距舟关节在体运动与足内侧纵弓变化的相关性

目的通过数字化技术探讨距舟关节的在体运动特点及其对足内侧纵弓变化的影响。方法采集5名健康志愿者(4男1女)9例足部在进行内翻内收背伸运动时初始体位(中立位)和终末体位(最大内翻内收背伸位)的足部CT影像,利用mimics和geomagic逆向工程软件,结合刚体运动学原理,计算出距舟关节在足部这一运动过程中的三维空间6个自由度的变化及其与足内侧纵弓变化之间关系。结果足内翻内收背伸运动时,距舟关节发生了内翻内收跖屈运动,其内翻幅度:(38.82±5.98)°,内收幅度:(19.71±6.33)°,跖屈幅度:(-5.09±6.89)°;距舟关节运动中足舟骨向内侧移位与足内弓顶角变化具有显著相关性(P<0.05)。结论数字化技术解决了距舟关节在体三维运动测量的难题,通过这一技术的测量与分析发现:距舟关节虽然是一个杵臼状关节,但其主要进行绕矢状轴旋转,距舟关节的运动是引起足内侧纵弓变化的主要因素之一。     

Relationship between static posture and rearfoot motion during walking in patellofemoral pain syndrome: effect of a reference posture for gait analysis

The reference posture used in angular motion calculations may play an important role in the relationship found between static posture and rearfoot motion in the frontal plane in a clinical population such as patients with patellofemoral pain syndrome. This study examined the relationship between rearfoot inversion and eversion during the stance phase of walking and the static relaxed standing measurement in women (aged 18 years and older) with patellofemoral pain syndrome and controls and examined the influence of the reference posture used when calculating dynamic motion. Two reference postures were investigated: vertical alignment between the rearfoot and the lower leg and relaxed calcaneal standing. When using the latter reference posture, a significant correlation was found between the static relaxed standing measurement and peak eversion in controls only. When using the vertical alignment reference posture, significant correlation was found only in the patellofemoral pain syndrome group for peak eversion and inversion. The positive relationship found in the patellofemoral pain syndrome group between dynamic angular measures, based on a neutral reference posture, and static relaxed standing indicated that for subjects with patellofemoral pain syndrome, the clinical rearfoot measurement of relaxed standing can be used to explain the pattern of rearfoot motion during walking.     

Use of plantar contact area to predict medial longitudinal arch height during walking

A study was conducted to determine whether plantar surface contact area measures calculated from footprints collected during walking can be used to predict the height of the medial longitudinal arch. Thirty healthy women participated in the study. Arch height was determined by the distance from the navicular tuberosity to the floor and by the "bony" arch index. Dynamic plantar surface contact area was recorded using a pressure platform as the subjects walked across a 12-m walkway. The arch index and the total plantar surface contact area were determined from the pressure sensor data. The results indicated that plantar surface contact area could be used to estimate only approximately 27% of the height of the medial longitudinal arch as determined by navicular tuberosity height and the bony arch index. These findings demonstrate the inability of the clinician to predict the vertical height of the medial longitudinal arch on the basis of the amount of foot plantar surface area in contact with the ground during walking.     

Serial measurement of calcaneal pitch during midstance

Although emerging evidence suggests a causal relationship between arch structure and musculoskeletal injury, few investigations have adequately assessed arch function during gait. In this study, digitized videofluoroscopy was used to evaluate the sagittal plane motion of the calcaneus during gait. Nine female subjects requiring diagnostic foot radiographs underwent videofluoroscopy. The calcaneal inclination angle, arch height ratio, and tarsal index were digitally analyzed for all radiographic images. Calcaneal pitch was correlated to both the arch height ratio and the tarsal index. Repeated measures analysis of variance helped to identify a significant reduction in the mean calcaneal pitch during the midstance and early propulsive periods of gait. These findings suggest that although calcaneal pitch may be used as an indicator of rearfoot position, biomechanical classification of foot types based on radiographs may result in erroneous conclusions concerning foot function.     

