青少年特发性脊柱侧弯患者足部姿势和步态特征的3D形态分析及生物力学评价  

Foot posture and gait in adolescent idiopathic scoliosis patients:three-dimensional morphological analysis and biomechanics evaluation

作　　者：朱飞龙 张明 吴宇[1] 王斌 郭晓琦 曹建刚 朱茜 陈伟[1,2] Zhu Feilong;Zhang Ming;Wu Yu;Wang Bin;Guo Xiaoqi;Cao Jiangang;Zhu Qian;Chen Wei(Department of Rehabilitation,Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Rehabilitation Medicine of Xuzhou Central Hospital,Xuzhou 221009,Jiangsu Province,China;Xuzhou Taishan Community Health Service Center,Xuzhou 221003,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属徐州康复医院康复科,江苏省徐州市221000 [2]徐州市中心医院康复医学科,江苏省徐州市221009 [3]徐州市泰山社区卫生服务中心,江苏省徐州市221003

出　　处：《中国组织工程研究》2021年第33期5294-5300,共7页Chinese Journal of Tissue Engineering Research

基　　金：江苏省科教强卫工程青年医学人才项目(QNRC2016376),项目负责人:张明。

摘　　要：背景:目前对青少年特发性脊柱侧弯患者步行表现的研究,缺少不同严重程度群体的对比,同时忽略了足部姿势对行走的影响。目的:比较轻、中和重度青少年特发性脊柱侧弯患者与健康同龄人在足部姿势和步行表现的差异,为未来青少年特发性脊柱侧弯行为功能评估和康复治疗提供科学依据。方法:纳入研究对象共96例,包括64例青少年特发性脊柱侧弯患者和32例健康青少年志愿者,青少年特发性脊柱侧弯患者根据Cobb角大小细分为轻、中和重度3个级别,其中轻度18例、中度32例及重度14例。由1名有着丰富经验的物理治疗师按照足姿指数标准来评估受试者足部姿势,采用3D足部形态学分析扫描仪进行足部扫描并提取足部形态参数,并用GaitScan仪器进行步态及足底压力数据采集。将轻、中和重度青少年特发性脊柱侧弯患者与同龄健康青少年进行比较分析,总结其足部姿势、平衡、步态及足底压力分布特征。结果与结论:①足形态和姿势方面,中和重度青少年特发性脊柱侧弯组足弓指数、重度青少年特发性脊柱侧弯组足姿指数明显高于健康组(P<0.05);②步态参数方面,重度青少年特发性脊柱侧弯组相对于健康组承重反应期提前,站立末期延迟(P<0.05),中和重度青少年特发性脊柱侧弯组行走速度较健康组减慢且足底压力中心漂移指数显著增加(P<0.05);③足底压力分布方面,中和重度青少年特发性脊柱侧弯组内侧、外侧足跟的压力百分比分别显著高于和低于健康组(P<0.05);重度青少年特发性脊柱侧弯组第一跖骨压力百分比显著高于健康组,而第三、四和五跖骨压力百分比显著低于健康组(P<0.05);④静态平衡方面,重度青少年特发性脊柱侧弯患者前足的负荷比显著小于后足,左足的负荷比显著小于右足(P<0.05);⑤结果证实,中至重度青少年特发性脊柱侧弯患者步行效率及平衡稳定性�BACKGROUND:The current studies of walking performance in adolescent idiopathic scoliosis patients lack comparison among groups with different severity levels and have ignored the impact of foot posture on walking.OBJECTIVE:To explore the differences in foot posture and walking performance of patients with mild,moderate,and severe adolescent idiopathic scoliosis compared with healthy peers and provide scientific basis for the function assessment and rehabilitation in the future.METHODS:A total of 96 subjects were included in the study,including 64 adolescent idiopathic scoliosis patients and 32 healthy voluntary adolescents as the healthy group.Adolescent idiopathic scoliosis patients were subdivided into mild,moderate,and severe grades according to the Cobb angle,including 18 mild cases,32 moderate cases and 14 severe cases.An experienced physiotherapist assessed a subject's foot posture according to the Foot Posture Index.A 3D foot morphology scanner was used to scan for morphological parameters of the foot and GaitScan instrument for gait and plantar pressure data collection.Comparative analysis was conducted between mild,moderate,and severe adolescent idiopathic scoliosis patients and healthy adolescents,and the characteristics of foot posture,balance,gait,and plantar pressure distribution were summarized.RESULTS AND CONCLUSION:(1)In terms of foot morphology and posture,the foot arch index of the moderate and severe adolescent idiopathic scoliosis groups was significantly higher than the healthy group,and the foot posture index of the severe adolescent idiopathic scoliosis group was significantly higher than the healthy group(P<0.05).(2)Regarding gait parameters,the severe adolescent idiopathic scoliosis group had advanced loading response,and a delayed terminal stance as compared with the healthy group(P<0.05).The walking speed of the moderate and severe adolescent idiopathic scoliosis group was slower than the healthy group,and the center of pressure excursion index increased significantly(P<0.05).(3)Regardi

关 键 词：脊柱 青少年 青少年特发性脊柱侧弯 生物力学 足形态 足部姿势 步态 足底压力 平衡 

分 类 号：R452[医药卫生—治疗学] R319[医药卫生—临床医学]