三步接骨法治疗Sanders Ⅱ型跟骨骨折的有限元研究

Finite element study on the treatment of Sanders type Ⅱ calcaneal fracture with three-step reduction method

目的量化评估三步接骨法治疗Sanders Ⅱ型跟骨骨折效能指标,阐明其科学机制。方法利用健康成年男性踝关节CT数据,构建正常足踝模型与Sanders Ⅱ型跟骨骨折模型,在骨折模型上进行三步接骨法的力学加载,模拟拔伸牵引、提按顶复、端挤捏骨等手法,评估跟骨复位情况并求解不同手法作用下力学的变化。结果建立正常足部模型与Sanders Ⅱ A/B/C型跟骨骨折模型;三步接骨法加载复位后跟骨长、高、宽、Gissane’s角及Bohler’s角得到明显纠正;求解不同手法的力学趋势,发现拔伸牵引法能有效纠正重叠位移,提按顶复法侧重纠正前后侧移位,端挤捏骨法致力纠正内外侧移位。结论三步接骨法通过依次纠正骨折位移,能恢复跟骨解剖结构,有效治疗跟骨SandersⅡ型损伤,具有有效性及科学性。

Objective To explore the feasibility and scientificity of the three-step reduction method for treating Sanders type Ⅱ calcaneal fracture,and to promote the optimization of the treatment plan for calcaneal fracture.Methods Using the CT data of healthy adult male ankle joints,normal ankle model and Sanders type Ⅱ calcaneal fracture model were constructed,and mechanical loading of the three-step reduction method was performed on the fracture model,simulating techniques such as traction,lifting and pressing,and pinching and joining ends.The reduction of the calcaneus before and after reduction was evaluated and the mechanical changes under different techniques were solved.Results Normal foot model and Sanders type Ⅱ A/B/C calcaneal fracture model were established.The calcaneal length,height,width,Gissane’s angle,and Bohler’s angle were significantly corrected after manual loading and reduction.By solving the mechanical trends of different techniques,it was found that traction effectively corrected overlapping displacement,pressing and pushing focused on correcting anterior-posterior displacement,and squeezing the bone ends aimed at correcting medial-lateral displacement.Conclusions The three-step reduction method can effectively treat Sanders type Ⅱ calcaneal fracture by correcting the fracture displacement and restoring the anatomical structure of the calcaneus in sequence,confirming the effectiveness and scientificity of this technique.