摘要
目的基于步态分析探讨改良平足重建术治疗不同分级僵硬性平足(Rigid flatfoot,RF)患儿的临床疗效。方法以2019年1月-2024年12月乌兹别克斯坦共和国安集延儿童多学科诊所收治的51名RF患儿为研究对象,其中男性42例,女性9例,平均年龄(10.5±1.4)岁。根据“第DGU42326号-儿童RF分类算法”(2024年),按照RA临床分级对患儿进行分组。采用改良平足重建术:腓骨长肌移位+胫后肌紧缩+舟楔关节楔形截骨融合[发明专利号:FAP 2416(2024)]进行手术干预。术前3天及术后6个月测定RF患儿跨步时间、站立时间、摆动时间、站立阶段、摆动阶段、单侧支撑相位、双侧支撑相位、平均速度、步频等。记录RF患儿手术前后美国足踝外科协会(American orthopaedic foot ankle society,AOFAS)踝-后足评分和视觉模拟量表(Visual analogue scale,VAS)评分。结果51例RF患儿中获得性41例(80.5%),先天性10例(19.5%),RF临床分级Ⅱ级13例(25.50%),Ⅲ级22例(43.20%),Ⅳ级16例(31.30%)。与术前比较,术后Ⅱ级RF患儿左右足跨步时间、左右足站立时间、左右足摆动时间均降低,左足摆动阶段、左足双侧支持相位、平均速度、步频均升高;术后Ⅲ级RF患儿左右足跨步时间、左右足站立时间、左足站立阶段、左足单侧支持相位、左足双侧支持相位均降低,左足摆动阶段、平均速度、步频均升高;术后Ⅳ级RF患儿左右足跨步时间、左右足站立时间均降低;右足单侧支持相位、左右足双侧支持相位、平均速度、步频均升高,差异均有统计学意义(P<0.05)。与术前比较,术后不同RF临床分级患儿AOFAS评分升高,VAS评分降低,差异均有统计学意义(P<0.001)。结论改良平足重建术能有效改善RF患儿足部功能及疼痛感受,恢复下肢主动稳定性及受损生物力学功能,值得临床推广。
Objective To explore the clinical efficacy of improved flatfoot reconstruction surgery based on gait analysis for the treatment of children with different grades of rigid flatfoot(RF).Methods A total of 51 RF patients admitted to the Anjiyan Children's Multidisciplinary Clinic in Uzbekistan from January 2019 to December 2024 were selected as study subjects,including 42 males and 9 females,with an average age of(10.5±1.4)years.According to the"DGU42326 Children's RF Classification Algorithm"(2024),children were grouped according to the clinical grading of RA.Adopting an improved surgical approach,including fibular long muscle displacement,posterior tibial muscle compression and wedge osteotomy and fusion of the scapula joint[Patent No.FAP 2416(2024)],surgical intervention was performed.Step time,standing time,swing time,standing stage,swing stage,unilateral support phase,bilateral support phase,average velocity,step frequency,etc.were measured in RF patients 3 days before surgery and 6 months after surgery.Recorded the American Orthopaedic FootAnkle Society(AOFAS)ankle hindfoot score and Visual Analog Scale(VAS)score before and after surgery in children with RA.Results Among 51 children with RF,41 cases(80.5%)were acquired,10 cases(19.5%)were congenital,and 13 cases(25.50%)were clinically classified as gradeⅡ,22 cases(43.20%)as gradeⅢ,and 16 cases(31.30%)as gradeⅣ.Compared with preoperative results,postoperative gradeⅡRF patients showed a decrease in left and right foot stride time,left and right foot standing time,and left and right foot swing time,while the left foot swing stage,left foot bilateral support phase,average velocity,and step frequency wereall in-creased;Postoperative gradeⅢRF patients showed a decrease in left and right foot stride time,left and right foot standing time,left foot standing stage,left foot unilateral support phase and left foot bilateral support phase,while the left foot swing stage,average velocity,and step frequency wasincreased.The stride time and standing time of both left and right feet were reduced in postoperative gradeⅣRF pa-tients.The unilateral support phase of the right foot,bilateral support phase of the left and right feet,av-erage velocity and step frequency were all increased,and the differences were statistically significant(P<0.05).Compared with preoperative levels,postoperative AOFAS scores were increased and VAS scores weredecreased in children with different RF clinical grades,and the differences were statistically significant(P<0.001).Conclusion The improved flat foot reconstruction surgery can effectively improve the foot function and pain perception of RF children,restore active stability and damaged biomechanical function of the lower limbs,and is worthy of clinical promotion.
作者
XODJANOV Iskandar Yunusovich
UMAROV Hasanali Ikromovich
KHAKIMOV Sherali Kuziyevich
田育魁
刘俊昌
XODJANOV Iskandar Yunusovich;UMAROV Hasanali Ikromovich;KHAKIMOV Sherali Kuziyevich;TIAN Yukui;LIU Junchang(Uzbekistan National Scientific Center for Orthopaedic and Orthopaedic Traumatology,Tashkent 100047,Republic of Uzbekistan;Andijan State Medical Academy,Andijan 170506,Republic of Uzbekistan;Bukhara State Abu Ali ibn Sina Medical Academy,Bukhara 200400,Republic of Uzbekistan;Xinjiang Uygur Autonomous Region Research Institute of TCM,Urumqi 830000,China;Xinjiang Medical University,Urumqi 830017,China)
出处
《新疆医科大学学报》
2025年第7期1010-1016,共7页
Journal of Xinjiang Medical University
基金
新疆维吾尔自治区科技创新团队(天山创新团队,2022TSYCTD0008)。