Effect of foot posture and inverted foot orthoses on hallux dorsiflexion

A pronated foot posture is considered to be a factor in limitation of dorsiflexion at the first metatarsophalangeal joint during weightbearing. Customized foot orthoses are widely used to increase dorsiflexion at the first metatarsophalangeal joint in people with pronated feet. However, the effect of foot posture and customized foot orthoses on maximum first metatarsophalangeal joint dorsiflexion has not been widely investigated. This study sought to determine 1) the relationship between foot posture and static maximum first metatarsophalangeal joint dorsiflexion and 2) the effect of customized foot orthoses on static maximum first metatarsophalangeal joint dorsiflexion in people with pronated feet. Foot posture was assessed using the Foot Posture Index. Static maximum first metatarsophalangeal joint dorsiflexion of the right foot was determined using a goniometer while participants stood relaxed with and without Blake-style inverted (30 degrees) foot orthoses positioned under their feet. There was a significant negative correlation between Foot Posture Index and static maximum first metatarsophalangeal joint dorsiflexion (r = -0.587). Inverted (30 degrees) foot orthoses increased the magnitude of static maximum first metatarsophalangeal joint dorsiflexion from 83.4 degrees to 85.3 degrees in participants with an excessively pronated foot posture. However, this difference was not statistically significant. People with pronated feet are more likely to exhibit limitation of dorsiflexion at the first metatarsophalangeal joint during gait, and inverted foot orthoses are unlikely to be effective in increasing dorsiflexion at the first metatarsophalangeal joint in these people.     

Ⅱ型糖尿病患者前行和倒走时的足底压力变化

目的 探讨Ⅱ型糖尿病患者前行与倒走时的足底压力与足部知识及自护行为的情况,为临床寻求减少糖尿病足发生率的方法提供依据.方法 对医院收治的105例Ⅱ型糖尿病患者设为观察组,同期选择在医院进行健康体检的105名正常人为对照组,检测两组足底压力及压力中心轨迹变化,并对观察组进行足部知识自护问卷调查.结果 与对照组相比,观察组在第2～5趾、第2跖骨区的峰值压力显著降低,差异具有统计学差异（P＜0.05）,而在第3跖骨、第1跖骨、足跟内侧这三个区域双足底的压力均增大（P＜0.05）;与前行时相比,观察组患者倒走时在第1趾、第2～5趾、第1跖骨、足中部或足弓、足跟内侧、足跟外侧等各个区域的双足足底峰值压力均有不同程度的增加（P＜0.05）;但在第3跖骨区域倒走时双足压力却较前行时显著降低（P＜0.05）;观察组倒走时的足底压力中心轨迹在X轴上的位移相比于前行时显著增大（P＜0.05）,但在Y轴上的位移则明显减小（P＜0.05）,双足在位移上差异不大;Ⅱ型糖尿病患者问卷总分为（20.64±3.47）分.结论 糖尿病患者前行时足底压力分布与正常人存在差异;倒走时较前行时足底压力区域分布更为均匀,前足掌压力减轻,缓解了该区疲劳损伤,能起到预防糖尿病的作用;应加强对糖尿病患者足部保护知识及自护行为的教育指导,减少糖尿病足的发生率.     

3-matic软件测量负重状态平足指标的可行性分析

目的:比较3-matic软件与传统X线平片对平足指标测量结果是否具有一致性。方法:在3-matic软件中,根据重建的足踝部负重状态三维骨骼模型,获取足踝部负重状态下的正位、侧位及后足冠状位图像,然后进行平足相关指标的测量,并与同一个体、同一指标的普通平片测量结果进行对比。结果:两种方法对于跟骨倾斜角、距舟覆盖角、正位距骨第一跖骨角的测量,两种测量方法没有统计学差异(P>0.05)。对于侧位距骨第一跖骨角、距骨倾斜角、跟骨外移距离、内侧柱长度、内侧足弓角、外侧柱长度、外侧足弓角和跟骨外翻角的测量,两种测量方法具有显著统计学差异(P<0.05)。结论:在3-matic软件中进行平足相关指标的测量具有直观清楚、非侵袭性、测量结果稳定等优点,测量时可以根据需要去除不相关的骨块,消除骨骼重影的干扰。对于平足各指标的测量,3-matic软件测量与平片测量结果不具有一致性,因此,利用数字化技术进行平足模拟手术时,不能直接参考平片测量的正常范围。     

