微创治疗拇外翻截骨端位移与跖痛症量化关系的有限元分析

Finite element analysis of quantitative relationship between displacement of osteotomy end of hallux valgus and plantar pain

目的明确微创治疗拇外翻截骨端位移与发生转移性跖痛症之间的关系,结合有限元进行量化分析,为手术治疗转移性跖痛症提供精准数字化依据。方法首先基于拇外翻患者术前足部相关数据的测量建立真实的拇外翻几何模型,参考文献对志愿者各方面生物力学系数赋值,根据模拟中西医结合手法整复微创治疗拇外翻技术,对其第一跖骨进行旋转、移动及截骨,最终得到微创治疗拇外翻合并跖痛症术后有限元模型。通过模拟微创治疗拇外翻截骨端位移,利用有限元计算获取拇外翻患者手术前后的第1跖骨下与第2跖骨头下最大压力数值,分析截骨远端位移方向和位移量与发生转移性跖痛症的量化关系。结果平衡站立时,当第1跖骨截骨远端向外侧水平位移为2 mm时,随着垂直位移的增加,第1跖骨头下压力与第2跖骨头下压力变化具有明显相关性,r值为0.954;垂直位移在2 mm时,随着水平位移的增加,第1跖骨头下压力与第2跖骨头下压力变化相关性最大,r值为-0.764。结论微创治疗拇外翻在截骨的基础上通过正骨手法将第1跖骨截骨远端向外侧位移2~4 mm时、跖侧位移2 mm时,能够有效减轻或治愈拇外翻及并发的跖痛症,避免拇外翻术后转移性跖痛症的发生。

Objective To clarify the relationship between the displacement of osteotomy end of hallux valgus and the occurrence of metastatic metatarsal pain,and to provide accurate digital basis for surgical treatment of metastatic metatarsal pain with finite element analysis.Methods First of all,based on the measurement of foot related data of patients with hallux valgus before operation,the real geometric model of hallux valgus was established,and the biomechanical coefficients of volunteers were assigned according to the references.According to the simulation of minimally invasive treatment of hallux valgus by manipulative reduction and minimally invasive treatment of hallux valgus,the first metatarsal bone was rotated,moved and osteotomized Meta model.By simulating the displacement of osteotomy end of hallux valgus,the maximum pressure under the first metatarsal and the second metatarsal head before and after the operation of hallux valgus patients were obtained by finite element calculation,and the quantitative relationship between the displacement direction and displacement of distal osteotomy and the occurrence of metastatic metatarsal pain was analyzed.Results When the lateral displacement of the distal end of the first metatarsal osteotomy was 2 mm,along with the increase of vertical displacement,the pressure under the first metatarsal head was significantly correlated with the change of the pressure under the second metatarsal head(r=0.954);when the vertical displacement was 2 mm,with the increase of horizontal displacement,the first metatarsal head pressure had the greatest correlation with the second metatarsal head pressure,R value was-0.764.Conclusions On the basis of osteotomy,minimally invasive treatment of hallux valgus can effectively reduce or cure hallux valgus and the concomitant metatarsal pain when the distal end of the first metatarsal osteotomy is displaced 2-4 mm outwards and the metatarsal displacement is 2mm,which can effectively avoid the occurrence of metastatic metatarsal pain after hallux valgus surgery.