后足冠状应力位X线图像的获取及在儿童柔韧性扁平足的应用

发布时间：2019-03-20 12:21

【摘要】：研究目的：应用X线数字断层融合摄影方法获得后足冠状位应力位的X线图像，根据图像结果提出后距跟角的测量方法，并将其应用于儿童柔韧性扁平足的测量，以及与临床检查中的RCSP值及传统Ｘ线侧位应力位片测量柔韧性扁平足的方法进行比较，探索后足冠状位应力位的X线图像的应用价值。方法： 1：儿童后足冠状应力位X线图像的获取及研究按照足踝外科协会的标准选择正常足、高弓足、扁平足3人，进行后足冠状位应力位Ｘ线数字断层融合摄影，分别获得正常足、扁平足、高弓足的后足冠状位的X线图像，比较三者后足冠状位X线图像上跟骨与距骨之间的纵向轴、横径以及后距跟角的改变。 2：儿童后足冠状应力位X线图像在儿童扁平足中的应用研究参照RCSP值和Meary角关于足弓的评判标准，从2013年9月～12月在湖南省人民医院小儿骨科门诊就诊的患儿中选择柔韧性扁平足患儿27例共54个足作为实验组；正常人群的志愿者19例共38个足（经伦理委员会的批准及征求志愿者的知情同意）作为正常组。患儿及志愿者年龄均分布在3岁至7岁之间。正常组和实验组均进行临床检查及Ｘ线摄影（包括后足冠状位应力位Ｘ线及足侧位应力位Ｘ线），获取正常组与实验组的后距跟角α、Meary角β、RCPS值γ。结果： 1：本研究中从后足冠状位应力位Ｘ线图像上能清晰的显示胫距关节、距跟关节之间的关节间隙及在后足冠状面上胫骨、距骨、跟骨之间的生物力学关系：对于高弓足的患儿从本研究中获得的后足冠状应力位的图像上我们发现足的跟骨与距骨之间的纵向轴变长、横径变短；柔韧性扁平足患儿的后足冠状位应力位Ｘ线图像上显示距骨头下降，跟骨外翻。 2：正常组与实验组的年龄比较差异无统计学意义(P0.05)，，正常组α、β、γ均低于实验组，两组比较差异有统计学意义(P0.05)。 3：α与β、α与γ之间均存在正相关性。相关系数分别为（r=0.891，P0.01）、（r=0.887, P0.05）。 4：本实验中正常组后距跟角α的范围为8.54°~10.01°。结论： 1、后足冠状位应力位X线图像能清楚地显示胫骨、距骨和跟骨在冠状位的相互关系；可能对评价儿童柔韧性扁平足、高弓足有意义。 2、后足冠状位应力位X线上测量的后距跟角与足侧位应力位X线上Meary角、以及临床检查的RCPS值具有一致性，有望成为儿童柔韧性扁平足的测量和评估指标。
[Abstract]:Objective: to obtain the X-ray images of stress position in posterior crown position by digital tomography fusion X-ray, and put forward the measurement method of heel angle according to the image results, and apply it to the measurement of flexible and flat foot in children. Compared with the RCP value in clinical examination and the traditional X-ray lateral stress potential film, the value of X-ray images in posterior crown position stress position was explored in order to explore the application value of the X-ray images of posterior crown position stress position in the measurement of flexible and flat foot. Methods: 1. X-ray images of posterior foot coronal stress position were obtained and studied in 3 children with normal foot, high arch foot and flat foot according to the criteria of the Society of ankle surgery. The coronal X-ray images of normal foot, flat foot and high arch foot were obtained respectively. The longitudinal axis, transverse diameter and heel angle of calcaneus and talus on coronal X-ray images of three hind feet were compared. Application of coronal stress X-ray images of the posterior foot in children with flat foot. Reference to the evaluation criteria of RCSS and Meary angle with regard to the arch of the foot. From September to December 2013, 54 feet of 27 children with flat feet were selected as the experimental group in the Department of Pediatric Orthopedics, people's Hospital of Hunan Province. A total of 38 feet (approved by the ethics committee and informed consent of volunteers) were selected as the normal group. The ages of children and volunteers ranged from 3 to 7 years old. Both normal and experimental groups were examined by clinical examination and X-ray (including posterior foot coronal stress X-ray and foot lateral stress X-ray). The calcaneal angle 伪, Meary angle 尾 and RCPS value 纬 were obtained from normal group and experimental group. Results: 1: in this study, the tibiotalar joint, talus-calcaneal joint and the tibia and talus on the coronal plane of the hind foot could be clearly displayed from the X-ray images of the posterior foot on the coronal plane. Biomechanical relationship between calcaneus: we found that the longitudinal axis between calcaneus and talus was longer and the transverse diameter was shorter in the images of coronal stress position of hind foot in children with high arched foot. X-ray images of posterior foot coronal stress in flexible flat foot children showed declination of talus and valgus of calcaneus. 2: there was no significant difference in age between the normal group and the experimental group (P0.05), while 伪, 尾, 纬 in the normal group were lower than those in the experimental group, and there was significant difference between the two groups (P0.05). 3: there is a positive correlation between 伪 and 尾, 伪 and 纬. The correlation coefficients were (r = 0.891, P0.01), (r = 0.887, P0.05). 4: the range of calcaneal angle 伪 in normal group ranged from 8.54 掳to 10.01 掳. Conclusion: 1 X-ray images of posterior foot in coronal plane can clearly show the relationship among tibia, talus and calcaneus in coronal plane, which may be of significance in evaluating flexible and flat foot and high arch foot in children. 2. The posterior heel angle measured on the coronal plane of the hind foot was consistent with the Meary angle on the lateral position of the foot, as well as the RCPS value of the clinical examination, which is expected to be used as an index for the measurement and evaluation of the flexible and flattened foot in children.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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