扁平足严重程度对膝踝足生物力学影响的横断面研究

Relationship Between the Severity of Flatfoot and Lower Extremity Biomechanics:Across-Sectional Study

目的探究不同严重程度的扁平足对膝踝足生物力学形态的影响。方法选取2019年4—9月于中山大学附属第一医院康复医学科义肢矫形部就诊的242例扁平足患者为研究对象,按照不同扁平足严重程度分为0度组、Ⅰ度组、Ⅱ度组和Ⅲ度组(足印法),于就诊时对各组患者进行膝踝足生物力学参数评定,包括双侧踇外翻角、膝外翻角、足跟外翻角,舟骨下降高度及双下肢长度差。采用克鲁斯卡尔-沃利斯单因素秩方差分析(Kruskal-Wallis检验)计算各组的组间差异,并采用Spearman等级相关分析相关性。结果左右侧下肢的踇外翻角(左:χ^(2)=4.868,P=0.182,右:χ^(2)=3.986,P=0.263)、膝外翻角(左:χ^(2)=3.342,P=0.342,右:χ^(2)=1.182,P=0.757)、绝对长度差(左:χ^(2)=0.591,P=0.898,右:χ^(2)=1.997,P=0.573)、相对长度差(左:χ^(2)=4.056,P=0.256,右:χ^(2)=0.742,P=0.863)在不同扁平足程度上的差异无统计学意义。左右侧足跟外翻角(左:χ^(2)=53.01,P=0.000,右:χ^(2)=57.045,P=0.000)、舟骨下降高度(左:χ^(2)=39.872,P=0.000,右:χ^(2)=25.137,P=0.000)在不同扁平足程度上的差异有统计学意义。足跟外翻角度大小与扁平程度呈正相关(左:r=0.440,P=0.000,右:r=0.435,P=0.000),扁平程度越严重,足跟外翻角越大。舟骨下降高度也与扁平程度呈正相关(左:r=0.378,P=0.000,右:r=0.316,P=0.000),扁平程度越严重,舟骨下降高度越大。结论扁平足的严重程度,即足内侧纵弓的高低,与足跟外翻角、舟骨下降高度有关,而对踇外翻程度、膝关节力学对线、双下肢骨长度发育等下肢生物力学可能并无影响。

Objective To study the relationship between the severity of flatfoot and lower extremity biomechanics.Methods 242 flatfoot patients who were admitted to the Prosthetics and Orthotics Department of the First Affiliated Hospital of Sun Yat-sen University from April to September 2019 were selected as the study objects.They were divided into a 0 degree group,a Ⅰ degree group,a Ⅱ degree group and a Ⅲ degree group according to different severity of flatfoot(foot printing method).At treatment,the knee,ankle and foot biomechanical parameters were evaluated for patients in each group,including bilateral hallux valgus angle,knee valgus angle,heel valgus angle,descending height of scaphoid bone and leg length discrepancy.Kruskal-Wallis single factor rank an OVA(Kruskal-Wallis test)was used to calculate inter-group differences and Spearman rank correlation was used to analyze correlations.Results The results are the same on both sides.There was no significant difference in these parameters among the different flatfoot groups,including hallux valgus angle(left:χ^(2)=4.868,P=0.182,right:χ^(2)=3.986,P=0.263),hallux valgus angle(left:χ^(2)=3.342,P=0.342,right:χ^(2)=1.182,P=0.757),absolute length difference(left:χ^(2)=0.591,P=0.898,right:χ^(2)=1.997,P=0.573),relative length difference(left:χ^(2)=4.056,P=0.256,right:χ^(2)=0.742,P=0.863).There were significant differences in heel valgus angle(left:χ^(2)=53.01,P=0.000,right:χ^(2)=57.045,P=0.000)and the height of the navicular tuberosity(left:χ^(2)=39.872,P=0.000,right:χ^(2)=25.137,P=0.000)among groups.Also,heel valgus angle(left:r=0.440,P=0.000,right:r=0.435,P=0.000)and the height of the navicular tuberosity(left:r=0.378,P=0.000,right:r=0.316,P=0.000)were positively correlated with the severity of flatfoot.The more serious the flatfoot is,the greater the heel valgus angle and the height of the navicular tuberosity are.Conclusion The severity of flatfoot,that is,the height of medial longitudinal arch of foot,is related to the angle of calcaneus valvulus and the height of scaphoid descent.But maybe it did not affect the degree of hallux valgus,the mechanical alignment of knee joint,the bone length development of both lower limbs and other lower limb biomechanics.