成人获得性扁平足畸形测量指标

Adult acquired flat foot deformity: index of measurement

目的通过对扁平足的临床和影像学检查，确认畸形角度，为精确的矫形手术奠定基础：方法门诊收集有症状扁平足病人的X线平片27例，平均年龄49岁（年龄范围43～58岁）。符合指标病人拍照全足负重正侧位X线平片。临床检查包括：双足跟抬高或单足抬高试验；啡肠肌比目鱼肌复合体张力试验；站立双足跟胫骨轴测量；多脚趾症观察；双侧足弓对比；第一跖骨抬高试验。X线平片测量包括正位和侧位，例位X线平片测量：距骨第一跖骨角；跟骨调整角；距跟角；足内柱高度；跟骨第五跖骨高度；外柱高度。正位X线平片测量：距骨第一跖骨角；距舟覆盖角；跟骨第五跖骨角；距骨头未覆盖距离。统计学分析采用扁平足测量值与标准值比较（t检验），统计意义设定为P〈0、05。结果患足跟抬高试验4例（13．8％），腓肠肌张力试验11例（37．9％），双侧足弓塌陷29例（100.0％），多趾症27例（93．1％），足跟胫骨轴21例（72．4％）。测量值与样本值比较，距骨第一跖骨角（侧位）、距骨第一跖骨角（正位）、跟骨调整角、内柱高度和距舟覆盖角（正位），P〈0．05。结论距舟覆盖角、距骨第一跖骨角和距跟角可作为PTTD的早期诊断，同时结合临床物理检查，如双足跟抬高试验、多趾症、足弓对比和跟骨胫骨轴更加具有临床意义。

Objective To accurate corrective procedure established foundation, through clinical and photocopy examining for adult flat foot deformity examined identification deformity angle, methods Outpatient had collected symptom flat foot deformity 27cases, average 49 years old （ range from 43 to 58 years old）. Factors of radiographic examination ： double - limb or single heel rise examination single; the gastrocnemius - soleus tightness test; stand double - heel tibia axis measurement; too many toes; double -foot arch contrast; elevation of the first metatarsal head test. Anteroposterior （AP） and lateral radiographs were take measure, measurement of lateral radiographs including： the talar - first metatarsal angle; ealcaneal pitch angle; talocaleaneal an- gle; medial column height; calcaneal - fifth metatarsal height; lateral column height. Measurement of AP radiographs including： the talar - first metatarsal angle ; talonavicular uncoverage angle ; calcaneal - fifth metatarsal angle ; talonavicular uncoverage distance. Statistical analysis involved comparing normal sample value using t test. Significance was set at P 〈 O. 05. Results The single -limb heel rise test had 4 cases （ 13.8% ） , tile gastrocnemius - soleus tightness test had 11 cases （37.9%） , the col- lapsed medial double- longitudinal arch had 29 cases （100.0%） , ＂too many toes＂ sign had 27 cases （93.1%）, heel - tibia axis had 21 cases （72.4%）. Statistical analysis involved comparing normal sample value were significance （ P 〈 0. 05 ） involved the lateral and AP radiograph talar -first metatarsal angle, ealcaneal pitch angle, medial column height, and talonavicular coverage angle. Conclusion Early index of diagnosis acquired fiat foot deformity （AFFD） invoked posterior final tendon dysfunction （PTTD） include talonavicular coverage angle,talar - first metatarsal angle, and talocaleaneal angle, meanwhile, measurement index must be combined with clinical physics examinee which that are double - limb or single heel rise examination, ＂too many toes＂ sign, and double- foot arch contrast.