标题：缝合锚钉固定下胫腓联合损伤对距骨应力分布影响的有限元分析

      作者：梁远，王静成，何金山，张佩，卢志华，王骅，吴志朋，张文东，白建中，陈鹏涛    (扬州大学临床医学院，苏北人民医院，江苏 扬州 225001)

      卷次： 2018年29卷15期

      【摘要】 目的 利用有限元方法分析缝合锚钉固定下胫腓联合损伤对距骨应力分布的影响。方法 选取1例下胫腓联合损伤患者右踝螺旋CT扫描图像，利用Mimics 10.01等软件进行骨骼的三维重建、模拟韧带连接和生成关节接触等，在模型中分别采用下胫腓螺钉和缝合锚钉固定下胫腓联合损伤，模拟前抽屉试验、内翻试验、内旋试验时所受外力，进行加载运算。结果 下胫腓螺钉：踝关节位于背屈20°、背屈10°、中立位、跖屈10°、跖屈20°，在模拟前抽屉试验时距骨的应力分别为6.496 MPa、5.653 MPa、3.882 MPa、5.875 MPa、6.946 MPa。在模拟内翻试验时距骨的应力分别为7.543 MPa、6.765 MPa、5.432 MPa、6.269 MPa、6.843 MPa。在模拟内旋试验时距骨的应力分别为8.269 MPa、7.541 MPa、6.712 MPa、7.668 MPa、8.683 MPa。缝合锚钉：踝关节位于背屈20°、背屈10°、中立位、跖屈10°、跖屈20°，在模拟前抽屉试验时距骨的应力分别为3.327 MPa、3.253 MPa、2.122 MPa、2.713 MPa、3.795 MPa。在模拟内翻试验时距骨的应力分别为4.475 MPa、4.113 MPa、3.351 MPa、4.352 MPa、4.795 MPa。在模拟内旋试验时距骨的应力分别为5.382 MPa、4.615 MPa、3.985 MPa、4.727 MPa、5.352 MPa。结论 通过有限元分析，相对于下胫腓螺钉而言，缝合锚钉固定下胫腓联合损伤可减轻距骨应力集中，且更符合下胫腓联合韧带的生物力学特征。
      【关键词】 下胫腓联合损伤；缝合锚钉；有限元分析
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2018）15—2097—03

Finite element analysis of the effect of suture anchor fixation for inferior tibiofibular syndesmosis injury on thestress distribution of talus.
LIANG Yuan, WANG Jing-cheng, HE Jin-shan, ZHANG Pei, LU Zhi-hua, WANG Hua, WUZhi-peng, ZHANG Wen-dong, BAI Jian-zhong, CHEN Peng-tao. Department of Clinical Medicine, Yangzhou University,the Subei People's Hospital, Yangzhou 225001, Jiangsu, CHINA
【Abstract】 Objective To analyze the effect of suture anchor fixation for inferior tibiofibular syndesmosis inju-ry on the stress distribution of talus by finite element method. Methods One right ankle spiral CT scanning image of apatient with inferior tibiofibular syndesmosis injury was loaded. Software such as Mimics 10.01 was used to performthree-dimensional reconstruction of the bone and to simulate the ligament connection and joint contact. In the model, thelower tibiofibular screw and the suture anchor fixation were used to treat the inferior tibiofibular syndesmosis injury, re-spectively. Then some loading operations were carried out including external force simulated in the anterior drawer, thevarus and the internal rotation test. Results Ankles were tested at 20° and 10° of dorsiflexion, neutral position, 10° and20° of plantar flexion. The stress of the talus treated by the lower tibiofibular screw in the simulated anterior drawer testwas 6.496 MPa, 5.653 MPa, 3.828 MPa, 5.875 MPa, 6.946 MPa, respectively, 7.543 MPa,6.765 MPa, 5.432 MPa, 6.269MPa, 6.843 MPa in the simulated varus test, and 8.269 MPa, 7.541 MPa, 6.712 MPa, 7.668 MPa, 8.683 MPa in the simu-lated internal rotation test. Then the stress of the talus treated by the suture anchor in the simulated anterior drawer testwas 3.327 MPa, 3.253 MPa, 2.122 MPa, 2.713 MPa, 3.795 MPa, respectively, 4.475 MPa, 4.113 MPa, 3.351 MPa, 4.352MPa, 4.795 MPa in the simulated varus test, and 5.382 MPa, 4.615 MPa, 3.985 MPa, 4.727 MPa, 5.352 MPa in the simu-lated internal rotation test. Conclusion Based on the finite element analysis, the suture anchor fixation can reduce thestress concentration of the talus compared to lower tibiofibular screw for inferior tibiofibular syndesmosis injury, and itis more consistent with the biomechanical characteristics of the tibiofibular ligament.
      【Key words】 Inferior tibiofibular syndesmosis injury; Suture anchor; Finite element analysis·论 著·doi:10.3969/j.issn.1003-6350.2018.15.008基金项目：江苏省扬州市自然科学基金青年人才项目(编号：YZ2016109)；扬州大学临床医学院技术项目(编号：fcjs201623)