Effects of Ankle Arthrodesis on Biomechanical Performance of the Entire Foot.
Effects of Ankle Arthrodesis on Biomechanical Performance of the Entire Foot.
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踝关节融合术对全足生物力学性能的影响
DOI：
10.1371/journal.pone.0134340
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Zhang M
中科院分区：
文献类型：
--
作者：
Wang Y;Li Z;Wong DW;Zhang M
踝关节融合术是治疗踝关节炎、慢性不稳定以及退行性畸形的一种常用手术方法。然而，诸如足部疼痛、关节关节炎和骨折等并发症可能会使患者遭受其他问题。了解足部内部生物力学对于评估踝关节融合术的效果至关重要，并为手术方案提供了一个基准。本研究旨在利用有限元分析了解踝关节融合术对整个足踝的生物力学影响。建立并验证了一个包含28块骨骼、103条韧带、足底筋膜、主要肌肉群以及包裹的软组织的足踝三维有限元模型。在三个步态瞬间（首次峰值、站立中期和第二次峰值）比较了正常足和进行踝关节融合术的足的生物力学性能。
预测了足底压力分布、关节接触压力和力、骨骼上的冯米塞斯应力以及足部变形的变化。与正常足相比，进行踝关节融合术的足的足底压力峰值升高，压力中心向前移动。距舟关节以及后足和中足的第一至第三跖列关节承受了大部分负荷，并且在踝关节融合术后承受的负荷大幅增加。术后距舟关节的平均接触压力预计为2.14兆帕，第一跖列关节的最大变化显示为80%。距下关节的接触力和压力在术后降低，这表明该关节的关节炎不一定是踝关节融合术的结果，而可能是先前存在的退行性变化的进展。术后在第二次峰值瞬间，第二和第三跖骨的冯米塞斯应力分别增加到52兆帕和34兆帕。这些变化可为踝关节融合术手术的结果评估提供指示。
Background/Methodology Ankle arthrodesis is one popular surgical treatment for ankle arthritis, chronic instability, and degenerative deformity. However, complications such as foot pain, joint arthritis, and bone fracture may cause patients to suffer other problems. Understanding the internal biomechanics of the foot is critical for assessing the effectiveness of ankle arthrodesis and provides a baseline for the surgical plan. This study aimed to understand the biomechanical effects of ankle arthrodesis on the entire foot and ankle using finite element analyses. A three-dimensional finite element model of the foot and ankle, involving 28 bones, 103 ligaments, the plantar fascia, major muscle groups, and encapsulated soft tissue, was developed and validated. The biomechanical performances of a normal foot and a foot with ankle arthrodesis were compared at three gait instants, first-peak, mid-stance, and second-peak. Principal Findings/Conclusions Changes in plantar pressure distribution, joint contact pressure and forces, von Mises stress on bone and foot deformation were predicted. Compared with those in the normal foot, the peak plantar pressure was increased and the center of pressure moved anteriorly in the foot with ankle arthrodesis. The talonavicular joint and joints of the first to third rays in the hind- and mid-foot bore the majority of the loading and sustained substantially increased loading after ankle arthrodesis. An average contact pressure of 2.14 MPa was predicted at the talonavicular joint after surgery and the maximum variation was shown to be 80% in joints of the first ray. The contact force and pressure of the subtalar joint decreased after surgery, indicating that arthritis at this joint was not necessarily a consequence of ankle arthrodesis but rather a progression of pre-existing degenerative changes. Von Mises stress in the second and third metatarsal bones at the second-peak instant increased to 52 MPa and 34 MPa, respectively, after surgery. These variations can provide indications for outcome assessment of ankle arthrodesis surgery.