不同踝关节外侧韧带重建术的有限元比较  

Comparison of different reconstructions of ankle lateral ligaments by finite element analysis

作　　者：龚远林 张晓林 曾吉祥[1] 王健[1] GONG Yuan-lin;ZHANG Xiao-lin;ZENG Ji-xiang;WANG Jian(School of Clinical Medicine,Dazhou Vocational and Technical College,Da⁃zhou 635001,China;Department of Science&Technology,The Second Affiliated Hospital(Nuclear Industry 16 Hospital),Chengdu Medical College,Chengdu 610000,China)

机构地区：[1]达州职业技术学院临床医学系,四川达州635001 [2]成都医学院第二附属医院核工业四一六医院,四川成都610000

出　　处：《中国矫形外科杂志》2020年第10期920-924,共5页Orthopedic Journal of China

摘　　要：[目的]通过有限元分析的方法研究不同踝关节外侧韧带重建术对踝关节稳定状态的影响。[方法]选取1例32岁健康男性志愿者的踝关节三维CT数据,构建骨骼的实体模型。设计正常对照模型、单韧带重建模型、Y形重建模型、双隧道重建模型。网格划分、定义材料力学属性及接触关系。在踝关节中立位、跖屈20°、背伸10°三种状态添加150 N牵引力模拟前抽屉试验,1.7 N·m内旋扭矩模拟跟骨内翻试验。[结果]ATFL的Von Mises应力在中立位和跖屈20°位距,4个模型间差异无统计学意义(P>0.05),但背伸10°位单韧带重建模型和双隧道重建模型的Von Mises应力显著小于对照模型和Y形重建模型,差异有统计学意义(P<0.05)。内翻载荷下,CFL的Von Mises应力双隧道重建模型、Y形重建模型和对照模型之间差异无统计学意义(P>0.05)。在前抽屉应力下,距骨的前移距离在中立位和跖屈20°位,4模型之间差异无统计学意义(P>0.05),而在背伸10°位,Y形重建模型和对照模型均显著小于单韧带重建模型和双隧道重建模型(P<0.05)。内翻应力下,在中立位、跖屈20°位、背伸10°位,单韧带重建模型的距骨倾斜度均大于其他三个模型(P<0.05),而对照模型、Y形重建模型、双隧道重建模型差异无统计学意义(P>0.05)。[结论]双隧道和Y形重建踝关节外侧复合体的稳定性优于单纯重建距腓前韧带,而Y形重建作为一种功能解剖重建优于双隧道重建。[Objective]To compare different reconstructions of ankle lateral ligament by finite element analysis.[Methods]After ankle 3 D CT data obtained from a 32-year-old healthy male volunteer,virtual reality of ankle models were constructed.Subsequently,four groups of target models were made,including normal ankle as control model,single reconstruction of anterior talofibular ligament(ATFL)model,Y-shaped reconstruction for both ATFL and calcaneofibular ligament(CFL)and double-tunnel reconstruction of ATFL and CFL model.The models were meshed to define mechanical properties and contact relationship of materials at ankle neutral position,20°of plantar flexion and 10°of dorsal extension,as well as 150 N of anterior pulling to simulate the anterior drawer test and 1.7 N of internal rotation torque to simulate calcaneal varus test.[Results]Under anterior drawer loading at neutral position and 20°of plantar flexion,the Von Mises stresses on the ATFL remained unchanged among the 4 models(P>0.05),although those in the simple reconstruction and double-tunnel reconstruction models proved significantly less than the normal control and Y-shaped reconstruction models at 10°of dorsal flexion(P<0.05).Under varus loading,the Von Mises stresses on the CFL were not statistically different among the normal,double-tunnel and Y-shaped models.However,the talus anterior displacement under anterior pulling at 10°of dorsal flexion was significantly less in the normal control and Y-shaped reconstruction models than the simple and double-tunnel reconstruction models(P<0.05),despite of no statistical differences at neutral and 20°of plantar flexion among the 4 models(P>0.05).Under varus stress,the talus tilt in the simple reconstruction was significantly greater than the other 3 groups(P<0.05),whereas the talus tilts were not statistically significant among the normal,Y-shaped and double-tunnel models(P>0.05).[Conclusion]In term of strength and stability of reconstructed ligament,it ranks as Y-shaped reconstructions>double tunnel reconstruct

关 键 词：慢性踝关节外侧不稳定 解剖重建 韧带 有限元分析 

分 类 号：R687.4[医药卫生—骨科学]