中足重建纠正可复性平足症力学环境的应用基础研究

The treatment of flexible flat foot which is the middle stage of adult acquire flatfoot deformity is the key point and a challenge to both the surgeons and patients. Surgical intervention is necessary to correct the resulting deformity and restore function of the limb by avoiding late rigid stage. Tendon transfer and joint fusion are used to release pain and modify foot appearance that means some physical structures are sacrificed. Most of the traditional treatment methods will lead the foot into a non-physiological state, and various complications are common. In recent years, according to some foreign reports and our clinical work, we found that the founctional reconstruction of the midfoot play a crucial role in the treatment and prognosis of flexible flatfoot, such as posterior tibial tendon reconstruction, plantar ligaments augmentation and bony structure realignment. Midfoot reconstruction will be the key stone to the treatment of flexible flat foot. However, few research focus on the biomechanical characteristics of the midfoot in flexibile flatfoot and how it works in the surgical correction. Based on our prior research, The aims of this project is to analyze the biomechanical characteristics of the midfoot and explore reasonable methods to correct and restore normal function of flexible flat foot, thus, to clear the role and significance of midfoot reconstruction in the flatfoot. So as to improve the efficacy and long term outcomes of the surgical treatment in flexible flat foot and save medical resources and costs.

可复性平足症为平足畸形发展的中期阶段，也是治疗上的重点和难点。为防止疾病进展到足踝关节僵硬的终末期，多采用手术方式进行干预。传统的肌腱转位和关节融合以牺牲正常软组织和骨性结构为代价以期达到缓解疼痛，改善畸形的目的，手术创伤大，并使足部处于非生理状态，有较高并发症。近年来，根据可复性平足症的解剖特点、国外少量报道和我们的临床工作发现，通过胫后肌腱的止点重建、足底韧带加强并结合中足骨性结构的整合等中足重建的方法，能获得较好的临床疗效，并最大限度保留足部关节功能。中足重建将会是可复性平足症治疗上的一个突破口，但目前仍缺乏基础研究的有力支持。本课拟在前期研究的基础上，通过生物力学、医学影像学和临床实践，研究中足的生物力学特点，明确中足重建在平足症治疗中的作用和意义。探讨科学合理的中足重建策略和手术方法，对临床合理治疗可复性平足症提供理论依据，以提高临床近期和远期疗效，节约医疗资源。

可复性平足症不仅会导致严重的足部疼痛和行走不稳定，更有甚者会丧失劳动能力。传统的手术方法创伤大，过于重视足部外形纠正，往往忽视了生物力学环境的改善。本项目旨在通过重建中足结构，最大限度地保留关节功能而纠正可复性平足，探索出科学合理的治疗策略和手术方法。本研究从基础和临床两方面进行论证和分析，利用尸体标本构建可复性平足模型，完成中足重建及稳定手术，分析畸形纠正和足部生物力学分布情况，并结合三维有限元分析进一步验证，最后与临床病例进行对照研究。结果发现，外侧柱延长术可以有效纠正前足外展，同时一定程度上改善后足外翻畸形。但关节内及足底压力结果提示当撑开宽度过大时，会导致关节及前足外侧柱负荷过高，联合内侧楔骨闭合截骨可以通过压低第一跖列，明显改善距下关节、距舟关节、跟骰关节及前足足底应力分布情况，三维有限元模拟结果与生物力学测试变化趋势一致。因此，我们最终提出中足截骨重建手术可以有效纠正可复性平足畸形，改善足部生物力学环境，同时避免关节融合导致的临近关节退变，在减轻患者痛苦、降低并发症发生率、节省医疗开支等方面具有重要的社会和经济价值。本项目的研究结果已撰写成文发表，并在国内外学术会议上交流，获得学术同行的支持和认可，为可复性平足症临床治疗方案的选择提供基础理论依据。