佩戴软式支具对慢性踝关节不稳患者足底动力学的效果

doi:10.3969/j.issn.1006-9771.2024.05.017

摘要/Abstract

摘要：

目的探讨日常佩戴软式支具对慢性踝关节不稳(CAI)患者步行时足底动力学的影响。

方法纳入2021年2月至2023年1月在北京康复医院就诊的单侧CAI患者52例，随机分为对照组(n = 26)和试验组(n = 26)，两组均进行为期8周的运动训练方案，在日常活动中对照组佩戴安慰支具，试验组佩戴踝关节软式支具。采用压力平板系统测量患者步行时的足底峰值压力和足底冲量。

结果对照组脱落6例，试验组脱落5例，最终纳入41例。干预后，对照组各区域足底峰值压力和冲量均无显著性差异(P > 0.05)，试验组足跟内侧、外侧和前足内侧区的峰值压力和冲量显著增加(|t| > 4.192, P < 0.001)，而中足和前足外侧峰值压力和冲量减小(t > 2.984, P < 0.05)；干预后，试验组患侧足跟内侧、外侧和前足内侧区的峰值压力和冲量高于对照组(|t| > 2.126, P < 0.05)，中足和前足外侧区峰值压力和冲量低于对照组(t > 2.133, P < 0.05)。

结论日常活动中佩戴软式支具可优化CAI患者患侧的足底峰值压力及足底冲量分布，预防再次发生扭伤。

关键词: 慢性踝关节不稳, 运动疗法, 软式支具, 足底压力

Abstract:

Objective To investigate the effect of daily soft brace wearing on plantar dynamics during walking in patients with chronic ankle instability (CAI).

Methods A total of 52 patients with unilateral chronic ankle instability (CAI) in Beijing Rehabilitation Hospital from February, 2021 to January, 2023 were randomly divided into control group (n= 26) and experimental group (n = 26). Both groups underwent an eight-week exercise training program. The control group wore placebo brace during daily activities, while the experimental group wore soft ankle brace. Plantar dynamic parameters were measured using a pressure plate system during walking, including peak plantar pressure and plantar impulse before and after intervention.

Results Six participants dropped out in the control group and five in the experimental group, resulting in a final inclusion of 41 participants. After intervention, there was no significant difference in peak plantar pressure and impulse on the affected side in the control group among different areas (P > 0.05). In the experimental group, the peak pressure and impulse in the heel medial, heel lateral and forefoot medial areas increased (|t| > 4.192, P < 0.001), while the peak pressure and impulse in the midfoot and lateral forefoot areas decreased (t > 2.984, P < 0.05); the peak pressure and impulse in the heel medial, heel lateral and forefoot medial areas were higher in the experimental group than in the control group (|t| > 2.126, P < 0.05), and the peak pressure and impulse were lower in the midfoot and forefoot lateral areas (t > 2.133, P < 0.05).

Conclusion Wearing a soft brace during daily activities may optimize the distribution of peak plantar pressure and plantar impulse on the affected side in patients with CAI, which may prevent recurrence of sprains.

Key words: chronic ankle instability, exercise therapy, soft brace, plantar pressure

中图分类号:

R684.7

马玉宝, 黄志彬, 李依格, 樊志娇, 张丽华, 孙凤龙. 佩戴软式支具对慢性踝关节不稳患者足底动力学的效果[J]. 《中国康复理论与实践》, 2024, 30(5): 613-620.

MA Yubao, HUANG Zhibin, LI Yige, FAN Zhijiao, ZHANG Lihua, SUN Fenglong. Effect of soft brace wearing on plantar dynamics in patients with chronic ankle instability[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 613-620.

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参考文献 24

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项目	对照组(n = 20)	试验组(n = 21)	t/χ²值	P值
年龄/岁	29.35±6.75	30.33±7.82
性别(男/女)/n	5/15	9/12
身高/cm	167.95±6.13	168.90±9.21	0.389	0.700
体质量/kg	64.50±13.75	71.81±16.76	1.522	0.316
体质量指数/(kg·m^-2)	22.78±4.09	24.89±3.79	1.714	0.094
患侧(左/右)/n	6/14	9/12	0.730	0.393