The effect of foot orthoses on transverse tibial rotation during walking

The purpose of this study was to determine the effectiveness of two types of foot orthoses in controlling the magnitude and rate of internal tibial rotation, measured by the tibial pointer device, during walking. Ten subjects between the ages of 23 and 43 years volunteered to participate in the study. Prior to data collection, each subject was issued two types of foot orthoses: a pair of rigid, plastic orthoses with posting in either the forefoot or the rearfoot, and a pair of soft, accommodative, premolded orthoses with no posting. All subjects wore standardized footwear. Following a controlled break-in period for both footwear and orthoses, each subject was asked to walk at a self-selected speed over a 12-m walkway while the movement of internal tibial rotation was recorded with a video camera during five trials. The results indicated that both the rigid plastic and the accommodative foot orthoses significantly reduced the magnitude and the rate of internal tibial rotation. No significant difference was noted between the soft and rigid foot orthoses conditions.     

扁平足第二跖纵弓疲劳损伤的生物力学机制

目的 研究扁平足和正常足的第二跖骨与足底腱膜的过劳性损伤生物力学机理,对比分析步态周期中扁平足与正常足疲劳损伤的危险性,为制定临床防治措施提供定量化理论依据。方法 采用生物力学实验和计算医学手段,通过有限元方法和疲劳损伤理论分析,开展了步态周期中扁平足和正常足疲劳行为的计算机定量模拟,并通过足骨应力集中部位测定及足弓变形X线片测量来验证模型的可靠性。结果 建立了扁平足弹性足弓有限元模型,计算得到步态周期各个阶段扁平足第二跖骨和足底腱膜的动态应力峰值分别约为28．77MPa和12．53MPa,扁平足的第二跖骨动态应力比正常足增加了8％～21％,扁平足的足底腱膜动态应力比正常足增加了21％～51％。足底腱膜发炎或部分切除后扁平足和正常足的张拉应力都发生了转移,最大相对量转移发生于足底长韧带,最大绝对量转移发生于第二跖骨底,但扁平足的最后应力始终超过正常足0．26～5．32MPa。结论 无论扁平足或正常足,其应力集中部位均发生于第二跖骨和足底腱膜,但扁平足的疲劳应力峰值始终高于正常足。足底各类软组织中,足底腱膜承受的张拉应力最大,足底腱膜发炎或外科部分切除导致腱膜张拉应力转移,加剧了足底固有肌和长韧带的劳损,同时也增加了第二跖骨疲劳骨折的危险性。扁平足的足踝内旋,足弓塌陷,以及mu囊炎引发的第二跖骨槌状畸变,均可增加过劳性损伤的发病率。     

Effect of anterior cruciate ligament reconstruction on biomechanical features of knee in level walking: a meta-analysis

Background The anterior cruciate ligament （ACL） is one of the most commonly injured knee ligaments. Even following ACL reconstruction, significant articular cartilage degeneration can be observed and most patients suffer from premature osteoarthritis. Articular cartilage degeneration and osteoarthritis development after ACL injury are regarded as progressive process that are affected by cyclic loading during frequently performed low-intensity daily activities. The purpose of this study was to perform a meta analysis on studies assessing the effects of ACL reconstruction on kinematics, kinetics and proprioception of knee during level walking.Methods This meta analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and July 2010 comparing gait and proprioception of a reconstructed-ACL group with an intact-ACL group were pooled for this review. Thirteen studies were included in the final meta analysis.Results There was no significant difference in step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion between the reconstructed-ACL group and the intact-ACL group （P 〉0.05）. However, there was a significant difference in peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle between the reconstructed-ACL group and the intact-ACL group （P 〈0.05）.Conclusions Step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion usually observed with ACL deficiency were restored after the ACL reconstruction and rehabilitation, but no significant improvements were observed for peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle.     

