基于有限元法对摇拔戳手法治疗外侧踝关节韧带联合损伤的研究

目的：对外侧踝关节距腓前韧带与跟腓韧带联合损伤进行初步研究,分析摇拔戳手法治疗踝关节的作用机理和韧带联合损伤恢复过程中足踝的生物力学特性。方法：基于1例患有右侧足踝扭伤的男性志愿者进行CT扫描,使用Mimics 10.0,Solidworks 2016,Hypermesh 12.0,Abaqus 6.13软件建立足踝三维非线性有限元分析模型,并验证了模型有效性,结合临床研究,通过调整韧带弹性模量来模拟韧带损伤,对踝关节在不同治疗时期下的趾屈、背伸、内翻、外翻4种工况进行有限元模拟分析。结果：随着摇拔戳手法的治疗和韧带损伤的恢复,4种工况下胫距与腓距关节面的最大应力和受力较大的区域逐渐增大,最大受力韧带的应力值逐渐增大,距腓前韧带和跟腓韧带应力发生分散和转移,所受轴力逐渐减小。结论：通过有限元方法模拟摇拔戳手法的力学状况,直观看出足踝距腓前和跟腓韧带联合损伤治疗前后韧带、关节面受力的变化,将治疗效果进行量化,为该手法的临床推广及应用提供客观、科学依据。

Treatment of lateral ankle joint ligament sprain by shaking and poking manipulation based on finite element method

Objective To conduct a preliminary study on joint injuries of anterior and calcaneal fibular ligaments of the lateral ankle joint,and to analyze mechanism of action of shaking and poking in treating ankle joint and biomechanical properties of ankle during the recovery of joint injuries.Methods CT scan was performed on a male volunteer with right ankle sprain. Mimics 10.0,Solidworks 2016,Hypermesh 12.0 and Abaqus 6.13 software were used to establish 3D nonlinear finite element analysis model of foot and ankle,and the validity of model was verified. Combined with clinical study,the finite element simulation analysis was carried out on the toe flexion,dorsiflexion,varus and valgus of ankle joint under different treatment periods by adjusting elastic modulus of ligament to simulate ligament injury.Results With the treatment of shake and prick and recovery of ligament injury,the maximum stress and area with large stress on tibial pitch and fibular joint surface gradually increased under the four working conditions,and the stress value of the maximum stress ligament gradually increased,and the stress of the anterior and calcaneal fibular ligament dispersed and transferred,and the axial force gradually decreased.Conclusion The finite element method was used to simulate the mechanical condition of the shaking and stamping technique,and the changes of the forces of the ligament and articular surface before and after treatment of anterior and calcaneal ligament combined injury of ankle talus were intuitively observed. The treatment effect was quantified,and could provid objective and scientific basis for clinical promotion and application of this technique.