跟骨骨折畸形愈合的足底压力分析及其临床意义

The clinical significance of plantar pressure analysis for malunion of calcaneal fracture

目的探讨足底压力分析在跟骨骨折畸形愈合诊治中的价值。方法2005年2月一2006年9月，26例陈旧性单侧跟骨关节内骨折患者，按Stephens-Sanders跟骨骨折畸形愈合分型：I型8例，Ⅱ型12例，Ⅲ型6例；既往采用手法复位及石膏固定治疗12例，未曾规范治疗14例。应用F—scan Mobile足底压力分析系统进行足底峰值压力测量。根据骨折分型分组计算并分析患者健足与患足的足底峰值压力分布差异。结果Stephens—Sanders分型I型组患者健足与患足7个足底解剖区域平均峰值压力除中足外差异均具有统计学意义（P〈0．05），患足躅趾、跖骨头负重增加，足跟部负重减少；Ⅱ型组除第3、4、5跖骨头外，其他解剖区域压力分布差异有统计学意义（P〈0．05），患足躅趾、第1—2跖骨头负重增加，足跟部负重减少；在Ⅲ型组内，除第2跖骨头外，其他解剖区域压力分布差异有统计学意义（P〈0．05），患足躅趾、第1跖骨头、中足负重增加，第3、4、5跖骨头及足跟部负重减少。结论足底压力分析可对跟骨骨折畸形愈合的病理力学变化进行更加深入的分析，对跟骨骨折畸形愈合的个性化治疗提供更为客观的量化理论依据。

Objective To evaluate the clinical significance of the plantar pressure analysis for malunion of calcaneal fracture. Methods From February 2005 to September 2006, 26 patients with old intra-artieular fracture of single ealeaneus who had not been operatively treated were available for this study. Sixteen cases involved the left side and 10 cases the right side. According to Stephen-sanders classification, 8 cases belonged to type I, 12 to type Ⅱ, and 6 to type Ⅲ. The plantar pressure was measured using dynamic pedography of F-scan Mobile （Tekscan, USA） . The differences in the plantar peak pressure between the healthy foot and the affected foot of the patients were comparatively analyzed on the basis of classification of the fracture. Results In the type I group, the plantar peak pressures at the hallux and metartasal head of the affected foot were significantly higher and that at the heel was significantly lower （ P 〈 0. 05）. In the type Ⅱ group, the plantar peak pressures at the hallux, the first and the second metartasal heads were significantly higher and that at the heel was significantly lower （ P 〈 0. 05） . In the type Ⅲ group, the plantar peak pressures at the hallux, the first metartasal head and midfoot were signifieandy higher and those at the third to fifth metartasal heads and the heel were significantly lower （ P 〈 0.05 ）. Conclusion Measurements of plantar pressure may provide useful evidenee for treatment of the patients with malunion of calcaneal fracture.