COA: Effect of anterior cruciate ligament reconstruction on biomechanical features of knee in level walking: a meta-analysis

Background The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments. Even following ACL reconstruction, significant articular cartilage degeneration can be observed and most patients suffer from premature osteoarthritis. Articular cartilage degeneration and osteoarthritis development after ACL injury are regarded as progressive process that are affected by cyclic loading during frequently performed low-intensity daily activities. The purpose of this study was to perform a meta-analysis on studies assessing the effects of ACL reconstruction on kinematics, kinetics and proprioception of knee during level walking. Methods This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and July 2010 comparing gait and proprioception of a reconstructed-ACL group with an intact-ACL group were pooled for this review. Thirteen studies were included in the final meta-analysis. Results There was no significant difference in step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion between the reconstructed-ACL group and the intact-ACL group (P>0.05). However, there was a significant difference in peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle between the reconstructed-ACL group and the intact-ACL group (P<0.05). Conclusions Step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion usually observed with ACL deficiency were restored after the ACL reconstruction and rehabilitation, but no significant improvements were observed for peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle. Methods This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials between January 1966 and September 2010 comparing ACL reconstruction group with ACL intact group in gait and proprioception were pooled for this review. Thirteen studies were finally recruited in the meta-analysis. Results There was no significant difference in step length,step speed,maximum knee flexion during loading response,joint position sense and threshold to detect passive motion between ACL reconstruction group and ACL intact group(p>0.05).However,there was a significant difference in peak knee flexion,maximum knee flexion angular joint during stance,knee moment peak knee flexion during walking and maximum tibial rotation during gait cycle between ACL reconstruction group and ACL intact group(p<0.05). Conclusions The step length,step speed,maximum knee flexion during loading response,joint position sense and threshold to detect passive motion for ACL deficiency were restored after the ACL reconstruction and rehabilitation,but no significant improvements were observed in terms of peak knee flexion,maximum knee flexion angular joint during stance,knee moment peak knee flexion during walking and maximum tibial rotation during gait cycle.     

Effect of the low-Dye strap on pronation-sensitive mechanical attributes of the foot

The low-Dye strap is used routinely to temporarily control pronation of the foot and, thereby, to diagnose and treat pronatory sequelae. However, the exact biomechanical effects of this strapping technique on the foot are not well documented. The main purpose of this study was to establish the specific mechanical effects of the low-Dye strap on the pronatory foot. Within this context, the specific aim was to assess the effect of the low-Dye strap on three distinct pronation-sensitive mechanical attributes of the foot in the weightbearing state: 1) calcaneal eversion, 2) first metatarsophalangeal joint range of motion, and 3) medial longitudinal arch height. Weightbearing measurements of these three attributes were made before and after application of a low-Dye strap, and statistical comparisons were made. The results of this study indicate that the low-Dye strap is effective in reducing calcaneal eversion, increasing first metatarsophalangeal joint range of motion, and increasing medial longitudinal arch height in the weightbearing state. Knowledge of the exact mechanisms of action of the low-Dye strap will provide practitioners with greater confidence in the use of this modality.     

运用三维步态分析评价下肢机器人训练对偏瘫患者步行能力的影响

正脑血管疾病是导致老年人慢性动作功能受损的主因之一,影响日常生活功能~([1])。机器人辅助疗法是近年来出现的脑卒中康复疗法,具有重复性、专一性、可定量评价等优点~([2-3])。既往评价偏瘫患者下肢机器人训练效果多采用量表评定,结果较主观,三维步态分析具有数据客观、定量、可信度高等优点~([4])。本研究利用三维步态分析系统对比观察脑卒中偏瘫患者经下肢机器人结合本体感觉训练或仅采用本体感觉训练后其三维步态参数的变化情况,评价下肢机器人训练对脑卒中偏瘫患者步行能力的改善效果。     

