成人腓骨切除术后下肢功能评价与步态特征研究

Evaluation of lower limb function and gait characteristics after fibulectomy in adults

目的通过步态检测探讨腓骨切除术对成年患者下肢功能及步态的影响,以期为临床治疗提供参考。方法回顾分析2017年1月—2022年12月接受腓骨切除且符合选择标准的24例患者临床资料。男12例,女12例;年龄18~68岁,平均25岁。术中腓骨切除长度为10~19 cm,平均15 cm。术后进行常规康复训练。记录术后并发症发生情况,采用疼痛视觉模拟评分(VAS)评价手术切口疼痛程度,影像学复查残余腓骨骨质情况。术前及术后6个月采用步态测试系统,采集慢、中、快速条件下健、患侧步态数据,包括步态参数(足转角、步长、支撑相、摆动相、步态线长度、单支撑线、最大力值1、最大力值2)以及三足区参数(前、中、后足的最大压力、时间最大力值、接触时间)。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间1~5年,平均3年。3例发生踇背伸肌力下降,5例发生术区及其远端部位感觉缺陷。术后6个月手术切口VAS评分为0~6分,平均4分;末次随访时为0~5分,平均2分。随访期间影像学复查示,5例出现腓骨远端残余骨质疏松改变,且残余节段越短,表现越显著;3例出现新生骨。步态测试示,3种步速下步态参数及三足区参数检测结果一致。术前健、患侧各项步态参数以及三足区参数差异均无统计学意义(P>0.05);术后与健侧相比,患侧足转角、单支撑线、最大力值1、最大力值2以及前、后足最大压力均减小,步长与中、后足时间最大力值以及前、中足接触时间均增大,差异有统计学意义(P<0.05)。与同侧术前相比,术后健、患侧足转角、步态线长度减小,前、中、后足最大压力以及中足时间最大力值均增大;健侧步长减小、患侧增大;健侧最大力值1及最大力值2增大、患侧减小;患侧单支撑线减小;差异均有统计学意义(P<0.05)。结论成年患者腓骨部分切除后会出现不同程度临床症状,步态模式发生改变,出现代偿性步态且步态稳定性下降,跌倒风险提高,因此建议术后慢速步行。

Objective To explore the effects of fibulectomy on lower limb function and gait of adult patients through gait analysis,in order to provide guidance for clinical treatment.Methods A clinical data of 24 patients who underwent fibulectomy and met the selection criteria between January 2017 and December 2022 was retrospectively analyzed.There were 12 males and 12 females with an average age of 25 years(range,18-68 years).The length of fibulectomy was 10-19 cm,with an average of 15 cm.The patients underwent routine rehabilitation training after operation.The occurrence of postoperative complications was recorded,the pain degree of surgical incision was evaluated by visual analogue scale(VAS)score,and the residual fibular bone was reviewed by imaging.A gait test system was used before operation and at 6 months after operation to collect gait data of healthy and affected sides under slow,medium,and fast velocity conditions,including gait parameters(foot rotation angle,step length,support phase,swing phase,gait line length, single support line, maximum force 1, maximum force 2) and the tripod area parameters (maximum pressure, timemaximum force, and contact time of forefoot, midfoot, and hindfoot). Results All incisions healed by first intentionafter operation. All patients were followed up 1-5 years, with an average of 3 years. The great dorso-extension musclestrength decreased in 3 cases, and the sensory defects in the operative area and distal part occurred in 5 cases. The VASscores of incisions were 0-6 (mean, 4) at 6 months after operation and 0-5 (mean, 2) at last follow-up. During follow-up,imaging review showed that 5 cases had osteoporotic changes of distal residual bone of the fibula, and the residual segmentwas shorter and more significant;3 cases had new bone formation. The results of gait test showed that the gait parametersand the tripod area parameters under the three gait speeds were consistent. There was no significant difference in the gaitparameters and the tripod area parameters between the healthy side and the affected side before operation (P>0.05).Compared with the healthy side, the foot rotation angle, the single support line, the maximum force 1, the maximum force2, and the maximum pressures of the forefoot and midfoot of the affected side significantly decreased after operation(P<0.05), and the step length, the time maximum force of midfoot and hindfoot, and the contact time of the forefoot andmidfoot significantly increased (P<0.05). Compared with preoperative conditions on the same side, the foot rotation angle,the gait line length of both sides significantly decreased (P<0.05), and the maximum pressures of the forefoot, midfoot,and hindfoot and the time maximum force of the midfoot significantly increased (P<0.05);the step length on healthy sidesignificantly decreased, while the affected side significantly increased (P<0.05);the maximum force 1 and the maximumforce 2 on the healthy side significantly increased, while the affected side significantly decreased (P<0.05);the singlesupport line on the affected side significantly decreased (P<0.05). Conclusion Different degrees of clinical symptomsoccurred, gait pattern changes, compensatory gait appears, gait stability decreases, and the risk of tumble increases in adultpatients after partial fibulectomy. Therefore, it is recommended to walk slowly after fibulectomy.