机构地区:[1]同济大学医学院同济大学附属同济医院骨科,上海200092
出 处:《中国修复重建外科杂志》2023年第7期796-801,共6页Chinese Journal of Reparative and Reconstructive Surgery
基 金:国家重点研发计划资助项目(2022YFC2009505)。
摘 要:目的 在建立内翻型踝关节炎有限元模型基础上,对踝上截骨术中不同胫骨远端关节面正位角(tibial anterior surface angle,TAS)矫正模型进行生物力学分析。方法 以1例左侧内翻型踝关节炎女性患者作为研究对象,踝关节炎Takakura分期为Ⅱ期,负重位X线片测量TAS 78°。基于踝关节CT扫描数据,采用Mimics 21.0软件、Geomagic Wrap 2021软件、Solidworks 2017软件和Workbench 17.0软件建立内翻型踝关节炎模型(内翻模型,TAS 78°),并基于该模型模拟斜形开口截骨术建立不同TAS矫正模型[正常模型(TAS 89°)、外翻5°模型(TAS 94°)和外翻10°模型(TAS 99°)]。在各模型胫骨表面施加290 N垂直向下压力,腓骨表面施加60 N垂直向下压力,计算Von Mises应力分布及应力峰值。结果 研究建立的正常模型基本符合足部力学情况。生物力学分析示,内翻模型最大应力出现在内侧胫距关节面和顶部胫距关节面偏内侧处,距腓关节面及顶部胫距关节面外侧应力分布均匀;正常模型距腓关节面和胫距关节面应力分布较均匀,未见明显应力集中现象;外翻5°模型最大应力出现在距腓关节面偏后侧和顶部胫距关节面偏外侧处,内侧胫距关节面应力分布较均匀;外翻10°模型最大应力出现在距腓关节面偏后侧和顶部胫距关节面偏外侧处,内侧胫距关节面应力增加。结论 随着外翻增加,踝关节应力分布呈现外移及逐渐集中趋势。TAS矫正10°以内不会出现明显腓骨阻挡现象,但超过10°时随着TAS增加腓骨阻挡作用愈严重。Objective To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle(TAS)in supramalleolar osteotomy.Methods A female patient with left varus-type ankle arthritis(Takakura stage Ⅱ,TAS 78°)was taken as the study object.Based on the CT data,the three-dimensional model of varus-type ankle arthritis(TAS 78°)and different TAS correction models[normal(TAS 89°),5°valgus(TAS 94°),and 10°valgus(TAS 99°)]were created by software Mimics 21.0,Geomagic Wrap 2021,Solidworks 2017,and Workbench 17.0.The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula.Von Mises stress distribution and stress peak were calculated.Results The finite element model of normal TAS was basically consistent with biomechanics of the foot.According to biomechanical analysis,the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface.The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform.In the normal model,the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform,and no obvious stress concentration was observed.The maximum stress in the 5°valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface.The stress distribution of medial tibiotalar joint surface was uniform.The maximum stress of the 10°valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface.The stress on the medial tibiotalar joint surface increased.Conclusion With the increase of valgus,the stress of ankle joint gradually shift outwards,and the stress concentration tends to appear.There was no obvious obstruction of fibul
关 键 词:内翻型踝关节炎 胫骨远端关节面正位角 踝上截骨术 有限元分析
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