第一跖骨头下籽骨切除术对前足第一序列功能的生物力学影响  

Biomechanical effect of the sesamoid resection below the head of the first metatarsal on the function of the first ray in forefoot

作　　者：朱越峰[1] 顾湘杰 李连生[1] 王旭 马昕 

机构地区：[1]华东医院骨科,上海200040 [2]华山医院

出　　处：《中国矫形外科杂志》2005年第1期40-42,共3页Orthopedic Journal of China

摘　　要：　　目的: 研究第一跖骨头下胫腓侧籽骨对前足第一序列功能的生物力学影响, 以探讨籽骨病变手术方式选择。方法: 取 12具人体膝关节以下新鲜正常下肢尸体标本, 建立第一序列正常状态生物力学模型。分别在不同状态下, 改变长屈肌和长伸肌的力量, 使跖趾关节平衡于多个角度, 记录长屈、伸肌腱的力量; 通过生物力学公式得出不同角度、不同籽骨状态下长屈伸肌腱的力矩臂比值。结果:(1) 足胫 /腓侧籽骨远侧半切除对长屈肌腱瞬间力矩臂影响与籽骨完整状态相比, 经过统计学检验差别无显著性意义 (p>0. 05); (2) 足胫 /腓侧籽骨全切除对屈肌腱瞬间力矩臂影响与籽骨完整状态相比, 经过统计学检验差别有显著性意义 (p<0. 05); (3) 足部胫腓侧籽骨全切除对长屈肌腱瞬间力矩臂的影响与籽骨完整状态相比, 经过统计学检验差别有显著性意义 (p<0. 05)。结论 : (1) 因第一跖骨头下胫腓侧籽骨远侧半切除对趾屈曲力影响很小, 临床中对于籽骨横行骨折及多分籽骨伴籽骨炎患者可行籽骨半切除术; (2) 胫 /腓侧籽骨单侧全切除和胫腓双侧籽骨全切除术对趾屈曲力量有明显影响, 所以手术切除单侧籽骨应慎重, 应尽量避免切除双侧籽骨。Objective:To investigate the biomechanical effect of the tibial and fibular sesamoids below the head of the first metatarsal on the first ray function of the forefoot and discuss the choice of sesamoid bone disease surgery.Method: Twelve fresh low limbs of frozen cadavers were obtained for the study.Established the first ray normal biomechanical model.A ramp controlled weight supplied a functional load force to the flexor hallucis longus.As a balance was reached between the flexors and extensors,the great toe was requested at the different angle of flexion.Force data were obtained at 6 progressively sesamoid state.Result: (1) When distal hemiresection of the tibial or fibular sesamoid,the effective tendon moment arm of the flexor hallucis longus was only descended 6～9% compared with that of intact state.There was no significant statistical difference( P >0.05);(2)When resection of the entire tibial or fibular sesamoid,the effective tendon moment arm of the flexor hallucis longus was descended 18～35% compared with that of intact state.There was significant statistical difference( P <0.05);(3)When resection of both the medial and lateral sesamoid,the effective tendon moment arm of the flexor hallucis longus was descended over 22% compared with that of intact state.There was significant statistical difference( P <0.05).Conclusion:(1)No significant change in effective flexor hallucis longus tendon moment arm is observed with hemiresection of either the medial or lateral sesamoid,hemiresection of either the medial or lateral sesamoid can be used in sesamoid fracture and multipartite sesamoids with sesamoiditis.(2) Significant decreases in the effective tendon moment arms occur with full medial sesamoid resection,full lateral sesamoid resection,and both of the medial and lateral sesamoids resection.Total excision of either the medial or lateral sesamoid should be cautious.Total excision of both the medial and lateral sesamoids must be avoided.

关 键 词：籽骨 拇长屈肌腱 第一跖趾关节 生物力学 

分 类 号：R687[医药卫生—骨科学]