单侧发育性髋关节脱位患儿早期进行Pemberton截骨术后的足底压力分析
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国家自然科学基金资助项目(81301292)


Analysis of the plantar pressure in children with unilateral developmental dysplasia of the hip following Pemberton’s pericapsular osteotomy at an early age
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    摘要:

    目的 研究单侧发育性髋关节脱位(developmental dysplasia of the hip, DDH)患儿早期进行Pemberton截骨术(Pemberton’s pericapsular osteotomy, PPO)后的足底压力变化情况,为患者的手术治疗和康复提供有参考价值的生物力学结果。方法 选取18名4岁前已行PPO的单侧DDH患儿作为实验组,同时以18名同年龄健康儿童作为对照组,采用Footscan足底压力测试系统进行动态足底压力测试。通过比较实验组与对照组足底各分区接触面积百分比(CA%)、压强时间积分(PTI)和站立相各分期时间百分比(CT%),评估行走状态下患者足底压力的变化。结果 与对照组和患者健肢相比,患肢在第2~5趾区PTI较高,在足跟内侧区PTI较低。与健肢和对照组相比,患肢第4、5跖骨区CA%较大,而第1、2跖骨区CA%较健肢小。与健肢和对照组相比,患肢前足离地期CT%增大,足跟着地期CT%减少,且总的触地时间更短。结论 DDH患者在早期进行PPO后足底压力存在残余异常,临床中还需要长时间的强化康复治疗来矫正患者异常的足底压力分布。

    Abstract:

    Objective To investigate the changes of plantar pressure distributions in children with the unilateral developmental dysplasia of the hip (DDH) who underwent the Pemberton’s pericapsular osteotomy (PPO) at early age, so as to provide valuable references for clinical therapy and rehabilitation of such patients. Methods Eighteen child patients who underwent PPO before 4 year old were selected as the PPO group, while 18 healthy children at the same age with normal feet were selected as the control group. Footscan system was used to measure the plantar pressure of these subjects during walking. The parameters, i.e. contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI) and contact time percentage of the stance time (CT%) in both PPO group and control group were compared to evaluate changes of the plantar pressures during walking. Results Compared with the sound limb in control group and the unaffected limb in PPO group, the affected limb in PPO group showed higher PTI in the 2nd to 5th toe zone and lower PTI in the medial heel zone. The affected limb in PPO group had a higher CA% in the 4th and 5th metatarsals than the unaffected limb in PPO group and the sound limb in control group, and a lower CA% in the 1st and 2nd metatarsals than the unaffected limb. Compared with the unaffected limb in PPO group and the sound limb in control group, CT% of the affected limb in PPO group increased in the forefoot push-off phase and decreased in the initial contact phase, and the total contact time of the affected limb was shorter than that of the unaffected limb in PPO group and the sound limb in control group. Conclusions There exist residual plantar pressure deviations during walking in DDH patients following PPO at early age, thus a longer period of intensive rehabilitation may be required to change the residual abnormality.

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徐超,严亚波,赵天峰,张扬,赵雄,黄鲁豫,雷伟.单侧发育性髋关节脱位患儿早期进行Pemberton截骨术后的足底压力分析[J].医用生物力学,2015,30(4):332-338

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  • 收稿日期:2014-10-17
  • 最后修改日期:2014-11-25
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  • 在线发布日期: 2015-08-27
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