曦,祝晓静,肖晓飞()

滨州医学院康复医学院，山东烟台市 264003

收稿日期:2022-11-17 修回日期:2022-11-29 出版日期:2022-12-25 发布日期:2023-01-10
通讯作者: 肖晓飞 E-mail:xxf1013@126.com
作者简介:黄兆欣(1997-)，女，汉族，山东菏泽市人，硕士研究生，主要研究方向：运动生物力学。|肖晓飞(1980-)，男，汉族，山东荣成市人，博士，副教授，主要研究方向：ICF应用、康复科学。
基金资助:
1.山东省自然科学基金项目(ZR2018LA011);2.中华医学会医学教育分会医学教育研究课题(2020B-N04272);3.山东省大学生创新创业训练计划项目(X202210440202);4.滨州医学院教学改革项目(JYKTMP2021028);4.滨州医学院教学改革项目(JYKTZD202211)

Biomechanical analysis of in-toeing gait in young females based on ICF

HUANG Zhaoxin,ZHANG Yi,CUI Chenxi,ZHU Xiaojing,XIAO Xiaofei()

School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong 264003, China

Received:2022-11-17 Revised:2022-11-29 Published:2022-12-25 Online:2023-01-10
Contact: XIAO Xiaofei E-mail:xxf1013@126.com
Supported by:
Shandong Natural Science Foundation(ZR2018LA011);Project of Medical Education Research in Chinese Medical Education(2020B-N04272);Shandong Innovation and Entrepreneurship Training Program for College Students(X202210440202);Course Reform Fund of Binzhou Medical University(JYKTMP2021028);Course Reform Fund of Binzhou Medical University(JYKTZD202211)

摘要/Abstract

摘要：

目的应用ICF和生物力学手段评定和分析“内八字”步态下肢肌肉活动和足底压力特征。

方法 2021年9月至2022年5月，共招募60例青年女性，30例异常步态(步向角 < -18°)作为试验组，30例正常步态作为对照组。运用《国际功能、残疾和健康分类》(ICF)对下肢运动功能进行编码，采用无线表面肌电测试仪和鞋垫式足底压力系统测试下肢肌肉表面肌电信号和足底压力。

结果试验组胫骨前肌的积分肌电值(iEMG)和肌肉贡献率高于对照组(|t| > 2.000, P < 0.05)，股直肌的iEMG和肌肉贡献率低于对照组(|t| > 2.233, P < 0.05)；第2~5跖骨区、足跟外侧区和全足区域的接触面积(t > 2.879, P < 0.01)，第1跖骨区、中足区和足跟外侧区的压力峰值(t > 2.720, P < 0.01)，第1~5跖骨区和足跟外侧区的峰值压强(t > 2.079, P < 0.05)以及第1、4跖骨区和足跟外侧区的冲量(t > 2.310, P < 0.05)高于对照组，在足跟内侧区域的冲量(t = -3.024, P = 0.002)低于对照组。

结论 “内八字”步态者以胫骨前肌和股直肌肌肉活动异常为主；足跟外侧区的接触面积较大，峰值压力、压强和冲量较高；足跟内侧区域的冲量较低。

关键词: 异常步态, 表面肌电, 足底压力, 国际功能、残疾和健康分类

Abstract:

Objective To evaluate and analyze the characteristics of lower limb muscle activity and plantar pressure in females with the in-toeing gait using International Classification of Functioning, Disability and Health (ICF) and biomechanical methods.

Methods A total of 60 young females were recruited from September 2021 to May 2022, out of whom 30 females with in-toeing gait were as experimental group, and 30 females with normal gait were as control group. The motor function of lower extremities was coded by ICF, and the surface EMG signals and plantar pressure characteristics of lower limbs (rectus femoris, biceps femoris, gastrocnemius and tibialis anterior) were measured by wireless surface EMG tester and insole plantar pressure system.

Results The integral electromyography (iEMG) and muscle contribution rate of tibialis anterior were higher (|t| > 2.000, P < 0.05), and the iEMG and muscle contribution rate of rectus femoris were lower (|t| > 2.233, P < 0.05) in the experimental group than in the control group. The contact area of the 2nd to the 5th metatarsal bone, heel lateral and total foot areas (t> 2.879, P < 0.01), the peak force of the 1st metatarsal bone, mid foot and heel lateral areas (t > 2.720, P < 0.01), the peak pressure of the 1st to the 5th metatarsal bone and heel lateral areas (t > 2.079, P < 0.05), and the impulse of the 1st and the 4th metatarsal bone, and heel lateral areas (t > 2.310, P < 0.05) were significantly higher, while the impulse of heel medial area was lower (t = -3.024, P = 0.002) in the experimental group than in the control group.

Conclusion In the process of natural walking, the muscle activity of the in-toeing gait in young female is dominated by tibialis anterior and rectus femoris, the contact area of heel lateral area is larger, the peak pressure, pressure, and impulse are higher, and the impulse of heel medial area is lower.

Key words: in-toeing gait, surface electromyography, plantar pressure, International Classification of Functioning, Disability and Health

中图分类号:

黄兆欣,张艺,崔晨曦,祝晓静,肖晓飞. 基于ICF的青年女性“内八字”步态生物力学分析[J]. 《中国康复理论与实践》, 2022, 28(12): 1459-1465.

HUANG Zhaoxin,ZHANG Yi,CUI Chenxi,ZHU Xiaojing,XIAO Xiaofei. Biomechanical analysis of in-toeing gait in young females based on ICF[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1459-1465.

