跟骨骨折后距下后关节面应力改变的实验研究  

Experimental Study of Stress from Posterior Articular Facet of Subtalar Joint after Calcaneus Fracture

作　　者：王振虎[1] 彭阿钦[2] 宋朝晖[2] 孙辉生[1] 刘大朋[1] 

机构地区：[1]解放军第252医院骨科,河北省保定市071000 [2]河北医科大学第三医院骨科

出　　处：《中国骨与关节损伤杂志》2008年第7期555-557,共3页Chinese Journal of Bone and Joint Injury

基　　金：河北省科技攻关计划资助项目(062761331)

摘　　要：目的研究载荷条件下跟骨后关节面骨折后,所受应力的改变对距下关节的影响,为临床治疗提供理论依据。方法取6具包括完整足和胫腓骨远端15～20cm的新鲜标本。剔除皮肤、肌肉和跟腱,保留除外距下关节后方的关节囊部分,保持韧带和关节囊的完整。将压敏片插入距下关节的后关节间隙,中立位状态下分别在500N载荷下,对6具标本的距下关节进行加载,完成完整足的测试。然后模拟原始骨折线用微型摆动锯将跟骨后关节面分为前内和后外2块,接着按解剖复位、后外侧骨折块向跖侧移位2、5、10mm等条件重复上述实验,记录距下后关节面所受应力的改变。结果完整的距下后关节面承载的平均应力为(1.83±0.56)MPa。跟骨后外侧骨折块向跖侧移位2mm时,后关节面所承载的应力为(2.41±0.84)MPa,较完整跟骨承载应力显著增加(P<0.01)。结论跟骨距下关节后关节面骨折跖侧移位≥2mm即应手术复位。Objective To observe the changes of stress from posterior articular facet of the subtalar joint after calcaneus fracture in the one load condition for providing a theoretical basis for its clinical treatment. Methods Six fresh specimens consisting of feet and lower legs were harvested. A specimen included an intact foot and 15-20 cm of the distal tibia and fibula, and was prepared by removing the skin, muscle and tendons down to the level of the hindfoot, the ligaments and joint capsules were kept intact with the exception of the posterior aspect of the posterior facet of the talocalcaneal joint. The pressure sensitive film was inserted into the posterior facets of the talocalcaneal articulation, and 500 - N load was applied on the six specimensin the neutral position. After testing of the intact foot, the calcaneus was splited into anterointernal and posterolateral components using microosciUating saw and the primary fracture line of calcaneus was simulated. The test was repeated after the posterolateral fragment was anatomically reduced and displaced 2 mm, 5 mm and 10mm respectively in a planter direction. The changes of stress from posterior articular facet of the subtalar joint were recorded. Results The average stress of the intact posterior facet to bear the weight was （ 1.83 ± 0.56） MPa. When the posterolateral component was displaced to plantar in 2 mm, the stress was （2.41 ± 0.84） MPa, and it was significantly increased （P 〈 0.01） compared with that of the intact calcaneus. Conclusion A calcaneus fracture with 2 mm of fracture component displacement in the posterior facet of subtalar joint should be reduced by surgery.

关 键 词：跟骨骨折 距下关节 后关节面 应力改变 

分 类 号：R683.420.4[医药卫生—骨科学] R687.31[医药卫生—外科学]