应用矫形器矫正儿童下肢畸形

儿童正是生长发育的关键时期,如果足部或下肢畸形而得不到及时矫正,将直接影响他们一生。下肢畸形的种类很多,如先天性的马蹄内翻足,静力性扁平足、足内翻、足外翻、尖足、膝内翻、、膝外翻、膝反屈、足内旋、足外旋等。对儿童下肢畸形的治疗,新生儿期、幼儿期以保守疗法为主,手术治疗为辅。在保守疗法中有徒手矫正法、石膏矫形法、矫形器等都有一定疗效。特别是矫形器,由于具有设计的多样化及便于动态调整,配合手法矫正,显现出独特的优越性。     

西安市2074名学龄前儿童扁平足发生情况

调查西安市学龄前儿童足弓发育情况,为儿童体质学研究提供资料.方法 使用足弓发育测评仪,对西安市5所幼儿园2 074名3~5岁儿童的足弓发育状况进行观测,统计扁平足发生率.结果 在受试儿童中,共检测出扁平足儿童1 244名,总发生率为59.98%,其中3~5岁扁平足儿童检出率分别为73.56%,60.89%,47.46%,不同年龄组检出率差异有统计学意义(x2=95.76,P<0.01);男童及女童扁平足检出率分别为66.39%,53.14%,差异有统计学意义(x2=37.86,P<0.01).3~5岁阶段,单侧扁平足儿童检出率分别为19.07%,18.86%,16.46%,双侧分别为54.49%,42.02%,31.00%,双侧扁平足儿童发生率均高于单侧扁平足儿童,差异有统计学意义(x2值分别为83.32,46.19,21.28,P值均<0.01).结论 西安市3~5岁儿童扁平足发生率高,应引起重视,做到早检测、早发现、早预防.     

上海市学龄儿童足弓指数及扁平足的流行病学研究

调查上海市学龄期(7~12岁)儿童足弓指数(arch index,AI)及扁平足的流行状况,及其与儿童年龄、性别、体质量指数(BMI)、左右侧分布的关系,为预防扁平足提供参考.方法 对上海市10所中小学校学龄期儿童(3 226名)应用三维足部测量仪器测量双侧脚长、内侧弓高、AI、弓高弓长比(arch height ratio,AHR)等足部参数,并进行统计分析.结果 上海市7~12岁儿童AI为(0.27±0.05),AHR为(3.02± 1.89),总体扁平足发生率为56.1%,7岁时为72.6%,12岁时降至37.9%;男童为62.9%,女童为47.8%.男童扁平足发生率高于女童(OR=1.81,95%CI=1.57~2.10),该风险大小与年龄无关,每个年龄段男童发生扁平足的风险始终高于女童.对7~8岁儿童,超重或肥胖与扁平足发生无相关;对9~12岁儿童,超重或肥胖与扁平足有相关,且OR值随着年龄的增加而增加,9岁时为1.44(95%CI=1.03~2.03),12岁时为2.96(95%CI=1.68~5.23).扁平足发生在左或右侧差异无统计学意义(x2=0.95,P=0.33).结论 7~12岁儿童的AI及扁平足发生率随年龄增加而降低,男童发生扁平足的风险更高.9岁及以上生长发育期儿童超重和肥胖者发生扁平足的风险更高.对扁平足应做到早发现、早干预.     

昆明市学龄期儿童扁平足筛查及影响因素分析

目的 了解昆明市学龄期儿童扁平足检出率并进行影响因素分析，为预防扁平足提供依据。方法 2021年12月—2022年2月利用光学足部评估记录装置对昆明市5所小学4 444名7～13岁儿童进行扁平足筛查，并采用Logistic回归分析扁平足发生的相关因素。结果 儿童扁平足检出率为29.10%,其中轻度占21.79%、中度占52.43%、重度占25.78%,双足型占89.10%、单足型占10.90%。7和13岁组扁平足的检出率分别为36.91%和10.43%,前者患病风险是后者的5.00倍(OR=5.00,95%CI=3.22～7.52);乡村和城镇学生检出率分别为38.53%和22.46%,前者患病风险是后者的2.17倍(OR=2.17,95%CI=1.90～2.47);男女生扁平足检出率分别为34.21%和23.29%,男生患病风险是女生的1.71倍(OR=1.71,95%CI=1.50～1.95);扁平足发生率与体质量指数(BMI)具有相关性，超重与肥胖组儿童扁平足风险更高(OR值分别为1.31,1.10,P值均<0.01)。结论 7～13岁儿童扁平足检出率与年龄、性别、城乡、B...     

闽西学龄前儿童足弓发育状况调查报告

为了解学龄前儿童扁平足发生情况,对我县六个幼儿园3～6岁1127名儿童进行普查。本研究采用足印法,即双足先踩上滑石粉,再踏上地面的黑板上,对其所显示出足印进行观察评定。将足印按常规方法分为足弓正常、轻度、中度和重度扁平足四种。结果表明:在1127名幼儿中共检出扁平足儿童447人,检出率为397%。其中双足319人,单足128人,单足中右足87人,左足41人,合计766个扁平足,实际检出率为3398%(766/2254)。1　年龄别检出率　3、4、5、6岁的检出率依次为471%(144/306)、4108%(133/323)、376%(88/234)和3106%(82/264),经趋势检验ｘ2=157166,Ｐ<001,表…     

6～11岁杜氏进行性肌营养不良儿童与正常儿童下肢肌力对照分析

目的 比较6～11岁杜氏进行性肌营养不良(DMD)患儿与正常儿童下肢肌力差异,为开展DMD患儿的肌力训练提供科学依据。方法 2015年4月-2017年4月选择DMD患儿和正常儿童各20例,其中DMD患儿男19例,女1例;正常组男18例,女2例,两组儿童平均年龄均为(9.0±1.7)岁。采用手持式肌力测定仪(HHD)测定下肢髋、膝、踝等部位肌群肌力,比较DMD与正常儿童下肢肌群间及不同年龄间的肌力差异。结果 DMD组下肢肌力除足跖屈肌群以外均明显弱于正常组(P＜0.05);DMD组中6岁～组和9～11岁组各组肌群肌力差异无统计学意义(P＞0.05);在6岁～组中DMD患儿双侧髋外展和足趾屈肌力与正常组差异无统计学意义(P＞0.05),DMD组足趾屈肌力甚至高于正常儿童; 9～11岁组中DMD患儿除足趾屈肌群外髋屈曲、髋伸展、髋外展、膝屈曲、膝伸展和踝背屈肌群肌力都已经显著落后于正常儿童(P＜0.05)。结论 DMD患儿下肢肌群除足跖屈肌外均明显低于正常组儿童。开展DMD患儿下肢力量训练应关注所有肌群,在较大年龄组尤其需要重视髋膝伸展肌群。     

天津市13～16岁中学生扁平足患病情况调查

【目的】调查天津市13～16岁初中生扁平足患病情况。【方法】采用足印法对天津市某中学468名13～16岁学生进行检查,统计扁平足发病率,并进行年龄、性别、轻重程度、单双足发病情况分析。【结果】468名13～16岁初中生扁平足总发病率为54.27%,不同年龄及男女发病率差异无统计学意义(P0.05)。扁平足总发病程度轻度57.87%、中度35.43%、重度6.70%,不同年龄组差异无统计学意义(P0.05)。扁平足发病双足型78.35%,左单足型11.81%,右单足型9.84%,单足左右型及不同年龄组差异无统计学意义(P0.05)。【结论】13～16岁初中生扁平足发病率高,应加以重视并积极防治。     

不同手术方法治疗踝外翻的疗效分析

目的：总结分析不同手术方法治疗踝外翻的疗效。方法：选取踝外翻患者40例,根据患者年龄及病情的具体情况采取不同手术治疗方法,评估临床疗效。结果：所有患者顺利完成手术,术后踝外翻角（HVA）在10°~20°,跖间角（IMA）在5°~10°,治疗效果优良率为97.5%,且无严重并发症的发生。结论：踝外翻治疗,应根据不同的患者不同的病情选择适宜的治疗方法,进行手术治疗,能取得良好的治疗效果,促进患者恢复。     

