Chevron截骨术对外翻足关节接触特征影响的生物力学研究

目的 探究Chevron截骨术截骨远端外侧位移距离对外翻足关节接触特征的影响，为临床上选择合适的位移距离提供参考依据。方法 测量踝关节中立位状态下正常足、外翻足及外翻足Chevron截骨术截骨远端分别向外侧位移2.0、4.0、6.0 mm后前足、中足和后足各关节接触力、峰值压强和接触面积，并对结果进行分析。结果 与正常足相比，外翻足第1跖楔关节（t=-3.33, P=0.02）、跟骰关节（t=-2.74, P=0.03）和距下关节（后关节面）（t=-2.89, P=0.03）的接触力显著增高；外翻足距舟关节（t=-2.73, P=0.03）与跟骰关节（t=-2.74, P=0.03）的峰值压强显著增高；行Chevron截骨术后，随着截骨远端向外侧位移距离的增加，外翻足第1跖楔关节和跟骰关节的接触力逐渐减小；外翻足距舟关节和跟骰关节的峰值压强逐渐减小。结论 中度外翻足行Chevron截骨术后，当第1跖骨截骨远端向外侧位移6 mm时能有效恢复部分关节间力的分布，且能缓解部分关节局部应力集中现象。

Biomechanical effect of the distal Chevron osteotomy on contact characteristics of foot joints of hallux valgus

Objective To explore the influence of the distal lateral displacement distance of Chevron osteotomy on contact characteristics of the hallux valgus, so as to provide reference for selecting suitable displacement distance in clinical practice. Methods The contact force, peak pressure and contact area of each joint of the forefoot, midfoot and hindfoot were measured in normal foot, hallux valgus foot, the distal Chevron osteotomy of the hallux valgus after the lateral displacement of 2.0, 4.0, 6.0 mm in the neutral position of the ankle joint, respectively. The results were compared and analyzed. Results Compared with the normal foot, the contact force of the 1st tarsometatarsal joint (t=-3.33, P=0.02), the calcaneocuboid joint (t=-2.74, P=0.03) and the subtalar joint (posterior articular surface) (t=-2.89, P=0.03) of hallux valgus foot significantly increased. The peak pressure of the talonavicular joint (t=-2.73, P=0.03) and the calcaneocuboid joint (t=-2.74, P=0.03) of the hallux valgus foot increased significantly. After Chevron osteotomy was performed, with the increasing of lateral displacement distance of distal osteotomy, the contact force of the 1st tarsometatarsal joint and the calcaneocuboid joint of hallux valgus foot decreased gradually; the peak pressure of the the talonavicular joint and the calcaneocuboid joint of hallux valgus decreased gradually. Conclusions After Chevron osteotomy is performed on moderate hallux valgus foot, when the distal end of the first metatarsal osteotomy is displaced outward by 4mm or 6mm, it can effectively restore the distribution of some inter articular forces and alleviate the local stress concentration of some joints.