Lampe Renée, Mitternacht Jürgen, von Pfister Lorenz, Turova Varvara, Blumenstein Tobias, Alves-Pinto Ana
aMarkus Würth Foundation bDepartment of Cerebral Palsy and Children Neuro-Orthopedics cDepartment Orthopedic, Klinikum Rechts der Isar, Technical University of Munich, Munich dDepartment Orthopedic and Trauma Surgery, Schlosspark-Klinik, Berlin, Germany.
J Pediatr Orthop B. 2017 Mar;26(2):122-132. doi: 10.1097/BPB.0000000000000288.
The aim of this study was to clarify the degree to which the operated congenital asymptomatic clubfoot still shows malpositions or whether it approaches a physiological development with increasing age. Clubfeet of 12 children were examined repeatedly over up to 10 years using pedobarography. The muscle volumes of the lower legs were investigated with MRI and compared with those of a healthy control group. Although some characteristics of clubfoot remained in the plantar pressure distribution, a gradual decrease in the heel and metatarsus load accompanied by an increase in the forefoot load could be registered as is typical for a developing healthy child's foot. The MRI showed a reduced volume of all muscles of the affected lower leg. A correlation was detected between the measured moments in the upper and lower ankle joints and the volumes of the muscles that move these joints. Even though a functional and anatomical separation between the two groups existed, the general developmental changes during growth were similar. The combination of pedobarographic data and derived joint moments with MRI-measured muscle volumes indicated that higher ankle joint moments in clubfoot were associated with smaller muscle volume and were therefore generated by higher joint rigidity.
本研究的目的是阐明手术治疗后的先天性无症状马蹄内翻足仍存在畸形的程度，或者其是否随着年龄增长接近生理发育。使用足压力描记法对12名儿童的马蹄内翻足进行了长达10年的反复检查。用磁共振成像（MRI）研究了小腿的肌肉体积，并与健康对照组进行了比较。尽管马蹄内翻足的一些特征仍存在于足底压力分布中，但可以记录到足跟和跖骨负荷逐渐减少，同时前足负荷增加，这是发育中的健康儿童足部的典型特征。MRI显示患侧小腿所有肌肉的体积减小。在上踝关节和下踝关节测量的力矩与移动这些关节的肌肉体积之间检测到相关性。尽管两组之间存在功能和解剖学上的差异，但生长过程中的总体发育变化是相似的。足压力描记数据、导出的关节力矩与MRI测量的肌肉体积相结合表明，马蹄内翻足较高的踝关节力矩与较小的肌肉体积相关，因此是由较高的关节刚度产生的。
