【目的】 评估理筋正骨手法结合距下关节制动术治疗青少年柔韧性平足的临床疗效。【方法】 回顾性分析广州中医药大 学东莞医院（东莞市中医院）2022年12月至2024年2月收治的86例柔韧性平足患儿的临床资料，根据治疗前医患沟通结果， 将患儿分为试验组 44例和对照组 42例。对照组给予单纯距下关节制动术治疗，试验组在对照组的基础上，于术前 1 d及术 后每周行1次理筋正骨手法治疗，疗程为1个月，并进行不少于6个月的随访。观察2组患儿手术前后的疼痛视觉模拟量表 （VAS）评分、踝与后足功能美国矫形足踝协会（AOFAS）评分、运动功能Tenger评分、影像学指标以及静态足底压力参数的变 化情况。【结果】（1）临床资料方面，2组患儿手术均顺利完成，患儿的手术时长、住院时长、并发症发生情况等围术期一般 资料比较，差异均无统计学意义（P＞0.05）。所有患儿均获得不少于6个月的随访。结果显示：末次随访时，2组患儿的疼痛 VAS评分、踝与后足功能AOFAS评分、运动功能Tegner评分均较术前明显改善（P＜0.05），且试验组的改善程度均明显优于 对照组（P＜0.05或 P＜0.01）。（2）影像学指标方面，末次随访时，2组患儿负重正位 X片上的距舟覆盖角（TNCA 角）、距骨- 第一跖骨角（T1MT角）、距骨-第二跖骨角（T2MT角）及负重侧位X片上的距骨-第一跖骨角（Meary角）、跟骨倾斜角（Pitch角） 均较术前明显改善（P＜0.05），且试验组对 Meary角、T1MT角、T2MT角的改善程度均明显优于对照组（P＜0.01）；而 2组末 次随访时的TNCA角、Pitch角比较，差异均无统计学意义（P＞0.05）。（3）足底压力测试方面，术后1个月随访时，2组患儿的 前足负荷均较术前提升（P＜0.05），中足负荷均较术前降低（P＜0.05），且试验组术后1个月随访时的前足负荷提升程度和中 足负荷降低程度均明显优于对照组（P＜0.05或 P＜0.01）；而 2组患儿术后 1个月随访时的后足负荷与术前比较及组间比较， 差异均无统计学意义（P＞0.05）。【结论】 针对青少年柔韧性平足，理筋正骨手法结合距下关节制动术能有效恢复足弓，改善 足部力学失衡，从而纠正平足畸形，改善关节运动功能。

Objective To evaluate the clinical efficacy of tendon-regulating and bone-setting manipulation combined with subtalar joint arthroereisis in the treatment of adolescent flexible flatfoot. Methods A retrospective analysis was conducted on the clinical data of 86 children with flexible flatfoot treated at Dongguan Hospital of Guangzhou University of Chinese Medicine （Dongguan Traditional Chinese Medicine Hospital） between December 2022 and February 2024. Based on pre-treatment physician-patient communication， the children were divided into an trial group （44 cases） and a control group （42 cases）. The control group received subtalar joint arthroereisis alone，while the trial group received additional tendon-regulating and bone-setting manipulation just once one day before surgery and once weekly postoperatively for one month，with a follow-up period of no less than 6 months. The Visual Analogue Scale （VAS） pain score， American Orthopaedic Foot & Ankle Society （AOFAS） anklehindfoot score，Tegner activity score，radiographic parameters，and static plantar pressure parameters of the two groups were observed before and after surgery. Results（1） Regarding clinical data，all surgeries were successfully completed in both groups. There were no statistically significant differences in perioperative general data， including operative time，hospital stays，and complication rates （P＞0.05）. All children were followed up for no less than 6 months. The results showed that at the final follow-up，the VAS pain score，AOFAS ankle-hindfoot score，and Tegner activity score were significantly improved in both groups compared to preoperative values （P＜ 0.05），and the improvement in the trial group was significantly greater than that in the control group （P＜0.05 or P＜0.01）.（2） Regarding radiographic parameters， at the final follow-up， the talonavicular coverage angle （TNCA）， talus-first metatarsal angle （T1MT）， talus-second metatarsal angle （T2MT） on weight-bearing anteroposterior radiographs，and the Meary angle between the talus and the first metatarsal as well as calcaneal Pitch angle （Pitch angle） on weight-bearing lateral radiographs were significantly improved in both groups compared to preoperative values （P＜0.05）. The improvement in Meary angle，T1MT angle，and T2MT angle in the trial group was significantly greater than that in the control group （P＜0.01）. However， there were no statistically significant differences in TNCA and Pitch angle between the two groups at the final follow-up （P＞ 0.05）. （3） Regarding plantar pressure testing， at the 1-month postoperative follow-up， the forefoot load increased significantly in both groups compared to preoperative values （P＜0.05）， while the midfoot load significantly decreased （P＜0.05）. The increase in forefoot load and decrease in midfoot load in the trial group were significantly greater than those in the control group （P＜0.05 or P＜0.01）. However，there were no statistically significant differences in hindfoot load between preoperative and postoperative values or between the two groups at the 1-month follow-up （P＞0.05）. Conclusion For adolescent flexible flatfoot， tendon-regulating and bonesetting manipulation combined with subtalar joint arthroereisis can effectively restore the arch， improve foot mechanical imbalance，thereby correcting flatfoot deformity and enhancing joint motor function.

R274.9

广东省中医药局科研项目（编号：20241341）；广东省医学科研基金资助项目（编号：A2023480）；东莞市社会发展科技项目（编号： 20231800900211）