超声下婴幼儿马蹄内翻足距舟角、跟骰角和胫跟角与Pirani评分的相关性分析  

Correlation analysis between Pirani score and talo-navicular angle,calcaneo-cuboid angle and tibio-calcaneall angle of infant clubfoot under ultrasound

作　　者：王文静 夏冰[1] 董英梅 贺盼盼[3] 程志伟 马凤群 王超华[3] 刘福云[1] 胡伟明[1] 王飞鹏 赵裕丰 栗河舟[3] 付家乐 Wang Wenjing;Xia Bing;Dong Yingmei;He Panpan;Cheng Zhiwei;Ma Fengqun;Wang Chaohua;Liu Fuyun;Hu Weiming;Wang Feipeng;Zhao Yufeng;Li Hezhou;Fu Jiale(Orthopaedic Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Emergency Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ultrasound,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Medical Record Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院骨科,郑州450052 [2]郑州大学第三附属医院急诊科,郑州450052 [3]郑州大学第三附属医院超声科,郑州450052 [4]郑州大学第三附属医院病案科,郑州450052

出　　处：《中华外科杂志》2024年第3期210-215,共6页Chinese Journal of Surgery

基　　金：河南省医学科技攻关计划联合共建项目(2018020206)。

摘　　要：目的探讨超声检查与Pirani评分对婴幼儿先天性马蹄内翻足各跗骨畸形、治疗效果及假性矫正情况的评估效果的相关性。方法本研究为回顾性病例系列研究。回顾性收集2020年1月至2023年1月在郑州大学第三附属医院经超声检查评估的26例(40足)先天性马蹄内翻足患儿的临床资料。男16例,女10例,首次超声检查时年龄为[M(IQR)]9.0(18.0)d(范围:1~46 d)。患儿均由同一名医师行Ponseti方法治疗。收集患儿治疗前后及末次检查时的Pirani评分及超声测得的距舟角、跟骰角和胫跟角,记录治疗情况及随访情况。数据比较采用配对样本t检验、重复测量方差分析或Kruskal-Wallis检验,相关性分析采用Spearman相关分析法。采用受试者工作特征曲线计算超声评估不同Pirani评分的效能。结果26例患儿石膏固定次数4.0(1.0)次(范围:2~8次),内侧距舟角、后侧胫跟角治疗后及末次随访时较治疗前明显改善,差异有统计学意义(P值均<0.01);外侧跟骰角治疗后及末次随访时较治疗前无差异(F=1.971,P>0.05)。治疗过程中2例(2足)出现假性矫正,发生率为5%。相关性分析结果显示,距舟角与Pirani中足评分呈中度正相关(r=0.480,P<0.01);跟骰角与Pirani中足评分不相关(r=0.114,P=0.105);胫跟角与Pirani后足评分呈中度负相关(r=-0.566,P<0.01)。以距舟角评估Pirani中足评分为1.5分的截点值为38.78°,灵敏度为0.90,特异度为0.56,曲线下面积为0.75;跟骰角的截点值为27.51°,灵敏度为0.16,特异度为0.92,曲线下面积为0.44。以距舟角和跟骰角评估Pirani中足评分为3.0分的截点值分别为45.08°和9.96°,灵敏度分别为0.94和0.91,特异度分别为0.37和0.42,曲线下面积分别为0.59和0.62。以胫跟角评估Pirani后足评分为2.0分和3.0分的截点值分别为167.46°和160.15°,灵敏度分别为0.75和0.67,特异度分别为0.81和0.83,曲线下面积分别为0.78和0.71。结论超声可与Pirani评分相互补�Objective To explore the evaluation effect of ultrasonography and Pirani score on tarsal deformity,treatment effect and pseudo-correction of congenital clubfoot in infants and young children,and the correlation between the two methods.Methods This is a retrospective case series study.The clinical data of 26 children(40 feet)with congenital clubfoot who were evaluated by ultrasonography in the Third Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected.There were 16 males and 10 females.The age at the first ultrasound examination was(M(IQR))9.0(18.0)days(range:1 to 46 days).All patients were treated with Ponseti method by the same physician.The Pirani scores before and after treatment and at the last examination,and the talonavicular angle,calcaneocuboid angle and tibiocalcaneal angle measured by ultrasound were collected,and the treatment and follow-up were recorded.Paired sample t test,repeated measures analysis of variance or Kruskal-Wallis test were used for data comparison,and Spearman correlation analysis was used for correlation analysis.The receiver operating characteristic curve was used to calculate the efficacy of ultrasound in evaluating different Pirani scores.Results The number of plaster fixation in 26 children was 4.0(1.0)times(range:2 to 8 times).The medial talonavicular angle and posterior tibiocalcaneal angle were significantly improved after treatment and at the last follow-up compared with those before treatment,and the differences were statistically significant(all P<0.01).There was no difference in lateral calcaneocuboid angle before and after treatment and at the last follow-up(F=1.971,P>0.05).Pseudo-correction occurred in 2 cases(2 feet)during the treatment,with an incidence of 5%.Correlation analysis showed that there was a moderate positive correlation between talonavicular angle and Pirani midfoot score(r=0.480,P<0.01).There was no correlation between calcaneocuboid angle and Pirani midfoot score(r=0.114,P=0.105).There was a moderat

关 键 词：马蹄足畸形 足畸形 先天性 超声 PONSETI方法 Pirani评分 

分 类 号：R726.8[医药卫生—儿科]