拇外翻足并发第2跖骨头下疼痛的相关因素研究

Study on the correlative factors of the pain under the second metatarsal in patients with hallux valgus

目的:通过对拇外翻足足弓的X线指标与足底压力指标的检测,分析拇趾外翻角的变化与足弓X线测量指标变化及足底压力变化的相关性,探讨拇外翻足并发第2跖骨头下疼痛影响因素。方法:采用回顾性研究方法,观察自2012年1月至2013年6月治疗的254例(477足)拇外翻患者病历资料,记录患者第2跖骨头下疼痛及年龄的情况,把所有拇外翻足按并发第2跖骨头下疼痛的有无分为两组(疼痛组和无痛组),分别测量各组负重位拇外翻足拇趾外翻角(hallux abductor valgus angle,HAVA),第1、2跖骨间角(the inter-metatarsal angle between the first and second metatarsals,IMA1-2),第1、5跖骨间角(the inter-metatarsal angle between the first and fifth metatarsals,IMA1-5),内弓顶角、前弓顶角及第1、2跖骨头的相对长度,检测步态中第2跖骨头下峰压强、冲量、触地时间百分比等压力的情况。运用相关性分析及Logistic回归分析方法,探讨拇外翻足并发第2跖骨头下疼痛的影响因素。结果:Spearman相关性分析结果示HAVA分别与各测量指标的IMA1-2、IMA1-5、内弓顶角、前弓顶角、第2跖骨触地时间百分比呈相关性(P<0.05,r=0.647、0.553、0.127、-0.165、0.158)。Logistic回归分析结果示并发第2跖骨头下疼痛的影响因素为HAVA、第2跖骨相对长度、第2跖骨头触地时间百分比(P<0.05,ORj=1.030,1.069,1.060)。结论:拇外翻角的增大导致了拇外翻足足弓塌陷,使步态中第2跖骨头负重的时间延长,从而导致了第2跖头下疼痛的发生。

Objective：To analyze the correlation between the hallux valgus angle and arch X-ray parameters change, plantar pressure by measuring the X-ray indexes and foot-pressure indexes in patients with hallux valgus, as well as to study the main cause factors for the pain under the second metatarsal head. Methods： A retrospective study of 254 patients （477 feet） treated in Wangjing Hospital from January 2012 to June 2013 was performed. The pain under the second metatarsal head and age distribution were recorded. All the patients were divided into two groups according to the second plantar bone pain：pain group and no pain group. The following indexes were measured and eompared：HAVA （hallux abductor valgus angle ）, IMA1-2 （the inter-metatarsal angle between the first and second metatarsals ）, IMA1-5 （the inter-metatarsal angle between the first and fifth metatarsals ）, TAOTMLA （top angle of the medial longitudinal arch）, AAOTMLA （anterior angle of the medial longitudi- nal arch） ,SMRL （the second metatarsal relative length than the first） ,and the plantar pressure indicators including TPUM （touch the ground time percentage under the seeond metatarsal head） ,PPUM （peak pressure under the second metatarsal head）, and IUM （impulse under the second metatarsal head）. All the factors were evaluated by Logistic regression analysis. Results：Spearman rank correlation test showed that there were statistical significance in correlation between HAVA and I- MA 1-2, IMA 1-5, TAOTMLA, AAOTMLA, TPUM （P〈0.05, r=0.647,0.553,0.127, -0.165,0.158 ）. Factors including the HAVA, SMRL and the TPUM were the risks for the pain under the second metatarsal head in patients with hallux valgus （P〈0.05, 0Rj=1.030,1.069,1.060）. Conclusion： Increase of the hallux valgus angle eauses the collapse of hallux valgus arch, extending the weight bearing time of the second metatarsal and increasing the possibility of the pain under the second metatarsal.