| 螺钉固定与Tight-rope固定治疗下胫腓前联合损伤的初步有限元分析 |
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投稿时间：2018-05-10
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| 作者 | Author | 单位 | Address | E-Mail |
| 刘忠鑫 |
LIU Zhong-xin |
中国医科大学附属盛京医院创伤骨科, 辽宁 沈阳 110004 |
Department of Orthopaedic Trauma, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China |
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| 王维 |
WANG Wei |
中国医科大学附属盛京医院创伤骨科, 辽宁 沈阳 110004 |
Department of Orthopaedic Trauma, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China |
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| 张欣 |
ZHANG Xin |
中国医科大学附属盛京医院创伤骨科, 辽宁 沈阳 110004 |
Department of Orthopaedic Trauma, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China |
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| 杨军 |
YANG Jun |
中国医科大学附属盛京医院创伤骨科, 辽宁 沈阳 110004 |
Department of Orthopaedic Trauma, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China |
yangj1@sj-hospital.org |
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| 期刊信息：《中国骨伤》2018年，第31卷，第10期，第937-943页 |
| DOI：10.3969/j.issn.1003-0034.2018.10.012 |
| 基金项目: |
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中文摘要:
目的：建立下胫腓前联合损伤（anterior inferior tibiofibular syndesmosis injuries，AITSI）螺钉固定及Tight-rope固定（TR）模型，比较其受力及位移情况，为临床诊治提供依据。
方法：选取1例正常人的踝关节CT图像建立3D模型。然后建立AITSI损伤模型，对损伤模型置入螺钉得到螺钉固定模型，使用Tight-rope固定得到TR模型。分析各模型单脚站立时的中立位、踝关节内旋以及外旋3种受力情况，观察胫腓骨及距骨关节面应力变化，以及胫腓骨远端位移情况。
结果：AITSI导致胫腓骨及距骨关节面受力增加，胫腓骨位移增加。使用螺钉固定及TR均能有效减少AITSI导致的胫腓骨远端过度位移，但在螺钉固定模型中，胫腓骨位移明显小于正常模型，且胫腓骨远端及距骨关节面受力增大，螺钉受力集中。螺钉固定模型中的胫骨及腓骨最大受力为TR模型的1.3倍以上，距骨关节面接触力为1.8倍，螺钉固定模型中下胫腓前韧带胫骨附着点位移约为正常模型的0.6倍，而TR模型中该数据约为正常模型的1.1倍，但TR对于腓骨位移控制欠佳。
结论：严重的下胫腓前联合损伤将改变踝关节受力及位移情况，应该行内固定治疗。下胫腓联合螺钉及TR都能有效地治疗下胫腓前联合分离，Tight-rope固定相较于螺钉固定在骨骼受力、踝关节微动及内固定物断裂方面具有优势，但存在腓骨旋转控制欠佳的劣势。伴有Weber C型踝关节骨折以及肥胖的患者更适合螺钉固定。 |
| 【关键词】踝关节 外固定器 有限元分析 |
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| Preliminary finite element analysis of anterior inferior tibiofibular syndesmosis injuries treated with screw and tight-rope fixation |
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ABSTRACT
Objective:To establish finite element models of anterior inferior tibiofibular syndesmosis injuries (AITSI),screw fixation and Tight-rope(TR) fixation,and to compare its force and displacement,so as provide evidence for clinical diagnosis and treatment.
Methods:A three-dimensional model of a healthy ankle complex was developed by computed tomography (CT) images,and anterior inferior tibiofibular syndesmosis injuries(AITSI) model also established,then a screw was inserted into AITSI model to obtain a screw fixation model,and a Tight-rope system was put into AITSI model to obtain a TR model. Simulated loads were applied under three conditions:neutral position with single-foot standing,internal and external rotation of the ankle. The focus was on the stress of distal tibia,distal fibula and talus articular surface,and displacement of distal tibia and fibula.
Results:AITSI increased the stress of distal tibia,distal fibula and talus articular surface,which also increased the displacement of distal tibia and fibula. when AITSI existing,either a screw or TR could restrict excessive displacement of distal tibia and fibula. However,screw fixation severely limited normal physiological activity of ankle,and increased the force of distal tibia,distal fibula and articular surface of talus. The forces were concentrated on the screw. In the screw fixation model,the maximum force of tibia and fibula was more than 1.3 times that of TR model,and the contact force of talus articular surface was about 1.8 times. In the screw fixation model,the displacement of tibial attachment point of anterior tibiofibular ligaments was approximately 0.6 times that of the normal model. While the data in the TR model is about 1.1 times,but TR has poor control of the displacement of fibula.
Conclusion:Severe anterior inferior tibiofibular syndesmosis injuries could cause stress and displacement distribution of ankle joint to change ankle instability and should be treated with internal fixation. Both of the screw and TR could be effective for AITSI. Tight-rope has advantages over screw fixation in terms of skeletal force,activity of ankle joint,and internal fixation fracture,but Tight-rope has disadvantage in fibular rotation. Patients with Weber type C ankle fractures and obesity are more suitable for screw fixation. |
| KEY WORDS Ankle joint External fixators Finite element analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘忠鑫,王维,张欣,杨军.螺钉固定与Tight-rope固定治疗下胫腓前联合损伤的初步有限元分析[J].中国骨伤,2018,31(10):937~943 |
| 英文格式: | LIU Zhong-xin,WANG Wei,ZHANG Xin,YANG Jun.Preliminary finite element analysis of anterior inferior tibiofibular syndesmosis injuries treated with screw and tight-rope fixation[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(10):937~943 |
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