贵州盘县与都匀两地农村苗族女性6～12岁儿童骨发育差异性比较研究

目的:探讨盘县与都匀两地农村苗族女性6~12岁儿童骨发育的差异性。方法:收集1 126名苗族女性6~12岁儿童作为研究对象,其中盘县535名,都匀591名;分别进行问卷调查,采用摄片法拍摄右手腕部X片,参照骨发育分级标准、骨24项骨骼发育指标进行阅片,通过数学模型法计算骨龄,然后利用SPSS16.0软件对骨龄与生活年龄的比值进行两地间的差异性比较;同时测量儿童身高、坐高、前臂长和下肢长等指标,并对影响骨发育相关因素进行Logistic多元回归分析。结果:两地农村苗族女性6~12岁儿童身高、坐高、前臂长、下肢长均值随着年龄的增大而增长;盘县9~10岁、10~11岁、11~12岁年龄段儿童身高、坐高、前臂长、下肢长均值与都匀同年龄段比较差异均有统计学意义(P<0.01),其余年龄段差异无统计学意义(P>0.05)。盘县女性儿童骨发育在9~10岁(不含10周岁)年龄段比都匀超前约0.30岁,在10~11岁(不含11周岁)年龄段比都匀超前约0.27岁,在11~12岁(不含12周岁)年龄段比都匀超前约0.41岁;多因素logistic回归分析结果表明,居住海拔高度、每天户外运动时间、饮食习惯、每周腌制食品摄入量等是影响苗族6~12岁女性儿童骨骼发育的相关因素。结论:贵州盘县与都匀两地农村苗族女性6~12岁儿童骨发育存在地区差异性,盘县女性儿童的骨骼发育早于都匀女性儿童,呈现先慢后快的趋势。     

广西壮族自治区某矿区学龄儿童血铅和血镉水平与体格发育的相关性研究

目的探讨广西壮族自治区某矿业污染区学龄儿童血铅和血镉水平与体格发育的关系。方法于2013—2014年选择可能受广西壮族自治区某矿业污染的5个村(5~14)岁儿童作为项目调查对象,对调查对象进行问卷调查,并通过体格检查测量儿童身高、体重等生长发育指标。应用电感耦合等离子体质谱法检测全血中铅、镉水平。分别根据血铅、血镉水平的四分位数将研究对象分为Q1~Q4组,采用多因素Logistic回归模型分析学龄儿童血铅、血镉水平与体格发育的相关关系。结果本文共收集儿童294名作为调查分析对象,儿童血铅与血镉水平的几何均值(95%CI)分别为36.96(35.41~38.59)μg/L和1.21(1.15~1.27)μg/L。儿童发育迟缓率为19.4%。多因素Logistic回归模型结果显示,调整年龄、性别、行为及饮食习惯等因素后,与Q1组相比,Q2~Q4组血铅水平组的儿童生长发育迟缓发生风险的OR(95%CI)值分别为3.04(0.76~10.12)、4.54(1.21~13.64)及6.89(1.75~21.29);与Q1组相比,Q2~Q4组血镉水平组的儿童生长发育迟缓发生风险的OR(95%CI)值分别为2.32(0.73~7.36)、4.17(1.28~13.65)及3.57(1.08~11.78)。结论儿童血铅与血镉水平与儿童体格发育之间存在负相关关系,需引起关注。     

痉挛性脑性瘫痪患儿扁平足及足运动情况调查

【目的】 调查痉挛性脑性瘫痪患儿扁平足患病率及足部运动情况。 【方法】 采用足印法、目测法,对天津儿童医院康复科治疗的56例2~6岁痉挛性脑性瘫痪患儿进行检查,对扁平足罹患率及程度、足跟骨内外翻及足拇趾内外翻、足踝及足趾能否跖屈和背屈情况进行统计分析。 【结果】 56名2~6岁痉挛性脑性瘫痪患儿共获得106个患足足印、目测检查106只患足。扁平足发病率为100%,扁平足程度轻度0.00%、中度2.83%、重度97.17%,足跟骨内翻0%、正位0.94%、外翻99.06%,足踝能跖屈100%,足踝能背屈0.94%,足趾能跖屈100%,足趾能背屈16.98%,不同年龄组差异均无显著性意义(P＞0.05);足拇趾内翻0.94%、正位5.66%、外翻93.40%,不同年龄组差异具有显著性意义(P＜0.05)。 【结论】 2~6岁痉挛性脑性瘫痪患儿扁平足患病率高,足部运动差,足跖屈肌痉挛及挛缩是致痉挛性脑瘫患儿足部异常的主要因素。康复治疗中应重视足部问题。     

An x-ray study of valgus ankles in spina bifida children with valgus flat foot deformity.

