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  • 學位論文

成人扁平足症狀分析

The Analysis Of Adult Pes Planus

指導教授 : 周明智
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摘要


背景及目的: 在台灣,成人扁平足(adult pes planus)的症狀一直沒有系統性的研究及標準的量化方式加以度量。因扁平足需接受複檢之役男應內政部之體位區分標準之規定皆需接受足部負重正側位X光攝影(weight-bearing true lateral view),藉此機會可分析成人扁平足之症狀盛行率並探討症狀與放射線學上變形之關係。 方法: 自民國92年1月1日起至民國94年12月31日止至某醫院接受兵役複檢之役男因足部問題而接受左右足X光正側位站立攝影之役男納入為本研究。接受左右足X光正側位站立攝影共525人。在醫學影像存檔與通信系統工作站上調閱其X光影像,度量其足跟第五蹠骨角、距骨蹠骨角及跟骨角。以距骨蹠骨角 < -4度為扁平足的黃金標準。以電話訪視這些扁平足的役男是否有症狀,記錄其美國骨科足踝醫學會臨床度量系統踝-後足量表及中足量表的主觀成分(subjective components of the American Orthopaedic Foot and Ankle Society midfoot and ankle-hindfoot scores),並記錄其身高及體重。 結果 : 525位役男其中接受電話訪視172人。 4人不願告知身高及體重。完成整份問卷168人。美國骨科足踝醫學會臨床度量系統問卷回覆率32%。排除14名非扁平足,共得158位扁平足受試對象。年齡平均為23.32±2.04歲,體重平均為72.22±9.62公斤,身高平均為173.21±5.22公分,身體質量指數平均為24.04±2.68 kg/m2。受試對象中足量表及踝-後足量表的主觀成分分數皆滿分者82人(51.9%, 95% 信賴區間 44.2% to 59.6% );中足量表及踝-後足量表的主觀成分分數未滿分者76人,症狀盛行率為48.1% (95% 信賴區間40.4% to 55.8%)。當在中足量表中,依滿分及未滿分者分為兩組作比較時,發現左右腳之距骨蹠骨角、跟骨第五蹠骨角及跟骨角無明顯差異。在踝-後足量表中,依滿分及未滿分者分為兩組作比較時,發現在左側跟骨第五蹠骨角及左側足跟角兩組有顯著差異;滿分組的左側足跟角較小(P = 0.008)且左側跟骨第五蹠骨角較大(P = 0.011)。中足量表與踝-後足量表高度顯著相關(rho = 0.904, P < 0.001)。身體質量指數與左跟骨第五蹠骨角低度顯著相關(rho = -0.18, P = 0.025)。中足量表與跟骨第五蹠骨角、距骨蹠骨角及足跟角無顯著相關。後足量表與左側跟骨第五蹠骨角(rho = 0.211, P = 0.007)、右側距骨蹠骨角(rho = 0.157, P = 0.049)及左側足跟角(rho = -0.191, P = 0.016)這三者度低度顯著相關。 結論: 可知在年輕男性成人扁平足無症狀者佔多數。扁平足其症狀與放射線學上變形的程度並非高度相關。

並列摘要


Background and purpose: In Taiwan, there were no systemic studies on or standardized methods of quantifying the symptoms of adult pes planus. The Physical Classification Criteria of the Ministry of Interior demands the conscripts with pes planus to take the weight-bearing true lateral radiographs of their feet. With this opportunity, we estimated the prevalence of symptoms among the conscripts with pes planus and studied the relationship between the symptoms of pes planus and the corresponding deformities on radiographs. Methods: From January 2003 to December 31 2005, all the consecutive conscripts underwent the physical checkup for their foot problems at a hospital were included. A total of 525 conscripts took the weight-bearing true lateral radiographs of their feet. The radiographs were retrieved from the picture archiving and communication systems workstation, and the talometatarsal angles, calcaneal-5th metatarsal angles, and calcaneal pitches were measured. The gold standard of being pes planus is the talometatarsal angle less than -4 degrees on the lateral radiograph. We telephone-interviewed these conscripts about their symptoms of pes planus. The subjective components of the American Orthopaedic Foot and Ankle Society midfoot and ankle-hindfoot score, body height, and bodyweight were recorded. Results: We successfully telephone interviewed 172 conscripts out of 525. Four conscripts refused to disclose their body height and bodyweight. We completed 168 questionnaires, and the response rate was 32%. After excluding 14 conscripts without pes planus, we obtained eligible 158 conscripts for further analysis. The average age, bodyweight, body height, and body mass index were 23.32±2.04 years, 72.22±9.62 kg, 173.21±5.22 cm, and 24.04±2.68 kg/m2, respectively. Eighty-two conscripts scored perfect scores of the subjective components of the American Orthopaedic Foot and Ankle Society midfoot and ankle-hindfoot scores (51.9%, 95% confidence interval 44.2% to 59.6% ). Seventy-six conscripts did not score perfect scores of the subjective components of the American Orthopaedic Foot and Ankle Society midfoot and ankle-hindfoot socres, and the prevalence of symptomatic pes planus was 48.1% (95% confidence interval 40.4% to 55.8%). When dichotomizing conscripts with or without perfect scores on the subjective components of American Orthopaedic Foot and Ankle Society midfoot scores for comparison, we found no statistically significant differences among talometatarsal angles, calcaneal-5th metatarsal angles, and calcaneal pitches. When dichotomizing conscripts with or without perfect scores on the subjective components of American Orthopaedic Foot and Ankle Society ankle-hindfoot scores for comparison, we found statistically significant differences among left calcaneal-5th metatarsal angles and left calcaneal pitches. The conscripts scored perfect scores on the subjective components of American Orthopaedic Foot and Ankle Society ankle-hindfoot scores had significantly smaller left calcaneal pitches (P = 0.008) and greater left calcaneal-5th metatarsal angles (P = 0.011). The midfoot scores were highly correlated to the ankle-hindfoot scores (rho = 0.904, P < 0.001). The body mass indexes were marginally correlated with the left calcaneal-5th metatarsal angles (rho = -0.18, P = 0.025). There were no correlations among body mass indices, subjective components of the American Orthopaedic Foot and Ankle Society midfoot scores, clacaneal-5th metatarsal angles, talometatarsal angles, and calcaneal pitches. The subjective components of the American Orthopaedic Foot and Ankle Society ankle-hindfoot scores were marginally correlated with the left calcaneal-5th metatarsal angles (rho = 0.211, P = 0.007), right talometatarsal angles (rho = 0.175, P = 0.049), and left calcaneal pitches (rho = -0.191, P = 0.016). Conclusion: Not all young adults with pes planus had significant symptoms. The symptomatic pes planus was not highly correlated with the deformities measurements on the lateral radiograph.

參考文獻


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被引用紀錄


Hsi, Y. F. (2013). 以影像辨識與分析為基礎之扁平足自動分類方法 [master's thesis, National Formosa University]. Airiti Library. https://www.airitilibrary.com/Article/Detail?DocID=U0028-2108201305403100

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