住院老年易跌倒人群的步态图特征分析

doi:10.3877/cma.j.issn.1674-134X.2026.04.005

中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 431 -443. doi: 10.3877/cma.j.issn.1674-134X.2026.04.005

临床论著

住院老年易跌倒人群的步态图特征分析

欧阳兰飞¹, 曾东禹², 杨培培¹, 黄星¹, 詹彦臻², 冼明桦², 张海庆¹, 张余², 王旭平¹^,^†(

)

¹ 210023　南京大学医学院附属泰康仙林鼓楼医院耳鼻咽喉头颈外科
² 510080　广州，广东省人民医院（广东省医学科学院）骨肿瘤科

收稿日期:2025-11-27 出版日期:2026-08-01
通信作者: 王旭平
基金资助:
泰康仙林鼓楼医院院内重点项目(TKKYZD20240802); 南京市卫生科技发展专项资金资助项目(ZDXX25213)

Gait characteristics in hospitalized elderly adults with high risk of falls

Lanfei Ouyang¹, Dongyu Zeng², Peipei Yang¹, Xing Huang¹, Yanzhen Zhan², Minghua Xian², Haiqing Zhang¹, Yu Zhang², Xuping Wang^†^,¹()

¹Department of Otolaryngology-Head and Neck Surgery, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210023, China
²Department of Orthopaedic Oncology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China

Received:2025-11-27 Published:2026-08-01
Corresponding author: Xuping Wang

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引用本文：

欧阳兰飞, 曾东禹, 杨培培, 黄星, 詹彦臻, 冼明桦, 张海庆, 张余, 王旭平. 住院老年易跌倒人群的步态图特征分析[J/OL]. 中华关节外科杂志(电子版), 2026, 20(04): 431-443.

Lanfei Ouyang, Dongyu Zeng, Peipei Yang, Xing Huang, Yanzhen Zhan, Minghua Xian, Haiqing Zhang, Yu Zhang, Xuping Wang. Gait characteristics in hospitalized elderly adults with high risk of falls[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(04): 431-443.

目的

探讨住院老年人单任务及不同认知负荷双任务行走（DTW）条件下髋、膝、踝关节6自由度连续步态曲线特征及双任务成本（DTC）与跌倒风险的关系。

方法

纳入2024年5月至2025年6月南京泰康仙林鼓楼医院156例老年患者。纳入年龄≥60岁、意识清楚、可独立步行＞10 m并自愿参加研究者；排除因严重创伤等无法完成步行测试、跌倒由外界暴力或突发疾病所致及拒绝参与者。基线采集一般资料及单任务行走和3种DTW条件下的下肢6自由度步态数据，3种DTW分别为（100-1）DTW、（100-7）DTW和记忆数字DTW，并计算DTC。随访1年记录跌倒事件。组间计量资料根据数据分布采用独立样本t检验或Mann-Whitney U检验，6自由度连续步态曲线采用一维统计参数映射（SPM1D）进行比较，并采用受试者工作特征曲线评价DTC对跌倒风险的判别能力。

结果

156例患者中46例发生跌倒，跌倒率为29.5%。单任务行走中，两组步速（t=0.342）、步态周期（Z=0.312）、步长（Z=0.734）及步频（t=0.354）差异均无统计学意义（均为P＞0.05）。3种DTW条件下，跌倒组步速、步长及步频均降低，步态周期延长（均为P＜0.05），且（100-1）DTW、（100-7）DTW和记忆数字DTW的DTC均高于非跌倒组（t=3.885、4.221、5.112，均为P＜0.001）。6自由度步态曲线分析显示，跌倒组双侧膝关节向上位移减小，单任务行走、（100-1）DTW、（100-7）DTW和记忆数字DTW条件下左膝SPM{t}最小值分别为−4.3、−4.7、−4.6和−5.6，右膝分别为−2.5、−3.7、−4.7和−5.2（均为P＜0.01）；跌倒组右膝伸展角度增大，相应SPM{t}最大值分别为4.6、5.2、6.1和6.3（均为P＜0.05）。双任务条件下，跌倒组踝关节伸展角度在多个步态周期区间增大，其中（100-1）DTW左踝SPM{t}最大值为3.7、右踝为5.8，（100-7）DTW右踝为5.0，记忆数字DTW右踝为4.1。进一步分析显示，跌倒组右髋外展角度在（100-7）DTW的7%～73%步态周期［SPM{t}最大值=2.93，P＜0.01］及记忆数字DTW的8%～71%步态周期［SPM{t}最大值=2.89，P＜0.01］增大；记忆数字DTW中左膝外展角度在67%～94%步态周期增大［SPM{t}最大值=2.16，P=0.014］；左踝内收角度在（100-1）DTW的26%～65%步态周期［SPM{t}最大值=4.40］及（100-7）DTW的26%～32%和40%～65%步态周期［SPM{t}最大值=4.20］增大。

