帕金森病伴冻结步态患者行走过程中下肢表面肌电图实时分析
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1.南京医科大学第一附属医院神经内科,江苏 南京 210029 ;2.宿迁京东医院(宿豫医院)神经内科,江苏 宿迁 223800 ;3.杭州临安区中医院神经内科,浙江 杭州 311300 ;4.南京医科大学附属无锡人民医院神经内科,江苏 无锡 214023 ;5.南京医科大学附属淮安第一医院神经内科,江苏 淮安 223300

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R742.5

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国家自然科学基金(82271273);江苏省社会发展项目(BE2022808);江苏省自然科学基金(BK20240307);无锡市卫生健康委员会青年科研项目(Q202344);无锡市人民医院博士人才经费(BSRC202307)


Real-time analysis of surface electromyography of lower limb muscles during gait in Parkinson’s disease patients with freezing of gait
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1.Department of Neurology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029 ;2.Department of Neurology,Suqian Jingdong Hospital(Suyu Hospital),Suqian 223800 ;3.Department of Neurology,Hangzhou Lin’an TCM Hospital,Hangzhou 311300 ;4.Department of Neurology,the Affiliated Wuxi People’s Hospital of Nanjing Medical University,Wuxi 214023 ;5.Department of Neurology,the Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University,Huaian 223300 ,China

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    摘要:

    目的:探索帕金森病伴冻结步态患者胫骨前肌和腓肠肌在直线行走过程中表面肌电(surface electromyogram, sEMG)的改变及其与临床特征之间的相关性。方法:选取符合入选标准的12例帕金森病伴冻结步态患者、13例帕金森病不伴冻结步态患者和11例健康对照受试者接受临床特征、步态时空参数和直线行走sEMG评估。分析步态周期各时段中重症侧胫骨前肌和腓肠肌内侧头的sEMG信号特征改变,指标选用标准化均方根振幅(root mean square,RMS)值和共激活比值。同时,探索sEMG改变与临床特征之间的相关性。结果:与健康受试者和非冻结步态患者相比,冻结步态患者的步速减慢、步幅缩短、摆动相减少、步态变异性增加(P < 0.05)。在步态周期的单支撑相阶段,冻结步态患者胫骨前肌标准化RMS较健康对照降低(P < 0.05);在摆动前期,冻结步态患者胫骨前肌标准化RMS较非冻结步态患者显著下降(P < 0.01),但非冻结步态患者胫骨前肌标准化RMS较健康对照增加(P < 0.01)。对于腓肠肌标准化RMS,冻结步态患者在摆动前期较非冻结步态患者和健康对照均显著降低(P < 0.05)。此外,冻结步态患者的胫骨前肌-腓肠肌共激活比值在摆动相较非冻结步态患者降低(P < 0.05)。冻结步态患者摆动前期腓肠肌标准化RMS与冻结步态严重程度(r=-0.758,P=0.007)、摆动相共激活比值和步幅变异性(r=0.716, P=0.013)显著相关。结论:直线行走步态周期中摆动前期胫骨前肌和腓肠肌的sEMG活动下降、摆动相胫骨前肌-腓肠肌共激活比值降低是帕金森病冻结步态患者的重要特征。

    Abstract:

    Objective:To investigate the alterations in surface electromyogram(sEMG)of the tibialis anterior and gastrocnemius muscles during straight-line walking in Parkinson’s disease(PD)patients with freezing of gait(FOG),and their correlations with clinical features. Methods:Twelve PD patients with FOG,thirteen PD patients without FOG,and eleven healthy controls(HC) underwent clinical assessments,gait kinematics acquisition,and sEMG evaluations during straight-line walking. The sEMG signal characteristics of the severely affected tibialis anterior and medial head of the gastrocnemius muscles during different phases of the gait cycle were analyzed using thenormalized root mean square(RMS)and co-activation ratio. Additionally,the correlations between sEMG alterations and clinical features were explored. Results:Compared to the HC and PD patients without FOG,PD patients with FOG exhibited slower gait speed,shorter stride length,reduced swing phase,and increased gait variability(P < 0.05). During the single support phase of the gait cycle,the normalized RMS of the tibialis anterior in FOG patients was significantly lower than that of the HC (P < 0.05). In the pre-swing phase,the normalized RMS of the tibialis anterior in the PD patients with FOG was significantly reduced compared to the PD patients without FOG(P < 0.01),while the PD patients without FOG showed elevated normalized RMS of the tibialis anterior compared to the HC(P < 0.01). For the gastrocnemius,the normalized RMS during the pre-swing phase was significantly lower in the FOG patients compared to the patients without FOG and HC(P < 0.05). Moreover,the co-activation ratio of the tibialis anterior and gastrocnemius during the swing phase was reduced in the FOG patients compared to the patients without FOG (P < 0.05). In the FOG patients,the normalized RMS of the gastrocnemius during the pre-swing phase was significantly correlated with the severity of FOG(r=-0.758,P=0.007),as well as the co -activation ratio during the swing phase and stride length variability(r= 0.716,P=0.013). Conclusion:The decreased sEMG activity of the tibialis anterior and gastrocnemius during the pre-swing phase, along with a reduced co-activation ratio during the swing phase,are key features of FOG in PD during straight-line walking.

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朱晓磊,计敏,史东艳,孙慧敏,王丽娜,张克忠.帕金森病伴冻结步态患者行走过程中下肢表面肌电图实时分析[J].南京医科大学学报(自然科学版),2025,(1):29-34,55

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  • 收稿日期:2024-02-17
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  • 在线发布日期: 2025-01-15
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