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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (5): 907-914. doi: 10.19723/j.issn.1671-167X.2021.05.016

• 论著 • 上一篇    下一篇

视觉重建对老年人行走动态足底压力的影响

敖明昕1,李学民1,于媛媛2,时会娟2,黄红拾2,敖英芳2,△(),王薇1,△()   

  1. 1.北京大学第三医院眼科,眼部神经损伤的重建保护与康复北京市重点实验室
    2.北京大学第三医院运动医学科,北京大学运动医学研究所,北京市运动医学关节伤病重点实验室,北京 100191
  • 收稿日期:2021-06-21 出版日期:2021-10-18 发布日期:2021-10-11
  • 通讯作者: 敖英芳,王薇 E-mail:aoyingfang@163.com;puh3_ww@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81600760)

Effects of visual restoration on dynamic plantar pressure features in elder individuals

AO Ming-xin1,LI Xue-min1,YU Yuan-yuan2,SHI Hui-juan2,HUANG Hong-shi2,AO Ying-fang2,△(),WANG Wei1,△()   

  1. 1. Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
    2. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2021-06-21 Online:2021-10-18 Published:2021-10-11
  • Contact: Ying-fang AO,Wei WANG E-mail:aoyingfang@163.com;puh3_ww@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81600760)

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摘要：

目的: 观察白内障超声乳化联合人工晶体植入术后老年人足底受力情况的变化,探讨视觉重建对老年人足踝部生物力学的影响。方法: 选择2016年10月至2019年12月在北京大学第三医院眼科行双眼白内障手术的32例年龄相关性白内障患者[男5例,女27例,平均年龄(70.1±5.2)岁]进行随访,以Footscan分析系统记录术前及术后1个月平地行走过程中的足底压力参数,对足底第1趾骨(1st toe,T1)、第2~5趾骨(2nd to 5th toe,T2-5)、第1~5跖骨(1st to 5th metatarsal heads,M1~M5)、中足(midfoot,MF)、足跟内侧(heel medial,HM)、足跟外侧(heel lateral,HL)区域触地最大压强(peak pressure,PP),触地冲量(impulse,I),压力时间积分(pressure-time integral,PTI)及触地压强达峰时间(time to peak pressure, TPP)进行对比分析。结果: 术后,患者视功能得到有效重建,双眼视力显著提高(Z=-4.878,-4.801,P<0.001);优势侧(右足)M2区受力较术前增强,PP值(t=2.266,P=0.031)及I值(t=2.152,P=0.039)均增大,其他区域受力强度及时间参数的变化差异均无统计学意义。足底受力分布具有侧向性,术前优势侧M1、M2、MF及HM区PP值大于非优势侧(t=-2.414,-2.478,-2.144,-5.269;P<0.05),非优势侧T1、M3、M5及HL区PP值大于优势侧(t=4.830,3.155,2.686,3.683;P<0.05),优势侧M1、MF及HM区I值大于非优势侧(t=-2.380,-2.185,-5.320;P<0.05),非优势侧T1、M3、M5及HL区I值大于优势侧(t=4.489,2.247,2.838,3.992;P<0.05);术后,M3及MF区双侧受力强度趋于一致;M1(ZPP△=-2.721,P=0.007;ZI△=-2.581,P=0.010)、M2(ZPP△=-2.674,P=0.007;ZI△=-2.375,P=0.018)和M5区(ZPP△=1.991,P=0.046;ZI△=2.150,P=0.032)双侧受力差异幅度有所增大。结论: 白内障手术后足底压力变化以优势侧前足内侧第二跖骨头区受力增大为特征,视觉重建可能加剧优势侧前足内侧着重受力及非优势侧前足外侧着重受力。

关键词: 足底压力, 超声乳化白内障吸除术, 人工晶状体, 老年人

Abstract:

