CAJ | 학술논문

目的通过有限元分析的方法研究骨密度对于距下关节融合初稳性的影响. 方法选取1名男性健康志愿者,25岁,体质量为70kg.基于志愿者右足的三维CT扫描数据利用Mimics 13.0、Geomagic 10.0等软件重建距下关节融合的三维有限元双顶模型:即距骨颈联合距骨顶前外、后外、前内、后内侧4种双钉模型,同时通过降低骨的弹性模量模拟不同程度的疏松骨质,最后将模型导入Abaqus 6.9软件进行赋值、划分网格,对每个模型施加4N·m的内旋、外旋作用力,通过计算分析模型应力后距下关节面间的相对位移来评估骨密度对距下关节融合初稳性的影响. 结果随着骨密度的降低,4种融合模型应力后关节面间的相对位移峰值均增大；距骨颈联合距骨前外侧顶的双钉模型在正常骨密度和骨质疏松存在的情况下,其应力后关节面间相对位移峰值均较其他模型低,是距下关节融合最优的选择；而距骨颈联合距骨后内侧顶的双钉模型,应力后关节面间相对位置峰值最大,关节融合时应避免使用此种配置. 结论骨密度越低融合后稳定性越差；距骨颈联合前外侧顶双钉模型对于正常或疏松骨质的距下关节融合都具有最好的稳定性,是距下关节融合最优的选择.
목적 통과유한원분석적방법연구골밀도대우거하관절융합초은성적영향. 방법 선취1명남성건강지원자,25세,체질량위70kg.기우지원자우족적삼유CT소묘수거이용Mimics 13.0、Geomagic 10.0등연건중건거하관절융합적삼유유한원쌍정모형:즉거골경연합거골정전외、후외、전내、후내측4충쌍정모형,동시통과강저골적탄성모량모의불동정도적소송골질,최후장모형도입Abaqus 6.9연건진행부치、화분망격,대매개모형시가4N·m적내선、외선작용력,통과계산분석모형응력후거하관절면간적상대위이래평고골밀도대거하관절융합초은성적영향. 결과 수착골밀도적강저,4충융합모형응력후관절면간적상대위이봉치균증대；거골경연합거골전외측정적쌍정모형재정상골밀도화골질소송존재적정황하,기응력후관절면간상대위이봉치균교기타모형저,시거하관절융합최우적선택；이거골경연합거골후내측정적쌍정모형,응력후관절면간상대위치봉치최대,관절융합시응피면사용차충배치. 결론 골밀도월저융합후은정성월차；거골경연합전외측정쌍정모형대우정상혹소송골질적거하관절융합도구유최호적은정성,시거하관절융합최우적선택.
Objective To assess the effect of bone density on the initial stability of subtalar arthrodesis by means of finite element analysis.Methods A volunteer was enrolled for this study who were 25 years old and 70 kg in weight.Four 3D finite element models of double-screw subtalar arthrodesis were reconstructed using Mimics 13.0 and Geomagic 10.0 software based on the 3D images of the volunteer's right foot,i.e.models of a talar neck screw plus an anterolateral,posterolateral,anteromedial and posteromedialdomescrew.Poor bone quality was simulated by uniformly decreasing Young' s modulus of the bone elements originally assigned from the CT scan images.The models were next imported into software Abaqus 6.9 for assignment and meshing before external and internal rotation torques of 4 N · m were applied and micromotions at the bone-to-bone interface were measured to evaluate the initial stability of subtalar arthrodesis.Results With reduction in bone density,the peak micromotions at the fusion site increased correspondingly in the 4 models.The model of a neck screw plus an anterolateral dome screw seemed the most stable,especially at decreased bone density,because the peak micromotions at fusion site of this fixation configuration were the lowest compared with other fixation configurations.With reduction in bone density,the double-screw model of a neck screw plus posteromedial dome screw showed the most unstable subtalar arthrodesis because the peak micromotions at the bone-to-bone interface were the highest.Conclusions A lower bone mineral density may result in a lower initial stability of subtalar arthrodesis.Fixation with a neck screw plus an anterolateral dome screw is the best configuration for patients with low bone density as well as for those with normal bone density.