【摘要】 目的 探讨脑卒中后下肢本体感觉障碍与步态及运动功能的相关性，为脑卒中患者的临床康复提供参考。方法 纳入55例可独立步行的脑卒中下肢功能障碍患者，以发病后约2周（T₁）作为第1次评估的基线时间，以发病后约6周（T₂）作为第2次评估时间，分别进行膝、踝关节位置觉及运动觉测试，并采集步速、空间步态对称率（SGS）、时间步态对称率（TGS）、Fugl-Meyer下肢运动评定量表（FMA-LE）评分及起立-行走计时（TUGT）。计算各指标T₂-T₁差值（Δ），采用Pearson相关分析检验基线下肢本体感觉指标与基线步态及运动功能指标、Δ本体感觉与Δ步态及运动功能指标以及基线本体感觉与Δ步态及运动功能指标之间的相关性。结果 Pearson相关分析结果显示，基线膝、踝关节位置觉与步速均呈正相关关系（r分别为0.006、0.048,P均<0.05），基线膝、踝关节运动觉与TGS均呈正相关关系（r分别为0.016、0.035,P均<0.05）；Δ膝关节位置觉及膝、踝关节运动觉均与Δ步速呈负相关关系（r分别为-0.381、-0.078、-0.301,P均<0.05）；Δ踝关节运动觉与ΔSGS呈正相关关系（r为0.317,P<0.05），与ΔFMA-LE评分呈负相关关系（r为-0.348,P<0.05）；Δ踝关节位置觉及Δ膝、踝关节运动觉均与ΔTUGT呈正相关关系（r分别为0.286、0.362、0.367,P均<0.05）；基线膝关节运动觉与ΔTGS呈负相关关系（r为-0.243,P<0.05），基线踝关节运动觉与ΔTUGT呈负相关关系（r为-0.237,P<0.05）。结论 脑卒中后下肢，尤其是踝关节运动觉障碍与步态时间对称性及步行效率下降密切相关；6周内运动觉和位置觉的改善可同步促进步速、步态对称性和下肢功能恢复。更多还原

【Abstract】 Objective To investigate the correlation between lower limb proprioceptive impairment and gait and motor function following stroke, providing reference for clinical rehabilitation of stroke patients. Methods Fifty-five stroke patients with lower limb dysfunction who could walk independently were enrolled. The baseline assessment（T₁） was conducted at approximately 2 weeks post-onset, with the second assessment（T₂） at approximately 6 weeks post-onset. Knee and ankle position sense and movement sense tests were administered. Additionally, gait parameters including walking speed, spatial gait symmetry（SGS）, temporal gait symmetry（TGS）, Fugl-Meyer assessment for the lower extremity（FMA-LE） scores, and Timed Up and Go Test（TUGT） were recorded. The difference （Δ） between T₂ and T₁ values for each indicator was calculated. Pearson correlation analysis was employed to examine the relationship between baseline lower limb proprioceptive indicators and baseline gait and motor function indicators, between Δ proprioception and Δ gait and motor function indicators, and between baseline proprioception and Δ gait and motor function indicators. Results Pearson correlation analysis revealed that baseline knee and ankle position sense were positively correlated with walking speed（r=0. 006 and 0. 048, respectively; both P<0. 05）; baseline knee and ankle kinesthesia were positively correlated with TGS（r=0. 016 and 0. 035, respectively; both P<0. 05）. Δ knee position sense and Δ knee/ankle kinesthesia were negatively correlated with Δ walking speed（r=-0. 381 and-0. 301, respectively; both P<0. 05）； Δ ankle kinesthesia was positively correlated with Δ SGS（r=0. 317, P<0. 05） and was negatively correlated with Δ FMA-LE score（r=-0. 348, P<0. 05） ； Δankle position sense and Δknee/ankle kinesthesia were both positively correlated with ΔTUGT（r=0. 286, 0. 362, and 0. 367, respectively; all P<0. 05）; baseline knee kinesthesia was negatively correlated with ΔTGS（r=-0. 243, P<0. 05）, while baseline ankle kinesthesia was negatively correlated with ΔTUGT（r=-0. 237, P<0. 05）. Conclusions Post-stroke lower limb kinesthesia impairment, particularly at the ankle joint, is closely associated with reduced gait temporal symmetry and walking efficiency. Improvement in kinesthesia and proprioception within 6 weeks can concurrently promote walking speed, gait symmetry, and lower limb functional recovery.更多还原