成人获得性可复性平足的生物力学研究进展

成人获得性扁平足主要由胫后肌腱功能不全引起,是足踝外科的常见病,其中以可复性平足最为多见。如何解释其发病机制并选择恰当的手术方式治疗是目前研究的热点。随着平足体外建模技术的日臻完善,生物力学试验的准确性和可重复性逐渐得到认可,其研究成果也成为临床平足治疗的重要理论依据。本文回顾了胫后肌腱功能不全导致平足的生物力学机制,及以此为基础在尸体标本和有限元模型上建立平足模型的各种不同方法,并对平足矫形相关基础研究中不同重建方法的生物力学特性进行分析比较。作者认为,在牵拉外在肌腱模拟其动力性稳定结构的前提下,采取破坏韧带等静力性稳定装置的方式建立起的可复性平足体外模型更为可靠;针对平足模型采用的各种重建方式的生物力学特性不尽相同,软组织重建应与骨性手术联合使用,而骨性手术需根据畸形程度和特点进行个性化的选择。

Advances in biomechanical studies of flexible adult-acquired flatfoot deformity

Adult-acquired flatfoot deformity (AAFD), which is mainly caused by posterior tibial tendon dysfunction (PTTD), is a common foot and ankle disease, and most of the deformities are flexible. How to explain the pathogenesis of AAFD and choose proper surgical treatment for the deformity has become a hot research focus nowadays. With the development of in vitro modeling technique for flatfoot, the accuracy and repeatability of the biomechanical tests have been gradually recognized, and the research results have also provided important theoretical basis for the clinical treatment of flatfoot deformity. In this article, the biomechanical mechanism of AAFD caused by PTTD, and the various modeling methods of flatfoot based on cadaver or finite element model were veviewed. The biomechanical characteristics of different reconstruction procedures in relative basic researches on flatfoot deformity were also analyzed and compared. The author believes that on the basis of simulating the dynamic stability of foot by tendon loading, the in vitro model of flexible flatfoot established by selective ligaments section is more reliable, and the reconstruction procedure adopted by various flatfoot models has different biomechanical characteristics. The soft tissue reconstruction and the bony procedures should be performed at the same time, and individual bony procedures should be chosen based on the degree and feature of the deformity.