后踝骨折固定对踝关节旋转稳定性影响的有限元分析  

Finite element analysis of the effects of posterior malleolar fracture fixation on the rotational stability of the ankle joint

作　　者：李勇奇 廖燚 方洲 王顺 赵甜 拉华欠 沙那提 杨云峰 Li Yongqi;Liao Yi;Fang Zhou;Wang Shun;Zhao Tian;La Huaqian;Sha Nati;Yang Yunfeng(Department of Orthopedics,Karamay Hospital of People′s Hospital of Xinjiang Uygur Autonomous Region(Karamay Central Hospital),Karamay 834000,China;Department of Orthopedics,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Department of Orthopedics,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]新疆维吾尔自治区人民医院克拉玛依医院(克拉玛依市中心医院)骨科,克拉玛依834000 [2]同济大学附属同济医院骨科,上海200065 [3]上海交通大学医学院附属瑞金医院骨科,上海200025

出　　处：《中华创伤杂志》2024年第8期707-714,共8页Chinese Journal of Trauma

基　　金：新疆天山英才培养计划(2023TSYCJC0053);上海市科委项目(21ZR1458500,22S31900300)。

摘　　要：目的探讨后踝骨折固定对踝关节旋转稳定性的影响。方法解剖20例新鲜下肢尸体标本,测量下胫腓后韧带、横韧带复合体在胫骨后方的附着范围。选择1名健康志愿者建立正常胫腓骨+踝关节有限元模型及后踝骨折有限元模型(不同后方投影面积),沿胫骨机械轴方向于跟骨下端垂直加载600 N,分析胫骨远端关节面的接触面积及最大Von Mises应力,验证正常胫腓骨+踝关节模型的有效性;在后踝骨折模型中(模型组S、1/2S、1/4S、1/8S及1/16S,S指韧带复合体在胫骨后方完整的投影面积),复位并固定后踝后,进行踝关节垂直加载600 N+外旋加载5 N·m时,分析各模型下胫腓间隙增宽值;分析能够维持踝关节旋转稳定性的后踝骨折后方投影面积截点值。结果尸体标本测量结果显示,下胫腓后韧带、横韧带复合体在胫骨后方附着范围相对较广,位于胫骨远端后外侧,最高点距关节面距离(45.2±5.6)mm。随着距关节线距离增大,该韧带复合体胫骨后方附着区宽度逐渐减小。有限元模型分析结果显示,在正常胫腓骨+踝关节有限元模型中,垂直加载600 N后,胫距关节接触面积为324.02 mm2,最大Von Mises应力为4.4951 MPa。在后踝骨折模型中,模型组S、1/2S、1/4S及1/8S加载后,下胫腓间隙增宽值均<2 mm,但1/16S模型组下胫腓间隙增宽值为3.4458 mm。能够维持踝关节旋转稳定性的后踝骨折后方投影面积截点值为1/8S。结论下胫腓后韧带、横韧带复合体在胫骨后方附着广泛。后踝骨折治疗方案的选择需兼顾踝关节轴向稳定性和旋转稳定性。当下胫腓联合不稳定并且后踝骨折后方投影面积≥1/8时,可行单纯后踝骨折复位固定以恢复踝关节旋转及轴向稳定性;当下胫腓联合不稳定并且后踝骨折后方投影面积<1/8时,需置入胫腓联合螺钉。Objective To explore the effects of posterior malleolar fracture fixation on the rotational stability of the ankle joint.Methods A total of 20 fresh cadaveric specimens of lower limbs were anatomized to measure the area of attachment of the posterior inferior tibiofibular ligament and transverse ligament complex to the posterior surface of the tibia.One healthy volunteer was selected to construct a finite element model for the intact tibiofibular and ankle joints and finite element models for posterior malleolar fracture with different posterior projection areas.A load of 600 N was vertically applied to the inferior calcaneus along the tibial mechanical axis.The contact area and maximum Von Mises stress of the distal tibial articular surface were analyzed to verify the validity of the model for the intact tibiofibular and ankle joints.In the finite element models for the posterior malleolar fracture(S,1/2S,1/4S,1/8S and 1/16S model groups,with S standing for the complete projection area of the ligament complex on the posterior surface of the tibia),the width increase in the tibiofibular clear space was measured when a vertical load of 600 N and external rotation load of 5 N·m were applied to the ankle joint after the reduction and fixation of posterior malleolar fracture.The cutoff value of the posterior projection area of posterior malleolar fracture that could maintain the rotational stability of the ankle joint was assessed.Results The measurement results of the cadaveric specimens showed that the area of attachment of the posterior inferior tibiofibular ligament and transverse ligament complex to the posterior surface of the tibia was relatively large.It was attached to the posterolateral area of the distal tibia with the highest point located at(45.2±5.6)mm from the articular surface.With the increase in the distance from the joint line,the width of the posterior attachment area of the ligament complex was decreased.Results of the finite element analysis showed that in the finite element model for the inta

关 键 词：踝损伤 骨折固定术 内 韧带 关节 旋转 有限元分析 

分 类 号：R687.4[医药卫生—骨科学]