| 1.BackgroundHallux valgus is one of the common diseases in the foot and ankle clinic.Patients often see foot deformities and pain,which seriously affects normal life.Surgical treatment is needed when conservative treatment is not effective.There are more than 200 types of hallux valgus surgery.The traditional open surgery is complicated and has a large damage to soft tissues.Internal fixation or plaster external fixation is required.The application of minimally invasive small incisions in foot and ankle surgery began in the United States in the 1970s.The osteotomy method was a"V" osteotomy of the first metatarsal head and neck.Clinically,the stability of the osteotomy end was poorProfessor Wen Jianmin innovated his osteotomy and fixation method based on the minimally invasive small incision osteotomy,guided by the theory of "bone staggered seams,tendons out of the groove" of traditional Chinese medicine,combined with the principle of small splint paper pressure pads,and coordinated with traditional Chinese medicine Manipulation and the "wrap method" of bandage external fixation have created a minimally invasive method for the treatment of hallux valgus with integrated traditional Chinese and Western medicine.After the oblique osteotomy of the 1st metatarsal head,based on the principles of tendons,osteosynthesis,and osteotomy,it must be touched by hand,pull and stretched,rotated around,lifted by the end,pressed by swing,touched,formed.Orthopedic methods such as angle folding tops and tendons,push the distal metatarsal head apart from the inside to the outside to open about a cortex,restore normal stress,correct the deviated tendons(tendons)and dislocated joints,so that",Correct the hallux valgus deformity.Metastatic palpitation is one of the common complications after hallux valgus surgery.The treatment and prevention of palatal pain is one of the key problems to be solved.Displacement and shortening of the first metatarsal bone are the main causes of postoperative metatarsal pain.To a certain extent,shortening of the patella is inevitable,and displacement can be controlled.Therefore,patella displacement is the key to the treatment and prevention of patella pain.The key technique of minimally invasive treatment of hallux valgus with integrated traditional Chinese and Western medicine is to use the orthopedic technique to displace the distal end of the osteotomy to the lateral and lateral sides,increase the weight of the first metatarsal bone,restore normal forefoot stress,and effectively treat and prevent cramp pain.happened.The external fixation of the bandage was changed regularly after surgery,and the position of the distal end of the osteotomy was adjusted in time.During the surgery,the displacement should be adjusted according to the amount of patella shortening and whether it is associated with palatal pain.At present,the quantitative relationship between distal osteotomy displacement and palatalgia during minimally invasive treatment of hallux valgus has not yet been clarified2.ObjectiveBy constructing a finite element model before and after surgery for the treatment of hallux valgus combined with palatal pain with minimally invasive treatment of traditional Chinese and western medicine,the changes of the displacement and shortening of the 1st metatarsal osteotomy and the pressure changes under the 1st and 2nd metatarsal heads were determined.Quantitative relationship between distal patella osteotomy displacement,shortening,and palatalgia.Provide a visualization platform for the treatment and prevention of metastatic palpitation after hallux valgus,and provide finite element modeling ideas for quantitative research on rehabilitation methods;provide reliable data for the standardization of rehabilitation methods,and promote the integration of traditional Chinese and western medicine in the treatment of thumb Standardized and scientific valgus diagnosis and treatment system3.MethodVolunteers who recovered from hallux valgus combined with palatalgia were selected to build a finite element model of minimally invasive combined traditional Chinese and western medicine for the treatment of hallux valgus.The Footscan pressure test system was used to test the plantar pressure of volunteers with hallux valgus,and the numerical value of the pressure under the metatarsal head of the finite element model was compared with the measured data of the Footscan force plate to verify the validity of the finite element model.The finite element model of minimally invasive treatment of hallux valgus combined with western medicine simulated the displacement of the 1st metatarsal head to the lateral and lateral sides,with a displacement length of 2mm and a displacement length of Omm,2mm,4mmand 6mm.Record the pressure of the plantar metatarsal head respectively,analyze the quantitative relationship between the lateral and lateral displacements of the metatarsal head and the first and second metatarsal head pressure,and clarify the quantitative relationship between the pressure changes of the first and second metatarsal heads and palatalgia;Tests and calculations were performed on the finite element model of postoperative hallux valgus combined with palatal pain.The displacement distance was 2mm,and the vertical and horizontal displacements were 0mm,2mm,4mm,and 6mm.Calculate the length of the first metatarsal shortening before and after surgery,observe the changes in plantar pressure,and