中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (31): 4926-4931.doi: 10.12307/2023.695

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

踝外侧副韧带损伤对踝关节稳定性及软骨接触应变影响的有限元分析

史  旭1,左  华2,王毓幸1,姚  翔1,袁即山1   

  1. 1江苏大学附属人民医院骨科,江苏省镇江市   212000;2江苏大学附属医院骨科,江苏省镇江市   212000
  • 收稿日期:2022-09-13 接受日期:2022-10-31 出版日期:2023-11-08 发布日期:2023-01-30
  • 通讯作者: 袁即山,博士,主任医师,江苏大学附属人民医院骨科,江苏省镇江市 212000
  • 作者简介:史旭,男,1995年生,江苏省盐城市人,汉族,2022年江苏大学毕业,硕士,医师,主要从事足踝外科方面的相关研究。
  • 基金资助:
    镇江市社会发展指导性科技计划项目资助(FZ2020077),项目负责人:左华

Finite element analysis of the influence of lateral ankle collateral ligament injury on ankle joint stability and cartilage contact strain

Shi Xu1, Zuo Hua2, Wang Yuxing1, Yao Xiang1, Yuan Jishan1   

  1. 1Department of Orthopedics, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China; 2Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
  • Received:2022-09-13 Accepted:2022-10-31 Online:2023-11-08 Published:2023-01-30
  • Contact: Yuan Jishan, MD, Chief physician, Department of Orthopedics, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
  • About author:Shi Xu, Master, Physician, Department of Orthopedics, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
  • Supported by:
    Zhenjiang Social Development Guiding Science and Technology Program, No. FZ2020077 (to ZH)

摘要:

文题释义:

踝关节:称为距小腿关节,是人体下肢运动系统中重要组成,也是在人体负重和运动时传递下肢载荷的枢纽关节,由胫骨、腓骨的下端与距骨滑车构成,其稳定性是由踝穴、距骨穹隆和踝关节韧带这些结构提供。
踝外侧副韧带:由距腓前韧带、跟腓韧带和距腓后韧带组成。距腓前韧带从腓骨远端前下缘延伸至距骨颈,是关节囊的关节内增强物;跟腓韧带从腓骨延伸至跟骨外侧结节,在踝关节中立位时向后倾斜,而在背伸时,它与腓骨成一直线,起到真正的侧副韧带的作用;距腓后韧带从腓骨后方的指窝延伸至距骨外侧结节,在踝关节背伸时绷紧,跖屈时松弛。

背景:在踝关节扭伤和踝关节韧带损伤中近85%涉及外侧副韧带,损伤的机制为足跖屈时踝关节内翻。 急性踝关节外侧扭伤的患者中有20%-40%会出现持续疼痛和慢性踝关节外侧不稳,导致距骨平移和旋转过大,加速软骨磨损,导致关节退化。
目的:通过有限元建模探究不同类型的踝外侧副韧带损伤模型对踝关节稳定性以及距骨穹窿软骨接触应变的影响。
方法:将1名27岁志愿者足踝CT扫描数据DICOM文件导入有限元软件中,进行三维重建及曲面拟合,再进行网格划分,建立含有骨骼、关节软骨和韧带的完整踝关节有限元模型,对比正常、距腓前韧带损伤、跟腓韧带损伤和距腓前韧带+跟腓韧带损伤 4种不同工况下的踝关节稳定性和距骨软骨接触应变的改变。

