摘要： 目的 探讨伴前庭症状与不伴前庭症状的脑卒中患者步行与静态站立特征差异。方法 纳入2020年5月至2021年12月在天津大学环湖医院行康复治疗的82例脑卒中患者以及49例性别、年龄、受教育程度相匹配的对照者，根据有无前庭症状将脑卒中患者分为前庭症状组（51例）和无前庭症状组（31例），采用7米步行测试评价步行稳定性，感觉整合平衡测试（CTSIB）评价静态站立平衡稳定性。结果 7米步行测试结果显示，3组受试者步态空间参数和时间参数，以及躯干冠状面摆动角度、摆动面积、冠状面姿势摆动的均方根差异均具有统计学意义（均P=0.000）。其中，前庭症状组和无前庭症状组步幅、步速、步频低于对照组（均P=0.000），双支撑相时间、终末双支撑相时间高于对照组（均P=0.000）；前庭症状组步幅、步速、步频亦低于无前庭症状组（均P<0.05），双支撑相时间、终末双支撑相时间亦高于无前庭症状组（均P=0.000）；前庭症状组和无前庭症状组躯干冠状面摆动角度（均P<0.01）、摆动面积（均P=0.000）和冠状面姿势摆动的均方根（均P=0.000）大于对照组，且前庭症状组躯干冠状面摆动角度和冠状面姿势摆动的均方根亦大于无前庭症状组（均P=0.000）。CTSIB测试结果显示，3组受试者躯干摆动面积、冠状面和矢状面姿势摆动的均方根差异均具有统计学意义（均P=0.000）。其中，前庭症状组和无前庭症状组在睁眼稳定面、闭眼稳定面、睁眼平衡软踏、闭眼平衡软踏共4种测试条件下，冠状面和矢状面姿势摆动的均方根大于对照组（均P<0.01）；前庭症状组和无前庭症状组在睁眼稳定面、闭眼稳定面、闭眼平衡软踏共3种测试条件下，躯干摆动面积大于对照组（均P=0.000）；前庭症状组在睁眼平衡软踏下的躯干摆动面积大于对照组（P=0.000），但无前庭症状组小于对照组（P=0.000）。结论 伴前庭症状的脑卒中患者步行参数较不伴前庭症状的脑卒中患者发生明显改变，可为实施精准化康复治疗提供重要的临床价值。

关键词: 卒中, 前庭,迷路, 步行, 姿势平衡, 康复

Abstract: Objective To investigate the difference between walking and static standing characteristics in stroke patients with and without vestibular symptoms.Methods A total of 82 stroke patients who received rehabilitation treatment in Tianjin Huanhu Hospital, Tianjin University from May 2020 to December 2021, and 49 controls with the matched gender, age and education level were included. The stroke patients were divided into vestibular symptom group (n = 51) and vestibular symptomless group (n = 31) according to the condition of vestibular symptoms. The walking stability was evaluated by 7-Meter Walking Test, and the stability of static standing balance was evaluated by the Clinical Test of Sensory Interaction and Balance (CTSIB).Results The results of the 7-Meter Walking Test showed that there were statistically significant differences in the spatial and temporal parameters of gait, the coronal plane swing angle of trunk, swing area and the root mean square of coronal plane posture swing among 3 groups (P=0.000, for all). The stride length, stride speed and stride frequency of the vestibular symptoms group and the vestibular symptomless group were lower than those of the control group (P=0.000, for all), and the time parameters of the double brace phase time and the terminal double brace phase time were higher than those of the control group (P=0.000, for all). The stride length, stride speed and stride frequency of the vestibular symptoms group were lower than those of vestibular symptomless group (P<0.05, for all), and the time of dual brace phase and terminal dual brace phase were higher than those of vestibular symptomless group (P=0.000, for all). The trunk coronal plane swing angle (P<0.01, for all), swing area (P=0.000, for all) and root mean square of coronal plane posture swing (P=0.000, for all) in vestibular symptoms group and vestibular symptomless group were greater than those in control group. The coronal plane swing angle of trunk and the root mean square of coronal plane posture swing of vestibular symptoms group were also greater than those of vestibular symptomless group (P=0.000, for all). The results of CTSIB showed there were statistically significant differences in trunk swing area, root mean square of coronal and sagittal plane postural swing among 3 groups (P=0.000, for all). In vestibular symptom group and vestibular symptomless group, the root mean square of coronal and sagittal plane postural swing were greater than those of the control group under the 4 test conditions of eyes open on firm, eyes closed of firm, eyes open on foam, eyes closed on foam (P<0.01, for all). In vestibular symptom group and vestibular symptomless group, the trunk swing area was greater than that in control group under 3 test conditions of eyes open on firm, eyes closed on firm and eyes closed on foam (P=0.000, for all). The trunk swing area in vestibular symptom group was greater than that in control group (P=0.000), but less than that in vestibular symptomless group (P=0.000). There was no statistical significance between vestibular symptoms group and vestibular symptomless group under 4 test conditions (P>0.05, for all).Conclusions The walking parameters of stroke patients with vestibular symptoms were significantly changed than those of vestibular symptomless, which can provide important clinical value for the implementation of precise rehabilitation treatment.

Key words: Stroke, Vestibular, labyrinth, Walking, Postural balance, Rehabilitation