Radiological examination of the ankles of spina bifida children with flail lower limbs and valgus flat foot deformity has revealed a high incidence of abnormal valgus tilt of the ankle-joint. A study of ankle X-rays of spina bifida children before and after extra-articular subtalar fusion in which the bone graft is removed from the ipsilateral tibia has shown that the valgus tilt of the mortice may increase after this procedure.     

生物力学矫形鞋垫对脑瘫伴足外翻儿童下肢功能的疗效

目的 探讨生物力学矫形鞋垫对脑瘫伴足外翻儿童下肢功能的疗效。 方法 选取2017年3月-9月在佳木斯大学附属第三医院收治的痉挛型双瘫伴足外翻儿童30例,随机分为对照组(n=15)和观察组(n=15)。对照组只接受常规康复训练,观察组在此基础上结合生物力学矫形鞋垫进行训练,两组均治疗3个月。治疗前后对两组儿童分别应用立姿跟骨休息位(RCSP)、粗大运动功能评定量表(GMFM)88项、Berg平衡量表(BBS)和足印分析法进行评定。 结果 两组治疗后RCSP、GMFM-88项D区和E区评分、BBS评分、步长及步速均优于治疗前(P<0.05),且观察组优于对照组(P<0.05)。 结论 生物力学矫形鞋垫可改善痉挛型双瘫儿童的足外翻畸形,提高粗大运动功能,改善步态及平衡功能。     

Musculoskeletal Problems in Overweight and Obese Children

PURPOSE The obesity epidemic in children is spreading at alarming rates. Because musculoskeletal problems can influence physical activity, we compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children.METHODS We performed a cross-sectional database and face-to-face interview study that included 2,459 children aged 2 to 17 years from Dutch family practices. We collected data on self-reported height and weight (body mass index), self-reported musculoskeletal problems in the 2 weeks before the interview, number of family physician consultations for musculoskeletal problems in 1 year, and age (2 age-groups were analyzed: 2 to 11 years and 12 to 17 years, because of the proxy interview in the youngest age-group). We calculated the odds ratio (OR) and 95% confidence interval (CI) for musculoskeletal problems in overweight and obese children, compared with normal-weight children.RESULTS Overweight and obese children in both age-groups (2 to 11 years and 12 to 17 years) reported significantly more musculoskeletal problems (OR = 1.86; 95% CI, 1.18–2.93; and OR = 1.69; 95% CI, 1.08–2.65, respectively) than normal-weight children. The total group of children who were overweight or obese reported more lower extremity problems than did the normal-weight children (OR = 1.62; 95% CI, 1.09–2.41); furthermore, they reported more ankle and foot problems than children who were of normal weight (OR = 1.92; 95% CI, 1.15–3.20). Overweight and obese children aged 12 to 17 years consulted their family physicians more often with lower extremity problems than did the normal-weight children (OR = 1.92; 95% CI, 1.05–3.51).CONCLUSION This study shows that overweight and obese children more frequently experience musculoskeletal problems than do normal-weight children.     

