黄江发医生的科普号

为什么宝宝生下来就没有足弓？为什么有的宝宝看起来脚后跟是歪的?为什么有的宝宝长大后会发育出足弓，有的宝宝却迟迟不能？宝宝是不是扁平足？是扁平足我该怎么办？这些问题是很多宝宝家长心里面的焦急的疑问，下面由广东省中医院足踝外科黄江发医生为你一一解答。1.问：足弓是怎样形成的？黄医生：足弓的形成是儿童生长发育过程中，足底骨与韧带的生长速度不均衡造成的。要知道，手和足是四肢骨中生长速度最快的部位，韧带生长速度跟不上骨，所以骨与韧带在原有附着点不变的情况下，随着骨的生长加快，失去纵向生长的空间，不得不通过骨的位置改变而形成向上生长的空间，逐渐形成足弓。 2.问：儿童扁平足很常见吗？黄医生：研究发现两岁以内婴幼儿扁平足发生率100%，3-4岁出现足弓，直到青春发育前期（男性16岁，女性13岁），足弓发育趋于完成，12岁儿童扁平足发生率为12.3%。但近20年来扁平足发现率有了明显的变化，同年龄段（12岁）发现率增加近1倍，70年代儿童参加家务劳动，娱乐已户外活动为主，可促进使部肌肉发达，增强韧带牢固性，促进骨骼生长，有利于足弓的形成和维持。但90年代以来，生活条件改善，儿童参与家务减少，娱乐以静态活动为主，足部肌肉，韧带缺少充分锻炼，此外，青少年中肥胖人群的增长，长时间穿旅游鞋等也是扁平足上升的原因。3.问：怎样判断是不是扁平足？黄医生：人的足弓分三个基本类型：正常足，扁平足，高弓足。有一个简单的方法可以测试自己足弓的类型：脚底沾水，踩在地上，检查脚印，如果看到脚印的绝大部分，这有可能就是足弓低平或者扁平足；如果只能看到一半左右，则有可能是高弓足。如果怀疑是扁平足，及早找骨科足踝专科的医生确诊。4.问：扁平足有什么危害？黄医生：扁平足的危害大！足部在人体行走，站立中发挥着重要的作用，扁平足的危害远远不止足底疼痛那么简单。扁平足改变了人的行走姿态，鞋跟外侧和足底内侧容易磨损，足跟也容易受伤，在长期站立，行走及跑跳时，由于没有良好的支撑，足弓消失后起不到缓冲的作用，其速度，耐力，爆发力都不如正常足，足、腿、腰、膝、颈等容易疲劳和疼痛。外力对脊柱、大脑及内脏器官的冲击同样得不到缓冲而受到伤害。重度的平足会引起其他部位的并发症，例如距下关节等足部关节的退行性变以及关节炎，跖骨疲劳性骨折等情况，从而出现足部明显的疼痛，在晚期可能会进一步影响骨盆，使大腿及骨盆架倾斜、旋转，使骨盆或尾椎骨下移，形成脊柱侧弯和斜肩。5.小孩得了扁平足怎么办？黄医生：小孩的扁平足跟成人的处理不一样。一般来说，小孩出生的时候大多都是扁平足。到四五岁以后，足弓逐渐开始发育，如果到学龄时期还是扁平足的话，那可能就要注意了，这时候有可能需要进行保守治疗干预，具体的方法包括：手法治疗，功能锻炼，或者支具和鞋垫的矫正。早期使用定制的鞋垫进行纠正，如果孩子走路疼痛比较明显，或者走时间比较长的时候会容易疲劳酸痛，那就要及时早足踝外科的医生就诊，医生会观察孩子的脚后跟歪的程度，如果歪得厉害，那么可能需要小的手术干预，也就是微创手术。微创手术简单来说就是在足部放一枚螺钉，把歪的足跟矫正，矫正后足弓才能在逐渐长正。术后切口大约是一公分左右，就会可以纠正孩子的扁平足，缓解症状，纠正畸形。目前疗效还是比较满意的。 但是治疗要及时，一般过了十四五岁以后的可能就不适合这种微创的手术，可能需要一些相对大点的手术，比如说截骨的手术，所以还是建议早期的进行诊断和治疗，找专科的足外科医生进行诊断，防止延误治疗，加重畸形。广东省中医院足踝专科黄江发医生出诊时间：周三全天（上午二沙岛骨科足踝门诊，下午大德路骨科足踝门诊）

膝关节力线外移术治疗膝骨关节炎 ——人工膝关节置换以外的另一种选择膝关节专科历来是二沙骨科的强项，许树柴主任等运用人工全膝关节置换术、单髁关节置换术、关节镜软骨修复术等治疗膝关节骨关节炎，已经处于国际国内先进水平，但我科仍孜孜不倦，精益求精，运用国际先进的矫形的理念开展膝关节力线外移手术，可同样达到关节置换的效果，避免过早进行膝关节置换手术，成为较为年轻患者以及畏惧人工关节置换患者的另一种选择。总结：严重膝骨关节炎患者行膝关节置换术是目前大多数医生的选择，但是膝关节假体像所有机器零件一样，有一定的使用年限，一般10-15年可能要面临第二次手术，如果对年纪比较轻的患者甚至可能还需要行第三次、第四次手术，不仅增加患者的创伤，而且一次手术比一次手术困难，手术失败的风险增高。另外有一部分患者出于畏惧心理，不能接受膝关节置换手术，这种情况下膝关节力线外移术治疗就是另一种选择。大部分膝关节骨关节炎患者膝关节疼痛主要应为膝关节内侧磨损严重，出现膝关节内翻畸形，即俗称的“O型腿”，在这种情况下人体的负重力线向内侧偏移，行走时的负重力量主要就集中在膝关节内侧，所以让原来磨损严重的内侧膝关节更加雪上加霜，形成恶性循环，越磨损越内翻、越内翻力线越往内，所以“O型腿”越来越严重，膝关节行走也越来越疼痛，病情逐渐加重。膝关节力线外移手术的原理是通过调整下肢力线，让膝关节负重力线移向没有磨损的外侧，让磨损的内侧减少负重，打破原来的恶性循环，让原来的疼痛得到大部分缓解，一般手术以后负重疼痛的症状就能缓解。同时做这个手术也不影响日后可能需要做的膝关节置换手术，对于年轻的患者这个手术至少可以延缓需要膝关节置换手术时限，甚至有些病人日后无需在做膝关节置换手术。手术优点：1. 创伤小，开刀伤口约1-2cm；2. 康复后体内无金属异物残留；3. 可以延缓需要膝关节置换手术时限，减少年轻患者更换假体的次数；4. 手术不影响日后可能需要做的膝关节置换手术。手术适应症：1. 年龄较轻，50-65岁的患者；2. 经过检查膝关节外侧磨损不严重者；3. 畏惧膝关节置换手术者； 4.不能耐受膝关节置换创伤者。 具体情况参阅下方PDF文件。