结论

与单任务行走相比，双任务行走可进一步揭示具有跌倒风险老年患者的步态异常，主要表现为双任务条件下传统步态参数恶化、DTC增加以及髋、膝、踝关节特定步态周期内6自由度运动模式改变。6自由度连续步态曲线联合DTC可为住院老年人跌倒风险识别提供客观的运动学依据。

关键词: 老年人, 意外跌倒, 步行, 步态

Objective

To investigate the associations of six-degree-of-freedom (6-DOF) continuous gait characteristics of the hip, knee, and ankle joints and dual-task cost (DTC) with fall risk in hospitalized older adults under single-task walking and dual-task walking (DTW) conditions with different cognitive loads.

Methods

A total of 156 older patients admitted to Taikang Xianlin Drum Tower Hospital, Nanjing, from May 2024 to June 2025 were enrolled. Patients aged ≥60 years who were conscious, able to walk independently for >10 m, and willing to participate were included. Patients who were unable to complete the walking tests because of severe trauma or other conditions, whose falls were caused by external violence or acute diseases, or who declined participation were excluded. Demographic characteristics and lower-limb six-degrees of freedom gait data were collected at baseline during single-task walking and three DTW conditions, including (100-1) DTW, (100-7) DTW, and digit-memory DTW, and DTC was calculated. Falls were recorded during a one-year follow-up. Depending on data distribution, between-group comparisons were performed using the independent-samples t test or Mann-Whitney U test. Continuous six-degrees of freedom gait curves were compared using one-dimensional statistical parametric mapping (SPM1D), and receiver operating characteristic analysis was used to evaluate the discriminative ability of DTC for fall risk.

Results

Among the 156 patients, 46 experienced falls, corresponding to a fall rate of 29.5%. During single-task walking, no significant between-group differences were observed in gait speed (t=0.342), gait cycle (Z=0.312), step length (Z=0.734), or cadence (t=0.354) (all P>0.05). Under all three DTW conditions, the fall group showed lower gait speed, step length, and cadence and a longer gait cycle (all P<0.05). DTC was significantly higher in the fall group during (100-1) DTW, (100-7) DTW, and digit-memory DTW (t=3.885, 4.221, and 5.112, respectively; all P<0.001). Analysis of the six-degrees of freedom gait curves showed reduced upward displacement of both knees in the fall group. The minimum SPM{t} values for the left knee during single-task walking, (100-1) DTW, (100-7) DTW, and digit-memory DTW were −4.3, −4.7, −4.6, and −5.6, respectively, while those for the right knee were −2.5, −3.7, −4.7, and −5.2, respectively (all P<0.01). Right-knee extension angles were greater in the fall group, with corresponding maximum SPM{t} values of 4.6, 5.2, 6.1, and 6.3, respectively (all P<0.05). Under DTW conditions, ankle extension angles were greater in the fall group during several phases of the gait cycle; the maximum SPM{t} values were 3.7 for the left ankle and 5.8 for the right ankle during (100-1) DTW, 5.0 for the right ankle during (100-7) DTW, and 4.1 for the right ankle during digit-memory DTW. In addition, the right-hip abduction angle was greater in the fall group during 7%–73% of the gait cycle in (100-7) DTW [maximum SPM{t}=2.93, P<0.01] and during 8% to 71% of the gait cycle in digit-memory DTW [maximum SPM{t}=2.89, P<0.01]. During digit-memory DTW, the left-knee abduction angle was greater during 67%–94% of the gait cycle [maximum SPM{t}=2.16, P=0.014]. The left-ankle adduction angle was also greater during 26%–65% of the gait cycle in (100-1) DTW [maximum SPM{t}=4.40] and during 26% to 32% and 40% to 65% of the gait cycle in (100-7) DTW [maximum SPM{t}=4.20].

Conclusions

Compared with single-task walking, dual-task walking may further reveal gait abnormalities in older patients at risk of falls, characterized by deterioration in conventional gait parameters, increased DTC, and altered 6-DOF movement patterns of the hip, knee, and ankle joints during specific phases of the gait cycle. Continuous 6-DOF gait analysis combined with DTC may provide objective kinematic evidence for identifying fall risk in hospitalized older adults.

