目的 探讨踝关节融合术后后足关节的生物力学特性。 方法 利用健康成年男性志愿者右踝关节CT图像，构建踝关节融合前的三维有限元模型，在此基础上模拟踝关节融合术后骨性融合状态，采用中立、外旋、内旋、背伸和跖屈的5种载荷工况分别对融合前、后模型组进行有限元分析，评估踝关节融合前后的整体刚度变化、距下关节和距舟关节的接触力学特性变化。 结果 踝关节发生骨性融合后，整体结构刚度较融合前模型显著增高；除中立位工况以外，融合后的距下关节的接触面积均有所减少，距舟关节接触面积则有所增加；而融合后的距下和距舟关节的接触应力在各工况下总体呈降低趋势。结论 踝关节骨性融合术后相邻关节的接触特性改变可能是足部整体结构刚度提高后承载模式发生变化的结果，其与相邻后足关节退行性改变之间的关联尚有待进一步研究证实。
Abstract
Objective To investigate the biomechanical characteristics of hindfoot joint after ankle arthrodesis. Methods Based on the CT images of the right ankle of healthy adult male volunteers, a three-dimensional finite element model of the normal ankle was constructed. On this basis, the bony fusion after ankle arthrodesis was simulated. Five load cases of neutral, external rotation, internal rotation, dorsiflexion， and plantar flexion were used to analyze the model group before and after fusion, and to evaluate the changes of overall stiffness and the contact mechanical characteristics of subtalar joint and talonavicular joint before and after ankle arthrodesis. Results After ankle arthrodesis, the overall structural stiffness was significantly higher than that of the model before fusion. Except for neutral condition, the contact area of subtalar joint after fusion decreased, while the contact area of talonavicular joint increased. The contact stress of subtalar joint and talonavicular joint after fusion generally showed a downward trend under various working conditions. Conclusions The change of contact characteristics of adjacent joints after ankle arthrodesis may be the result of the change of bearing mode after the improvement of the overall structural stiffness of the foot, and its association with the degenerative changes of adjacent hindfoot joints needs to be confirmed by further research.
关键词
踝关节创伤性关节炎 /
/
/
踝关节融合术 /
/
/
后足关节 /
/
/
有限元分析 /
/
/
生物力学
Key words
Traumatic arthritis of ankle /
/
/
Ankle arthrodesis /
/
/
Hindfoot joint /
/
/
Finite element analysis /
/
/
Biomechanics
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center[J]. Iowa Orthop J, 2005, 25(19): 44–46. PMID: 16089071
[2] Hautmann MG, Hipp M, Neumaier U, et al. Radiotherapy for osteoarthritis of the ankle and tarsal joints-analysis of 66 joints[J]. Strahlentherapie und Onkologie,2020,196(6): 569-575. DOI: 10.1007/s00066-019-01551-5.
[3] Fuentes-Sanz A, Moya-Angeler J, López-Oliva F, et al. Clinical Outcome and Gait Analysis of Ankle Arthrodesis[J]. Foot Ankle Int, 2012, 33(10): 819-827. DOI: 10.3113/FAI.2012.0819.
[4] Coester LM, Saltzman CL, Leupold J, et al. Long-term results following ankle arthrodesis for post-traumatic arthritis[J]. J Bone Joint Surg Am, 2001, 83(2): 219-28. DOI: 10.2106/00004623-200102000-00009.
[5] 金乾坤,何盛为,何飞熊,等.足踝部三维有限元仿真模型的构建及验证[J].中国数字医学,2016, 11(4): 83-86. DOI: 10.3969/j.issn.1673-7571.2016.04.029.
[6] Ramlee MH, Gan HS, Daud SA, et al. Stress distributions and micromovement of fragment bone of pilon fracture treated with external fixator: a finite element analysis[J]. J Foot Ankle Surg, 2020, 59(4): 664-672. DOI: 10.1053/j.jfas.2019.09.006.
