跗骨窦螺钉术后矫正器对青少年平足症的影响

doi:10.3877/cma.j.issn.1674-134X.2025.05.004

目的

探究HyProCure跗骨窦螺钉内固定术后应用矫正器对青少年平足症患者的治疗效果。

方法

回顾性研究2022年7月至2024年7月在四川大学华西医院上锦医院治疗的106例平足症患者，‌纳入标准‌：年龄≤18岁，临床资料完整，无手术史，影像学确诊平足症（站立时足弓消失、舟骨突出、足跟外翻）且伴反复足底/足弓疼痛。‌排除标准‌：合并脊柱疾病、神经肌肉病变、严重骨关节炎、免疫系统疾病或足部感染迹象。根据治疗方法分为手术组（n=52）和联合组（n=54）；手术组采用HyProCure跗骨窦螺钉内固定治疗，联合组在HyProCure跗骨窦螺钉内固定术后3周应用矫正器治疗。采用卡方检验和t检验比较两组临床疗效、治疗前后下肢平衡情况、足底压力和影像学测量指标。

结果

联合组患者临床总有效率高于手术组，差异有统计学意义（χ²=5.075，P<0.05）；治疗后，与手术组相比，联合组后踝关节和后足功能评分更高，差异有统计学意义（t=5.620，P<0.05）；治疗后，联合组第1跖楔关节高度、跟骨倾斜角（Pitch角）高于手术组，第1跖骨角（Meary角）小于手术组，差异有统计学意义（t=3.234、6.666、12.041，均为P<0.05）；治疗后，联合组足底最大压力、平均压力均低于手术组，差异有统计学意义（t=6.568、6.984，均为P<0.05）。

结论

HyProCure跗骨窦螺钉内固定术后3周应用矫正器治疗青少年平足症，能够使临床疗效和下肢平衡提高，改善青少年平足症的足部结构和足底压力。

关键词: 矫正装置, 扁平足, 下肢, 治疗结果

Objective

To explore the therapeutic effect of application of orthosis after HyProCure tarsal sinus screw internal fixation on adolescent patients with flatfoot.

Methods

A retrospective study was conducted on 106 patients with flatfoot who were treated in Shangjin Hospital, West China Hospital of Sichuan University from July 2022 to July 2024. Inclusion criteria: age≤18 years old, complete clinical data, no history of surgery, imaging diagnosis of flatfoot (arch disappearance, scaphoid protrusion and heel valgus when standing) and repeated plantar/arch pain. Exclusion criteria: spinal disease, neuromuscular disease, severe osteoarthritis, immune system disease or signs of foot infection. According to the treatment methods, the enrolled patients were divided into operation group (n=52) and combination group (n=54). The operation group accepted HyProCure tarsal sinus screw internal fixation, while the combination group accepted orthosis at three weeks after HyProCure tarsal sinus screw internal fixation. The clinical efficacy as well as lower limb balance status, plantar pressure and imaging measurement indicators before and after treatment were compared between both groups by chi square test and t test.

Results

The total clinical effective rate in the combination group was higher than that in the operation group (χ²=5.075, P<0.05). After treatment, compared with the operation group, the posterior ankle joint-hind foot function score in the combination group was higher (t=5.620, P<0.05). After treatment, the height of the first tarsometatarsal joint and calcaneal inclination angle (Pitch angle) in the combination group were higher than those in the operation group, and the first metatarsal angle (Meary angle) was smaller than that in the operation group (t=3.234, 6.666, 12.041, all P<0.05). The maximum plantar pressure and average plantar pressure in the combination group after treatment were lower than those in the operation group (t=6.568, 6.984, both P<0.05).

Conclusion

Orthosis application at three weeks after HyProCure tarsal sinus screw internal fixation in the treatment of adolescent flatfoot can enhance the clinical efficacy and lower limb balance, and improve the foot structure and plantar pressure of adolescent flatfoot.

Key words: Orthosis, Flatfoot, Lower limb, Therapeutic effect

图1 跗骨窦螺钉内固定术前后左足负重侧位X线片，示矫正前后角度变化。图A为术前X线片；图B为术后X线片；图C为术后3个月X线片注：MA-Meary角（第一跖骨角）；PA- Pitch角（跟骨倾斜角）

Figure 1 X-ray images at lateral view of left foot at weight-bearing position before and after tarsal sinus screw internal fixation, showing the changes of angels before and after correction. A is the image before surgery; B is the image after surgery; C is the image three months after surgeryNote: MA-Meary angle; PA-Pitch angle

表1 两组患者一般资料比较

Table 1 Comparison of general data between the two groups

组别Groups	例数Number of cases	年龄[岁，（±s）]Age（year）	性别（男/女）Gender (male/female)	体重[kg，（±s）]Weight	患足（双足/单足）Involved foot (bipedal/monpedal)
手术组Operation group	52	13±3	25/27	50±3	8/44
联合组Combination group	54	14±3	25/29	51±3	6/48
统计值Statistical value		t=1.716	χ²=0.034	t=1.716	χ²=0.422
P值		>0.05	>0.05	>0.05	>0.05

