内、外踝韧带缺损对邻近核心肌腱生物力学影响的有限元分析  

Finite element analysis of biomechanical effect of medial or lateral malleolar ligament defects on its neighboring core tendons

作　　者：徐天宇 陈默迪 谢明茹 叶兴华 潘朝晖 Xu Tianyu;Chen Modi;Xie Mingru;Ye Xinghua;Pan Zhaohui(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,Shandong Province,China;Institute of Orthopedics and Traumatology of Chinese PLA,Hospital of Chinese PLA 80th Group Army,Weifang 261053,Shandong Province,China)

机构地区：[1]山东第二医科大学临床医学院,山东省潍坊市261053 [2]陆军第八十集团军医院骨科研究所,山东省潍坊市261053

出　　处：《中国组织工程研究》2025年第33期7223-7230,共8页Chinese Journal of Tissue Engineering Research

基　　金：潍坊市卫健委科研项目(WFWSJK-2023-040),项目负责人:潘朝晖。

摘　　要：背景:高能量损伤导致的内、外踝韧带断裂、缺损是足踝外科常见难题之一,邻近肌腱常作为移植材料重建缺损,探究韧带缺损状态下邻近核心肌腱的力学特性对于选择肌腱供区具有重要意义。目的:探究踝关节活动过程中,内、外踝韧带不同程度缺损时,其各自邻近核心肌腱间的相互作用及生物力学变化。方法:基于一名50岁健康男性左足的CT影像数据,通过MIMICS软件提取并构建表面立体模型,利用Geomagic Wrap进行拟合曲面,并在SOLIDWORKS中构建包含不同程度韧带缺损的骨-软骨-韧带-肌腱足踝复合体模型。采用Ansys Workbench进行有限元分析,通过前抽屉实验验证模型有效后,模拟踝关节内、外翻及内、外旋条件,观察腓骨短、长肌腱与胫前、后肌腱的Von-Mises应力最大值变化及分布特征。结果与结论:①前抽屉实验中距骨最大位移5.2085 mm,与文献报道的数据相似,验证模型有效;②4种工况下,踝关节单侧单束韧带缺损对邻近核心肌腱的应力最大值影响较小,单侧多束韧带缺损则显著增加肌腱应力最大值;除胫前肌腱各段应力载荷均偏高外,腓骨短、长肌腱及胫后肌腱的高应力区域均集中在肌腱远端;③外踝韧带一旦缺损,内翻、内旋时腓骨短肌腱的应力最大值及变化量均高于腓骨长肌腱;距腓前韧带缺损时内翻,腓骨短肌腱应力最大值较正常相比增加0.9512 MPa,腓骨长肌腱应力最大值降低0.0651 MPa;跟腓韧带缺损时内旋,腓骨短肌腱应力最大值增加2.3529 MPa,腓骨长肌腱应力最大值降低0.2692 MPa;④提示内踝韧带缺损时外翻、外旋,胫前、后肌腱的应力最大值变化复杂,取决于缺损韧带类型,尤其全层韧带缺损将显著增加二者应力最大值。BACKGROUND:Ligament rupture and defect of the lateral or medial malleolus caused by high-energy injuries are common challenges in foot and ankle surgery.Their neighboring core tendons are often used as grafts to reconstruct the deficient ligaments.It is of paramount importance to investigate the mechanical properties of such tendons in the context of ligament defects to provide a suitable donor tendon.OBJECTIVE:To investigate the interactive dynamics and biomechanical alterations among their core tendons during ankle joint motions under varying degrees of lateral or medial malleolar ligament defect.METHODS:Based on CT imaging data of the left foot of a 50-year-old healthy male,a surface stereolithography model was extracted and constructed using MIMICS software.After Geomagic Wrap software was employed to fit the surfaces,a bone-cartilage-ligament-tendon ankle complex model incorporating varying degrees of ligament deficiencies was created within SOLIDWORKS software.Finite element analysis was then conducted using Ansys Workbench software,and the model’s validity was verified through a simulated anterior drawer test.Following validation,the mechanical response of the ankle under the conditions of internal and external rotation,as well as inversion and eversion,was simulated.The variation and distribution patterns of the maximum Von-Mises stress in the peroneus brevis and longus tendons,as well as the anterior and posterior tibial tendons,were observed.RESULTS AND CONCLUSION:(1)In the anterior drawer test,the maximum talar displacement reached 5.2085 mm,which was similar to the data in the previous literature,thereby the effectiveness of the model was validated.(2)Under four loading conditions,the defect of unilateral single-bundle ligaments exerted minimal influence on the maximum stress of adjacent core tendons,whereas the defect of unilateral multi-bundle ligament significantly increased the maximum tendon stress.Except for the consistently high stress across segments of the anterior tibial tendon,the high-st

关 键 词：踝关节 肌腱 韧带缺损 邻近核心肌腱 有限元分析 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687