Objective: To analyze the effects of visual restoration after cataract surgery on plantar pressure and biomechanics of foot in elder individuals. Methods: Thirty-two patients [male/female 5/27, (70.1±5.2) years old] with age-related cataract were recruited between October 2016 and December 2019. The footscan system was employed to record the data of plantar pressure during level walking before and 1-month after the cataract surgery. Parameters of peak pressure (PP), impulse (I), pressure-time integral (PTI) and time to peak pressure (TPP) from the regions of the 1st toe (T1), 2nd to 5th toes (T2-5), 1st to 5th metatarsal heads (M1-M5), midfoot (MF), medial hindfoot (HM) and lateral hindfoot (HL) were analyzed respectively. Results: Post-operatively, the visual function was effectively reconstructed with improved visual acuity in both eyes (Z=-4.878, -4.801; P<0.001). The PP (t=2.266, P=0.031) and I (t=2.152, P=0.039) values in M2 region on the dominant side (right foot) increased statistically at post-operative phase, while the changes of pressure and temporal para-meters in other regions remained stable. There was laterality in plantar pressure at pre-operative phase, manifested as greater PP values in M1, M2, MF, and HM regions on the dominant sides (t=-2.414, -2.478, -2.144, -5.269; P<0.05), greater PP values in T1, M3, M5 and HL regions on the non-dominant sides (t=4.830, 3.155, 2.686, 3.683; P<0.05), greater I values in M1, MF, and HM regions on the dominant sides (t=-2.380, -2.185, -5.320; P<0.05) and greater I values in T1, M3, M5 and HL regions on the non-dominant sides (t=4.489, 2.247, 2.838, 3.992; P<0.05). post-operatively, the pressure tended to be compatible between the two sides in regions of M3 and MF, while the magnitude of laterality in regions of M1 (ZPP△= -2.721, P=0.007; ZI△=-2.581, P=0.010), M2 (ZPP△=-2.674, P=0.007; ZI△=-2.375, P=0.018) and M5 (ZPP△=1.991, P=0.046; ZI△=2.150, P=0.032) was further increased. Conclusion: Changes in plantar pressure after cataract surgery were characterized as increased pressure in the 2nd metatarsal head area on the dominant side. Visual restoration might intensify the laterality in the medial of forefoot on the dominant side and the lateral of forefoot on the non-dominant side.

Key words: Plantar pressure, Phacoemulsification, Intraocular lenses, Elderly

中图分类号: 

  • R779.66

表1

白内障患者手术前后平地步行足底压力参数比较"