calculate the quantitative relationship between the amount of metatarsal shortening and the pressure changes under the first and second metatarsal heads.Linear correlation analysis of the maximum pressure under the 1st metatarsal head and the maximum pressure under the 2nd metatarsal head under different displacement and shortening conditions.4.ResultIn this study,a finite element model of the right foot bones,cartilage,skin,and soft tissues was established with hallux valgus and palatal pain,including modules such as the full foot stress model,skeletal stress,and displacement.The finite element model of right foot hallux valgus with palatalgia includes 7 metatarsals,5 metatarsals,14 phalanges,31 articular cartilage,and 23 tendons and ligaments(lateral ligament,medial ligament,long thumb extension,long thumb flexion).Tendons,inner foot muscles,etc.),there are 550971 units and 154777 nodes in the whole foot.The finite element model was used to simulate the equilibrium standing condition,and the displacement of the 1st metatarsal osteotomy was analyzed.It was found that when the horizontal displacement was 0mm,the increase in vertical displacement was highly correlated with the pressure change of the 1st metatarsal head.There is a negative correlation between pressure changes,r values are 0.816,-0.494;when the vertical displacement is 0mm,the increase in horizontal displacement has a moderate correlation with the change in pressure under the 1st metatarsal head,and has a high degree with the change in pressure under the 2nd metatarsal head Correlation,r values are 0.534,-0.949.When the vertical displacement is constant(0～6mm),the increase in horizontal displacement has no significant correlation with the change in pressure under the 1 st metatarsal head,and the r value is a maximum of 0.259;when the vertical displacement is constant(0-4mm),the horizontal displacement increases with the second There is a high negative correlation between the pressure of the metatarsal head and the highest r value is-0.949.When the vertical displacement is 4mm,with the increase of the horizontal displacement,the subtarsal pressure of the first metatarsal head is negatively related to the subtarsal pressure of the second metatarsal head.The value of r is-0.658.When the horizontal displacement is constant(0～6mm),the increase in vertical displacement is highly correlated with the change in pressure under the 1st metatarsal head;when the horizontal displacement is constant(0～4mm),the increase in vertical displacement is related to the change in pressure under the 2nd metatarsal head Moderately negative correlation.Among them,when the horizontal displacement must be 2mm,the increase in vertical displacement has the greatest correlation with the change in pressure under the first and second metatarsal heads.The pressures were 0.4582 MPa and 0.3732 MPa,respectively When the horizontal displacement was 4 to 6 mm,the increase in vertical displacement had a moderate positive correlation with the change in pressure under the lateral metatarsal head.When the horizontal displacement was 2 mm,with the increase in vertical displacement,the first There is a significant negative correlation between the subtarsal head pressure of the 1st metatarsal head and the subtarsal head pressure of the 2nd metatarsal head.The r value is-0.738,and the quantitative relationship between the two is y=-0.3544x+0.5362.Loaded and calculated on the finite element model of postoperative hallux valgus combined with palatal pain,and calculated the measured shortening length of the first metatarsal bone before and after the operation according to the displacement distance.2 The pressure change of the metatarsal head was found:when the horizontal displacement was 0mm,2mm,4mm,and 6mm,the corresponding shortening lengths were 0mm,0.73mm,1.45mm,and 2.18mm;the horizontal shortening was positively correlated with the pressure of the first metatarsal head Is significantly negatively related to the pressure of the second metatarsal head.The first metatarsal head pressure was significantly negatively related to the second metatarsal head pressure,with an r value of-0.611.The quantitative relationship equation between them is y=-0.6114x+0.6327.When the vertical displacement is 0mm,2mm,4mm,and 6mm,the corresponding shortening lengths are 0mm,2.38mm,4.76mm,and 7.14mm,respectively.The vertical shortening is positively related to the pressure of the first metatarsal head and is related to the pressure of the second metatarsal head Negative correlation.The first metatarsal head pressure is significantly negatively related to the second metatarsal head pressure,with an r value of-0.529,and the quantitative relationship equation between the two is y=-0.2581x+0.5336.5.ConclusionIn this study,by constructing a minimally invasive combined finite element model of traditional Chinese and western medicine for the treatment of hallux valgus combined with palatal pain,comparing the pressure changes before and after the 1st and 2nd metatarsal heads in the balanced standing condition before and after the operation.Combined with minimally invasive treatment of hallux valgus,when the distal end of the first metatarsal osteotomy is displaced 2mm laterally and the metatarsal 4mm by orthopedic manipulation,it can effectively correct hallux valgus deformity and treat or prevent metatarsal pain after hallux valgus. |
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