克氏针和绷带固定对微创术后拇外翻的生物力学影响

Biomechanical Study on Kirschner and Bandage Fixation for Treatment of Hallux Valgus after Minimally Invasive Surgery

目的研究第1跖骨远端截骨后克氏针和绷带固定对拇外翻的作用效果。方法通过拇外翻的医学影像数据建立完整的三维足部有限元模型,此模型包括足骨、籽骨、软骨、韧带、软组织、跟腱等;分别建立克氏针和绷带固定的模型,分析拇外翻平衡站立时的足部受载特点。结果绷带固定下截骨之间的压应力（14.9 MPa）大于克氏针峰值应力（6.71 MPa）。从背侧、跖侧、内侧、外侧来看,克氏针固定对截骨面的稳定作用都优于绷带固定,更有利于截骨面的稳定。结论绷带固定可减少截骨端的愈合时间,有利于临床上拇外翻术后固定方式的优化选择。

Objective To investigate the effect of Kirschner and bandage fixation on the hallux valgus（ HV） after distal osteotomy of the first metatarsus. Methods A comprehensive three-dimensional finite-element model of the foot was established based on medical images of the foot of a patient with HV,including bones,sesamoid,cartilage,ligaments,soft tissues,and Achilles tendon. The models of Kirschner and bandage fixation were also established to investigate the biomechanical behavior of the foot with HV during full weight-bearing standing. Results The compressive stress（ 14. 9 MPa） between the osteotomy fragment surfaces in bandage fixation was higher than the peak stress of the Kirschner needle（ 6. 71 MPa）. The Kirschner fixation was better than the bandage fixation from the dorsal,plantar,medial,and lateral foot. Therefore,it was more favorable for the stability of the osteotomy. Conclusions The bandage fixation can reduce the healing time of osteotomy,providing an optimal design for fixation methods after hallux valgus operations.