Haraguchi Naoki, Armiger Robert S, Myerson Mark S, Campbell John T, Chao Edmund Y S
Department of Orthopaedic Surgery, West Tokyo Metropolitan Police Hospital, 4-8-1 Nishimotomachi, Kokubunji-shi, Tokyo 185-0023, Japan.
Foot Ankle Int. 2009 Feb;30(2):177-85. doi: 10.3113/FAI-2009-0177.
Our goal was to quantify and visualize the three-dimensional loading relationship between the ligaments and articular surfaces of the ankle to identify and determine the stabilizing roles of these anatomical structures during the stance phase of gait.
We applied discrete element analysis to computationally model the three-dimensional contact characteristics and ligament loading of the ankle joint. Physiologic loads approximating those at five positions in the stance phase of a normal walk cycle were applied. We analyzed joint contact pressures and periankle ligament tension concurrently.
Most ankle joint loading during the stance phase occurred across the articular surfaces of the joint, and the amount of ligament tension was small. The tibiotalar articulation showed full congruency throughout most of the stance phase, with peak pressure developing anteriorly toward the toe-off frame. Of the periankle ligaments, the deep deltoid ligament transferred the most force during the stance phase (57.2%); the superficial deltoid ligament transferred the second-most force (26.1%). The anterior talofibular ligament transferred force between the talus and fibula continuously, whereas the calcaneofibular ligament did not carry force during gait. The distal tibiofibular ligaments and the interosseous membrane were loaded throughout the stance phase.
Force transmission through the ankle joint during the stance phase is predominantly through the articular surfaces, and the periankle ligaments do not play a major stabilizing role in constraining ankle motion. The medial ligaments have a more important role than do the lateral ligaments in stabilizing the ankle joint.
In addition to ligament insufficiency, other factors, such as varus tilt of the tibial plafond, may be important in the development of recurrent instability. Continuous loading of syndesmosis ligaments provides a theoretical basis for evidence of syndesmosis screw breakage or loosening. The analysis method has potential applications for clarifying ankle joint function and providing a basis for comparison between normal and abnormal joint conditions.
我们的目标是量化并可视化踝关节韧带与关节面之间的三维负荷关系，以识别并确定这些解剖结构在步态站立期的稳定作用。
我们应用离散元分析对踝关节的三维接触特征和韧带负荷进行计算建模。施加了接近正常步行周期站立期五个位置负荷的生理负荷。我们同时分析了关节接触压力和踝关节周围韧带张力。
站立期大部分踝关节负荷发生在关节的关节面上，韧带张力较小。胫距关节在大部分站立期显示完全吻合，峰值压力在向前蹬离阶段向前发展。在踝关节周围韧带中，深层三角韧带在站立期传递的力最大（57.2%）；浅层三角韧带传递的力次之（26.1%）。距腓前韧带持续在距骨和腓骨之间传递力，而跟腓韧带在步态中不传递力。胫腓远侧韧带和骨间膜在整个站立期均承受负荷。
站立期通过踝关节的力传递主要通过关节面，踝关节周围韧带在限制踝关节运动方面不发挥主要稳定作用。内侧韧带在稳定踝关节方面比外侧韧带发挥更重要的作用。
除了韧带功能不全外，其他因素，如胫骨平台内翻倾斜，可能在复发性不稳定的发生中起重要作用。下胫腓韧带的持续负荷为下胫腓螺钉断裂或松动的证据提供了理论基础。该分析方法在阐明踝关节功能以及为正常和异常关节状况的比较提供依据方面具有潜在应用价值。
