全踝置换术后不同高度的Salto胫骨组件对骨-假体界面的稳定性影响  

The Effect of Different Heights of Salto Tibial Components on Stability of the Bone-Prosthesis Interface after Total Ankle Replacement Surgery

作　　者：潘昇妤 卢达 许阳阳 武勇 张乐 武雪晴 杜辉 赖良鹏 裴葆青[1] PAN Shengyu;LU Da;XU Yangyang;WU Yong;ZHANG Le;WU Xueqing;DU Hui;LAI Liangpeng;PEI Baoqing(School of Biological Science and Medical Engineering,Beihang University,Beijing 100083,China;Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]北京航空航天大学生物与医学工程学院,北京100083 [2]首都医科大学附属北京积水潭医院足踝外科,北京100035

出　　处：《医用生物力学》2025年第2期428-434,共7页Journal of Medical Biomechanics

基　　金：北京市自然科学基金项目(L232004)。

摘　　要：目的 研究全踝置换后不同高度的Salto Talaris胫骨组件在不同步态支撑期骨-假体界面的生物力学特征。方法 基于1名61岁女性踝关节炎患者的负重CT重建踝关节模型,并建立不同高度(5、7、9、11 mm)的Salto胫骨组件模型,仿真模拟胫骨-假体在4个步态支撑期的载荷,分析骨-假体界面的微动和应力。结果 11、9 mm模型的假体稳定性较差,微动峰值超过50μm,且胫骨内部应力峰值分别为30.75、29.86 MPa,超出了松质骨屈服应力;7、5 mm模型的胫骨应力在合理范围内,且平均微动峰值仅为42.66、40.32μm,相比之下,5 mm模型假体的初期稳定性最好。结论 使用Salto假体进行全踝置换,应选择合适的胫骨组件高度,5 mm左右最优。同时术后应适当避免踝关节过度屈伸活动,维持假体稳定性。研究结果为Salto假体结构参数的改进提供理论依据,对临床手术假体选择有一定价值,有助于改善全踝置换效果。Objective To investigate the biomechanical characteristics of Salto Talaris tibial components with different heights at the bone-prosthesis interface during different gait support phases after total ankle replacement.Methods An ankle joint model was reconstructed using a weight-bearing CT from a 61-year-old female patient with ankle arthritis,and Salto Talaris tibial components with different heights(5,7,9,11 mm)were modelled to simulate the loading of the tibial-prosthesis during four gait support phases,and to analyse the micromotion and stresses at the bone-prosthesis interface.Results The 11 mm and 9 mm models had a poorer prosthesis stability,with the peak micromotion exceeding 50μm and the peak internal tibial stresses of 30.75 MPa and 29.86 MPa,respectively,which exceeded the yield stress of the cancellous bone.The tibial stresses of the 7 mm and 5 mm models were within reasonable ranges and the average peak micromotions were only 42.66μm and 40.32μm.In contrast,the initial stability of the 5 mm model prosthesis was the best.Conclusions For total ankle replacement with Salto prosthesis,the height of the tibial component should be chosen appropriately,and the optimal height was about 5 mm.Excessive flexion and extension activities of the ankle joint should be avoided to maintain the stability of the prosthesis after surgery.This study provides a theoretical basis for the improvement of the structural parameters of the Salto prosthesis,which is valuable for the selection of clinical surgical prostheses and helps to improve the results of total ankle replacement.

关 键 词：全踝关节置换术 Salto Talaris假体 有限元分析 微动 

分 类 号：R318.01[医药卫生—生物医学工程]