Bowed Legs（弓状腿） Bowed legs in a toddler is very common. When a child with bowed legs stands with his or her feet together, there is a distinct space between the lower legs and knees. This may be a result of either one, or both, of the legs curving outward. Walking often exaggerates this bowed appearance.Adolescents occasionally have bowed legs. In many of these cases, the child is significantly overweight. 弓状腿在蹒跚学步的儿童中很常见。当弓状腿的儿童双脚并拢站立时，两小腿和两膝关节之间会有明显的距离，这可能是由于一条腿或者两条腿向外旋转造成的。走路时会使这种弯曲畸形更加明显。青少年偶尔会有弧形腿，这种情况的孩子通常是明显超重的。 Cause（病因） Physiologic Genu Varum（生理性膝内翻） In most children under 2 years old, bowing of the legs is simply a normal variation in leg appearance. Doctors refer to this type of bowing as physiologic genu varum. 大多数2岁以下的儿童孩子，双腿弓状弯曲仅仅是腿部外观的正常变化。医生把这种类型的弯曲定义为生理性膝内翻。 In children with physiologic genu varum, the bowing begins to slowly improve at approximately 18 months of age and continues as the child grows. By ages 3 to 4, the bowing has corrected and the legs typically have a normal appearance. 生理性膝内翻的儿童，腿的弯曲在大约18个月龄开始慢慢好转，随着年龄的增长逐渐改善。到3-4岁时，腿的弯曲已能纠正，也具有了正常的外观。 Blount's Disease（布朗特氏病） Left:Toddler with infantile Blount's disease involving the left leg. Right: X-ray of the left knee shows the Blount's abnormality along the top of the shinbone. 左图：患有婴儿型布朗特氏病的幼儿被累及左腿。右图：左膝X线显示胫骨近端的异常。 Blount's disease is a condition that can occur in toddlers, as well as in adolescents. It results from an abnormality of the growth plate in the upper part of the shinbone (tibia). Growth plates are located at the ends of a child's long bones. They help determine the length and shape of the adult bone. 布朗特氏病可发病于婴幼儿和青少年。这种疾病将导致胫骨近端的骨骺发育异常。骨骺位于儿童长骨的两端，它们有助于决定成年骨的长度和形状。 In a child under the age of 2 years, it may be impossible to distinguish infantile Blount's disease from physiologic genu varum. By the age of 3 years, however, the bowing will worsen and an obvious problem can often be seen in an x-ray. 2岁以下的幼儿，可能无法区分究竟是婴儿型布朗特氏病还是生理性膝内翻。然而，到3岁时，患有布朗特氏病的儿童腿的弯曲更加严重，X线片也通常能发现明显的问题。 Rickets(佝偻病) Rickets is a bone disease in children that causes bowed legs and other bone deformities. Children with rickets do not get enough calcium, phosphorus, or Vitamin D — all of which are important for healthy growing bones. 佝偻病是一种儿童骨病，会导致弓状腿和其他骨骼畸形。患有佝偻病的儿童通常缺钙、磷或者维生素D，而这些都是骨骼健康生长的重要元素。 Nutritional rickets is unusual in developed countries because many foods, including milk products, are fortified with Vitamin D. Rickets can also be caused by a genetic abnormality that does not allow Vitamin D to be absorbed correctly. This form of rickets may be inherited. 