不同分型青少年特发性脊柱侧弯患者足底压力分布及其相关影响因素

Plantar pressure distribution and related factors in adolescents with different subtypes of idiopathic scoliosis

摘要

目的 比较不同分型青少年特发性脊柱侧弯(AIS)患者与健康青少年的静态足底压力分布,及存在足底压力异常的AIS亚型影像学参数、身高、体重与足底压力参数的相关性。方法 采用横断面研究设计,纳入2024年1月—2025年7月在南通大学附属常州儿童医院康复科就诊的157例10~16岁青少年,包括健康组32例,AIS组125例,其中胸弯组28例、腰弯组33例、胸腰弯组32例、S型胸腰弯组32例。采用FeetMapping平板式足底压力测试系统测量静态足底压力;对非正态或方差不齐数据进行秩转换后,采用协方差分析校正性别并进行组间比较;分析存在足底压力异常的AIS亚型影像学参数、身高、体重与足底压力参数的相关性。结果 校正性别后,5组左足足弓指数(F=2.970)、左足压力百分比(F=5.659)和右足压力百分比(F=6.497)组间差异有统计学意义(P<0.05)。两两比较显示,腰弯组与胸腰弯组的左足足弓指数不同(P＜0.05);健康组分别与腰弯组、S型胸腰弯组的双足压力百分比不同(P＜0.05)。S型胸腰弯组左足压力百分比与Cobb角(r=0.356,P=0.045)和颈7侧方偏移(r=0.371,P=0.037)呈正相关,与骨盆倾斜角(r=－0.364,P=0.041)和身高(r=－0.555,P=0.001)呈负相关;腰弯组未观察到显著相关性(P＞0.05)。结论 不同分型AIS患者足底压力存在差异,S型胸腰弯型足底压力与冠状面失衡、身高指标关联密切,为临床评估干预提供依据。

Abstract

Objective To compare static plantar pressure distributions among patients with different subtypes of adolescent idiopathic scoliosis (AIS) and healthy adolescents, and to investigate the correlations of plantar pressure parameters with coronal radiographic parameters, height, and weight in AIS subtypes exhibiting abnormal plantar pressure distributions. Methods This cross-sectional study included 157 participants aged 10-16 years who were treated or assessed at the Department of Rehabilitation, Changzhou Children's Hospital Affiliated with Nantong University, between January 2024 and July 2025. The participants comprised 32 healthy controls and 125 patients with AIS, including 28 with thoracic curves, 33 with lumbar curves, 32 with thoracolumbar curves, and 32 with S-shaped thoracolumbar curves. Static plantar pressure was measured using a FeetMapping platform system. Data with non-normal distributions or unequal variances were rank-transformed, followed by analysis of covariance adjusted for sex to compare differences among the groups. Correlations of plantar pressure parameters with radiographic parameters, height, and weight were analyzed in AIS subtypes exhibiting abnormal plantar pressure distributions. Results After adjustment for sex, significant differences among the five groups were observed in the left arch index (F=2.970), left plantar pressure percentage (F=5.659), and right plantar pressure percentage (F=6.497) (P<0.05). Pairwise comparisons showed that the left arch index differed between the lumbar curve and thoracolumbar curve groups (P<0.05). Bilateral plantar pressure percentages differed between the healthy control group and both the lumbar curve and S-shaped thoracolumbar curve groups (P<0.05). In the S-shaped thoracolumbar curve group, the left plantar pressure percentage was positively correlated with the Cobb angle (r=0.356, P=0.045) and C7 lateral offset (r=0.371, P=0.037), and negatively correlated with pelvic obliquity (r=-0.364, P=0.041) and height (r=-0.555, P=0.001). No significant correlations were observed in the lumbar curve group (P>0.05). Conclusions Static plantar pressure distributions differ across AIS subtypes. In patients with S-shaped thoracolumbar curves, plantar pressure distribution is closely associated with coronal imbalance and height, which may provide reference for clinical assessment and intervention.

关键词

青少年特发性脊柱侧弯 / 足底压力 / 冠状位失衡 / 生物力学

Key words

adolescent idiopathic scoliosis / plantar pressure / coronal imbalance / biomechanics

