摘要
研究目的：扁平足和内翻膝是常见的下肢畸形,并且会给患者带来严重后果,影响到人们的健康生活。本文拟通过分析扁平足和内翻膝受试者在步态特征中与正常人群的异同处,及使用矫形鞋垫后主观感觉和步态特征变化情况,来研究矫形鞋垫对扁平足和内翻膝的作用和机制,为人们提供选择矫形器具的参考信息。
研究方法：男性扁平足12名、内翻膝12名和正常受试者8名参与实验。其中第一次试验使用红外高速运动捕捉、表面肌电和足底压力鞋垫测试系统采集受试者步态特征以及除正常组外受试者穿戴对应矫形鞋垫的步态特征。在第一次测试后的两个月内,扁平足和内翻膝组中各有6名将穿戴矫形鞋垫进行干预,使用压力鞋垫对除正常组外受试者进行跟踪测试。通过Visual3D、Matlab等数据分析软件对测试所得数据进行处理,并运用SPSS软件中单因素方差分析、配对样本t检验、重复测量方差分析及Pearson相关分析检验三组受试者之间的异同,统计结果显著性水平为p<0.05。
研究结果：第一次测试,扁平足组和内翻膝组跖屈力量加垫时均减小,压力中心曲线整体外移；跟踪测试,不加垫时扁平足矫形组跖屈力量随时间增加。MF区压力在扁平足各组别均减小；M1-2区压力在矫形组不加垫时减小。足跟着地瞬间,扁平足组不加垫时踝关节背伸角度为93.1。,加垫时增大到99.3。(p<0.05),更接近正常组；内翻膝组中足关节的跖屈角度不加垫时为-30.6。,加垫时增大到-41.7。(p<0.05)。踝关节外翻和胫骨内旋的幅值比,扁平足组加垫时支撑中期和后期接近正常组；内翻膝组中,膝关节内外旋角度较大,加垫时增加。扁平足组不加垫时支撑中期膝关节屈与后足外翻的极值时序差为正常组的近两倍,加垫时降低；内翻膝组的变化情况同扁平足组。
研究结论：1矫形鞋垫,在扁平足受试者组中产生了较好的主观感觉效果,但内翻膝组的主观感觉因人而异。2扁平足与内翻膝存在与正常人群不同的步态特征。穿戴矫形鞋垫的即刻效果表明：矫形鞋垫可以改善扁平足的步态特征,可以改变内翻膝的步态特征。3穿戴矫形鞋垫的长期效果为：增加跖屈力量；增加外侧纵弓的支撑作用,减轻踝关节外翻程度。
Purpose:
Flat foot and varus knee are common lower extremities deformity. Serious deformities can cause arthritis or muscle dysfunction in the lower extremities and even low-back. This study will explore the similarities and differences of gait between flatfoot and varus knee subjects and normal population, and their subjective feelings and the biomechanical characteristics changes of gait after the use of orthopaedic insole. This can help to study the effect and mechanism of orthopaedic insole in redressing the flat feet and varus knee, to provide better clinical services, and reference information of selecting orthopaedic appliances for people with such deformities.
Methods:
Twelve male flatfoot,12varus knee and8normal subjects were sinvolved in this study. In the first test, the gait cycle characteristics of all subjects'without insoles and all subjects without mormal group with particular insloes were collected by infrared high-speed motion capture system, surface EMG test system and plantar pressure insoles test system. In the following two months after the first test,6members of either the flatfoot or the varus knees subjects, respectively, were selected to wear orthopaedic insoles as padded group, and the rest as control groups, and all the subjects except the normal group had track test of their gait by Tekscan plantar pressure insoles test system. The subjects of padded group filled the wearing evaluation form in each test. After all the tests, Visual3D and Matlab program and etc. were used to process the collected data. The gait cycle kinematics, the lower extremity coupling mechanism, the muscle activate order and duration, and the plantar pressure distribution were calculated. The statistic analysis were processed by SPSS. One-way ANOVA, paired t-test, repeated measures, and Pearson simple relative test were used to evaluate the differences and correlations among all the groups. All the significant levels were set at p<0.05.
Results:
In the first test, the relative plantar flexion strength of the flatfoot and varus knee group were significantly reduced when padded. The center of force curve was whole relocated to lateral side. In the tracking test, the plantar flexion force of padded flatfoot group was increasing with time when not padded. The pressure of MF was in a trend of decreasing of all flatfoot groups; The pressure of M1-2in the padded group showing a decreasing trend when not padded. At the moment of heel contact, the ankle dorsiflexion angle of flatfoot group was93.1°without padded increased to99.3°(p<0.05) when padded, which was closer to the normal group; the midfoot plantar flexion angle of varus knee group was-30.6°when without padded, increased to-41.7°(p<0.05) when padded. The excursion ratio of ankle eversion and tibial internal rotation of the flatfoot group when padded in mid and late stance phase were closer than when not padded to the normal group; in the varus knee groups, the internal/external rotation angle of knee in the early and mid stance phase were bigger than that of the normal group, which increased when padded. The time difference of knee flexion and ankle pronation in the mid stance phase of the flatfoot group was decreased when padded.
Conclusions:
1, The thopaedic insole gave the flat foot group better feeling, but the subjective feeling in the varus knee group vatied.2, The flat foot and the varus knee groups did domenstrated different gait characteristics from the normal group. The immediate effect of thopaedic insole on the flat foot group was improving the gait characteristics, and changing the characteristics of the varus knee group.3The long term effect of thopaedic insole was:increasing the plantar flexing strength, increasing the support under the lateral longitudinal arch, and decreasing the ankle pronation.
引文
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