营养性佝偻病在发达国家很少见，因为许多食品（包括乳制品）都富含维生素D。佝偻病还可以因基因异常导致不能吸收维生素D造成，这种类型的佝偻病可能是遗传的。 Top of page Symptoms（症状） Bowed legs are most evident when a child stands and walks. The most common symptom of bowed legs is an awkward walking pattern. 弓状腿在儿童站立和行走时最明显。最常见的症状就是一种“笨拙”的走路方式。 Toddlers with bowed legs usually have normal coordination, and are not delayed in learning how to walk. The amount of bowing can be significant, however, and can be quite alarming to parents and family members. 患有弓状腿的幼儿通常有正常的协调性，也不会因此推迟学步。然而，腿的弯曲量会变得很明显，足以惊醒父母和家庭成员。 Turning in of the feet (intoeing) is also common in toddlers and frequently occurs in combination with bowed legs. 患有弓状腿的幼儿通常也会发生拇内翻。 Bowed legs do not typically cause any pain. During adolescence, however, persistent bowing can lead to discomfort in the hips, knees, and/or ankles because of the abnormal stress that the curved legs have on these joints. In addition, parents are often concerned that the child trips too frequently, particularly if intoeing is also present. 弓状腿通常不会造成任何疼痛。然而到了青春期，随着腿长期弯曲形成的异常异常应力会导致髋关节、膝关节或者踝关节的不适。此外，父母通常会误以为孩子的不适是由于旅行过于频繁引起，尤其是如果孩子有拇内翻的话。 Top of page Tests Your doctor will begin your child's evaluation with a thorough physical examination. 医生会对您的孩子做全面的体格检查从而进行评估。 If your child is under age 2, in good health, and has symmetrical bowing (the same amount of bowing in both legs), then your doctor will most likely tell you that no further tests are currently needed. 如果您的孩子是2岁以下，身体健康并且双腿具有对称的弓状弯曲（双腿弯曲量相同），那么您的医生很可能会告诉您目前不需要进一步测试。 However, if your doctor notes that one leg is more severely bowed than the other, he or she may recommend an x-ray of the lower legs. An x-ray of your child's legs in the standing position can show Blount's disease or rickets. 但是，如果您的医生认为您孩子的一条腿比另一条腿弯曲得更严重，他会建议对小腿进行X线检查。小腿站立位X线能显示布朗特氏病或佝偻病。 If your child is older than 2 1/2 at the first doctor's visit and has symmetrical bowing, your doctor will most likely recommend an x-ray. The likelihood of your child having infantile Blount's disease or rickets is greater at this age. If the x-ray shows signs of rickets, your doctor will order blood tests to confirm the presence of this disorder. 如果您的孩子初次就诊时大于两岁半并且双腿对称弯曲，您的医生也将建议进行X线检查，因为在这个年龄段小孩患布朗特氏病或佝偻病的可能性更大。如果X线显示佝偻病的征象，会进行验血以确诊。Natural Progession of Disease（疾病自然进展） Physiologic genu varum nearly always spontaneously corrects itself as the child grows. This correction usually occurs by the age of 3 to 4 years. 