拇趾外翻微创截骨术后三种固定方式截骨端的生物力学三维有限元分析  

Three-Dimensional Finite Element Analysis of the Biomechanics of the Osteotomy Ends of the Hallux Valgus Osteotomy with Three Different Fixations

作　　者：谢强[1] 郝宇 孔宇 李小东[1] 王培[1] XIE Qiang;HAO Yu;KONG Yu;LI Xiaodong;WANG Pei(Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei China)

机构地区：[1]承德医学院附属医院,河北承德067000

出　　处：《中国中医骨伤科杂志》2024年第10期64-70,共7页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：2023年承德市科技计划自筹经费项目(第二批)(2023A03054)。

摘　　要：目的:对比拇趾外翻微创截骨术后三种不同固定方式截骨端位移及应力分布情况,以及内固定的最大应力及分布情况。方法:对1位轻中度拇趾外翻患者扫描其足部CT图像,通过其足部CT图像建立拇趾外翻三维有限元模型,模拟微创截骨后绷带、克氏针和Herbert螺钉固定,分析固定术后足部跖屈位生物力学参数。结果:绷带、克氏针及Herbert螺钉固定截骨端最大等效应力分别为7.8615,14.2530,8.3156 MPa。绷带、克氏针及Herbert螺钉固定截骨端总位移分别为0.268960,0.022779,0.029195 mm。克氏针及Herbert螺钉在截骨端附近的最大应力分别高达154.700 MPa和46.404 MPa。结论:克氏针及Herbert螺钉固定强度和稳定性优于绷带固定,但绷带固定也符合骨折二期愈合理论,对断端愈合无不利影响。克氏针本身存在应力集中现象,有潜在断裂风险。Herbert螺钉应力围绕截骨端均匀分布,存在一定应力集中,这种应力集中对早期维持骨折断端的稳定有着非常重要的作用。Herbert螺钉具有较好的固定强度和稳定性,应力分布均匀,能很好地维持微创截骨端部的稳定性。Objective:To compare three different fixation methods after hallux valgus minimally invasive osteotomy,namely bandage split-toe pad,Kirschner wire and Herbert screw fixation,the displacement and stress distribution of osteotomy end,and the maximum stress and distribution of internal fixation.Methods:A patient with mild or moderate hallux valgus was scanned with foot CT image,and a three-dimensional finite element model was established by CT images of his foot.The maximum displacement and stress distribution of osteotomy end in plantar flexion of foot were analyzed by simulating minimally invasive osteotomy with bandage,Kirschner wire and Herbert screw fixation.Results:Maximum equivalent stress of osteotomy end fixed with bandage,Kirschner wire,Herbert screw was 7.8615,14.2530,8.3156 MPa,respectively.Total displacement of osteotomy end fixed by bandage,Kirschner wire,Herbert screw was 0.268960,0.022779,0.029195 mm,respectively.Maximum stress of Kirschner wire and Herbert screw near osteotomy end was 154.700 and 46.404 MPa,respectively.Conclusion:Fixation strength and stability of Kirschner wire and Herbert screw were better than bandage.Kirschner wire had stress concentration phenomenon,with potential fracture risk.Stress of Herbert screw was evenly distributed around osteotomy end,and there was a certain stress concentration,playing an important role in maintaining fracture end stability.

关 键 词：拇趾外翻 微创截骨 绷带 克氏针 HERBERT螺钉 有限元 稳定性 

分 类 号：R682.1[医药卫生—骨科学]