儿童扁平足病因、检测方法和治疗现状

　　摘   要：扁平足在兒童中常见，特别是学龄前儿童。迄今为止扁平足仍没有标准的定义，一般认为，扁平足的形成与足部骨结构异常或肌肉韧带松弛导致内侧纵弓塌陷有关。扁平足一般情况下是生理性的，表现为柔韧性扁平足，绝大部分随着年龄的增加症状会逐渐得到改善。在罕见的情况下，扁平足也可能是病理性的，表现为僵硬性扁平足，如先天性垂直距骨、跗骨联合等。随着生物力学的不断发展，扁平足的检测及评估不仅包括简单的足印分析和X射线平片，还包括足底压力测试、三维激光扫描等，大大提高了检测及评估的准确率及效率。在治疗方面，虽然目前暂没有大型的前瞻性研究肯定保守治疗的疗效，也不能通过现有的检测及评估方法确定哪些患者即使在成年后仍不能缓解疼痛及畸形，但根据生物力学制定的矫形器械如鞋垫等在缓解扁平足的疼痛、改善步态方面确有一定作用。手术的疗效是值得肯定的，手术治疗扁平足主要从软组织、截骨术、关节融合、关节制动术等方面选择或联合，效果良好，需严格掌握手术适应证和禁忌证。
　　关键词：儿童;扁平足;发育;病理生理;检测;评估
　　中图分类号：R726.8                                 文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2018.05.020
　　文章编号：1006-1959（2018）05-0056-06
　　The Cause，Detection Method and Treatment Status of Children"s Flat Foot
　　GUO Peng，LUO Cong
　　（Department of Orthopaedics，Room One，Children"s Hospital，Chongqing Medical University，Chongqing 400000，China）
　　Abstract：Flat feet are common in children，especially preschool children.So far there is no standard definition of flat feet，generally believed that the formation of flat feet and foot bone structure or muscle ligament relaxation causes the medial longitudinal arch collapse related.Flat feet are generally physiological，showing a flexible flat foot，and most of the symptoms gradually improve with age. In rare cases，the flat foot may also be pathological，showing a rigid flat foot，such as congenital vertical talus，zygomatic unity.With the continuous development of biomechanics，the detection and evaluation of flat feet not only include simple footprint analysis and X-ray film，but also include plantar pressure testing and three-dimensional laser scanning，which greatly improves the accuracy and efficiency of detection and evaluation.In terms of treatment，although there is currently no large-scale prospective study confirming the efficacy of conservative treatment，it cannot be determined through existing tests and assessments which patients do not relieve pain and deformity even after adulthood，but according to biomechanics orthopaedics Instruments such as insoles have a certain role in relieving flat foot pain and improving gait.The efficacy of the surgery is worthy of recognition.Surgical treatment of flat feet is mainly selected from the aspects of soft tissue，osteotomy，arthrodesis，etc.The effect is good，and surgical indications and contraindications need to be strictly controlled.

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