舞蹈演员跖趾关节炎发生机制的有限元分析

目的??通过构建 3 个不同角度的全足三维有限元模型,施加重力模拟舞蹈演员踮脚站立的工况,以 此探究舞蹈演员多发跖趾关节炎的生物力学机制。方法??利用石膏托固定研究对象的足踝关节后拍摄全足 CT图像,构建出包括骨与足周围软组织及关节韧带的全足三维有限元模型,并对模型设定边界条件、施加载负并进行应力分析, 研究舞蹈演员踮脚站立时的全足应力分布情况。结果??分别建立中立位, 跖屈 20°, 跖屈 40°的全足三维有限元模型, 施加载负后有限元分析的结果表明, 站立平衡时随着踮脚角度的增加, 前足应力向跖趾关节集中,其中第 2、3 足趾的应力变化最大,第 2 跖骨的最大应力值从 4.77?MPa 增加到 34.61?MPa,第 2 近节趾骨的最大应力值从 2.38?MPa 增加到 166.40?MPa, 第 3 跖骨的最大应力值从 4.53MPa 增加到 30.21?MPa, 第 3 近节趾骨的最大应力值从 2.19?MPa 增加到 157.80?MPa。结论??舞蹈演员踮脚站立时的角度越大,第 2 和第 3 跖趾关节附近应力值迅速增大, 长时间的踮脚站立很容易造成跖趾关节炎, 引发前足疼痛。     

跪位姿势控制训练结合应用踝足矫形器在提高脑瘫儿步行水平中的作用研究

目的：研究经过康复治疗改善脑瘫（cerebralpalsy）患儿的跪位姿势控制能力并结合应用踝足矫形器在提高脑瘫儿步行水平中所起的作用。方法：选择2011年9月-2013年7月收治的脑瘫患儿50例,随机分为治疗组和对照组,治疗组在常规康复治疗的基础上,重点强化跪位姿势控制训练并佩戴踝足矫形器（anklefootorthoses,AFO）,对照组常规康复治疗,跪位姿势控制能力采用粗大运动功能量表（grossmotorfunctionmeasure,GMFM）的c区评定,步行水平采用Gillette功能性步行量表评定。结果：对照组中途脱落2例,共有48例患儿进入结果分析。结果表明治疗组治疗后GMFMC区评分显著高于治疗前（P〈0．01）,并且治疗后治疗组GMFMC区评分显著优于对照组（P〈0．01）;Gillette功能性步行量表步行水平分级评定显示：治疗后治疗组步行水平显著优于对照组（P〈0．05）。结论：跪位姿势控制能力（髋关节运动控制）、踝足控制的稳定性在脑瘫儿步行中的作用非常重要,这2方面的作用主要在于维系步行中控制重心的稳定,在此基础上步态才能改善,步行水平才能提高。     

Effects of simulated genu valgum and genu varum on ground reaction forces and subtalar joint function during gait

The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. First, a theoretical model of the forces within the foot and lower extremity during relaxed bipedal stance was developed predicting the rotational effect on the subtalar joint due to genu valgum and varum deformities. Second, a kinetic gait study was performed involving 15 subjects who walked with simulated genu valgum and genu varum over a force plate and a plantar pressure mat to determine the changes in the ground reaction force vector within the frontal plane and the changes in the center-of-pressure location on the plantar foot. These results predicted that a genu varum deformity would tend to cause a subtalar pronation moment to increase or a supination moment to decrease during the contact and propulsion phases of walking. With genu valgum, it was determined that during the contact phase a subtalar pronation moment would increase, whereas in the early propulsive phase, a subtalar supination moment would increase or a pronation moment would decrease. However, the current inability to track the spatial position of the subtalar joint axis makes it difficult to determine the absolute direction and magnitudes of the subtalar joint moments.     

