Evans手术对跟骰关节压力影响的生物力学研究
Biomechanical effects on calcaneocuboid joint pressure after lateral column lengthening (Evans) procedure
目的 研究Evans手术矫正平足畸形对跟骰关节压力的影响以及该术式的足外侧柱最佳撑开宽度，为临床提供借鉴与参考。 方法 6例正常成人新鲜足标本，根据不同工况分为正常对照组、平足模型组、Evans手术外侧柱延长的LCL*4 mm、LCL*6 mm、LCL*8 mm、LCL*10 mm及LCL*12 mm组。实验标本逐级加载至350 N，利用K-ScanTM骨关节接触面测量系统的K-Scan6900#压敏片分别测量7组跟骰关节压力变化。 结果 在350 N垂直载荷下跟骰关节的峰值压强分别为（kg/cm2）：对照组(9.21± 1.60)、平足组(24.90±2.45)、LCL*4 mm组(21.68±2.21)、LCL*6 mm组(15.95±2.59)、LCL*8 mm组(11.04± 1.15)、LCL*10 mm组(15.20±2.35)、LCL*12 mm组(21.55±2.03)。平足组跟骰关节峰值压强较对照组显著增高（P＜0.05）；Evans术后的所有组跟骰关节峰值压强较平足组有明显降低（P＜0.05）；LCL*8 mm组与正常对照组跟骰关节峰值压强接近（P=0.143）；LCL*8mm组跟骰关节峰值压强较其他外侧柱延长组小（P＜0.05）。 结论 Evans手术治疗获得性平足，其术后对跟骰关节压力在一定范围内较平足术前有所减小，呈先减小后增大的趋势；而撑开长度在8 mm时跟骰关节压力最小，且最接近正常状态。
Objective To study the pressure change across the calcaneocuboid joint after lateral column lengthening (Evans) procedure and the best width of the lateral column distraction, for providing information and reference for Evans osteotomy. Methods Six fresh-frozen cadaveric specimens of foot were randomized into 7 experimental groups: intact, flatfoot deformity model, Evans osteotomy to extend the lateral columns of different widths (from 4mm to 12mm, in 2-mm increments). Vertical downward axial loads of 350N were applied to the specimens, the calcaneocuboid joint pressures were measured by the K-Scan joint analysis system and K-Scan6900# Sensor Model. Results Under loads of 350N, the calcaneocuboid joint peak pressure were: intact group: (9.21±1.60), flatfoot deformity model group: (24.90±2.45), LCL*4mm group: (21.68±2.21), LCL*6mm group: (15.95±2.59), LCL*8mm group: (11.04±1.15), LCL*10mm group: (15.20±2.35) and LCL*12mm group: (21.55±2.03) kg/cm2, respectively. The calcaneocuboid joint peak pressure was significantly higher in the flatfoot than intact group（P＜0.05); after the different Evans osteotomy, the pressure has been significantly reduced in LCL groups than the flatfoot (P <0.05)；there was no significant difference in the calcaneocuboid joint peak pressure between LCL*8mm group and intact group (P=0.143); the pressure in LCL*8mm group was relatively smaller than the other lateral column lengthening groups (P<0.05). Conclusions Lateral column lengthening by means of an Evans osteotomy within a certain extent will decreases the pressure across the calcaneocuboid joint on the flatfoot deformity. The pressure is minimal at the 8 mm width of the lateral column distraction, and we consider it near the normal state.
Evans osteotomy / Calcaneocuboid joint / Flatfoot / Biomechanics
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