图/表 7

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测量工具	内容	编码	类目名称	编码	类目名称	编码	类目名称
表面肌电系统	10 m步态行道，行走3次	b730	肌肉力量功能	b7304	四肢肌肉力量	b73041	肌肉iEMG
表面肌电系统		b730	肌肉力量功能	b7304	四肢肌肉力量	b73042	肌肉贡献率
鞋垫式足底压力系统		b770	步态功能	b7701	足底压力状态	b77011	足底接触面积
						b77012	足底峰值压力
						b77013	足底峰值压强
						b77014	足底冲量

组别	n	胫骨前肌	腓肠肌	股直肌	股二头肌
对照组	30	22.42±8.44	17.54±6.04	29.19±6.50	40.16±80.78
试验组	30	33.86±11.42	28.37±9.97	18.21±4.44	27.91±30.54
t值		3.219	3.679	-4.355	-0.054
P值		0.001	< 0.001	< 0.001	0.957

组别	n	胫骨前肌	腓肠肌	股直肌	股二头肌
对照组	30	26.46±14.71	20.92±11.69	25.33±14.79	27.14±17.18
试验组	30	37.13±15.19	22.59±9.77	17.53±12.75	21.54±12.81
t值		-2.000	-0.803	2.233	1.200
P值		0.046	0.435	0.025	0.281

分区	对照组	试验组	t值	P值
第1趾骨区	3.71±1.73	3.84±1.46	0.635	0.551
第2趾骨区	1.74±1.01	1.61±0.86	-0.607	0.551
第3趾骨区	1.29±0.75	0.96±0.69	-0.848	0.396
第4、5趾骨区	0.31±0.35	0.54±0.70	0.433	0.665
第1跖骨区	6.47±2.06	6.41±2.69	-0.144	0.887
第2跖骨区	4.95±0.48	6.21±0.91	3.640	< 0.001
第3跖骨区	5.80±0.44	7.19±0.60	3.985	< 0.001
第4跖骨区	6.26±0.38	7.59±0.96	3.004	0.002
第5跖骨区	5.22±1.21	8.00±1.20	4.042	< 0.001
中足区	8.67±5.98	10.24±6.18	0.716	0.474
足跟内侧区	11.90±3.31	12.69±2.26	0.453	0.654
足跟外侧区	10.00±1.27	13.89±1.41	2.882	0.002
全足	61.93± 9.73	71.18±7.27	2.879	0.003

分区	对照组	试验组	t值	P值
第1趾骨区	9.28±6.99	9.79±10.37	0.780	0.443
第2趾骨区	2.58±2.45	2.48±3.23	-0.462	0.671
第3趾骨区	1.55±0.50	1.15±1.02	-1.249	0.218
第4、5趾骨区	0.23±0.33	0.27±0.52	0.162	0.912
第1跖骨区	7.23±4.02	16.65±3.90	4.043	< 0.001
第2跖骨区	8.58±1.53	7.68±4.06	-1.589	0.114
第3跖骨区	13.62±3.92	12.71±4.05	-0.578	0.590
第4跖骨区	11.13±4.41	14.27±5.51	1.819	0.068
第5跖骨区	6.68±3.65	13.01±6.13	1.570	0.116
中足区	5.02±4.44	13.69±9.20	2.720	0.005
足跟内侧区	42.50±17.14	34.53±9.06	-1.250	0.218
足跟外侧区	27.48±6.32	42.08±3.65	2.882	0.002
全足	111.07±6.14	130.94±32.28	1.589	0.114

基于ICF的青年女性“内八字”步态生物力学分析

Biomechanical analysis of in-toeing gait in young females based on ICF

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分区	对照组	试验组	t值	P值
第1趾骨区	310.08±275.33	316.83±283.90	0.289	0.799
第2趾骨区	137.92±97.21	107.67±78.37	-0.838	0.410
第3趾骨区	102.70±24.65	91.30±61.95	-1.209	0.247
第4、5趾骨区	38.30±38.70	28.70±33.67	-0.713	0.529
第1跖骨区	123.50±51.93	220.50±86.99	4.044	< 0.001
第2跖骨区	108.33±30.45	164.92±31.00	3.205	0.001
第3跖骨区	179.67±46.99	274.83±47.72	3.495	< 0.001
第4跖骨区	142.67±35.45	274.92±75.41	4.042	< 0.001
第5跖骨区	103.50±30.34	180.33±73.96	2.079	0.039
中足区	84.70±34.45	110.50±66.47	0.681	0.529
足跟内侧区	561.00±287.12	343.40±136.06	-1.777	0.075
足跟外侧区	376.33±47.45	536.33±28.46	2.882	0.002
全足	589.42±280.84	532.92±215.10	-0.347	0.755

分区	对照组	试验组	t值	P值
第1趾骨区	25.6±29.77	41.60±28.01	1.762	0.078
第2趾骨区	18.52±19.35	41.60±28.01	0.641	0.589
第3趾骨区	21.8±14.69	32.19±25.04	1.058	0.315
第4、5趾骨区	8.47±9.59	14.80±21.71	0.154	0.912
第1跖骨区	23.82±12.11	47.72±21.87	2.714	0.006
第2跖骨区	34.90±13.47	46.26±16.86	1.386	0.178
第3跖骨区	48.37±18.08	83.51±30.50	1.762	0.078
第4跖骨区	45.01±22.82	85.88±35.08	2.714	0.006
第5跖骨区	29.78±15.38	58.55±27.33	0.578	0.590
中足区	20.93±10.04	23.89±11.60	0.378	0.739
足跟内侧区	118.94±20.25	85.23±45.94	-3.024	0.002
足跟外侧区	70.42±14.65	81.22±18.93	2.310	0.020
全足	72.05±11.99	75.98±8.29	0.404	0.713

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