青少年特发性脊柱侧弯症患者的足底压力差异分析及穿戴矫形鞋垫的影响

Analysis of Plantar Pressure Differences in Patients with Adolescent Idiopathic Scoliosis and Influence of Insoles on Patients

【目的】分析青少年特发性脊柱侧弯症(AIS)患者的足底压力指标,探讨AIS患者的足底压力特征。【方法】选取2015年10月至2017年3月中山大学附一院东院康复科就诊的AIS患者56例,以脊柱侧弯方向的不同分为3组:右侧弯18例,左侧弯18例,S型脊柱胸腰段侧弯20例;另选同期健康对照组19例。对4组受试者的双侧足总压力,前半足、后半足压力等生物力学指标进行检测和比较,以分析不同类型AIS患者和健康人的足底压力分布特征。对3组穿戴了矫形鞋垫的患者,分析其穿鞋垫前后足底压力变化,并对穿着矫形鞋垫条件下重新拍摄脊柱全长片的患者,分析其Cobb角度的变化。【结果】与对照组相比,右侧弯组患者的左足平均压力、左前半足压力小于对照组,右足平均压力、右后半足压力大于对照组(P<0.017)。左侧弯组患者的右前半足压力小于对照组,右后半足压力大于对照组(P<0.017)。S型胸腰弯组左前半足压力小于对照组。右侧弯组左足平均压力(44.7%±6.0%)明显小于右足平均压力(55.4%±6.0%),差异具有统计学意义(P<0.05),左侧弯组、S型胸腰弯组与对照组左右足底压力无差异。配制矫形鞋垫后,即刻为患者测量穿戴矫形鞋垫时的足底压力,单弯型脊柱侧弯(左侧弯或右侧弯)患者足底压力分布存在差异,而S型胸腰弯组患者穿戴前后足底压力无差异。患者在穿戴矫形鞋垫前后Cobb角度对比没有统计学意义(P=0.102)。【结论】右侧弯患者的左右足底压力对称性较差,S型胸腰弯患者的左、右足底压力呈现对称。矫形鞋垫可以有效调整单弯型脊柱侧弯(左或右侧弯)患者的足底压力分布,但对于患者侧弯角度的影响还需要进一步的跟踪观察。

[Objective ] To explore the characteristics of the plantar pressure data of the patients with adolescent idiopathic scoli- osis （AIS）. [ Methods ] 56 AIS patients who were diagnosed from October 2015 to March 2017 in the East branch of the First Affiliat- ed Hospital of Sun Yat-sen University divided into 3 groups, 18 cases in spinal lateral bending to right, 18 cases in spinal lateral bending to left, 20 cases in type S who were thoracolumbar scoliosis. Another 19 healthy persons were as the control group. The left and right foot pressure, half foot pressure and other biomechanical data were compared. The changes of the plantar pressure and the Cobb angle were analyzed with the patients who wore orthopedic insoles. [ Results ] Compared with the control group, the mean pres- sure of the left foot and the pressure of the left anterior half of the right bending group were less than those of the control group, and the right half foot pressure were greater than those of the control group （P 〈 0.017）. To the left bending group, the mean pressure of right anterior half foot were less than those of the control group, and the right rear half foot pressure was greater than that of the control group （P 〈 0.017）. The pressure of the left anterior half foot of the S type scoliosis group was less than that of the control group. To the right bending group, the left foot average pressure （44.7%±6.0%） was significantly less than the average pressure of right foot （55.4% ± 6.0% ）. There was no difference in bilateral plantar pressure of the left bending group, S type group and control group. There was difference with the plantar pressure distribution in patients with only one curve after they wore orthotic insoles, but there was no difference in patients with type S. There was no significant difference in the Cobb angle after the patients wearing the orthot- ic insoles （P = 0.102）. [ Conclusions ] The right and left foot pressure symmetry of the right bending patients is poor, but the left and right plantar pressure in the patients with type S is symmetrical. The orthotic insole can be used to adjust the plantar pressure distribution in patients with a single curved scoliosis （left or right）, but their effect on the patient＇s spinal lateral curvature should be further observed.