跟骨三维形态学参数与踝后足功能的关系  

Relationship between ankle-hind foot function and calcaneal three-dimensional morphological parameters

作　　者：许灿[1] 李明清[1] 李康华[1] 刘华[1] 

机构地区：[1]中南大学湘雅医院骨科,湖南省长沙市410008

出　　处：《中国组织工程研究》2016年第46期6899-6906,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年基金项目(81301543)~~

摘　　要：背景:跟骨整体形态与后距下关节面解剖对位都是跟骨关节内骨折手术治疗的重要预后因素,但当前仍缺少系统的生物力学实验证实跟骨三维形态学参数对于踝-后足功能的重要性。目的:综合利用实体实验与数值分析方法,明确跟骨三维形态学参数与踝后足功能的相关性。方法:首先使用人体踝足尸体标本构建跟骨高度、宽度和长度异常模型,通过生物力学加载支架对各组模型进行加载,分析跟骨高度丢失、宽度增加和长度短缩模型的动力学数据。进而构建正常人体踝后足有限元模型,在其基础上建立跟骨高度丢失、宽度增加和长度短缩数值模型,计算后距下关节面的接触特征。结果与结论:(1)跟骨宽度增加和长度短缩会部分限制踝后足的活动度,跟骨高度丢失则会引起距下关节活动度增加;(2)跟骨宽度增加会增加距下关节的接触面积,高度丢失会减少距下关节的接触面积,并使关节应力中心向关节面前下方移动;(3)跟骨三维形态学参数的改变会导致踝后足生物力学异常,因此跟骨骨折修复治疗中应当细致恢复跟骨的整体形态。BACKGROUND： Both the overall appearance of the calcaneus and anatomical reduction of posterior subtalar joint are important prognostic factors of calcaneal intra-articular fracture repair. However, there is a lack of biomechanical data supporting the clinical importance of calcaneus height, length and heel width for the ankle-hind foot function. OBJECTIVE： To determine the correlation of the three-dimensional morphological parameters with the ankle-hind foot biomechanics as determined by the entity experiment and numerical analysis. METHODS： Models of abnormal calcaneus height, length and width were constructed in the human cadaveric feet and underwent a biomechanical load. The kinematics of the ankle-hind foot were compared between normal and simulated calcaneal fractures with reductions in calcaneal height and length as well as increases in calcaneal width. In finite element analysis, static loading was simulated at an axial load with the subtalar joint in a neutral position, and the effects of the injured calcaneus on the contact characteristics of the subtalar joints were evaluated in terms of contact areas, peak contact pressures and pressure distributions. RESULTS AND CONCLUSION： The increase in calcaneal width somewhat limited the subtalar motion, and the reduction in length mainly limited the external rotation and plantar flexion of the subtalar joint. However, the reduction in height mainly resulted in the subtalar rotatory instability. The increase in width broadened the contact area but more notably increased the high pressure contact zone. With height loss, the overall contact area decreased, and the contact pressure center shifted to the anteroinferior portion of articulation. In conclusion, the normal biomechanics of the ankle-hind foot are severely disrupted by the abnormal calcaneus morphology. Therefore, the three-dimensional calcaneus morphology must be carefully restored in the treatment of calcaneus fractures.

关 键 词：跟骨 骨折 生物力学 有限元分析 组织工程 组织构建 骨组织工程 跟骨骨折 形态学 踝后足 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]