學齡前兒童扁平足相關因素與足印評估方法之探討

研究目的：本研究的主要目的在(1)完整探討年齡、性別、體重、關節鬆弛度，與跪坐習慣等因素對學齡前兒童扁平足的影響；(2)驗證足印分析方法是否適用於判斷學齡前兒童的扁平足狀況，並找出其適用的標準；(3)探討扁平足症狀隨著年紀增加後所產生的變化。研究方法及資料：本研究收集了台灣台中地區幼兒園所共1598位學齡前兒童（833位男生及765位女生）。首先將受測者依臨床症狀判斷分成三組，正常組（733人）、單腳扁平組（266人）及雙腳扁平組（599人），以多項式羅吉斯迴歸模型來做分析，以瞭解這些相關因素對學齡前兒童扁平足的影響。將臨床判斷結果與3種足印判斷方法，足弓角度、足弓指數及CSI指數的足印判斷結果以接受者操作特徵曲線作分析比較，為了表達足印判斷方法在臨床診斷試驗的有用程度，再計算其概似比與事前及事後機率，並做成列線圖來表示。追蹤其足印變化以探討扁平足症狀隨著年紀增加後所產生的變化。研究結果：結果顯示(1)年紀越小、男生、體重肥胖、有關節過度鬆弛及跪坐習慣的學齡前兒童容易增加雙腳扁平的風險。(2)證實了足印分析方法適用於評估學齡前兒童的扁平足狀況，以CSI指數所呈現的結果較佳，有高達90％以上的預測準確性，在學齡前兒童扁平足的判斷上，CA<14.04°, CSI的比值>62.70%, AI的比值>107.42%可認定為具有扁平足症狀。(3)在學齡前階段的兒童，其扁平足的盛行率確實會隨著年紀增加而減少，平均年紀增加一歲則有扁平足症狀的比例約會減少14%。結論與建議：學齡前兒童扁平足症狀確實會隨著年紀增加而恢復正常，但有部分的學齡前兒童會隨著年紀增加而出現。最適合用來判斷學齡前兒童扁平足的足印方法為CSI指數，適用於判斷學齡前兒童的扁平足狀況。單腳扁平的學齡前兒童建議可先行觀察其變化再做介入處理。以上研究結果希望能提供給臨床工作者作為判斷學齡前兒童扁平足時的參考。

關鍵字

扁平足；學齡前兒童；足印

並列摘要

Objective: The aims of this study were to (1) discuss the relevant factors of flatfoot including age, gender, obesity status, joint laxity, and the W-sitting habit with preschool-aged children; (2) analyze the footprint measurements and grades of flatfoot in a population of preschool children; and (3) follow up the changes of footprints for discussed the improvement of flatfoot in preschool-aged children. Materials and methods: A total of 1,598 children (833 boys and 765 girls) between 3 and 6 years of age from kindergartens in the central area of Taiwan were studied. At first, the children were divided into a normal group (n=733), a unilateral flatfoot group (n=266), and a bilateral flatfoot group (n=599), and a multinomial logistic regression model was used to analyze the data. Three footprint measurements, the Clarke's angle (CA), Chippaux-Smirak index (CSI), and Staheli arch index (AI), were used for comparison with clinical diagnosis and displayed in a receiver operating characteristic (ROC) curve. In order to illustrate the diagnostic accuracy in clinical settings, their likelihood ratios were calculated given their cutoff points, and their pretest/posttest probabilities were plotted as the Fagan nomogram. To follow up the changes of footprints for discussed the improvement of flatfoot in preschool-aged children. Results: Our study demonstrates that (1) preschool-aged children with bilateral flat feet were influenced by age, gender, obesity status, joint laxity, and W-sitting; (2) footprint analysis methods are suitable for diagnosing flatfoot in preschool-aged children, and the CSI had a predictive probability of more than 90% and the most appropriate cutoffs are as follows: CA≤14.04°, CSI>62.70% and AI>107.42%; and (3) the incidence of flatfoot is reduced with age in preschool aged children and the proportion was reduced about 14% with increased one year age. Conclusion: Flatfoot in preschool-aged children will resolve with increasing age but some children will represent. The CSI had an especially outstanding performance, and is recommended as the screening tool of choice for flatfoot in preschool-aged children. Children with unilateral flatfoot should be followed and observed before making a diagnosis of flatfoot and initiating treatments. Our findings should provide reference information for researchers and clinical staffs in diagnosing flatfoot in preschool-aged children.

並列關鍵字

flat foot ； preschool-aged children ； footprint

參考文獻

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學齡前兒童扁平足相關因素與足印評估方法之探討

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