Key words: Aged, Accidental falls, Walking, Gait

表1 两组患者一般资料比较

Table 1 Comparison of general characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	性别［n（%）］ Gender
组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	男Male	女Female
跌倒组 Fall group	46	73±10	159±8	59±9	24±3	12（26.1）	34（73.9）
非跌倒组 Non-fall group	110	76±9	165±32	62±12	24±7	53（48.2）	57（51.8）
统计值 Statistical values		t=1.33	t=1.70	t=1.30	t=0.08	χ²=6.51
P值		＞0.05	＞0.05	＞0.05	＞0.05	＜0.05

表1 两组患者一般资料比较

Table 1 Comparison of general characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	性别［n（%）］ Gender
组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	男Male	女Female
跌倒组 Fall group	46	73±10	159±8	59±9	24±3	12（26.1）	34（73.9）
非跌倒组 Non-fall group	110	76±9	165±32	62±12	24±7	53（48.2）	57（51.8）
统计值 Statistical values		t=1.33	t=1.70	t=1.30	t=0.08	χ²=6.51
P值		＞0.05	＞0.05	＞0.05	＞0.05	＜0.05

表2 不同测试条件下两组患者步态参数比较

Table 2 Comparison of gait parameters between the fall and non-fall groups under different test conditions

组别 Groups	例数 Number of cases	单任务行走Single task walking
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	1.16±0.14	1.11（1.03，1.16）	1.12（1.03，1.18）	109.55±8.28	-
非跌倒组	110	1.18±0.16	1.12（1.05，1.16）	1.11（1.05，1.18）	110.15±8.65	-
统计值 Statistical values		t=0.342	Z=0.312	Z=0.734	t=0.354	-
P值		＞0.05	＞0.05	＞0.05	＞0.05	-
组别 Groups	例数 Number of cases	（100-1）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.82±0.17	1.32（1.20，1.45）	0.98（0.93，1.06）	93.45±12.50	25.10±12.30
非跌倒组	110	0.88±0.14	1.25（1.16，1.38）	1.05（0.97，1.11）	96.88±11.20	19.05±11.00
统计值 Statistical values		t=3.112	Z=2.402	Z=3.421	t=2.232	t=3.885
P值		＜0.01	＜0.05	＜0.01	＜0.05	＜0.001
组别 Groups	例数 Number of cases	（100-7）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.80±0.15	1.29（1.20，1.43）	0.99（0.93，1.07）	93.50±11.60	26.00±11.50
非跌倒组	110	0.85±0.16	1.23（1.16，1.33）	1.03（0.96，1.12）	98.02±11.40	18.50±10.20
统计值 Statistical values		t=3.501	Z=2.754	Z=2.981	t=2.845	t=4.221
P值		＜0.001	＜0.01	＜0.01	＜0.01	＜0.001
组别 Groups	例数 Number of cases	记忆数字DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.72±0.16	1.35（1.23，1.49）	0.94（0.88，1.05）	89.75±12.10	31.25±11.80
非跌倒组	110	0.83±0.13	1.26（1.18，1.41）	1.01（0.93，1.10）	94.50±10.90	22.75±10.30
统计值 Statistical values		t=5.012	Z=3.275	Z=3.592	t=3.672	t=5.112
P值		＜0.001	＜0.01	＜0.001	＜0.001	＜0.001

表2 不同测试条件下两组患者步态参数比较

Table 2 Comparison of gait parameters between the fall and non-fall groups under different test conditions

组别 Groups	例数 Number of cases	单任务行走Single task walking
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	1.16±0.14	1.11（1.03，1.16）	1.12（1.03，1.18）	109.55±8.28	-
非跌倒组	110	1.18±0.16	1.12（1.05，1.16）	1.11（1.05，1.18）	110.15±8.65	-
统计值 Statistical values		t=0.342	Z=0.312	Z=0.734	t=0.354	-
P值		＞0.05	＞0.05	＞0.05	＞0.05	-
组别 Groups	例数 Number of cases	（100-1）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.82±0.17	1.32（1.20，1.45）	0.98（0.93，1.06）	93.45±12.50	25.10±12.30
非跌倒组	110	0.88±0.14	1.25（1.16，1.38）	1.05（0.97，1.11）	96.88±11.20	19.05±11.00
统计值 Statistical values		t=3.112	Z=2.402	Z=3.421	t=2.232	t=3.885
P值		＜0.01	＜0.05	＜0.01	＜0.05	＜0.001
组别 Groups	例数 Number of cases	（100-7）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.80±0.15	1.29（1.20，1.43）	0.99（0.93，1.07）	93.50±11.60	26.00±11.50
非跌倒组	110	0.85±0.16	1.23（1.16，1.33）	1.03（0.96，1.12）	98.02±11.40	18.50±10.20
统计值 Statistical values		t=3.501	Z=2.754	Z=2.981	t=2.845	t=4.221
P值		＜0.001	＜0.01	＜0.01	＜0.01	＜0.001
组别 Groups	例数 Number of cases	记忆数字DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.72±0.16	1.35（1.23，1.49）	0.94（0.88，1.05）	89.75±12.10	31.25±11.80
非跌倒组	110	0.83±0.13	1.26（1.18，1.41）	1.01（0.93，1.10）	94.50±10.90	22.75±10.30
统计值 Statistical values		t=5.012	Z=3.275	Z=3.592	t=3.672	t=5.112
P值		＜0.001	＜0.01	＜0.001	＜0.001	＜0.001