慢性踝关节不稳患者足底压力特征及相关因素分析

目的: 探讨慢性踝关节不稳(chronic ankle instability,CAI)患者在步行与单足支撑时的足底压力分布特点及其相关因素。方法: 纳入75例CAI患者及40例正常人,对步行及单足站立时的足底压力参数进行对比分析,测量指标为足底每个区域的压强峰值、达峰时间、边界时间(time to boundary,TTB)和压力中心(center of pressure,COP)偏移速度等系列指标。评估CAI患、健侧差异以及与正常对照组的差异,并分析存在差异的足底压力指标与患者年龄、性别、侧别、体重指数、Beighton评分的相关性。结果: CAI患者患、健侧步行时均化峰值压力差异无统计学意义,但是与正常人相比,患侧的第一跖骨(t=2.99,P=0.02)和第二跖骨(t=2.09,P=0.01)、双侧的足跟内侧(患侧t=2.33,P=0.01;健侧t=3.74,P=0.02)和足趾区峰值压力(患侧t=2.23,P=0.01;健侧t=3.28,P=0.02)较小,患侧的第五跖骨区域(t=-3.86,P=0.03)的均化峰值压力较大,且患侧第四跖骨达峰时间较晚(t=3.33,P=0.01)。患侧的内外侧TTB最小值(t=-2.67,P=0.03)、极小值的平均值(t=-3.54,P=0.02)和标准差(t=-2.86,P=0.04)均明显小于健侧,与正常人相比,TTB系列与压力中心系列指标提示患、健侧在内外向和前后向均存在明显的稳定性缺陷(P<0.05)。女性、Beighton评分高的CAI患者内外向稳定性缺陷更明显(P<0.05)。结论: CAI患者在平地步行时患、健侧的足底压力分布特征与正常人存在明显差异,患侧足底COP明显向足外侧偏移。单足支撑时,患侧前后向及双侧的内外向姿势控制稳定性均明显弱于正常人,女性及伴有全身韧带松弛症的CAI患者内外向稳定性缺陷更明显。     

三维超声对青少年不同体位下脊柱侧凸与旋转角度变化的研究

目的 在站立位和仰卧位下,采用三维超声成像技术探索青少年特发性脊柱侧凸 (adolescent idiopathic scoliosis, AIS) 患者侧凸与旋转角度的变化规律。方法 2位测评者采用SonixTABLET三维超声成像系统,对16例AIS女性患者〔平均 (14.8 ± 1.7)岁〕进行站立位和仰卧位下扫描。AIS患者侧凸与旋转角度均采用椎板中心法(center of laminae, COL)进行测量。比较三维超声成像在站立位和仰卧位下测量结果的变化。采用多元线性回归法分析两种体位下三维超声测量结果变化的相关因素;应用Pearson相关分析评价两种体位下测量结果之间的相关性。结果 三维超声成像在站立位和仰卧位下测量脊柱侧凸角度的变化范围为1.9°~11.7°,顶锥旋转角度的变化范围为0.0°~5.9°。两种体位下脊柱侧凸角度的变化与侧凸角度的大小及侧凸上端椎选择的差异有关;而顶锥旋转角度的变化与旋转角度本身的大小有关;且两种体位之间高度相关 (r>0.9)。结论 三维超声成像能够显示出AIS患者在站立位和仰卧位下脊柱侧凸与旋转角度的变化规律,随着脊柱侧凸角度的增加,两种体位下侧凸角度的变化幅度均增加,椎骨旋转角度的变化情况不同。     

弹性绷带对脑瘫患儿立位及步行功能的作用观察

目的:探讨弹性绷带的应用对脑瘫儿立位及步行功能的影响。方法:立位及步行功能异常的脑瘫患儿71例,随机分为矫正组50例和对照组21例,两组均采用以Bobath技术为主的综合康复治疗,矫正组同时据患儿情况配备弹性绷带进行训练。2组治疗前后用粗大运动功能评定量表(GMFM)对爬和跪、立位、步行等项进行功能评定。结果:治疗3个月后2组患儿GMFM得分较治疗前明显提高(P<0.001),矫正组得分高于对照组(P<0.05)。结论:配备弹性绷带并采用神经生理学疗法为主的综合康复治疗更有利于患儿立位及步行功能的提高。