Chinese Journal of Tissue Engineering Research ›› 2023, Vol. 27 ›› Issue (27): 4283-4290.doi: 10.12307/2023.611
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Tang Zhi1, Lang Lei1, Wang Renyuan2, Gu Song2
Received:
2022-06-17
Accepted:
2022-08-03
Online:
2023-09-28
Published:
2022-11-07
Contact:
Gu Song, MD, Associate chief physician, Trauma Clinic, Shanghai General Hospital, Shanghai 201600, China
About author:
Tang Zhi, MD, Professor, School of Mechanical Engineering, Donghua University, Shanghai 201600, China
Supported by:
CLC Number:
Tang Zhi, Lang Lei, Wang Renyuan, Gu Song. Construction of finite element model of hallux valgus foot and biomechanical analysis of the first metatarsophalangeal joint[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(27): 4283-4290.
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2.1 模型验证 此次预测的足底压力与文献[18]中拇外翻模型足底压力对比结果显示:两种模型的压力峰值分别为 0.123 MPa和0.144 MPa,差异无显著性意义(P > 0.05)[4]。压力分布趋势上,此次构建的模型足底外侧、大脚趾正下方的受力会更明显一些,推测与影像数据的采集为模拟平衡站立状态,而对比文献中的模型是在松弛不受力状态采集相关,但整体压力分布趋势较吻合,峰值位于足跟区域。由文献[18]中对正常足与拇外翻足底压力分布对比试验可知,拇外翻足第3跖骨的von Mises应力集中程度最高,其次是第2、第4和第1跖骨,第5跖骨最低,即应力集中现象在跖骨区域整体外移;此次试验结果也符合这一观点,由图3可以看出此次试验预测和文献[18]试验结果的压力分布与峰值的分布模式也较一致。以上证明该模型的构建及模拟是有效的。"
2.2 第1跖趾关节区域应力 拇外翻即第1跖趾关节拇外翻,第1跖趾关节区域的应力分布及大小与拇外翻发展有直接关系。YU 等[13]利用有限元方法,证明了在长时间穿高跟鞋站立时,第1跖趾关节外侧和背侧区域von Mises应力的增加可能诱发拇外翻畸形的发展。在模拟裸足静止站立工况下,对拇外翻足右侧第1跖趾关节区域进行有限元分析,见图4;拇趾远节趾骨受力最小,基本无应力集中,拇趾近节趾骨应力也较小,集中在骨体背侧与底侧的中心,数值在1.875-2.500 MPa之间。较大的应力集中现象出现在第1跖骨,分布趋势为由骨体内侧中部及外侧中部,逐渐向骨体背侧底侧减小,von Mises应力的最大值为8.103 MPa。与正常足第1跖趾关节区域应力分布情况相比,第1跖骨Von Mises应力值更大,且随着拇外翻角的增大,最大主应力值也会增大[13]。这表明减小第1跖趾关节区域的应力集中现象,可以改善拇外翻症状。"
