距下关节制动治疗青少年柔韧性平足症术后骨盆冠状面倾角变化的研究  

Pelvic coronal inclination change in adolescent flexible flatfoot surgically treated with arthroereisis

作　　者：白露[1] 周雯[2] 谢小肖 陈粟蒙 颜钰鑫 张新涛[1] Bai Lu;Zhou Wen;Xie Xiaoxiao;Chen Sumeng;Yan Yuxin;Zhang Xintao(Department of Sports Medicine,Peking University Shenzhen Hospital,Shenzhen 518036,China;Department of Radiology,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院运动医学科,深圳518036 [2]北京大学深圳医院放射科,深圳518036

出　　处：《中华医学杂志》2023年第37期2921-2925,共5页National Medical Journal of China

基　　金：深圳市卫计委三名工程学科能力提升项目(SZXJ2018085);深圳市三名工程项目(SZSM201612078)

摘　　要：目的探究采用距下关节制动治疗青少年柔韧性平足症术后骨盆冠状面倾斜角度的变化。方法病例系列研究。回顾性分析2018年6月至2020年9月在北京大学深圳医院接受治疗的25例术前存在骨盆倾斜的青少年柔韧性平足症患者的临床资料。其中单侧5例,双侧20例。男17例,女8例,年龄(11.2±2.2)岁(9~15岁)。所有患者均采用距下关节制动手术治疗。术后规律随访,并在术后3个月、1年、2年拍摄双下肢站立X线全长片及双足站立正侧位X线片测量足部距骨第一跖骨角(Meary角)、跟骨倾斜角(Pitch角)、双侧踝关节平面高度差、骨盆高度差、骨盆倾斜角及骶髂距离差F值。结果本组患者平足均得到明显改善。其中Meary角在术后3个月(3.1°±1.5°)较术前(25.9°±4.3°)明显改善(P<0.001),且其在术后1年和2年的对比无明显变化(P=0.748)。Pitch角在术后3个月(16.6°±2.4°)较术前(9.9°±1.5°)明显增高(P<0.001),其在术后1年和2年对比亦无明显变化(P=0.542)。踝穴高度差在术后3个月较术前明显减小(P<0.001),其在术后1年和2年的随访中无明显变化(P=0.159)。术后3个月骨盆高度差为(7.1±1.2)mm,较术前的(12.4±1.7)mm明显减小(P<0.001),术后1年为(3.6±1.8)mm,较术后3个月仍有改善(P<0.001);术后2年与术后1年相比差异无统计学意义(P=0.483)。术后3个月骨盆倾斜角和骶髂距F值均较术前明显改善(均P<0.001),术后1年亦均进一步改善(均P<0.05),但术后2年与术后1年比较差异均无统计学意义(均P>0.05)。结论距下关节制动术可矫正伴骨盆倾斜的青少年柔韧性平足症患者的平足,且术后其骨盆在冠状面的倾斜和不等高会有所改善,但在术后2年的随访期仍不能达到完全纠正。Objective To evaluate adolescent pelvic coronal inclination angle change after flatfoot treated with arthroereisis.Method A case-series study.From June 2018 to September 2020,25 children with flexible flat foot and pelvic obliquity were included in this retrospective study in Peking University Shenzhen Hospital.There were 17 males and 8 females with a mean age of(11.2±2.2)years(9-15 years).There were 5 cases of unilateral flatfoot and 20 cases of bilateral flatfoot.All of the patients were surgically treated with arthroereisis.Regular follow-up was done in 3 months,1 and 2 years postoperatively.Weightbearing fluoroscopy of entire lower limb and foot were investigated to measure Meary′s angle,calcaneal pitch angle,height difference at ankle and pelvic plane,pelvic inclination and sacrum-iliac distance(F value)on coronal plane.Results The mean Mearys′angle at 3 month postoperatively was improved when compared with that before the operation(3.1°±1.5°vs 25.9°±4.3°,P<0.001),and it remained at the same level 2 years after the operation(compared with that at 1 year after the operation,P=0.748).The calcaneal pitch angle improved significantly at 3-month follow-up when compared with that before the operation(16.6°±2.4°vs 9.9°±1.5°,P<0.001),and there was no significant change between 1 year and 2 years after operation(P=0.542).The height difference at mortise plane were also reduced at the 3-month follow-up(P<0.001),and it remained at the same level at 1 year and 2 years after the operation(P=0.159).Pelvic height difference decreased dramatically from(12.4±1.7)mm(before operation)to(7.1±1.2)mm(3 month after the operation)(P<0.001),it decreased to(3.6±1.8)mm 1 year after the operation(compared with that at 3 months after the operation,P<0.001),and no further reduction was observed 2 years after the surgery(P=0.483).The pelvic inclination angle and sacrum-iliac distance were also improved at 3-month follow-up when compared with those before the operation(both P<0.001),and they declined further 1 year afte

关 键 词：扁平足 柔韧性平足症 青少年 骨盆倾斜 冠状面倾角 

分 类 号：R687.3[医药卫生—骨科学]