先天性马蹄内翻足胫前肌外移前后三维步态分析  

Three-dimensional gait analysis of patients with club foot undergoing anterior tibialis transfer

作　　者：李敬春 徐宏文 荀福兴 于凌佳 黎艺强 雍碧城 袁哲 

机构地区：[1]广州市妇女儿童医疗中心骨科,广东省广州市510623

出　　处：《临床小儿外科杂志》2016年第6期544-547,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的通过三维步态分析的生物力学方法评定先天性马蹄内翻足患儿胫骨前肌外移术后疗效，明确其手术指证。方法收集2010年7月至2014年7月在本院就诊的先天性马蹄内翻足20例，年龄4～6岁，平均4．5岁。男性15例，女性5例，均行胫骨前肌外移术，手术前后均应用三维步态分析系统（美国motion步态分析系统）对患者进行步态分析，每次测量要求至少有3个步长长度，步速恒定。将骨盆、髋、膝、踝关节共设置15个点，并连接成面，建成三维动态图像。对胫骨前肌外移术前后的步态在三维方向进行步态分析。结果胫骨前肌外移手术前、后三维步态分析结果：①行走速度、步频、步长较术前无明显差异，与正常儿童比较也无明显差异。②术后患儿足内收较术前明显改善。③胫骨前肌在术前术后活动状态无明显改变。④胫骨前肌外移术后患侧下肢行进线内旋情况较术前改善。结论运用三维步态分析对行胫骨前肌外移术的患者进行功能量化评价，可以更为准确地了解踝关节的生物力学及胫骨前肌肌电活动变化，因而可以准确判断手术指证和全面评估患儿术后畸形矫正情况。Objective To explore the gaits of patients with club foot undergoing anterior tibialis transfer by three-dimensional （3D） gait analysis through a biomechanical approach. Methods Twenty patients under- going anterior tibialis transfer were recruited between July 2011 and July 2014. There were 15 males and 5 fe- males with an average age of 6.3 （5 - 8 ） years. All patients were evaluated by 3 D gait analysis motion analysis system （Motion Inc. ,USA）. Three-step lengths at constant gait speed were measured. Fifteen points were set up around pelvis, hip, knee and ankle and connected for constructing 3D dynamic images. Results After an- terior tibialis transfer, no significant differences existed in walking speed, cadence and step compared with pre- operative values. Foot abduction of postoperative children significantly improved compared with preoperative sta- tus. Preoperative and postoperative muscle activity of anterior tibialis had no significant change and it stayed ac- tive post-operation. The postoperative moving line of affected-side lower extremities improved compared with pre- operative status. Conclusions 3-D gait analysis can clearly evaluate bilateral lower extremity joint motions in all planes in patients with club foot undergoing anterior tibialis transfer. Also it helps us understand accurately the changes in muscle activity of anterior tibialis and biomechanics of ankle joint. Therefore deformity correction of patients with club foot undergoing anterior tibialis transfer may be fully evaluated through 3-D gait analysis.

关 键 词：畸形足 步态/生物学 胫骨/外科学 

分 类 号：R726.8[医药卫生—儿科]