摘要
目的研究不同术式的拇手指再造术后患者步态及足底应力的改变。方法利用F-scan足底压力步态分析系统，对接受不同术式的拇手指再造术后患者行步态分析及动态足底压力测定。结果不同术式拇手指再造术后接受步态分析的患者共38例，术后随访时间平均25个月（4-182个月）。10例传统拇甲皮瓣患者的供足与健足相比，供足的步态周期持续时间、双支撑相所占比例均有延长的趋势；部分供足拇趾的峰压力、峰压强异常增高，而另有部分供趾的则明显降低甚至缺失；供足第三、四跖骨头的峰压强显著增高，差异有统计学意义，峰压力亦有增高趋势；供足底压力中心轨迹前移的距离明显变小。18例改良蹲甲皮瓣患者的供足与健足相比，供足拇趾峰压力及压强．时间积分小于健侧拇趾，差异有统计学意义，而峰压强差异元统计学意义；步态周期及其各步态时相所占比例及双侧前足各跖骨头部位的峰压力、峰压强与压强．时间积分的差异均无统计学意义，供、健足足底压力中心轨迹基本相同。其他再造术式术后供足的运动学及动力学参数均有不同程度的改变。结论各种游离足部组织移植再造拇手指术后供足步态和足底应力都有一定程度的改变，传统拇甲皮瓣移植对供足步态和足底应力分布有很大的影响，而改良游离拇甲皮瓣移植对供足功能的影响较小。
Objective To study the changes of gait and plantar pressure after various thumb/finger reconstruction with different techniques. Methods Gait analyses and dynamic plantar pressure measurements by F-scan system were performed to patients who underwent various thumb/finger reconstruction with different techniques. Results Thirty-eight patients who underwent various thumb/finger reconstruction were followed up, with a mean period of 25 months （4 to 182 months）, and given gait analysis. In 10 cases the thumbs were reconstructed with the traditional wrap-around flap. Their gait cycle and sub-phase of double support of the donor foot had the trend of prolonging compared with those of the intact foot. The peak force and peak pressure greatly increased in some donor great toes, but distinctly decreased, even undetectable for some others. The peak pressure under the 3rd and 4th metatarsal head of the donor foot significantly increased, as well as the peak force. The range that the center of force trajectory moved forward diminished significantly. In 18 cases, the thumbs were reconstructed with the modified wrap-around flap. The peak force and pressure-time integral of donor toes were both decreased statistically, but the peak pressure was nearly the same to that of the intact toes. The duration of the gait cycle and its sub-phases, together with the peak force, peak pressure and pressure-time integral under the lst to 5th metatarsal heads had no difference between the donor and the intact foot. The center of force trajectory was almost the same on both sides. The kinematic and kinetic parameters of the donor foot were all changed to some extent after other reconstructive procedures. Conclusion Each thumb/finger reconstructive technique may cause certain degree of influence to the kinematics and kinetics of the donor foot. The traditional wrap-around teclmique brings significant changes, while the modified wrap-around technique has minor trouble to the donor foot function.
出处
《中华手外科杂志》
CSCD
北大核心
2009年第5期312-316,共5页
Chinese Journal of Hand Surgery
基金
北京市优秀人才专项基金资助项目（20081d0300200062）
北京市卫生局“十百千”人才专项资助项目
关键词
拇指
足
步态
再造术
Thumb
Foot
Gait
Reconstructive surgical procedures
