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-  2016 

胫骨远端内外翻畸形对胫距关节接触的影响

DOI: doi:10.7507/1002-1892.20160169

Keywords: 踝关节畸形, 踝上截骨, 生物力学

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Abstract:

目的通过生物力学方法研究胫骨远端不同程度内外翻畸形对胫距关节接触情况的影响,以及腓骨截骨在其中的作用 方法选取8具新鲜下肢标本,通过踝上截骨建立胫骨远端内外翻模型,包括9种工况:正常中立位(A组),保留腓骨的10°内翻模型(B组)、5°内翻模型(C组)、5°外翻模型(D组)、10°外翻模型(E组),及截断腓骨后的10°内翻模型(F组)、5°内翻模型(G组)、5°外翻模型(H组)、10°外翻模型(I组)。通过TekScan踝关节压敏片法测试不同工况下胫距关节的接触面积、接触压强及峰值压强,观察胫距关节受力中心的位置变化。 结果B~E组接触面积、接触压强及峰值压强与A组比较差异均无统计学意义(P>0.05)。截断腓骨时,F、I组接触面积显著小于A组(P < 0.05),F、H、I组接触压强及F、I组峰值压强均显著大于A组(P < 0.05)。胫距关节在正常中立位载荷时,有前外侧和前内侧两个主要受力区域;关节整体的受力中心位于前外侧象限,接近关节中心区域。保留腓骨时,随着内翻角度的增大,受力中心向前外侧转移;随着外翻角度的增大,受力中心则向后内侧转移。截断腓骨时,受力中心的移位正好相反,内翻时向后内侧转移,外翻时则向前外侧转移。 结论腓骨的完整性对胫骨远端内外翻畸形的胫距关节接触情况有显著影响;临床中针对不同的畸形特征,应选择合适的截骨方式

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