中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (28): 5237-5243.doi: 10.3969/j.issn.1673-8225.2010.28.025

• 组织构建与生物力学 tissue construction and biomechanics • 上一篇    下一篇

Ludloff截骨治疗拇外翻对前足底压力的影响

毛  威，张建中，孙  超，王显军   

  1. 首都医科大学附属北京同仁医院足踝外科，北京市   100730
  • 出版日期:2010-07-09 发布日期:2010-07-09
  • 通讯作者: 张建中，主任医师，首都医科大学附属北京同仁医院足踝外科，北京市 100730
  • 作者简介:毛 威★，男，1980年生，北京市人，汉族，2007年首都医科大学毕业，硕士，医师，主要从事足踝研究。 trfoot@126.com

Changes in forefoot plantar pressure distribution following Hallux valgus treatment with Ludloff osteotomy 

Mao Wei, Zhang Jian-zhong, Sun Chao, Wang Xian-jun   

  1. Department of Orthopeadics, Tongren Hospital, Capital University of Medical Science, Beijing  100075, China
  • Online:2010-07-09 Published:2010-07-09
  • Contact: Zhang Jian-zhong, Chief physician, Department of Orthopeadics, Tongren Hospital, Capital University of Medical Science, Beijing 100075, China
  • About author:Mao Wei★, Master, Physician, Department of Orthopeadics, Tongren Hospital, Capital University of Medical Science, Beijing 100075, China trfoot@126.com

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764

被引次数

18

摘要：

背景：目前Ludloff截骨术虽在国内外应用广泛，但对其造成具体的前足底生物力学改变研究较少。
目的：了解Ludloff截骨造成足底压力分布的改变，并进一步推测其特点及适应证。
方法：实验组选取拇外翻患者11例15足，行第1跖骨远端软组织松解、近端改良 Ludloff截骨术。对照组选取健康成人11名16足。对照组、实验组术前及术后6个月均采用Tekscan 足底压力测试系统进行动态测试，将前足底依5个跖骨头位置划分为5个研究区域，分别用Mn(1，2，3，4，5)表示。通过比较术前术后及对照组之间的区域压力峰值(PF)和区域压力总合(F)来评估足底压力变化。
结果与结论：F值：患者术前步态周期中，当第1跖骨头负荷达峰值时，通过第2跖骨的负荷最大，第1跖骨次之；而术后则为通过第1跖骨的负荷最大，第2跖骨次之；对照组则为通过第1，2跖骨的负荷最大，两者之间差异无显著性意义。各组中第3，4，5跖骨负荷均是由内向外依次递减。PF值：术前与对照组均表现为M2、 M1(M3)、M4、M5 依次递减；术后为M1(M2、M3)、M4、M5依次递减。M1/M2、M2/M3仅在术前与术后有明显差异。结果提示：①拇外翻患者足底压力的确存在外移，但主要是由第1跖骨移向第4、5跖骨。②Ludloff截骨术主要影响第1，2跖骨负荷，而对3，4，5跖骨影响较小。

关键词: 拇外翻, Ludloff截骨术, 足底压力, 生物力学, 组织构建

Abstract:

BACKGROUND: Ludloff osteotomy has been used widely in China and abroad, but it is not clear which causes biomechanical changes in the forefoot.
OBJECTIVE: To investigate the distribution of plantar pressure after Ludloff osteotomy, and to study its features and indications.
METHODS: A total of 11 patients (15 feet) were treated by modified Ludloff osteotomy on the first metatarsal and release on the lateral of the first metatarsophalangeal joint. Eleven volunteers (16 feet) were served as the controls. All of the persons were measured in dynamic state by Tekscan-system prior to the operation and 6 months later, 5 anatomical pressure areas were identified by the researcher, based on the peak pressure footprint and standing anteroposterior radiograph of the foot. These areas were defined as metatarsal heads 1-5 (M1, M2, M3, M4 and M5); Peak force (PF) and total force (F) of the regions were used respectively.
RESULTS AND CONCLUSION: F analysis: before operation, when the load of the 1st metatarsal got the maximum in gait, the load of the 2nd was the largest among 5 metatarsals, followed by the 1st metatarsal. After operation, the load of the 1st was the largest, followed by the 2nd metatarsal. In the control group, the maximum lad appeared on the 1st and 2nd metatarsals, and the differences had no significance. The loads of the 3rd, 4th and 5th metatarsals were decreased one by one. PF analysis: the PF of the M2, M1 (M3), M4, M5 decreased one by one in the pre-operative and the control group; the PF of the M1 (M2, M3), M4, M5 were decreased one by one post-operatively. The ratios of the M1/M2, M2/M3, only were found significant differences between the pre-operative and the post-operative. All results demonstrated that: ①Hallux valgus deformity really exhibited a typical loading pattern of forefoot characterized by a medio-lateral transfer from the 1st metatarsal to the 4th, 5th metatarsals in this study. ②Ludloff osteotomy mainly changes the load of the 1st and 2nd metatarsals, which has no significant effect on the 3rd, 4th and 5th metatarsals.

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