表1 两组患者一般资料比较

Table 1 Comparison of general data between the two groups

组别Groups	例数Number of cases	年龄[岁，（±s）]Age（year）	性别（男/女）Gender (male/female)	体重[kg，（±s）]Weight	患足（双足/单足）Involved foot (bipedal/monpedal)
手术组Operation group	52	13±3	25/27	50±3	8/44
联合组Combination group	54	14±3	25/29	51±3	6/48
统计值Statistical value		t=1.716	χ²=0.034	t=1.716	χ²=0.422
P值		>0.05	>0.05	>0.05	>0.05

表2 两组患者临床疗效比较

Table 2 Comparison of clinical efficacy between the two groups

组别Groups	例数Number of cases	显效Remarkable	有效Effective	无效In vain	总有效率（%） Total effective rate
手术组Operation group	52	26	14	12	76.9
联合组Combination group	54	28	22	4	92.6
χ²值					5.075
P值					0.024

表2 两组患者临床疗效比较

Table 2 Comparison of clinical efficacy between the two groups

组别Groups	例数Number of cases	显效Remarkable	有效Effective	无效In vain	总有效率（%） Total effective rate
手术组Operation group	52	26	14	12	76.9
联合组Combination group	54	28	22	4	92.6
χ²值					5.075
P值					0.024

表3 治疗前后AOFAS踝－后足功能评分（

±s）

Table 3 Comparison of AOFAS ankle-posterior foot function score before and after treatment

组别Groups	例数Number of cases	治疗前Before treatment	治疗后After treatment
手术组Operation group	52	64±5	73±5
联合组Combination group	54	65±5	78±5
t值		1.029	5.147
P值		>0.05	<0.001

表3 治疗前后AOFAS踝－后足功能评分（

±s）

Table 3 Comparison of AOFAS ankle-posterior foot function score before and after treatment

组别Groups	例数Number of cases	治疗前Before treatment	治疗后After treatment
手术组Operation group	52	64±5	73±5
联合组Combination group	54	65±5	78±5
t值		1.029	5.147
P值		>0.05	<0.001

表4 治疗前后影像学测量指标比较（

±s）

Table 4 Comparison of Imaging measurement indicators before and after treatment

组别Groups	例数Number of cases	第1跖楔关节高度（mm）First metatarsal cuneate joint height		Pitch角（°）Pitch angle		Meary角（°）Meary angle
组别Groups	例数Number of cases	治疗前Before treatment	治疗后After treatment	治疗前Before treatment	治疗后After treatment	治疗前Before treatment	治疗后After treatment
手术组Operation group	52	13.14±2.14	15.54±3.22	15.53±2.34	18.56±2.35	8.93±2.12	2.51±0.23
联合组Combination group	54	13.21±2.13	17.56±3.21	15.47±2.42	21.54±2.33	8.82±2.04	2.82±0.21
t值		0.169	3.234	0.130	6.666	0.272	7.251
P值		>0.05	0.002	>0.05	<0.001	>0.05	<0.001

表4 治疗前后影像学测量指标比较（

±s）

Table 4 Comparison of Imaging measurement indicators before and after treatment

组别Groups	例数Number of cases	第1跖楔关节高度（mm）First metatarsal cuneate joint height		Pitch角（°）Pitch angle		Meary角（°）Meary angle
组别Groups	例数Number of cases	治疗前Before treatment	治疗后After treatment	治疗前Before treatment	治疗后After treatment	治疗前Before treatment	治疗后After treatment
手术组Operation group	52	13.14±2.14	15.54±3.22	15.53±2.34	18.56±2.35	8.93±2.12	2.51±0.23
联合组Combination group	54	13.21±2.13	17.56±3.21	15.47±2.42	21.54±2.33	8.82±2.04	2.82±0.21
t值		0.169	3.234	0.130	6.666	0.272	7.251
P值		>0.05	0.002	>0.05	<0.001	>0.05	<0.001

表5 治疗前后足底压力比较[g/cm²，（

±s）]

Table 5 Comparison of plantar pressure before and after treatment

组别Group	例数Number of cases	最大压力Maximum pressure		平均压力Average pressure
组别Group	例数Number of cases	治疗前Before treatment	治疗后After treatment	治疗前Before treatment	治疗后After treatment
手术组Operation group	52	72.3±4.1	66.4±3.1	22.5±1.3	21.3±1.5
联合组Combination group	54	72.2±4.1	62.4±3.1	22.4±1.3	19.5±1.0
t值		0.126	6.641	0.396	7.295
P值		>0.05	<0.001	>0.05	<0.001

表5 治疗前后足底压力比较[g/cm²，（

±s）]

Table 5 Comparison of plantar pressure before and after treatment

组别Group	例数Number of cases	最大压力Maximum pressure		平均压力Average pressure
组别Group	例数Number of cases	治疗前Before treatment	治疗后After treatment	治疗前Before treatment	治疗后After treatment
手术组Operation group	52	72.3±4.1	66.4±3.1	22.5±1.3	21.3±1.5
联合组Combination group	54	72.2±4.1	62.4±3.1	22.4±1.3	19.5±1.0
t值		0.126	6.641	0.396	7.295
P值		>0.05	<0.001	>0.05	<0.001

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Influence of orthosis after tarsal sinus screw on adolescents with flatfoot

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Influence of orthosis after tarsal sinus screw on adolescents with flatfoot