先天性马蹄内翻足术后远期足底压应力分析

Analysis of Long-term Changes of Sole Stress in Surgically Treated Congenital Clubfoot

对先天性马蹄内翻足早期肌力平衡手术后远期足底压应力进行测试，旨在从生物力学角度分析和评价手术疗效。采用自行设计的足底压应力分布测试系统，测试术后６年６个月～２８年６个月（平均１５年１个月），年龄１３～３２岁（平均１６．９岁）的３３例（４２足）的足底压应力，并与正常足相比较。结果：临床疗效优良者３５足的足底压应力分布接近正常，但部分指标仍有异常。全足着地期延长，足跟离地期缩短（Ｐ＜０．０５），动态第５跖骨头部位和拇趾部位压应力峰值减小（Ｐ＜０．０５，Ｐ＜０．０１），拇趾部位压应力。时间积分减小（Ｐ＜０．０５）。临床疗效可和差者７足的足底压应力分布所有指标均显著异常（Ｐ＜０．０５及Ｐ＜０．０１）。结论：足底压应力分布测试可作为从生物力学角度分析和评价足部手术疗效的有效指标。

The sole pressure was measured in patients with congenital clubfoot treated by early muscular power balancing.The purpose of this study is to analyze the long-term results of this operation by biomechanics. Using the sole stress testing distribution system designed by the authors,33 cases(42 feet)with an average of 16.9 years(range,13 to 32yrs)were measured 6.5-28.5 years(mean 15 years and one month)after operation. The results were compared with those in the normal control.The sole pressure distribution was nearly normal in 35 feet and clinically evaluated as excellent and good. The time of full-foot on ground prolonged and that of the heel-off decreased significantly(P< 0.05).The dynamic peak pressures of fifth matatarsal head and halluces were lower than those in control(P<0.05,P<0.01)and the stresstime integrals of halluces decreased(P<0.05).The therapoutic results of 7 fair and poor feet revealed abnormal parameters of sole pressure distribution(P<0. 05 or P<0.01).Concltlsion: The sole pressure distribution test serves as a valuable biomechanical parameter to evaluate the oporative outcome.