制造业工人肌肉骨骼疾患和劳动负荷及工作姿势分析

目的 分析制造业工人肌肉骨骼疾患和劳动负荷及工作姿势在不同企业、性别、文化程度、年龄和工龄组间的分布.方法 采用横断面研究设计和问卷调查方法对12家制造业企业5134名工人进行近1年内肌肉骨骼疾患发生情况调查.结果 调查对象在近12个月内身体腰、颈、肩、腕、踝足、膝、髋臀、肘部肌肉骨骼疾患发生率分别为59.7%、47.9%、38.1%、33.7%、26.9%、25.4%、15.2%、14.9%.不同企业工人身体各部位肌肉骨骼疾患发生率的差异有统计学意义(P＜0.05或P＜0.01).耐火材料厂和化纤厂工人肘、腰、腕、足(踝)等部位肌肉骨骼疾患发生率高于其他企业,而服装厂和金刚石厂工人肌肉骨骼疾患发生率低于其他企业.女性工人颈、肩、腕部肌肉骨骼疾患发生率高于男性,差异有统计学意义(P＜0.01).不同文化程度工人身体各部位肌肉骨骼疾患发生率差异有统计学意义(P＜0.05或P＜0.01).颈、肩、肘、腰、髋臀和膝部肌肉骨骼疾患发生率的年龄和工龄组间差异有统计学意义(P＜0.01),肌肉骨骼疾患发生率随年龄和工龄增长而增加.耐火材料厂和化纤厂工人劳动负荷大者和不良姿势者比例较高,金刚石和服装厂工人较低.结论 制造业工人腰、颈、肩、腕部肌肉骨骼疾患发生率较高,性别、文化程度、年龄和工龄对肌肉骨骼疾患的发生存在影响.

Abstract：

Objective To analyze the distribution of the musculoskeletal disorders, work load and working postures in different factories, gender, education levels, age and working years among manufacturing workers. Methods In a cross-sectional study of 5134 manufacturing workers in 12 factories, the morbidities for musculoskeletal disorders in one year period were measured with questionnaires. Results The morbidities for musculoskeletal disorders in body sites: waist, neck, shoulder, wrist, ankle/feet, knee, hip/buttocks and elbows were 59.7%, 47.9%, 38.1%, 33.7%, 26.9%, 25.4%, 15.2%, and 14.9%, respectively in one year period.There were significant differences of morbidities for musculoskeletal symptoms in body sites of workers among different factories (P＜0.05 or P＜0.01 ). The morbidities of musculoskeletal symptoms in elbows, waist, wrists and ankle/feet of the workers in refractory material and chemical fiber factories were higher than those in other factories, the morbidities for musculoskeletal symptoms of workers in garments and diamond factories were lower than those in other factories. The morbidities for musculoskeletal symptoms in neck, shoulders and wrists of female workers were significantly higher than those of male workers (P＜0.01). There were significant differences of the morbidities for musculoskeletal symptoms in body sites among workers with different educational levels(P＜0.05 or P＜0.01 ). There were significant differences of the morbidities for musculoskeletal symptoms in neck, shoulders, wrists, hip/buttocks and knee among groups with different age or different working years (P＜0.01), and the morbidities for musculoskeletal symptoms increased with age and working years. The proportions of unhealthy working postures and high working load among workers in refractory material and chemical fiber factories were higher;, but those in garments and diamond factories were lower.Conclusion The morbidities for musculoskeletal symptoms in waist, neck, shoulder and wrists of workers in manufacturing workers were higher; the gender, education level, age and working years could influenced the morbidities for musculoskeletal disorders.     

膝关节骨性关节炎患者下肢扭转角度CT评价的临床价值研究

目的：深入探讨膝关节骨性关节炎患者下肢扭转角度CT评价的意义。方法：选取2019年1月～2020年1月来本院就诊的102例膝关节骨性节炎患者作为本次研究对象,其中,男性患者23例,女性患者79例,总共204个膝关节。对患者实施伸膝旋转中立位CT扫描,测量胫骨扭转角、膝关节股骨后髁角以及α角等。结果：患者膝关节股骨后髁角中位数为（2.40±7.31）?,内翻畸形α角为（10.74±10.03）?,外翻畸形α角为（11.75±7.26）?。患者手术前膝扭转角左膝为（10.69±7.74）?,右膝为（9.46±5.79）?。胫骨扭转角左侧为（27.76±10.18）?,右侧为（28.16±10.91）?。结论：在下肢扭转角度的测量过程中,使用CT扫描的方式精准客观,可以给人工假体相对旋转定位提供科学的引导。而且在手术后膝扭转角度的测量过程中使用CT影像技术,可以为术后疗效的评估和医院随访提供较高价值参考。     

