矫形鞋垫对青少年特发性脊柱侧弯患者脊柱畸形和步行的改善效果  

Effect of Insoles on Patients with Adolescent Idiopathic Scoliosis

作　　者：朱飞龙 张明 郭晓琦[2] 曹建刚 朱茜 陈杰[1,2] 王斌 吴宇[1] 陈伟 ZHU Fei-long;ZHANG Ming;GUO Xiao-qi;CAO Jian-gang;ZHU Qian;CHEN Jie;WANG Bin;WU Yu;CHEN Wei(The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China;Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China;Xuzhou Taishan Community Health Service Center,Xuzhou,Jiangsu 221003,China)

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

出　　处：《中国康复理论与实践》2021年第6期645-652,共8页Chinese Journal of Rehabilitation Theory and Practice

基　　金：江苏省科教强卫工程青年医学人才项目(No.QNRC2016376)。

摘　　要：目的观察侧弯支具联合矫形鞋垫对青少年特发性脊柱侧弯(AIS)患者脊柱畸形和步行表现改善的效果。方法 2019年9月至2020年9月,门诊AIS患者42例随机分为支具组(n=21)和支具联合矫形鞋垫组(n=21)。两组均每天佩戴支具22~23 h,矫正体操每天1次,每天30 min,共2个月。支具联合矫形鞋垫组在此基础上增加矫形鞋垫干预,每天至少8 h,共2个月。同时,招募32例脊柱发育正常的同龄青少年作为健康组。采用GaitScan仪器采集研究对象步态及足底压力测量数据。先将AIS患者与健康组的步态与足底压力数据进行横向对比,找出异常指标,再进行支具组与支具联合矫形鞋垫组之间脊柱畸形和上述异常指标的比较。结果 AIS组足底压力中心漂移指数(CPEI)高于健康组(F=3.120, P <0.05),AIS组与健康组比较,单足足跟内侧与足跟外侧压力比值(M/L)和全足压力均存在显著性差异(P <0.05);支撑相周期、步行速度、各时相所占比例均不存在显著性差异(P> 0.05)。治疗后,支具组和支具联合矫形鞋垫组Cobb角均显著减小(t>7.552, P <0.001),组间比较无显著性差异(t=0.459, P> 0.05);支具组CPEI、M/L、双侧全足压力比无显著变化(P> 0.05);支具联合矫形鞋垫组CPEI减小(t=2.209, P <0.05),M/L、双侧全足压力比值趋于1(t> 2.306, P <0.05),且优于支具组(|t|> 2.319, P <0.05)。结论 AIS患者可能存在足底压力分布局部及整体不对称改变。加用矫形鞋垫改善AIS患者侧弯畸形的效果有限,但可有效改善AIS患者的异常生物力学,使患者受力趋于平衡。Objective To observe the effect of braces combined with insoles on scoliosis and walking performance in patients with adolescent idiopathic scoliosis(AIS).Methods From September,2019 to September,2020,42 subjects with AIS were selected and randomly divided into brace group(n=21)and brace combined with insole group(n=21).Both groups received two-month routine rehabilitation,including braces for 22 to 23 hours a day and gymnastics for 30 minutes a day.The brace combined with insole group additionally wore insoles,at least eight hours a day for two months.Meanwhile,32 even-aged adolescents were recruited as healthy controls.Firstly,gait and plantar pressure of 42 patients and 32 healthy adolescents were compared to find out abnormal indicators.Secondly,the scoliosis and above abnormal indicators were compared between the brace group and the brace combined with insole group Results The center of pressure excursion index(CPEI)was higher in AIS group than in the healthy group(F=3.120,P<0.05),and there was no significant difference in walking speed,gait cycle and phase between two groups(P>0.05).An obvious imbalanced pressure was observed between the medial and lateral heel of the single foot and the bilateral foot in AIS patients(P<0.05).After treatment,the Cobb’s angle decreased in AIS patients(t>7.552,P<0.001),however,no difference was found between the brace group and the brace combined with insole group(t=0.459,P>0.05);the CPEI decreased(t=2.209,P<0.05),and the pressure in medial and lateral heel as well as the left and right foot tended to be balanced(t>2.306,P<0.05)in the brace combined with insole group,and were better than that of the brace group(|t|>2.319,P<0.05).Conclusion Plantar pressure distribution shows obvious local and global asymmetric changes in AIS patients.The efficacy of insoles on the scoliosis is limited,but the insole can effectively improve the abnormal biomechanics and balance the force.

关 键 词：青少年特发性脊柱侧弯 步态 足底压力 支具 矫形鞋垫 

分 类 号：R496[医药卫生—康复医学]