2.3 不同外力作用下的模拟分析 2.3.1 标准化角度测量及载荷 临床上利用X射线片诊断拇外翻时,跖趾关节角是一个重要的形态学指标[19],即跖趾关节角越大,拇外翻病症越严重。第1跖趾关节角定义为以第1跖骨的纵轴和长轴作为跖趾关节的矢状面;在矢状面上,第1跖骨长轴与第1近节指骨的夹角为跖趾关节的夹角[13]。 在有限元模拟分析时,模型不同的选取角度、测量方式、外力施加位置都会使结果出现巨大差异,导致同一模型下的数据也不具有可对比性,因此针对此次试验确定一套标准十分有必要。在跖趾关节角测量方面,首先将整足模型体坐标标准化,之后使用COUGHLIN等[20]出版在美国足与踝关节协会(The American Orthopaedic Foot & Ankle Society,AOFAS)角度测量专门委员会报告上的第1跖骨、第2跖骨和拇趾近节趾骨轴线参考点的确定方法,见图5;取顶视图,无透视,测量得初始第1跖趾关节角=(27.67±0.10)°,第1-2跖骨间角(Intermetatarsal Angle,IMA1-2)=(12.34±0.10)°。该组数据与此次试验医生通过临床方法给出的诊断数值(跖趾关节角)=26°、(IMA1-2)=13°差值< 2°,证明了由上述测量方法所得数据是有效的。"
2.3.2 矫正力与跖趾关节角 通常当15° <第1跖趾关节角< 20°,和(或 )9° < (IMA1-2) < 11°时,被认为是轻度拇外翻足;20° <第1跖趾关节角< 40°,11°< (IMA1-2) < 16°为中度;第1跖趾关节角> 40°,(IMA1-2) > 16°为重度拇外翻足[22]。初始工况下,对足第1拇趾远节趾骨外侧中部区域施加向足内侧水平力F1、对足跖趾关节内侧囊处区域施加向足外侧水平力F2、对跖骨近端内侧面施加向足外侧的水平力F3。力的大小通过估测一组定值并控制变量来完成试验,结合试验多组力下第1跖趾关节区域骨头形变及应力分布,并考虑实际骨可承受的外力,将初始一组数据选取原则定为该组值可使第1跖趾关节角< 27°,即第1跖骨长轴与第1近节指骨长轴间的夹角减小,且(IMA1-2) < 12°,通过试验,选取的值分别为F1=50 N,F2=30 N,F3=30 N。第1次试验保持F2与F3的大小不变,等量增加F1的值,设定10组(A-J组),通过上述第1跖趾关节角和IMA1-2测量方式记录不同外力作用下对应跖趾关节角值、IMA1-2值及第1跖趾关节区域最大应力值,所得数据见表3与图7。"
由所得数据表3可知,随着F1的增加跖趾关节角减小,但持续增加F1值,见第J组数据,并不能使跖趾关节角继续减小,反而会增加;IMA1-2只有起初B组数据有明显的减小,随后F1增加,IMA1-2的值逐步增大。图7为A-J组外力作用下拇外翻足拇趾形变模拟图,可以看到B-G组有直观明显的矫正效果,而H-J组由于外力过大而产生了畸变,结合表3数据,认为G组F1数据已经达到矫正效果,H-J组的数据不具有参考性。 图8为10组外力作用下第1跖趾关节区域应力分布情况,观察可知B-J组与A组相比,拇趾近节趾骨上的应力集中现象由上下侧分布变为内外两侧分布;且由图9可知,随着F1的增加,von Mises应力最大值增大;第1跖骨内外两侧的应力也随F1的增大而增大。"
选取上述G组数据,保持作用在第1拇趾远节趾骨外侧中部区域水平力F1、作用在跖骨近端内侧面水平力F3不变,改变作用于足跖趾关节内侧囊处区域F2的大小,分为8组(G-G7组),观察跖趾关节角及IMA1-2的变化,见表4。对于跖趾关节角,随着F2的增加,其数值先增加后减小再增加,在G5后随F2的增加跖趾关节角不能继续减小。图10为拇趾形变及骨骼位移对比图,可以证明F2的变化对第1跖趾关节角度影响不大;IMA1-2的值随着F2的增加,持续减小,G7组与G组下IMA1-2差值为-3.34,说明对其影响较明显。图11,12分别为8组力作用下第1跖骨及近节趾骨应力分布及数值变化,可以看出F2对第1跖骨应力分布及大小影响较小,但可一定程度上减小近节趾骨上的应力集中现象。"
综上选取G5组数据完成下面的研究,保持作用在第1拇趾远节趾骨外侧中部区域水平力F1、作用在足跖趾关节内侧囊处区域F2不变,改变作用在跖骨近端内侧面水平力F3的大小,分为8组(G5至G5-7组),观察跖趾关节角及IMA1-2的变化。观察表5可知,随着F3的增加,G5到G5-4组跖趾关节角的值减小,但最大差值只有-0.39,而F3由500 N继续增加,跖趾关节角开始增大,见G5-5、G5-6、G5-7组数据;对于IMA1-2值,同样在G5到G5-5组,随F3的增加而减小,F3由500 N继续增加使得IMA1-2值开始增大,从图13,14也可看出,在G5-5组数据后第1跖骨及近节趾骨von Mises应力出现增加及波动。观察图15骨骼位移变化及拇趾的形变情况可知F3的变化对于第1跖趾关节区域的影响较小。"
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