摘要
目的:探讨外侧柱延长术联合趾长屈肌腱(FDL)转位术治疗可复性平足的生物力学改变。方法:本院采用外侧柱延长术联合FDL转位术治疗可复性平足患者32例:男18例,女14例;年龄6~45岁,平均22.5岁;左足15例,右足17例。采用美国足与踝关节协会(AOFAS)踝与足评分标准对其治疗前后临床疗效进行评估;术前、术后6个月测量足负重正侧位X光片,测量弓高、距跟角、距骨-第一跖骨间角、跟骨倾斜角、距舟覆盖角。采用比利时Footscan 2m3D足底压强分布测试系统测量第1~5跖骨头(M1~M5)负重足底压强峰值和动态推进期各跖骨下压强值。结果:入组32例患者均获得随访,随访时间为10~35个月,平均21.9个月。所有患者足内侧纵弓及前足外展、后足外翻畸形均取得良好恢复,术后患足恢复正常行走能力。末次随访AOFAS踝与足评分为75~100分,优良率为90.6%(29/32)。术前术后患者X线检查各指标间差异均有统计学意义(P<0.05)。术后M1负重足底压强峰值及动态推进期压强峰值均较术前显著升高,M2~M5负重足底压强峰值及动态推进期压强峰值均较术前显著降低,差异有统计学意义(P<0.05)。结论:外侧柱延长术联合FDL转位术治疗可复性平足,能够明显改善平足的足底压强分布,恢复其生物力学结构,临床效果良好,值得临床推广应用。
Objective：To discuss the biomechanics changes of the recoverable flatfoot by lengthening lateral column osteotomy and FDL（flexor digitorum longus）transposition.Methods：32 cases of recoverable flatfoot were treated by lengthening lateral column osteotomy and FDL transposition.There were 18 males and 14 females with an mean age of 22.5 years（rang from 6 to 45 years）.The left feet were involved in 15 cases and the right were affected in 17 cases.American Orthopaedic Foot and Ankle Society（AOFAS）score was used to evaluate the functions of ankle and foot.The positive and lateral X-ray of the foot in weight loading should be taken 6 months before and after operation,and measure the arch height,calcaneus-talus angle,the first metatarsal bone-astragalus angle and calcaneus slant angle.Using the Belgian Footscan 2 m3 Dplantar pressure distribution measurement system,we record the weight-bearing plantar peak stress and dynamic stress peak of the M1- M5.Results：Eventually,all the patients were followed up with an average duration of 21.9 months（range 10-35 months）.AOFAS scores rang from 75 to 100 points,and the excellent and good rate was 90.6%（29/32）.The specific indexes of X-ray taken before and after operation had great statistical significances（P〈0.05）.After surgery,the weight-bearing plantar peak stress and dynamic stress peak of the M1 was significantly higher than those preoperative,and the weight-bearing plantar peak stress and dynamic stress peak of the M2~M5 was significantly lower than those preoperative（P〈0.05）.Conclusion：The surgical treatment combined with lateral column lengthening osteotomy and FDL transposition for recoverable flatfoot can improve the distribution of plantar pressure and restore its biomechanical structure,and it had a good clinical effect,deserving further clinical application.
出处
《中国中医骨伤科杂志》
CAS
2018年第3期41-45,共5页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
可复性平足
外侧柱延长术
趾长屈肌腱转位术
生物力学
recoverable flatfoot
lateral column lengthening osteotomy
flexor digitorum longus transposition
biomechanical
