中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2809-2813.doi: 10.12307/2023.291

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

跖骨间弹性固定矫正拇外翻畸形后应力变化的有限元分析

杨  俊，孔维峰，袁晓庆，金荣忠，李桂军   

  1. 常州市肿瘤医院骨科，江苏省常州市   213000
  • 收稿日期:2022-04-12 接受日期:2022-05-21 出版日期:2023-06-28 发布日期:2022-09-15
  • 通讯作者: 李桂军，在读硕士，主治医师，常州市肿瘤医院骨科，江苏省常州市 213000
  • 作者简介:杨俊，男，1980年生，江苏省常州市人，汉族，2004年南通医学院毕业，副主任医师，主要从事足矫形及骨科创伤的研究。
  • 基金资助:
    常州市科技计划资助(CJ20200064)，项目负责人：李桂军

Finite element analysis of stress changes after elastic fixation between metatarsal bones for correction of hallux valgus deformity

Yang Jun, Kong Weifeng, Yuan Xiaoqing, Jin Rongzhong, Li Guijun   

  1. Department of Orthopedics, Changzhou Tumor Hospital, Changzhou 213000, Jiangsu Province, China
  • Received:2022-04-12 Accepted:2022-05-21 Online:2023-06-28 Published:2022-09-15
  • Contact: Li Guijun, Master candidate, Attending physician, Department of Orthopedics, Changzhou Tumor Hospital, Changzhou 213000, Jiangsu Province, China
  • About author:Yang Jun, Associate chief physician, Department of Orthopedics, Changzhou Tumor Hospital, Changzhou 213000, Jiangsu Province, China
  • Supported by:
    Changzhou Science & Technology Program, No. CJ20200064 (to LGJ)

PDF

197

摘要：

文题释义：
第1，2跖骨固定治疗拇外翻：是不截骨矫正拇外翻的一种治疗方案，是将第1、2跖骨建立可靠的连接，通过水平作用力来减小第1、2跖骨间角，并结合软组织平衡来矫正拇外翻畸形的一种手术方式。
有限元分析：将拇外翻足部CT图像数据导入相关有限元软件中，经过相关处理得到作用单元，对每个单元进行相关操作得到逼近无限未知量的真实系统，是行之有效的工程分析手段。

背景：第1，2跖骨间弹性固定治疗拇外翻虽可获得满意的临床疗效，但报道中发生第2跖骨应力性骨折的并发症风险较高，课题组前期研究中使用这种弹性固定治疗拇外翻获得了良好临床效果。
目的：通过对第1，2跖骨间固定建立拇外翻手术有限元模型，并进行力学加载分析，进一步验证该技术的安全可靠性。
方法：基于1例女性拇外翻患者的CT图像作为建模数据，利用软件Mimics 19.0、Geomagic Studio、Hypermesh 12.0、ANSYS 19.0进行相关操作建立拇外翻三维模型，对拇外翻模型进行手术位点划分：自第1跖骨远节基底部分别至第2跖骨的远节基底部(A组)、中段(B组)、近节基底部(C组)分为3个手术模型。对3组手术模型进行水平力学加载逐步减小跖骨间角力学测试分析；模拟人体站立时的受力方式，在胫腓骨上段逐步进行垂直力学加载，观察全足及第1，2跖骨的力学及形变。
结果与结论：①在应力方面，在第1，2跖骨间角施加水平方向的作用力在50，100，200，300 N时，跖骨整体作用点时最大应力发生在B组；第1跖骨应力最大发生在A组模型；第2跖骨应力最大发生在C组模型，第2跖骨应力最小发生在B组模型；②在形变方面，第1跖骨形变向外侧移位最大在A组模型，B组次之，C组最小；对于垂直施加作用各组模型差别较小；③结果提示，A组及B组模型具有较好的矫形能力且不易导致第2跖骨应力性骨折；该研究为临床不截骨进行第1，2跖骨间弹性固定矫正拇外翻手术的实施提供了力学数据。

https://orcid.org/0000-0001-7120-720X (杨俊)；https://orcid.org/0000-0003-2307-3571 (李桂军) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 拇外翻, 生物力学, 截骨术, 有限元分析, 跖骨间固定, 弹性固定

Abstract: BACKGROUND: Although the elastic fixation between the first and second metatarsal bones can achieve satisfactory clinical effects in the treatment of hallux valgus, the reported risk of complications of stress fracture of the second metatarsal bone is higher. In the previous study of the research group, good clinical results were obtained using this elastic fixation in the treatment of hallux valgus.  
OBJECTIVE: To further verify the safety and reliability of the technique by establishing a finite element model of hallux valgus surgery for the fixation of the first and second metatarsal bones, and perform mechanical loading analysis.
METHODS: Based on the CT image of a female hallux valgus patient as modeling data, relevant operations were carried out to establish a three-dimensional model of hallux valgus using the software Mimics 19.0, Geomagic Studio, Hypermesh 12.0, and ANSYS 19.0. The hallux valgus model was divided into three kinds of surgical models according to surgical sites: from the base of the distal segment of the first metatarsal to the base of the distal segment of the second metatarsal (group A), the middle segment (group B), and the proximal base (group C) of the second metatarsal. The three groups of surgical models were subjected to horizontal mechanical loading to gradually reduce the intermetatarsal angle for mechanical test analysis. To simulate the stress mode of the human body when standing, the vertical loading mechanics were gradually performed on the upper segment of the tibia and fibula, and the mechanics and deformation of the whole foot and the first and second metatarsal bones were observed.  
RESULTS AND CONCLUSION: (1) In terms of stress, when the horizontal force applied to the angle between the first and second metatarsal bones was 50, 100, 200, and 300 N, the maximum stress at the overall action point of the metatarsal bones occurred in group B. The maximum stress of the first metatarsal occurred in the model of group A. The maximum stress of the second metatarsal occurred in the model of group C. The minimum stress of the second metatarsal occurred in the B model. (2) In terms of deformation, the lateral displacement of the first metatarsal was the largest in model A, followed by group B, the smallest in group C. The difference between the models in each group was small for vertical application. (3) The results showed that models of group A and group B had better orthopedic ability and were less likely to cause stress fracture of the second metatarsal. This study provides mechanical data for the clinical implementation of the first and second metatarsal elastic fixation to correct hallux valgus surgery without osteotomy.

Key words: hallux valgus, biomechanics, osteotomy, finite element analysis, metatarsal bone fixation, elastic fixation

中图分类号: