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三种空心钉构型踝关节融合的有限元分析

A finite element analysis on ankle joint fusion with three cannulated screw configurations

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[目的]通过有限元分析,研究空心钉不同构型对镜下踝关节融合稳定性的影响.[方法]选择1例37岁男性志愿者为研究对象,螺旋CT自膝关节至足底进行薄层扫描,获得DICOM图像导入到Mimics中分割跟骨、距骨、胫骨、腓骨三维点云,Geomagic、Hypermesh中模拟构建踝关节有限元模型,分别建立正常对照模型和双钉平行、双钉交叉和三钉交叉的踝关节融合模型.观察模型中胫距关节面相对位移、Mises应力峰值及平均Mises应力.[结果]载荷下双钉平行组位移显著大于双钉交叉组和三钉交叉组,包括跖屈[(106.2±8.6)µm vs(58.9±4.5)μm vs(58.5±4.1)µm,P<0.001],内旋[(101.6±6.4)µm vs(59.1± 4.4)μm vs(58.5±4.0)μm,P<0.001]和外旋[(101.5±6.6)μm vs(58.5±4.6)µm vs(58.3±4.2)µm,P<0.001],而双钉交叉组和三钉交叉组之间差异无统计学意义(P>0.05).双钉平行组空心钉的应力峰值大于双钉交叉组和三钉交叉组,其中站立状态下(65.5 MPa,51.3 MPa,50.5 MPa),双钉平行组胫距关节平均Mises应力显著小于双钉交叉组、三钉交叉组(P<0.05),双钉交叉组、三钉交叉组之间差异无统计学意义(P>0.05).[结论]双钉交叉组、三钉交叉组空心钉构型的稳定性优于双钉平行组,有利于提高镜下踝关节融合的成功率.
[Objective]To explore the effect of different configurations of cannulated screws on the stability of ankle joint fusion by fi-nite element analysis.[Methods]Thin-layer scan from knee joint to sole was performed in a 37-year-old male volunteer by spiral CT,and DICOM images were obtained and imported into Mimics to segment three-dimensional point clouds of calcaneus,talus,tibia and fibula,and then,the finite element model of ankle joint was simulated in Geomagic and Hypermesh.The normal control model and the ankle joint fusion models with double screws parallel(DSP),double screws crossover(DSC)and triple screws crossover(TSC)were established respec-tively.The relative displacement of the tibial talar joint surface,the Mises stress peak value and the mean Mises stress in the model were ob-served.[Results]The DSP group proved significantly greater than the DSC and TSC groups in term of displacements under loading,includ-ing plantar flexion[(106.2±8.6)μm vs(58.9±4.5)μm vs(58.5±4.1)μm,P<0.001]internal rotation[(101.6±6.4)μm vs(59.1±4.4)pm vs(58.5±4.0)μm,P<0.001]and external rotation[(101.5±6.6)μm vs(58.5±4.6)μm vs(58.3±4.2)μm,P<0.001],while there was no signifi-cant difference between the DSC and TSC groups(P>0.05).The DSP had significantly greater peaks Mises stress on the implant than DSC group and the TSC group(65.5 MPa,51.3 MPa,50.5 MPa).In addition,the Mises stress on the tibiotalar articular surface in the DSP group was significantly less than those in the DSC and the TSC groups(P<0.05),whereas which was not statistically significant between DSC group and TSC group(P>0.05).[Conclusion]The DSC and TSC have significantly better stability of the screw placement configuration than that in DCP placement,while good stability of the screw palcement is conducive to improving the success rate of arthroscopic ankle arthrod-esis.

ankle arthrodesisarthroscopyinternal fixationfinite element analysis

张宁、康颂科、李伟延、李强、朱涛

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山东第一医科大学附属人民医院手足外科,山东济南 271199

踝关节融合 关节镜 内固定 有限元分析

2024

中国矫形外科杂志
中国残疾人康复协会 中国人民解放军第八十八医院

中国矫形外科杂志

CSTPCD北大核心
影响因子:1.521
ISSN:1005-8478
年,卷(期):2024.32(8)
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