生理性膝内翻会随着儿童年龄的增长自然纠正。纠正过程通常发生在3-4岁时。 An adolescent with Blount's disease.（一名患有布朗特氏病的少年） Untreated infantile Blount's disease or untreated rickets results in progressive worsening of the bowing in later childhood and adolescence. Ultimately, these children have leg discomfort (especially the knees) due to the abnormal stresses that occur on the joints. Adolescents with Blount's disease are most likely to experience pain with the bowing. 未经治疗的婴儿型布朗特氏病或佝偻病将导致孩子的腿在童年后期和青春期弯曲得更加严重。最终，这些孩子由于关节的异常应力会造成腿部的不适（尤其是膝关节）。患有布朗特氏病的青少年最有可能经历腿的弯曲带来的痛哭。 Nonsurgical Treatment（保守治疗） Physiologic genu varum. Although physiologic genu varum does not require active treatment, your doctor will want to see your child every 6 months until the bowing has resolved. 生理性膝内翻：虽然生理性膝内翻不需要积极治疗，但您的医生仍希望每6个月见一次您的孩子，直到腿的弯曲已经消失。 Blount's disease. Infantile Blount's disease does require treatment for the bowing to improve. If the disease is caught early, treatment with a brace may be all that is needed. Bracing is not effective, however, for adolescents with Blount's disease. 布朗特氏病：婴儿型布朗特氏病需要治疗来改善腿部的弯曲。如果早期发现这种疾病，可能仅需要支具治疗就足够了。但对于患有布朗特氏病的青少年，支具治疗是无效的。 Rickets. If your child has rickets, your doctor will refer you to a metabolic specialist for medical management, in addition to regular orthopaedicfollowup. The effects of rickets can often be controlled with medication. 佝偻病：如果您的孩子患有佝偻病，除了常规的骨科随访，医生还会为您推荐代谢专家为您的孩子进行诊疗。佝偻病的影响通常是可以通过药物控制的。 Surgical Treatment（手术治疗） Physiologic genu varum. In rare instances, physiologic genu varum in the toddler will not completely resolve and during adolescence, the bowing may cause the child and family to have cosmetic concerns. If the deformity is severe enough, then surgery to correct the remaining bowing may be needed. 生理性膝内翻：在极少数的情况下，幼儿的生理性膝内翻直到青春期也没有彻底纠正，弓状腿会使孩子和家人关注美观问题。如果畸形足够严重，那么就需要手术纠正多余的弯曲。 Blount's disease. If bowing continues to progress in a child with infantile Blount's disease despite the use of a brace, surgery will be needed by the age of 4 years. Surgery may stop further worsening and prevent permanent damage to the growth area of the shinbone. 布朗特氏病：如果使用了支具纠正仍不能阻止婴儿型布朗特氏病的继续进展，那么到了4岁时就可以采取手术治疗。手术会阻止病情的进一步恶化并防止胫骨生长区受到持续的损害。 Older children with bowed legs due to adolescent Blount's disease require surgery to correct the problem. 因患青少年型布朗特氏病造成弓状腿的孩子也需要手术来解决问题。 Rickets. Surgery may also be needed for children with rickets whose deformities persist despite proper management with medications. 佝偻病：用药物治疗但畸形仍存在的佝偻病患儿同样需要手术治疗。