结果与结论:①在前抽屉试验中,距腓前韧带损伤和距腓前韧带+跟腓韧带损伤距骨前移距离明显大于正常和跟腓韧带损伤(P < 0.05),而距腓前韧带损伤和距腓前韧带+跟腓韧带损伤之间、正常和跟腓韧带损伤之间差异无显著性意义(P > 0.05);②在距骨倾斜试验中,跟腓韧带损伤和距腓前韧带+跟腓韧带损伤距骨倾斜角度明显大于正常和距腓前韧带损伤,而跟腓韧带损伤和距腓前韧带+跟腓韧带损伤之间、正常和距腓前韧带损伤之间无明显差异;③在单足站立试验中,与正常模型相比,上述3种损伤模型改变了距骨穹窿软骨接触应变分布,峰值由距骨穹窿前外侧转移至前内侧,导致了距骨穹窿软骨前内侧压力增高,并且峰值大小比较:距腓前韧带+跟腓韧带损伤>距腓前韧带损伤>跟腓韧带损伤>正常,距腓前韧带+跟腓韧带损伤的峰值明显大于距腓前韧带损伤和跟腓韧带损伤;④研究结果验证了踝外侧副韧带损伤时踝关节稳定性的丢失和前内侧软骨接触应变峰值增加,揭示了慢性踝关节外侧不稳和踝关节骨关节炎之间的联系,确认了修复或者重建距腓前韧带和跟腓韧带的必要性,为慢性踝关节外侧不稳的手术治疗提供了理论依据。

https://orcid.org/0000-0003-2614-7986 (史旭) 

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: 踝外侧副韧带, 踝关节, 有限元, 生物力学, 距腓前韧带, 跟腓韧带

Abstract: BACKGROUND: Of ankle sprains and ankle ligament injuries, nearly 85% involved the lateral collateral ligaments, and the mechanism of injury was ankle varus during plantar flexion. Between 20% and 40% of patients with acute lateral ankle sprains develop persistent pain and chronic lateral ankle instability, resulting in excessive translation and rotation of the talus, accelerated cartilage wear and joint degeneration.
OBJECTIVE: To explore the effects of different types of lateral ankle collateral ligament injury models on ankle joint stability and contact strain of talus dome cartilage through finite element modeling. 
METHODS: The DICOM file of CT scan data of the ankle joint of a 27-year-old volunteer was imported into the finite element software for three-dimensional reconstruction and surface fitting, and then mesh division was carried out to establish a complete finite element model of the ankle joint containing bones, articular cartilage and ligaments. The changes of the ankle joint stability and talus cartilage contact strain were compared under four different conditions: normal, anterior talofibular ligament injury, calcaneofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury. 
RESULTS AND CONCLUSION: (1) In the anterior drawer test, the anterior talar translation of anterior talofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury was significantly greater than that of normal and calcaneofibular ligament injury (P < 0.05), but there was no significant difference between anterior talofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury and between normal and calcaneofibular ligament injury (P > 0.05). (2) In the talus tilt test, the talus tilt angle of calcaneofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury was significantly larger than that of normal and anterior talofibular ligament injury, but there was no significant difference between calcaneofibular ligament injury and anterior talofibular ligament + calcaneofibular ligament injury, and between normal and anterior talofibular ligament injury. (3) In the unipedal standing test, compared with the normal model, the above three injury models changed the contact strain distribution of talus dome cartilage and shifted the peak value from the anterolateral side to the anteromedial side of the talus dome, resulting in the increase of anteromedial pressure of talus dome cartilage, and the comparison of the peak values was: anterior talofibular ligament + calcaneofibular ligament injury > anterior talofibular ligament injury > calcaneofibular ligament injury > normal, and the peak value of anterior talofibular ligament + calcaneofibular ligament injury was significantly higher than that of anterior talofibular ligament injury and calcaneofibular ligament injury. (4) The results confirmed that the injury of the lateral collateral ligament of the ankle would lead to the loss of ankle stability and the increase of peak contact strain of anterior medial cartilage, revealed the relationship between chronic lateral ankle instability and ankle osteoarthritis, and concluded the necessity of repairing or reconstructing anterior talofibular ligament and calcaneofibular ligament, which provided a theoretical basis for surgical treatment of chronic lateral ankle instability. 

Key words: ankle lateral collateral ligament, ankle joint, finite element, biomechanics, anterior talofibular ligament, calcaneofibular ligament

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