Brilakis Emmanouil V, Kaselouris Evaggelos, Markatos Konstantinos, Mastrokalos Dimitrios, Provatidis Christopher, Efstathopoulos Nicolas, Chronopoulos Efstathios
3rd Orthopaedic Department of "Hygeia" General Hospital, Athens, Greece.
J Musculoskelet Neuronal Interact. 2019 Jun 1;19(2):234-244.
There is an inadequacy of conventional means to assess the surgical outcomes of a bunion surgery. We used the Finite Element Analysis for evaluating the typical Mitchell's procedure outcomes with or without bio-absorbable pins.
We developed a 3D FE model based on the CT images of a female volunteer with hallux valgus. A typical procedure was simulated on the foot model and two pins were virtually inserted for enhancing the fixation. We validated our model by comparing the predicted pressure results with the plantar pressure measured by a specific platform.
The comparison of the plantar pressure distribution revealed similar patterns. A greater displacement was observed on the medial side of the osteotomy, but it was decreased after using pins. The maximum average pressure under the 1 metatarsal head was decreased after the osteotomy. The respective pressure under the 3 and 5 metatarsal head was decreased more after using pins, while, under the 2 and 4 metatarsal head, an increase was developed.
The use of pins had no significant influence on the healing process but gave additional stability inside the osteotomy and could be used in cases where enhancement is needed. The surgeon should be familiar with the expected stress rising to the other metatarsal, considering the concomitant pathology or the additional interventions that should be performed.
传统方法在评估拇囊炎手术的手术效果方面存在不足。我们使用有限元分析来评估典型的米切尔手术在使用或不使用生物可吸收钢针情况下的效果。
我们基于一名患有拇外翻的女性志愿者的CT图像开发了一个三维有限元模型。在足部模型上模拟了一个典型手术，并虚拟插入两根钢针以增强固定效果。我们通过将预测的压力结果与由特定平台测量的足底压力进行比较来验证我们的模型。
足底压力分布的比较显示出相似的模式。在截骨术的内侧观察到更大的位移，但使用钢针后位移减小。截骨术后第一跖骨头下方的最大平均压力降低。使用钢针后，第三和第五跖骨头下方的各自压力降低得更多，而在第二和第四跖骨头下方则出现了增加。
使用钢针对愈合过程没有显著影响，但在截骨术内部提供了额外的稳定性，可用于需要增强效果的情况。考虑到伴随的病理情况或应进行的额外干预措施，外科医生应熟悉其他跖骨预期的应力增加情况。