分区	组别	n	测试	$\bar{x} \pm s$	t值	P值
HM区	对照组	20	前测	2.91±0.35	-2.086	0.051
			后测	3.03±0.40
	试验组	21	前测	2.78±0.51	-4.841	< 0.001
			后测	3.32±0.46
	干预前均值差			0.13±0.45	0.978	0.334
	干预后均值差			0.29±0.43	-2.126	0.040
HL区	对照组	20	前测	2.72±0.46	-0.509	0.617
			后测	2.76±0.36
	试验组	21	前测	2.70±0.52	-4.192	< 0.001
			后测	3.05±0.51
	干预前均值差			0.02±0.49	0.176	0.861
	干预后均值差			0.29±0.45	-2.140	0.039
MF区	对照组	20	前测	1.83±0.46	0.034	0.973
			后测	1.82±0.50
	试验组	21	前测	1.83±0.50	4.533	< 0.001
			后测	1.45±0.39
	干预前均值差			0.01±0.48	0.007	0.995
	干预后均值差			0.37±0.46	2.724	0.010
FM区	对照组	20	前测	1.48±0.26	-1.033	0.315
			后测	1.56±0.33
	试验组	21	前测	1.38±0.37	-5.661	< 0.001
			后测	1.90±0.47
	干预前均值差			0.10±0.33	1.049	0.301
	干预后均值差			0.34±0.42	-2.608	0.013
FI区	对照组	20	前测	3.80±0.70	-1.909	0.071
			后测	4.04±0.81
	试验组	21	前测	3.71±1.08	-1.335	0.197
			后测	3.98±0.62
	干预前均值差			0.09±0.95	0.270	0.789
	干预后均值差			0.06±0.73	0.291	0.773
FL区	对照组	20	前测	1.37±0.34	0.167	0.869
			后测	1.36±0.28
	试验组	21	前测	1.41±0.33	2.984	0.007
			后测	1.20±0.19
	干预前均值差			0.04±0.34	-0.442	0.661
	干预后均值差			0.16±0.25	2.133	0.039
T区	对照组	20	前测	1.67±0.32	-1.262	0.222
			后测	1.82±0.41
	试验组	21	前测	1.72±0.19	-0.793	0.437
			后测	1.80±0.48
	干预前均值差			0.05±0.28	-0.633	0.530
	干预后均值差			0.02±0.45	0.141	0.888

分区	组别	n	测试	$\bar{x} \pm s$	t值	P值
HM区	对照组	20	前测	17.39±4.33	-1.640	0.117
			后测	18.41±3.48
	试验组	21	前测	17.21±3.53	-8.024	< 0.001
			后测	22.28±2.92
	干预前均值差			0.18±4.01	0.149	0.882
	干预后均值差			3.87±3.23	-3.861	< 0.001
HL区	对照组	20	前测	16.21±3.51	-0.721	0.480
			后测	16.56±3.79
	试验组	21	前测	16.07±3.55	-4.638	< 0.001
			后测	19.45±4.32
	干预前均值差			0.14±3.53	0.122	0.904
	干预后均值差			2.89±4.09	-2.279	0.028
MF区	对照组	20	前测	14.82±3.23	0.625	0.539
			后测	14.38±3.20
	试验组	21	前测	15.31±3.64	9.512	< 0.001
			后测	8.80±1.88
	干预前均值差			0.49±3.45	-0.459	0.649
	干预后均值差			5.58±2.86	6.836	< 0.001
FM区	对照组	20	前测	10.27±2.22	-0.897	0.381
			后测	10.70±2.20
	试验组	21	前测	9.68±2.22	-6.543	< 0.001
			后测	12.45±2.30
	干预前均值差			0.59±2.22	0.854	0.399
	干预后均值差			1.65±2.25	-2.487	0.017
FI区	对照组	20	前测	22.11±5.49	0.405	0.690
			后测	21.84±5.50
	试验组	21	前测	21.97±4.91	1.653	0.114
			后测	0.16±4.60
	干预前均值差			0.14±5.22	0.086	0.932
	干预后均值差			1.68±5.11	1.079	0.287
FL区	对照组	20	前测	9.60±2.11	0.920	0.369
			后测	9.26±2.18
	试验组	21	前测	10.20±1.88	4.617	< 0.001
			后测	7.72±1.77
	干预前均值差			0.60±2.01	-0.944	0.351
	干预后均值差			1.56±2.01	2.497	0.017
T区	对照组	20	前测	9.60±1.92	1.736	0.099
			后测	8.86±2.42
	试验组	21	前测	9.59±2.33	0.859	0.401
			后测	9.19±2.22
	干预前均值差			0.01±2.15	0.020	0.984
	干预后均值差			0.33±2.33	-0.454	0.653