目的

探索下肢生物力学评估在足踝部疾病中的作用。

方法

回顾分析衡水市第二人民医院收治的疑似足踝外伤及畸形患者360例，按疑似疾病类型分类：A群（踝关节骨折患者），B群（Lisfranc损伤患者），C群（平足症患者），D群（拇外翻患者）；每个群按照随机数表法随机分为对照组、观察组；对照组按照传统影像学测量评估制定诊疗计划；观察组添加下肢生物力学评估制定诊疗计划，记录两组患者诊断结果差异；治疗结束后3个月、12个月回访，利用美国足踝外科会（AOFAS）的中足评分、疼痛视觉模拟评分（VAS）评估改善情况，对对照组和观察组数据进行统计分析。

结果

两组81例疑似踝关节骨折患者中，观察组的诊断准确率高于对照组；误诊率、漏诊率低于对照组，差异有统计学意义（P＜0.05）；两组35 例疑似Lisfranc 损伤患者中，观察组的诊断准确率高于对照组；误诊率、漏诊率低于对照组，差异有统计学意义（P＜0.05）；两组42例疑似扁平足患者中，观察组的诊断准确率高于对照组；误诊率、漏诊率低于对照组，差异有统计学意义（P＜0.05）；两组22例疑似拇外翻患者中，观察组的诊断准确率高于对照组；误诊率、漏诊率低于对照组，差异有统计学意义（P＜0.05）。相关性分析显示患者踝关节骨折AOFAS、VAS评分和中足内侧峰值压强相关性最强（r=0.787，-0.740，P=0.012，0.033）；Lisfranc损伤患者AOFAS评分和平均步速相关性最强（r=0.711，P=0.015），VAS评分和中足内侧峰值压强相关性最强（r=-0.707，P=0.013）；扁平足患者AOFAS评分和自选步速相关性最强（r=0.597，P=0.035），VAS评分和第一跖骨峰值压强相关性最强（r=-0.550，P=0.041）；拇外翻患者AOFAS评分和第一跖骨峰值压强相关性最强（r=0.641，P=0.027），VAS评分和中足内侧峰值压强相关性最强（r=-0.623，P=0.042）。

结论

在传统X线诊断基础上添加生物力学评估对足踝外伤及畸形疾病诊断准确度和灵敏度有较为显著的提升。部分力学评估指标和患者临床评分具有较强相关性，对足踝外伤和畸形治疗及术后复健具导向意义。

Objective

To explore the role of lower extremity biomechanical evaluation in foot and ankle disease.

Methods

360 patients suspected of foot and ankle disease in Hengshui Second People's Hospital were analyzed retrospectively.All patients were classified according to suspected disease types： Group A（ankle fracture patients）， group B （Lisfranc injury patients）， group C （flat foot patients）， group D （bunion valva patients）；Each group was randomly divided into control group and observation groups according to the random number table method. The patients in control group were diagnosed and treated according to traditional imaging evaluation； In the observation group， lower extremity biomechanical assessment was added along with imaging evaluation to make diagnosis and treatment plan，and the differences of diagnosis results between the two groups were recorded. Follow-up visits at 3 months and 12 months after the end of treatment were conducted to evaluate the improvement using the AOFAS（American Orthopaedic Foot and Ankle Society） median foot score and VAS （Visual Analogue Scales） scores. The therapeutic effects of the control group and the observation group were statistically analyzed.

Results

Among 81 patients suspected of ankle fracture in each group of GroupA，the diagnostic accuracy of the observation group was 92.59%，higher than that of the control group（77.78%）.The rates of misdiagnosis and missed diagnosis were 28.57%and 5.41%，lower than those of the control group （46.15% and 17.65%）， the difference was statistically significant （P＜0.05）.Among 35 patients with suspected Lisfranc injury in each group of Group B，the diagnostic accuracy of the observation group was 94.29%，higher than that of the control group（62.86%）.The rates of misdiagnosis and missed diagnosis were 12.50% and 3.70%， lower than those of the control group （70.00% and 24.00%），the difference was statistically significant（P＜0.05）.Among 42 patients suspected of flatfoot in each group of GroupC，the diagnostic accuracy of the observation group was 95.24%，higher than that of the control group（71.43%）.The rates of misdiagnosis and missed diagnosis were 10.00% and 3.13%， lower than those of the control group （50.00% and 20.00%）， the difference was statistically significant （P＜0.05）. Similarly，Among 22 suspected bunion valgus patients in each group of GroupD， the diagnostic accuracy of observation group was 90.91%，higher than that of control group（59.09%）.The rates of misdiagnosis and missed diagnosis were 0.00%and 11.11%，lower than those of the control group（80.00%and 29.41%），the difference was statistically significant （P＜0.05）. Correlation analysis showed that AOFAS and VAS scores were the most correlated with the peak pressure of medial foot （r=0.787，-0.740， P=0.012， 0.033） among ankle fracture patients. The correlation between AOFAS score and average walking speed was the strongest （r=0.711， P=0.015）， and the correlation between VAS score and peak pressure of medial foot was the strongest（r=-0.707，P=0.013）in Lisfranc injury patients.The correlation between AOFAS score and self-selected step speed was the strongest（r=0.597，P=0.035），the correlation between VAS score and the peak pressure of the first metatarsal bone was the strongest（r=-0.550，P=0.041）in patients with flat feet.In bunion valgus patients，the correlation between AOFAS score and the peak pressure of the first metatarsal bone was the strongest（r=0.641，P=0.027），and the correlation between VAS score and the peak pressure of the medial foot was the strongest （r=-0.623， P=0.042）.

Conclusions

The addition of biomechanical evaluation on the basis of traditional X-ray diagnosis could significantly improve the accuracy of some diagnosis of foot and ankle diseases.A part of the mechanical evaluation indexes had strong correlation with the clinical scores of patients，and might have guiding significance for the treatment of foot and ankle diseases，as well as postoperative rehabilitation.