生物力学矫形鞋垫对痉挛型脑性瘫痪足外翻患儿下肢功能及步态的影响

目的 探讨生物力学(ICB)矫形鞋垫对痉挛型脑性瘫痪足外翻患儿下肢功能及步态的影响,为治疗痉挛型脑性瘫痪足外翻患儿提供有效的治疗方法及临床依据。方法 将2017年1月—2019年12月收治的80例痉挛型脑瘫患儿采用随机数字表法分为对照组和观察组,对照组(40例)行常规康复训练,观察组(40例)在常规康复训练的基础上联合ICB矫形鞋垫康复治疗,分别于治疗6月后进行内侧纵弓(MLA)、支撑相各分期、足弓指数(AI)、步长、步频、步速、88项粗大运动功能评定量表(GMFM-88)、Berg平衡量表(BBS)指标检测。结果 1)对照组与观察组组内治疗前后相比MLA、支撑相各分期、AI、步长、步频、步速、GMFM-88、BBS均呈明显的下降趋势,差异有统计学意义(P＜0.01);2)治疗后对照组右MLA、支撑相早、中、末期、AI、步长、步频、步速、BBS、GMFM-88的D能区和E能区与观察组之间有明显的统计学差异(t=2.571、0.827、1.449、1.670、3.512、3.202、5.828.5.585、2.675、4.721、2.345,P＜0.05);3)治疗后对照组左足内弓角与观察组之间无明显的统计学差异(P＞0.05),但观察组下降趋势优于对照组。结论 ICB矫形鞋垫联合康复训练能够改善痉挛型脑瘫患儿外翻足,提高双下肢运动功能及步行能力,可作为临床治疗痉挛型脑瘫患儿外翻足的辅助方法推广应用。     

The prevalence of foot problems in older women: a cause for concern

BACKGROUND: Painful feet are an extremely common problem amongst older women. Such problems increase the risk of falls and hamper mobility. The aetiology of painful and deformed feet is poorly understood. METHODS: Data were obtained during a pilot case-control study about past high heel usage in women, in relation to osteoarthritis of the knee. A total of 127 women aged 50-70 were interviewed (31 cases, 96 controls); case-control sets were matched for age. The following information was obtained about footwear: (1) age when first wore shoes with heels 1, 2 and 3 inches high; (2) height of heels worn for work; (3) maximum height of heels worn regularly for work, going out socially and for dancing, in 10-year age bands. Information about work-related activities and lifetime occupational history was gathered using a Life-Grid. The interview included a foot inspection. RESULTS: Foot problems, particularly foot arthritis, affected considerably more cases than controls (45 per cent versus 16 per cent, p = 0.001) and was considered a confounder. Cases were therefore excluded from subsequent analyses. Amongst controls, the prevalence of any foot problems was very high (83 per cent). All women had regularly worn one inch heels and few (8 per cent) had never worn 2 inch heels. Foot problems were significantly associated with a history of wearing relatively lower heels. Few work activities were related to foot problems; regular lifting was associated with foot pain (p = 0.03). CONCLUSION: Most women in this age-group have been exposed to high-heeled shoes over many years, making aetiological research difficult in this area. Foot pain and deformities are widespread. The relationship between footwear, occupational activities and foot problems is a complex one that deserves considerably more research.     

沧州市1 629名儿童青少年足弓发育状况

目的探讨儿童青少年足弓发育状况,为儿童青少年体质学研究提供依据。方法采用足印比值法,对沧州市幼儿园、小学、初中、高中1629名儿童青少年进行足弓测量。结果1629名受试者中,右足型大于左足型者677人,占41.6%;左足型大于右足型者453人,占27.8%。男性1652只单足检出扁平足789只,检出率为47.8%;女性1606只单足检出扁平足577只,检出率为35.9%,男、女生扁平足检出率差异有统计学意义（u=7.54,P〈0.01）。3岁时男性扁平足检出率为84.1%,女性为66.7%;3～18岁儿童青少年扁平足检出率随年龄增长呈递减趋势;男性在11岁、女性在9岁时出现突降低谷,此后至18岁趋于平稳。结论3～18岁人群足弓高度男性在11岁,女性在9岁出现突增高峰。