摘要
目的测量并计算正常后跟部形态学数据,依此设计解剖型跟骨外固定器。方法随机抽取100名符合选择标准的正常人群,获得200足后足数据,其中男45例,女55例;年龄19~67岁,平均43.9岁。根据人体工程学和局部解剖学原理,以直接测量模式分别测量负重站立位及平卧位后跟部形态学数据。负重站立位采用游标卡尺骨性标志测量法,测量后跟长、后跟宽、后跟高、内踝高、外踝高及后跟倾斜角(calcaneal pitch angle,CPA),并进行男女分组及左右足分组比较;平卧位采用3D点阵倒模测量法,测量平卧位后跟部形态。根据后跟部综合解剖形态立体数据,以AutoCAD 2019等三维工业设计软件设计解剖型跟骨外固定器。结果站立位游标卡尺测量法示,男性鞋码、后跟长、后跟宽、后跟高、内踝高、外踝高、CPA均显著大于女性(P<0.05)。除左足内踝高明显小于右足(t=?2.827,P=0.005)外,其余各指标左右足间比较差异均无统计学意义(P>0.05),从形态上基本可认为左右足为镜像对称关系。平卧位3D点阵倒模测量法测量示,后跟部为非正圆弧边,多组弧边总体在一个有限范围内波动。以上述数据为基础设计出一种解剖型跟骨外固定环,理论上能贴合解剖弧度,以便灵活构型。在此基础上分别设计出普通构型、加压构型及正畸构型,以满足不同程度足踝损伤的治疗需求。普通构型适用于关节内骨折块无移位或轻度移位的SandersⅠ、ⅡA、ⅡB型跟骨骨折患者,以简单固定为主;加压构型适用于关节内骨折块中度移位的SandersⅡC、ⅢA、ⅢB型以及舌型和撕脱型跟骨骨折患者,该构型以橄榄针斜拉固定方式来固定移位骨块;正畸构型适用于关节内骨折块严重移位或跟骨骨质重度缺损的SandersⅢC、Ⅳ型跟骨骨折患者,以多模块设计兼顾稳固固定骨折和任意调节关节固定角度。结论后跟形态特殊,因此根据游标卡尺测量法和3D点阵倒模测量法测量数据设计的跟骨外固定器为解剖型,其构型理论上能满足临床上稳定固定、灵活构型的需要。
Objective The anatomical calcaneal external fixator was designed by measuring and calculating the morphological data of the heel.Methods A total of 100 normal people were randomly selected to obtain 200 hind foot data,including 45 males and 55 females,with an average age of 43.9 years(range,19-67 years).According to the principles of human engineering and local anatomy,the morphological data of the heel in the weight-bearing standing position and supine position were measured with the direct measurement mode.The heel length,heel width,heel height,medial ankle height,lateral ankle height,and calcaneal pitch angle(CPA)were measured by vernier calipers and ulnar markers in weight-bearing standing position,and the gender groups and left and right foot groups were compared;the shape of the hind foot in the supine position was measured by three-dimensional(3D)dot matrix inverse model method.According to the stereoscopic data of the comprehensive anatomical morphology of the heel,the anatomical calcaneal external fixator was designed with AutoCAD 2019 and other 3D industrial design softwares.Results The measurements of shoe size,heel length,heel width,heel height,medial ankle height,lateral ankle height,and CPA in male were significantly higher than those in female(P<0.05).There was no significant difference between the left and right feet in the other indexes except that the height of the medial malleolus of the left foot was significantly lower than that of the right foot(t=?2.827,P=0.005).The measurement of 3D dot matrix inverse model in supine position showed that the heel part was non-circular arc edge,and many groups of arc edges fluctuate in a limited range.Based on the above data,an anatomical calcaneal external fixator was designed,which could fit the anatomic radian in theory,so as to be flexible in configuration.On this basis,the ordinary configuration,compression configuration,and orthodontic configuration were designed to meet the treatment needs of calcaneal fractures in different degrees.The ordinary configuration was suitable for patients with SandersⅠ,ⅡA,andⅡB calcaneal fractures with no or slight displacement of intra-articular fractures;the ordinary configuration was mainly used for simple fixing.The compression configuration was suitable for patients with SandersⅡC,ⅢA,and ⅢB,tongue fractures,and avulsion fractures with severe displacement of intra-articular fractures;the compression configuration used obliquely drawn console wires to fix the displaced bones.The orthodontic configuration was suitable for patients with SandersⅢC andⅣcalcaneal fractures with severe displacement of intra-articular fractures or severe calcaneal bone defects;the orthodontic configuration was a multi-module design,which took into account the stable fixation of the fracture and the arbitrary adjustment of the joint fixation angle.Conclusion The hind foot is special for morphology,so the external fixator designed based on the vernier caliper measurement method and 3D dot matrix measuring plate measurement method is an anatomical type and its configuration can theoretically meet stable and flexible clinical needs.
作者
夏燊
赵泽雨
徐永清
吕乾
浦绍全
陈汉芬
齐欣
朱跃良
XIA Shen;ZHAO Zeyu;XU Yongqing;Lü Qian;PU Shaoquan;CHEN Hanfen;QI Xin;ZHU Yueliang(Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University,Kunming Yunnan,650032,P.R.China;Department of Orthopaedics and Traumatology,920th Hospital of Joint Logistics Support Force,Kunming Yunnan,650032,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第4期475-481,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
云南省创伤骨科临床医学中心建设项目(ZX20191001)。
关键词
跟骨
后足
形态学
解剖型
外固定器
Calcaneus
hind foot
morphology
anatomical type
external fixator
作者简介
通信作者:朱跃良,Email:zhuyuelianghu@sina.com。
