第二足趾游离移植手术前后供趾足足底应力分析

目的 检测第2足趾游离移植手术前、后供趾足足底应力的变化.方法 2005年9月至2007年6月应用比利时Footscan公司的足底压力步态分析系统,检测15例采取保留第2跖骨头的第2足趾游离移植术患者手术前、后足底生物力学的各项指标.结果 供趾足术后与术前相比,术后1个月第1趾区(T1)、第1,2,3跖骨头(M1～M3)最大压强减小,足跟内侧(HM)、足跟外侧(HL)最大压强增加,T1、M1～M3冲量值减小,HM、HL冲量值增加,M1、M2、前足蹬离期(FFPOP)接触时间减小,前足接触期(FFCP)、全足放平期(FFP)、M3、HM、HL接触时间增加,初始接触期(ICP)、FFP、FFPOP期x坐标值负向增大,FFP、FFPOP期y坐标值减小,FFP期足外侧压力增大;术后3个月T1最大压强减小,HM、HL最大雎强增加,M1、M2冲量值仍减小,FFCP、FFP足外侧压力增大;术后6个月仅T1、M3、M4、M5最大压强值略增加,但差异无统计学意义,其余指标趋于正常化.结论 保留第2跖骨头的第2足趾游离移植术术后6个月供足足底生物力学各项指标趋于正常.

Preoperative vs. postoperative plantar stress in patients undergoing second toe transfer

Objective To investigate the biomechanical differences in plantar stress between pre-operative and postoperative patients undergoing the second toe transfer. Methods The plantar biome-chanical indexes were measured in 15 patients undergoing the second toe transfer by an instrument made by Belgium Footscan company. Results One month after operation, the maximum pressures of T1 and M1-M3 reduced while those of HM and HL increased. The impulses of T1 and M1-M3 reduced while those of HM and HL increased. The contact periods of M1, M2 and FFPOP reduced while those of FFCP, FFP, M3, HM and HL increased. The value of X increased negatively during the periods of ICP, FFP and FFPOP. The value of Y reduced during the periods of FFP and FFPOP. The lateral foot pressure increased during the period of FFP. Three months after operation, the maximum pressure of M1 reduced while those of HM and HL in-creased. The impulses of M1 and M2 reduced. The lateral foot pressure increased during the periods of FFCP and FFP. Six months after operation, all the indexes became normal, except the maximum pressures of M3-M5 which increased slightly. Conclusion The plantar biomechanical indexes tend to become normal 6 months after the second toe transfer which reserves the head of the second metatarsal bone.