[7] 刘忠鑫,王维,张欣,等.螺钉固定与Tight-rope固定治疗下胫腓前联合损伤的初步有限元分析[J].中国骨伤, 2018, 31(10): 937-943. DOI: 10.3969/j.issn.1003-0034.2018.10.012.
[8] Wang S, Yu J, Ma X, et al. Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw[J]. J Orthop Surg Res, 2020, 15(1): 252. DOI: 10.1186/s13018-020-01767-7.
[9] Anderson DD, Goldsworthy JK, et al. Physical validation of a patient-specific contact finite element model of the ankle[J]. J Biomech, 2007, 40(8): 1662-1669. DOI: 10.1016/j.jbiomech.2007.01.024
[10]Schuh R, Hofstaetter JG, Hofstaetter SG, et al. Plantar pressure distribution after tibiotalar arthrodesis[J]. Clin Biomech (Bristol, Avon), 2011, 26(6): 620-625. DOI: 10.1016/j.clinbiomech.2011.02.001.
[11]Sturnick DR, Demetracopoulos CA, Ellis SJ, et al. Adjacent joint kinematics after ankle arthrodesis during cadaveric gait simulation[J].Foot Ankle Int, 2017,38(11): 1249-1259.DOI: 10.1177/107110071 7726806.
[12] 俞光荣, 杨云峰, 张凯, 等. 距下关节、踝关节对后足运动影响的实验研究[J]. 中华骨科杂志, 2005, 25(4): 236-239. DOI: 10.3760/j.issn:0253-2352.2005.04.012.
[13] Sealey RJ, Myerson MS, Molloy A, et al. Sagittal plane motion of the hindfoot following ankle arthrodesis: a prospective analysis[J]. Foot Ankle Int, 2009, 30(3): 187-96. DOI: 10.3113/FAI.2009.0187.
[14] Bruening DA, Cooney TE, Ray MS, et al. Multisegment foot kinematic and kinetic compensations in level and uphill walking following tibiotalar arthrodesis[J]. Foot Ankle Int, 2016, 37(10): 1119-1129. DOI: 10.1177/1071100716655205.
[15] 燕晓宇,俞光荣,丁祖泉,等.距舟关节的三维运动度及其临床意义[J].中国临床解剖学杂志, 2007, 25(6): 693-695. DOI: 10.3969/j.issn.1001-165X.2007.06.024.
[16]Wayne JS, Lawhorn KW, Davis KE, et al. The effect of tibiotalar fixation on foot biomechanics[J]. Foot Ankle Int, 1997, 18(12):792-797. DOI: 10.1177/107110079701801207.
[17]Jung HG, Parks BG, Nguyen A, et al. Effect of tibiotalar joint arthrodesis on adjacent tarsal joint pressure in a cadaver model[J]. Foot Ankle Int, 2007, 28(1): 103-108. DOI: 10.3113/FAI.2007.0019.
[18]Wang Y, Li Z, Wong DW, Zhang M. Effects of ankle arthrodesis on biomechanical performance of the entire foot [J]. PLoS One, 2015, 10(7): e0134340. DOI: 10.1371/journal.pone.0134340.
[19]Jones CR, Wong E, Applegate GR, et al. Arthroscopic ankle arthrodesis: a 2-15year follow-up study[J]. Arthroscopy, 2018, 34(5): 1641-1649. DOI: 10.1016/j.arthro.2017.11.031.
[20] Ling JS, Smyth NA, Fraser EJ, et al. Investigating the relationship between ankle arthrodesis and adjacent-joint arthritis in the hindfoot: a systematic review[J]. J Bone Joint Surg Am, 2015, 97(6): 513-520. PMID: 25948528.
基金
广东省医学科研基金项目（B2021213）；广东省科技计划项目（2018B090944002）；湛江市科技发展专项资金竞争性分配项目（2020A01025）；广东医科大学大学生创新实验项目（FYZY001）
PDF(2924 KB)
京ICP备08002354号-3
