扁平足合并特发性脊柱侧凸的影像学特征及危险因素分析

Imaging Characteristics and Risk Factors of Flatfoot Combined with Idiopathic Scoliosis

目的探讨扁平足病人中特发性脊柱侧凸(idiopathic scoliosis,IS)的发病情况及影像学特征,分析扁平足病人合并IS的危险因素。方法回顾性分析2021年10月至2023年3月于武汉儿童医院就诊的608例扁平足病人的一般情况和影像学资料,统计扁平足病人中IS的发病率,采用秩和检验比较IS病人与非IS病人、IS中Cobb角>20°病人与Cobb角≤20°病人的一般情况及足影像学参数。采用单因素分析IS病人与非IS病人、IS中Cobb角>20°病人与Cobb角≤20°病人左足外翻角(hallux valgus angle,HVA)、右足HVA、左足(侧位)距骨第1跖骨角(Meary’s angle,MA)、右足MA、HVA差值、MA差值等指标,将P<0.20的指标纳入多因素Logistic回归分析,评估扁平足病人发生IS的危险因素,扁平足合并IS病人Cobb角>20°的危险因素。结果608例扁平足病人中,发生IS的有67例(67/608,11.01%)。扁平足合并IS病人与非IS病人比较,存在双侧外翻角不对称和双侧足弓不对称,差异均有统计学意义(P<0.05)。大于10岁病人(OR=2.866,95%CI:1.683~4.881,P<0.001),女性病人(OR=1.892,95%CI:1.121~3.193,P=0.017),双侧足弓不对称的扁平足病人(OR=1.194,95%CI:1.023~1.393,P=0.025),有更高的IS患病风险。IS病人Cobb角>20°病人左足足弓水平低于Cobb角≤20°病人(P=0.019)。结论IS在扁平足病人中的发病率可能较正常人群发病率高。扁平足合并IS病人存在双侧足形态不对称,包括双侧外翻角不对称及双侧足弓不对称,且双侧足弓不对称是扁平足合并IS的危险因素。

Objective Explore the incidence and radiographic features of idiopathic scoliosis(IS)in individuals with flatfoot,and analyze the risk factors for the coexistence of flatfoot and IS.Methods Retrospectively analyze the general characteristics and imaging data of 608 flatfoot patients treated at Wuhan Childrens Hospital from October 2021 to March 2023.Calculate the incidence in flatfoot patients with a focus on IS.Employ rank⁃sum tests to compare the general characteristics and foot imaging parameters between IS and non⁃IS patients,as well as between IS patients with Cobb angles>20°and≤20°.Use univariate analysis for IS versus non⁃IS patients and IS patients with Cobb angles>20°versus≤20°,considering hallux valgus angle(HVA),Meary’s angle(MA),HVA difference,MA difference,and other indicators.Include P<0.20 indicators in multifactorial Logistic regression analysis to assess risk factors for IS in flatfoot patients and risk factors for Cobb angles>20°in flatfoot patients with IS.Results Among the 608 flatfoot patients,67 cases(11.01%)developed IS.Patients with flatfoot and IS exhibited statistically significant asymmetry in bilateral hallux valgus angles and asymmetry in bilateral foot arches(P<0.05).Patients older than 10 years(OR=2.866,95%CI:1.683⁃4.881,P<0.001),female patients(OR=1.892,95%CI:1.121⁃3.193,P=0.017),and flatfoot patients with asymmetrical foot arches(OR=1.194,95%CI:1.023⁃1.393,P=0.025)had a higher risk of developing IS.In flatfoot patients with IS and Cobb angles>20°,the left foot arch was horizontally lower than in the Cobb angles≤20°group(P=0.019).Conclusion The incidence of idiopathic scoliosis(IS)in individuals with flatfoot might be higher compared to the general population.Patients with flatfoot and IS exhibit bilateral asymmetry in foot morphology,including asymmetry in bilateral hallux valgus angles and asymmetry in bilateral foot arches.Additionally,bilateral foot arch asymmetry is identified as a risk factor for the coexistence of flatfoot and IS.