摘要
背景:儿童柔性扁平足是一种常见的足部畸形,常导致足部疼痛和生活质量下降。目的:探讨距下关节制动治疗儿童柔性扁平足的影像学指标与临床疗效的关系。方法:回顾性分析2022年1月至2023年5月在广州市正骨医院接受距下关节制动治疗的56例儿童患者(平均年龄11.8岁)的病历资料。所有患者在术前和术后均进行了详细的影像学检查和临床评估,包括美国足踝外科协会踝-后足评分和疼痛目测类比评分。采用配对t检验、独立t检验比较术前和术后影像学指标及临床评分的变化,并采用相关性分析评估影像学指标与临床疗效之间的关系。结果与结论:①术后随访8-12个月,所有患者的影像学指标均较术前显著改善(P<0.001);②临床评估结果显示,美国足踝外科协会踝-后足评分从术前的66.2±6.0显著提高到术后的91.3±5.8,目测类比评分从术前的3.1±0.8显著降低到术后的1.3±0.8(P<0.001);③独立t检验显示,术后第一跖距角和目测类比评分等级存在显著差异(P=0.043),说明较小的第一跖距角与较轻的术后疼痛相关;术前后弓角在术后美国足踝外科协会踝-后足评分等级“优”和“良”两组间差异有显著性意义(P=0.033),提示术前较小的后弓角可能预示更好的术后足部功能恢复;④相关性分析表明,术前后弓角(r=-0.486,P<0.01)、跟骨倾斜角(r=-0.344,P<0.01)与术后美国足踝外科协会踝-后足评分呈显著负相关,而术前内侧纵弓角(r=0.293,P<0.05)与术后美国足踝外科协会踝-后足评分呈显著正相关;术后内侧纵弓角(r=0.331,P<0.05)和外侧纵弓角(r=0.387,P<0.01)与术后美国足踝外科协会踝-后足评分呈显著正相关,而术后跟骨结节角(r=-0.272,P<0.05)、后弓角(r=-0.461,P<0.01)、跟骨倾斜角(r=-0.318,P<0.01)与术后AOFAS-AH评分之间存在显著负相关;⑤提示距下关节制动在矫正儿童柔性扁平足方面具有显著疗效,影像学指标的改善与临床疗效密切相关;术前和术后的影像学评估可作为预测术后临床效果的重要参考指标,指导临床医生优化治疗方案和康复计划。
BACKGROUND:Pediatric flexible flatfoot is a common foot deformity that often leads to foot pain and reduced quality of life.OBJECTIVE:To explore the relationship between radiographic parameters and clinical efficacy of subtalar arthroereisis in the treatment of pediatric flexible flatfoot.METHODS:A retrospective study was conducted on 56 pediatric patients(mean age of 11.8 years)who underwent subtalar arthroereisis at Guangzhou Orthopedic Hospital between January 2022 and May 2023.All patients underwent detailed radiographic examinations and clinical evaluations before and after surgery,including the American Orthopaedic Foot&Ankle Society Ankle-Hindfoot score and Visual Analog Scale score.Paired t-tests and independent t-tests were used to compare changes in radiographic parameters and clinical scores before and after surgery.Correlation analyses were conducted to evaluate the relationship between radiographic parameters and clinical outcomes.RESULTS AND CONCLUSION:(1)All radiographic parameters significantly improved during the 8 to 12-month follow-up after surgery(P<0.001).(2)Clinical evaluation results indicated that the American Orthopaedic Foot&Ankle Society Ankle-Hindfoot score significantly improved from 66.2±6.0 preoperatively to 91.3±5.8 postoperatively,and the Visual Analog Scale score significantly decreased from 3.1±0.8 preoperatively to 1.3±0.8 postoperatively(P<0.001).(3)Independent t-tests showed a significant difference in postoperative the first metatarsal angle and Visual Analog Scale score grades(P=0.043),with a smaller the first metatarsal angle associated with less postoperative pain;preoperative lateral arch angle showed a significant difference between the“excellent”and“good”groups in postoperative American Orthopaedic Foot&Ankle Society Ankle-Hindfoot scores(P=0.033),suggesting that a smaller preoperative posterior arch angle might predict better postoperative foot function recovery.(4)Correlation analysis showed that preoperative posterior arch angle(r=-0.486,P<0.01)and heel pitch angle(r=-0.344,P<0.01)were significantly negatively correlated with postoperative American Orthopaedic Foot&Ankle Society Ankle-Hindfoot,while preoperative medial longitudinal arch angle(r=0.293,P<0.05)was significantly positively correlated with postoperative American Orthopaedic Foot&Ankle Society Ankle-Hindfoot.Postoperative medial longitudinal arch angle(r=0.331,P<0.05)and lateral arch angle(r=0.387,P<0.01)were significantly positively correlated with postoperative American Orthopaedic Foot&Ankle Society Ankle-Hindfoot,whereas postoperative Bohler's angle(r=-0.272,P<0.05),posterior arch angle(r=-0.461,P<0.01),and heel pitch angle(r=-0.318,P<0.01)were significantly negatively correlated with postoperative American Orthopaedic Foot&Ankle Society Ankle-Hindfoot.(5)It is concluded that subtalar arthroereisis is significantly effective in correcting pediatric flexible flatfoot,and improvements in radiographic parameters are closely related to clinical efficacy.Preoperative and postoperative radiographic evaluations can serve as important reference indicators for predicting postoperative clinical outcomes,guiding clinicians to optimize treatment plans and rehabilitation programs.
作者
廖广滔
冯梓誉
傅小勇
赵清兰
陈超
洪劲松
Liao Guangtao;Feng Ziyu;Fu Xiaoyong;Zhao Qinglan;Chen Chao;Hong Jinsong(Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Guangzhou Orthopedic Hospital,Guangzhou 510045,Guangdong Province,China;School of Traditional Chinese Medicine,Southern Medical University,Guangzhou 510515,Guangdong Province,China;First Affiliated Hospital of Jinan University,Guangzhou 510630,Guangdong Province,China)
出处
《中国组织工程研究》
北大核心
2026年第3期661-670,共10页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金-面上项目(82374605),项目负责人:陈超。
关键词
柔性扁平足
距下关节制动术
临床疗效
相关性分析
术后康复
儿童
影像学指标
骨科植入物
flexible flatfoot
subtalar arthroereisis
clinical efficacy
correlation analysis
postoperative rehabilitation
children
radiographic indicators
orthopedic implant