[1] Addai D, Zarkos J, Bowey AJ. Current concepts in the diagnosis and management of adolescent idiopathic scoliosis[J]. Child's Nerv Syst, 2020, 36(6): 1111-1119.
[2] Kuznia AL, Hernandez AK, Lee LU. Adolescent idiopathic scoliosis: Common questions and answers[J]. Am Fam Physician, 2020, 101(1): 19-23.
[3] Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: Diagnosis and management[J]. Am Fam Physician, 2014, 89(3): 193-198.
[4] Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis[J]. Nat Rev Dis Primers, 2015, 1: 15030.
[5] Sung S, Chae HW, Lee HS, et al. Incidence and surgery rate of idiopathic scoliosis: A nationwide database study[J]. Int J Environ Res Public Health, 2021, 18(15): 8152.
[6] Buldt AK, Allan JJ, Landorf KB, et al. The relationship between foot posture and plantar pressure during walking in adults: A systematic review[J]. Gait Posture, 2018, 62: 56-67.
[7] Wu KW, Lu TW, Lee WC, et al. Whole body balance control in Lenke 1 thoracic adolescent idiopathic scoliosis during level walking[J]. PLoS One, 2020, 15(3): e0229775.
[8] Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth[J]. Scoliosis Spinal Disord, 2018, 13: 3.
[9] 张帅, 赵莉, 杨阳, 等. 青少年脊柱弯曲异常危险因素的Meta分析[J]. 中国儿童保健杂志, 2023, 31(10): 1121-1126.
Zhang S, Zhao L, Yang Y, et al. Meta-analysis of risk factors for abnormal spinal curvature in adolescents[J]. Chin J Child Health Care, 2023, 31(10): 1121-1126. (in Chinese)
[10] Ma Q, Wang L, Zhao L, et al. Coronal balance vs. sagittal profile in adolescent idiopathic scoliosis, are they correlated[J]. Front Pediatr, 2020, 7: 523.
[11] 胡婷, 周劲松, 王卓慧, 等. 成都市青羊区小学儿童特发性脊柱侧弯现状及其相关因素分析[J]. 中国儿童保健杂志, 2022, 30(6): 617-621.
Hu T, Zhou JS, Wang ZH, et al. Current situation and related factors of idiopathic scoliosis in primary school children from Qingyang district Chengdu[J]. Chin J Child Health Care, 2022, 30(6): 617-621. (in Chinese)
[12] 鲁德志, 王金武, 许金霞, 等. 特发性脊柱侧弯患者躯干倾斜角与脊柱Cobb角、冠状面平衡的相关性研究[J]. 中国康复, 2021, 36(1): 3-7.
Lu DZ, Wang JW, Xu JX, et al. Correlation of trunk inclination angle with Cobb angle and coronal plane balance in idiopathic scoliosis[J]. Chin J Rehabil, 2021, 36(1): 3-7. (in Chinese)
[13] Caţan L, Cerbu S, Amaricai E, et al. Assessment of static plantar pressure, stabilometry, vitamin D and bone mineral density in female adolescents with moderate idiopathic scoliosis[J]. Int J Environ Res Public Health, 2020, 17(6): 2167.
[14] 白森, 郄淑燕. 成人型脊柱畸形患者运动功能的三维步态分析[J]. 首都医科大学学报, 2021, 42(6): 1070-1075.
Bai S, Qi SY. An analysis on three-dimensional gait of patients with adult spinal deformity[J]. J Cap Med Univ, 2021, 42(6): 1070-1075. (in Chinese)
[15] Solomonow-Avnon D, Levin D, Elboim-Gabyzon M, et al. Neuromuscular response of hip-spanning and low back muscles to medio-lateral foot center of pressure manipulation during gait[J]. J Electromyogr Kinesiol, 2016, 28: 53-60.
[16] 史祎, 许亚民, 马晓丽, 等. 中度Lenke 3CN型女性青少年特发性脊柱侧弯的静态平衡足底压力特征[J]. 医用生物力学, 2024, 39(5): 923-930.
Shi Y, Xu YM, Ma XL, et al. Characterization of static equilibrium plantar pressure in female adolescents with moderate lenke 3CN idiopathic scoliosis[J]. J Med Biomech, 2024, 39(5): 923-930. (in Chinese)
[17] Qiu XS, Wang ZW, Qiu Y, et al. Preoperative pelvic axial rotation: A possible predictor for postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis[J]. Eur Spine J, 2013, 22(6): 1264-1272.
[18] 李富丽, 张书豪, 王帅, 等. 青少年特发性脊柱侧凸患者病情进展影响因素的研究进展[J]. 广西医学, 2022, 44(17): 2031-2035.
Li FL, Zhang SH, Wang S, et al. Research progress on influencing factors for disease progression in patients with adolescent idiopathic scoliosis[J]. Guangxi Med J, 2022, 44(17): 2031-2035. (in Chinese)
[19] Miura K, Kadone H, Koda M, et al. Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: Analyses of dynamic alignment change using a three-dimensional gait motion analysis system[J]. Eur Spine J, 2020, 29(4): 840-848.
[20] Hu W, Song Y, Ma H, et al. Correlation analysis of the characteristics of spino-pelvic parameters and health-related quality of life after long-segment fixation for lenke-silva type 5 or 6 degenerative scoliosis[J]. J Pain Res, 2022, 15: 2171-2179.
[21] Ma Q, Lin H, Wang L, et al. Correlation between spinal coronal balance and static baropodometry in children with adolescent idiopathic scoliosis[J]. Gait Posture, 2020, 75: 93-97.
[22] Stein K, Holzgreve F, Keil F, et al. Improvement of pulmonary function parameters in female patients with adolescent idiopathic scoliosis by Schroth rehabilitative therapy[J]. Heliyon, 2024, 10(15): e34758.
[23] 侯颖, 李翔宇, 孔超, 等. 基于骨盆代偿及胸椎代偿对腰椎退变患者脊柱-骨盆矢状面平衡的评估方法[J]. 中国骨与关节杂志, 2022, 11(11): 825-830.
Hou Y, Li XY, Kong C, et al. A new method to evaluate spine-pelvis sagittal balance based on pelvic and thoracic compensation[J]. Chin J Bone Jt, 2022, 11(11): 825-830. (in Chinese)