中西医结合微创技术治疗拇外翻截骨端稳定性生物力学机制的有限元研究

Wen's procedure (Minimal incision osteotomy )treat hallux abducto valgus ,which is basic on tendon bundle bone in TCM theory,and pressure pad of paper under the splint.Bandage of "8" elastic fixation, Abandon the traditional fixed by screw plate and cast, Wear orthopedic shoes and walk after operation,so the patients can take care of themselves. However, this method is questioned by some orthopedic scholars, the osteotomy must remain stable to heal, osteotomy do not within fixed and do not use orthopaedic local brake,it will affect stability,may occur osteotomy delayed union and nonunion. The fact is that in clinical observation after many years, the method did not appear these situation. How explain the mechanism of the '8' bandage fixation stability through the scientific method? Whether the effect healing of osteotomy to patients with early walk aroud after operation? These problems still need to do in-depth study.Our study through the establishment of hallux valgus osteotomy finite element model research, ①soft tissue affect for the stability of osteotomy, confirmed the therapy based on the "tendon bundle bone"is scientific; ②the "8" bandage elastic external fixation system for osteotomy terminal effects in displacement and stress, it is proved that the system can effectively maintain broken end stability; ③the external fixation after osteotomy of the gait cycle end displacement and stress change, proved the end to maintain stability, consistent with the stress environment for osteotomy healing. Through the above research, further expounds the combination of traditional Chinese and Western medicine treatment of hallux valgus biomechanics, as the method provide a scientific basis to promotion and application.

中西医结合治疗拇外翻依据小夹板纸夹垫原理及"筋束骨"理论，采用8字绷带弹性固定截骨端，摒弃传统钢板螺钉固定和石膏固定，术后可下地行走。此方法受到部分骨科学者的质疑，截骨端必须保持稳定才能愈合，截骨不做内固定，又不制动，会影响稳定性，可能会出现截骨延迟愈合和不愈合。但该方法经过近二十年全国2万余例临床观察，并未出现上述情况。如何通过科学方法说明8字绷带外固定稳定的机理？患者早期行走是否影响截骨端愈合？这些问题尚需做深入研究。本课题在原课题研究的基础上通过拇外翻足截骨有限元模型研究①软组织对截骨端稳定性的影响，证实"筋束骨"理论的科学性；②8字绷带弹性外固定系统对截骨端的位移和应力影响，证明该方法能有效维持断端稳定；③外固定后步态周期中截骨端的位移和应力变化，证明断端能维持稳定，符合截骨愈合的应力环境。通过以上研究，进一步阐述中西医结合治疗拇外翻的生物力学机制，为该方法的推广运用提供科学依据。

中西医结合治疗拇外翻依据小夹板纸夹垫原理及“筋束骨”理论，采用8字绷带弹性固定截骨端，摒弃传统钢板螺钉固定和石膏固定，术后可下地行走。此方法受到部分骨科学者的质疑，截骨端必须保持稳定才能愈合，截骨不做内固定，又不制动，会影响稳定性，可能会出现截骨延迟愈合和不愈合。但该方法经过近二十年全国2万余例临床观察，并未出现上述情况。如何通过科学方法说明8字绷带外固定稳定的机理？患者早期行走是否影响截骨端愈合？这些问题尚需做深入研究。本课题在原课题研究的基础上通过拇外翻足截骨有限元模型研究①软组织对截骨端稳定性的影响，证实“筋束骨”理论的科学性；②8字绷带弹性外固定系统对截骨端的位移和应力影响，证明该方法能有效维持断端稳定；③外固定后步态周期中截骨端的位移和应力变化，证明断端能维持稳定，符合截骨愈合的应力环境。.通过以上研究，进一步阐述中西医结合治疗拇外翻的生物力学机制，为该方法的推广运用提供科学依据。课题成功建立了足拇外翻模型，验证了模型的有效性，无外固定工况最大相对位移0.101mm，有外固定工况最大相对位移0.046mm，经单因素方差分析，有/无外固定工况4个节点相对位移存在统计学差异（P<0.05）。第1波峰工况总位移0.133mm，Von Mises应力1.3 MPa；波谷时工况总位移0.183mm，Von Mises应力3.4 MPa；第2波峰工况总位移0.115mm，Von Mises应力24.8 MPa。X轴相对位移、Z轴相对位移和总相对位移有显著性差异（P<0.01），而Y轴位移无统计学差异（P>0.05），证实了在该外固定法可以维持截骨端相对稳定，应力适中，有利于截骨端骨折愈合，是一种安全、有效的外固定方法。