微型钢板联合超强缝线弹性固定治疗拇外翻畸形的有限元分析

Finite element analysis of the treatment of hallux valgus deformity by microplate combined with super strong suture elastic fixation

背景:目前截骨治疗拇外翻为主流的手术治疗方式,但存在众多的并发症。第1,2跖骨间弹性固定治疗拇外翻是一种新的手术方式。目的:应用有限元分析的方法,对第1,2跖骨间固定治疗拇外翻进行力学分析,为临床治疗提供理论数据。方法:收集苏州大学附属常州肿瘤医院骨科的1例女性拇外翻患者的CT数据建立拇外翻有限元模型,对有限元模型进行3个手术位点的分组:A组为自第1跖骨远节基底部至第2跖骨远节基底部;B组为自第1跖骨远节基底部至第2跖骨中段;C组为自第1跖骨远节基底部至第2跖骨近节基底部,在3组模型分别实施第1,2跖骨间固定纠正拇外翻角至9°,分析各组固定后应力及形变情况。研究方案符合常州市肿瘤医院的相关伦理要求(伦理批号:2019-SY-031,审批时间:2019),并获得患者及其家属知情授权。结果与结论:(1)在3组手术位点实施手术方案后,A组的全足应力为202.43MPa,形变1.71 mm,第1跖骨应力为37.38 MPa,形变为1.71 mm,第2跖骨应力为1.16 MPa,形变为0.005 mm;B组的全足应力为220.58 MPa,形变1.47 mm,第1跖骨应力为29.26 MPa,形变为1.47 mm,第2跖骨应力为0.94 MPa,形变为0.0045 mm;C组的全足应力为141.94 MPa,形变1.07 mm,第1跖骨应力为23.62 MPa,形变为1.07 mm,第2跖骨应力为1.43 MPa,形变为0.0032 mm;(2)结果表明,手术位点为自第1跖骨远节基底部至第2跖骨远节基底部或第2跖骨中段具有较高的形变能力,更利于拇外翻角的矫正。

BACKGROUND:At present,the osteotomy is the mainstream surgical method,and there are many complications.Elastic fixation between the first and second metatarsals is a new surgical method for hallux valgus.OBJECTIVE:Using the method of finite element analysis,the treatment of hallux valgus with fixation between the first and second metatarsals was studied,which provided theoretical data for clinical treatment.METHODS:CT data of a female patient with hallux valgus in Changzhou Tumor Hospital Affiliated to Soochow University were collected to establish a finite element model of hallux valgus.Three surgical sites were divided into group A(from the base of the distal first metatarsal to the base of the distal second metatarsal);group B(from the base of the distal first metatarsal to the middle segment of the second metatarsal);group C(from the base of the distal segment of the first metatarsal to the base of the proximal segment of the second metatarsal).The first metatarsal and the second metatarsal were fixed respectively to correct the hallux valgus angle to 9 degrees in the three groups to analyze stress and deformation after fixation.The protocol was conducted in accordance with relevant ethical requirements of Changzhou Tumor Hospital(approval No.2019-SY-031;date:2019).Patients and their family signed the informed consent.RESULTS AND CONCLUSION:(1)After implementing the surgical plan at the three groups of surgical sites,in group A,the total foot stress was 202.43 MPa,and the deformation was 1.71 mm;the first metatarsal stress was 37.38 MPa,and the deformation was 1.71 mm;the second metatarsal stress was 1.16 MPa,and the deformation was 0.005 mm.In group B,the stress of the whole foot was 220.58 MPa,and the deformation was 1.47 mm;the first metatarsal stress was 29.26 MPa,and the deformation was 1.47 mm;the second metatarsal stress was 0.94 MPa,and the deformation was 0.0045 mm.In group C,the total foot stress was 141.94 MPa,and the deformation was 1.07 mm;the first metatarsal stress was 23.62 MPa,and the deformation was 1.07 mm;the second metatarsal stress was 1.43 MPa,and the deformation was 0.0032 mm.(2)The results showed that the surgical site from the base of the distal first metatarsal to the base of the distal second metatarsal or the middle segment of the second metatarsal had higher deformation ability,which was more conducive to the correction of hallux valgus angle.