Ankle fusion by plating through an anterior approach followed by posterolateral approach: a three-dimensional finite element analysis

doi:10.3969/j.issn.2095-4344.2017.35.020

Abstract

Abstract:

BACKGROUND: End-stage ankle arthritis will cause sustained pain of the ankle joint, which severely affects patients’ life quality. Surgical treatment is necessary when conservative method is invalid, and ankle fusion is the gold standard for end-stage ankle arthritis.

OBJECTIVE: To establish a three-dimensional finite element model of ankle fusion by anterior plating, followed by a posterolateral screw, thus analyzing the biomechanical changes.

METHODS: CT data of normal people were imported into the relevant software to establish a three-dimensional finite element model of the ankle, and simulated ankle fusion by software processing. Subsequently, the models of ankle fusion by anterior plating system and combined posterolateral screws were established, and a three-dimensional finite element analysis was performed under neutral position, dorsiflexion, intorsion and extorsion.

RESULTS AND CONCLUSION: The maximum displacement and stress under dorsiflexion, intorsion and extorsion in the combined model were significantly decreased compared with the simple model, and the values under neutral position showed no significant changes in the two methods. Additionally, the stress distribution did not differ significantly between two models. To conclude, plates combined with screws significantly improve the stability and safety of fusion.

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

Key words: Osteoarthritis, Finite Element Analysis, Internal Fixators, Biomechanics

CLC Number:

R318

Xie Qiang. Ankle fusion by plating through an anterior approach followed by posterolateral approach: a three-dimensional finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5697-5702.

Figures/Tables 5

References

[1] 李为,李颖,周一新,等.人工全踝关节置换术治疗踝关节骨关节炎的疗效分析[J].中华创伤杂志,2011(27):1012-1016．

[2] Giannini S,Buda R,Faldini C,et a1.The treatment of severe posttraumatic arthritis of the ankle joint.J Bone Joint Surg Am.2007;(9):15-28．

[3] Nihal A, Gellman RE,Embil JM,et al.Ankle arthrodesis.Foot Ankle Surg.2008(14):1-10．

[4] Abidi NA,Gnlen GS,Conti SF.Ankle arthrodesis:indications and techniques.J Am Acad Orthop Surg.2000;(8):200-209.

[5] Haddad SL,Coetzee JC,Estok R,et a1.Intermediate and longterm outcomes of total ankle arthroplasty and ankle arthrodesis.A systematic review of the literature.J Bone Joint Surg Am.2007;(89):1899-1905．

[6] Zwipp H, Rammelt S, Endres T, et al. High union rates and function scores at midterm follow-up with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res.2010; 468(4): 958-968.

[7] Easley ME, Montijo HE, Wilson JB, et al. Revisiontibiotalar arthrodesis. JBoneJoint SurgAm.2008;(6): 1212-1223.

[8] 梅国华,许同龙, 蒋尧.踝关节融合术研究进展[J].国际骨科学杂志,2015,3(2):100-104.

[9] Holt ES，Hansen ST, Mayo KA, et al. Ankle arthrodesis using internal screw fixation．ClinOrthop.1991;268: 21-28．

[10] Ogilvie-Harris DJ, Fitsialos D, Hedman TP. Arthrodesisof theankle. A comparison of two versus three screw fixation in acrossed configuration. ClinOrthop.1994;304: 195-199.

[11] Clifford C , Berg S , McCann K ,et al.A biomechanical comparison of internal fixation techniques for ankle arthrodesis. J Foot Ankle Surg.2015;(2):188-191.

[12] 熊良平,张世民.使用前置钢板行踝关节融合的技巧和短期效果[J].中国矫形外科杂志,2010,18(24):2055.

[13] Schuberth JM, Ruch JA, Hansen ST. The tripod fixation technique for ankle arthrodesis. J Foot Ankle Surg.48:93–96, 2009.

[14] 卢昌怀,余斌,陈辉强,等. 正常步态下距骨三维有限元模型的建立及应力分析[J]．南方医科大学学报,2010,10: 2273-2276．

[15] 谢新敏,李来峰,赵学春,等.腓骨中上段骨折对踝关节生物力学影响的临床研究[J]. 中国矫形外科杂志,2009,17(14):1077-1080.

[16] Thordarson DB, Markolf K, Cracchiolo AR．Stability of an ankle arthrodesis fixed by cancellous-bone screws compared with that fixed by anexternal fixator.A biomechanical study. J Bone Joint Surg Am.1992;7:1050-1055.

[17] Alonso-Vazquez A, Lauge-Pedersen H, Lidgren L, et al. Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis. Clin Biomech (Bristol, Avon).2004;19(7): 751-759.

[18] 杨成伟,李全,孙伟,等.内收型股骨颈骨折多根空心螺钉固定的三维有限元分析[J]. 中国矫形外科杂志, 2009,17(14):1077-1080.

[19] 赵文志,李斌.颈椎三维有限元模型的建立方法与评价[J]．大连医科大学学报,2009,31(5):8-13.

[20] Morales-Orcajo E, Souza TR, Bayod J, et al.Non-linear finite element model to assess the effect of tendon forces on the foot-ankle complex.Med Eng Phys. 2017;pii: S1350-4533(17)30206-0.

[21] Tsai A, Coats B, Kleinman PK.Biomechanics of the classic metaphyseal lesion: finite element analysis.Pediatr Radiol. 2017 Jul 18.

[22] Ji Y, Tang X, Li Y, et al.Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament.Exp Ther Med. 2016;12(6):3913-3916.

[23] Hejazi S, Rouhi G, Rasmussen J.The effects of gastrocnemius-soleus muscle forces on ankle biomechanics during triple arthrodesis.Comput Methods Biomech Biomed Engin. 2017;20(2):130-141

[24] Zhao Y, Wang G.Advances on biomechanics and kinematics of sprain of ankle joint].Zhongguo Gu Shang. 2015;28(4): 374-377.

[25] Liu Q, Zhao G, Yu B, et al.Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle: a finite element study.Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1228-1235.

[26] 郭鹏超,王成伟. 踝关节三维有限元生物力学研究的临床转化[J]. 中国组织工程研究, 2014,18(31):5056-5061.

[27] 陈振兵,洪光祥,王发斌.上肢功能评定表[J].中国修复重建外科杂志,2004,18:520-521.