图1 不同步行任务下的髋关节步态图。图A～B为单任务左右髋步态图；图C～D为（100-1）DTW任务左右髋步态图；图E～F为（100-7）DTW任务左右髋步态图；图G～H为记忆数字DTW任务左右髋步态图注：红实线及红实线与上方或下方的红虚线的距离代表跌倒组步态周期的平均值和标准差；蓝实线及蓝实线与上方或下方的蓝虚线的距离代表非跌倒组步态周期的均值和标准差；步态图下方跌倒组与非跌倒组SPM t检验的结果

Figure 1 Hip gait plots for different walking tasks. A and B show left and right hip gait plots for the single-task condition; C and D show left and right hip gait plots for the (100-1) DTW task; E and F show left and right hip gait plots for the (100-7) DTW task; G and H show left and right hip gait plots for the DTW digit memory task Note: The solid red lines and the distances between these lines and the solid or dashed red lines above or below them represent the mean and standard deviation of the gait cycles in the fall group; the solid blue lines and the distances between these lines and the solid or dashed blue lines above or below them represent the mean and standard deviation of the gait cycles in the non-fall group; the results of the SPM t-test comparing the fall group and the non-fall group are shown below the gait plots

图2 不同步行任务下的膝关节步态图。图A～B为单任务左右膝步态图；图C～D为（100-1）DTW任务左右膝步态图；图E～F为（100-7）DTW任务左右膝步态图；图G～H为记忆数字DTW任务左右膝步态图注：红实线及红实线与上方或下方的红虚线的距离代表跌倒组步态周期的平均值和标准差；蓝实线及蓝实线与上方或下方的蓝虚线的距离代表非跌倒组步态周期的均值和标准差；步态图下方为跌倒组与非跌倒组SPM t检验的结果

Figure 2 Knee gait patterns for different walking tasks. A and B show left and right knee gait patterns for the single-task condition; C and D show left and right knee gait patterns for the (100-1) DTW task; E and F show left and right knee gait patterns for the (100-7) DTW task; G and H show left and right knee gait patterns for the DTW number-memory task Note: The solid red lines and the distances between these lines and the solid or dashed red lines above or below them represent the mean and standard deviation of the gait cycles in the fall group; the solid blue lines and the distances between these lines and the solid or dashed blue lines above or below them represent the mean and standard deviation of the gait cycles in the non-fall group; the results of the SPM t test comparing the fall group and the non-fall group are shown below the gait plots

图3 不同步行任务下的踝关节步态图。图A～B为单任务左右踝步态图；图C～D为（100-1）DTW任务左右踝步态图；图E～F为（100-7）DTW任务左右踝步态图；图G～H为DTW_记忆数字任务左右踝步态图注：红实线及红实线与上方或下方的红虚线的距离代表跌倒组步态周期的平均值和标准差；蓝实线及蓝实线与上方或下方的蓝虚线的距离代表非跌倒组步态周期的平均值和标准差；步态图下方跌倒组与非跌倒组SPM t检验的结果

Figure 3 Ankle gait plots for different walking tasks. A and B show left and right ankle gait plots for the single-task condition; C and D show left and right ankle gait plots for the (100-1) DTW task; E and F show left and right ankle gait plots for the (100-7) DTW task; G and H show left and right ankle gait plots for the DTW digit memory task Note: The solid red line and the distance between the solid red line and the solid or dashed red lines above or below it represent the mean and standard deviation of the gait cycle in the fall group; the solid blue line and the distance between the solid blue line and the solid or dashed blue lines above or below it represent the mean and standard deviation of the gait cycle in the non-fall group. The results of the SPM t-test comparing the fall group and the non-fall group are shown below the gait plot

图4 DTW（双任务步行测试）记忆数字任务下DTC（双任务成本）的ROC（受试者工作特征曲线）分析图

Figure 4 ROC (receiver operating characteristic) curve analysis of DTC (dual-task cost) in the DTW (dual-task walking) digital memory task

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Gait characteristics in hospitalized elderly adults with high risk of falls

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Gait characteristics in hospitalized elderly adults with high risk of falls