Region Peak pressure/Pa Impulse/(N·s) Pressure-time integral/ms Time to peak pressure/ms
Pre Post Pre Post Pre Post Pre Post
Right
T1 12.29±8.34 15.00±13.14 1.72±1.54 1.81±1.60 257.58±98.41 257.15±97.69 573.32±68.59 557.16±73.95
T2-5 8.80±5.39 11.18±14.17 1.28±0.95 1.41±1.50 274.67±84.43 274.30±85.01 544.06±57.90 541.12±78.84
M1 18.04±17.98# 22.30±16.38# 3.38±3.77# 3.62±2.28# 329.98±96.98 366.86±113.45 476.36±81.76 484.58±62.21
M2 42.23±23.54# 53.21±35.40*# 8.23±4.25 9.35±5.12*# 456.13±75.14 473.87±76.89 527.40±57.66 531.61±54.87
M3 34.61±16.69 39.21±28.57 8.01±4.14 8.37±4.96 493.03±65.69 494.59±94.12 492.18±80.69 493.91±81.62
M4 19.00±9.06 19.71±10.31 5.19±2.70 5.06±2.28 478.58±83.60 487.28±90.20 384.22±104.04 407.37±86.51
M5 17.06±13.91 16.73±26.41 3.98±3.67 3.53±5.32 417.25±111.72 400.27±110.28 367.32±95.94 359.51±87.39
MF 7.41±5.81# 8.09±6.39 1.26±0.96# 1.32±1.03 263.21±102.64 277.05±124.64 241.83±75.39 258.38±88.58
HM 32.11±14.90# 32.03±13.36# 6.13±3.30# 5.79±2.39# 332.53±68.28 339.23±66.49 115.77±47.10 117.22±56.30
HL 22.48±8.07 23.97±10.60 3.96±1.90 4.25±2.16 307.33±66.38 318.30±71.01 109.78±45.26 121.68±57.11
Left
T1 22.36±14.67§ 25.38±32.47 3.17±2.20§ 3.14±3.49§ 320.41±95.61 319.49±97.18 559.19±58.78 552.11±60.83
T2-5 11.78±11.57 9.02±6.84 1.42±1.35 1.23±0.97 267.42±79.14 278.37±105.46 546.95±83.11 542.03±87.51
M1 11.18±10.13 10.42±12.00 1.89±1.45 1.61±1.45 331.78±96.31 322.01±117.12 439.69±75.67 434.98±84.19
M2 31.88±19.29 31.63±25.32 7.10±5.16 6.47±4.49 460.20±88.77 449.79±99.68 496.31±63.91 487.39±67.69
M3 44.94±22.68§ 44.88±26.58 9.70±4.75§ 9.67±5.14 492.33±80.13 496.21±85.76 509.09±70.78 499.95±76.05
M4 22.56±12.49 21.05±13.07 5.30±3.20 5.20±3.22 470.07±87.55 472.73±106.23 456.42±85.32 445.14±90.23
M5 22.72±15.43§ 28.56±26.07§ 5.47±3.86§ 6.81±6.09§ 471.53±70.56 471.04±79.10 384.60±85.31 376.78±71.24
MF 5.68±3.04 7.74±8.49 0.96±0.66 1.14±0.83 263.60±108.42 271.62±116.15 259.16±83.47 253.90±69.96
HM 20.02±8.52 20.72±7.43 3.64±1.96 3.51±1.50 322.58±66.61 314.03±70.68 104.24±47.81 100.36±57.65
HL 27.48±10.52§ 31.10±13.82§ 5.18±2.30§ 5.32±2.46§ 328.528±66.66 322.72±61.31 103.00±51.11 90.68±52.94

图1

白内障患者手术前后足底压力分布的侧向性"

表2

白内障患者手术前后双足受力差异幅度比较"

Region PP△/Pa I△/(N·s)
Pre Post Pre Post
T1 -6.4 (-19.1, -1.1) -3.4 (-15.4, 0.5) -1.0 (-2.5, -0.3) -0.7 (-1.9, -0.2)
T2-5 -0.2 (-5.4, 3.3) -0.5 (-3.8, 3.3) 0.2 (-1.1, 0.4) 0.0 (-0.6, 0.5)
M1 3.0 (-2.3, 13.8) 8.2 (1.2, 17.4)* 0.7 (-0.5, 2.1) 1.4 (0.3, 3.5)*
M2 6.5 (-4.6, 20.6) 10.2 (0.8, 38.9)* 1.5 (-1.0, 3.3) 1.8 (0.2, 5.8)*
M3 -7.8 (-15.2, -1.1) -8.3 (-19.4, 4.6) -1.8 (-4.0, 0.8) -1.3 (-4.6, 1.5)
M4 -2.8 (-10.1, 3.1) -0.4 (-6.9, 3.4) 0.0 (-2.2, 1.8) 0.0 (-1.6, 0.9)
M5 -5.3 (-11.0, -0.4) -6.8 (-25.2, -2.7)* -1.6 (-2.7, -0.3) -2.1 (-5.6, -1.0)*
MF 0.9 (-0.6, 3.9) 1.4 (-1.0, 4.4) 0.1 (-0.2, 0.5) 0.2 (-0.3, 0.8)
HM 9.6 (4.5, 18.6) 10.2 (0.8, 17.8) 2.2 (0.8, 4.2) 2.0 (0.8, 3.6)
HL -4.7 (-11.4, 0.0) -7.1 (-15.8, 0.0) -1.0 (-2.3, 0.0) -0.8 (-2.2, -0.1)

图2

白内障患者手术对足底压力侧向性幅度的影响"

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CN 11-4691/R
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