| BackgroundHallux valgus deformity of the foot is one of the common diseases, in particular to the outward from the center, outward tilt angle is greater than the normal angle of 15 degrees. It is always accompanied by the vertical axis rotation deformity outward. After the formation of the hallux valgus deformity, can temporarily ease the pain only by conservative method. With the development of the disease the first metatarsophalangeal joint subluxation and medial osseous prominence effect will continue to increase shoes and walk everyday, serious influence patient’s quality of life. With the development of the disease in patients with hallux valgus, often accompanied by other toe deformity and forefoot pain and other symptoms. So the hallux valgus is a progressive disease, for obvious deformity, pain of the patients should be treated by operation as soon as possible, to prevent the illness of incur loss through delay, severe malformation.The etiology of hallux valgus is unclear, a variety of reasons can lead to the formation and development of hallux valgus, but its pathogenesis and pathological change aspect are roughly the same, the modern medical science thinks that contains the genetic factors, and factors and bony structures and soft tissue changes and so on. Traditional Chinese medicine believes that including the main causes:dampness evil invasion and external trauma, chronic fatigue, be congenitally deficient, acquired dystrophy, but these reasons will eventually make the liver blood is not wing, tendons dystrophy causing "Gu Li Feng, Jin Chu Cao". Through the understanding of the pathological changes of hallux valgus, biomechanics,and application of "Jin Shu Gu" theory in the treatment of hallux valgus.The tutor team more than 10 years of exploration, the use of the first metatarsal head and neckoblique osteotomy, and the traditional Chinese medicine, Chinese medicine, bone setting manipulation "tendon bone" theory, "wrapped curtain" method and minimally invasivetechniques, created a new method of combining traditional Chinese and Western medicinetreatment of minimally invasive treatment of hallux valgus and varus minimi, metatarsalgiaother related deformity. It has the advantages of simple operation, little pain, less complications, the curative effectdetermination. Through our continuous improvement, innovation and development, has formed astandardized diagnosis and treatment system. In 2002 won the two national science and technology progress award, Ministry of science and technology was recommended to participate in the international exposition held in Germany’s "new thinking, new inventions, new technology", won the gold medal. Combination of traditional Chinese and Western medicine treatment of hallux valgus byState Administration of traditional Chinese medicine as a national ten outstanding projectsto promote the country. At present, the country has more than 20 provinces, city hospital to carry out this technique, has been treated more than 2 cases of hallux valgus patients, the excellent and good rate was 98.5%. The technical key points of the method for the application of minimally invasive technique in traditional Chinese medicine:1)foot and ankle surgery; 2)the first metatarsal head and neck oblique osteotomy for correction of the deformity; 3)of traditional bone setting manipulation to correct the deformity and joint dislocation; 4)small splint clip pad basis and principle of "Jin Shu Gu" theory, the "8" bandage fixed osteotomy end. Abandon the traditional steel plate screw internal fixation and plaster external fixation after operation, patients could walk.Muscle imbalance of foot muscle and other soft tissue leads to the formation of hallux valgus and further development. In recent years, many researchers found the importance of soft tissue on the formation ofhallux valgus:If the valgus varus muscle strength and muscle strength is greater than the failure ofposterior tibial tendon, can induce the hallux valgus. Many patients are not simple and bunions, the first metatarsophalangeal joint subluxation of the first metatarsal is often associated with osteoarthritis of the knee, foot transverse arch and longitudinal arch collapse, the first metatarsal sesamoids system dislocation, subluxation of the second toe, hammer toe, toe varus and so on, at the same time, the first ray of the surrounding muscles such as the abductor hallucis muscle, flexor pollicis brevis, adductor pollicis displacement and lateral joint capsule strain changes of soft tissue. So we think will gradually make the hallux valgus foot biomechanical irreversible changes in the process of development, so that the function of the foot function disorder, and to give the patient more pain.Not only to the deformity of hallux valgus osteotomy to correct the manipulative reductionwith combination of Chinese traditional and Western medicine, is still in operation at the same time manipulation, normal biomechanical environment to restore the front foot. Minimally invasive osteotomy technique this method was put forward, it has been questioned part of scholars in Department of orthopedics. Modern medicine thinksosteotomy healing need stability, osteotomy reduction must be stable to heal. The human body in the weight-bearing foot loads increase, especially in the first metatarsal. Department of orthopedics doctors think osteotomy fixed here do not, nor do the plasterfixation for braking, osteotomy, stability is not good, there end of the cut bone delayed union or nonunion of the possibility of greatly increased. But the fact is the treatment of hallux valgus with combination of TCM and Western medicine, the clinical application of more than ten years, did not appear the phenomenon of osteotomy non union, and complications of the patients with metastatic metatarsalgia is less. After the osteotomy according to the small splint pressure pad of paper principle and" Jin Shu Gu" theory and the "8" bandage external fixation is stable or not? Patients were allowed to walk early effects of osteotomy healing? These problems still need to do in-depth research.The method of finite element analysis with the modeling and computing ability of digital and computer technology is the development of continuous improvement and has become more and more powerful and precise. Finite element analysis can be solved directly by mechanical test or as a result of these problems difficult to solve ethical problems. Three dimensional finite element can be either in dynamic or static state, with irregular shape, uneven stress conditions, different material parameter and so on the object model is built, the need to measure the part is calculated. The foot is one of the structure of human body is very complex, including the 26 bones,and the formation of the ankle and tibia and fibula, foot ligaments, fascia, includingmuscle also quantity and different functions. Therefore the foot structure should be the calculation problem of the complicated stress and strain. But we use three dimensional finite element analysis method, not only can get the whole foot three-dimensional stress state, but also the repeatability of contact stress, so as to display the articular surfacestress distribution. And all kinds of treatment effect on foot. Through the finite element analysis of hallux valgus and a series of disease research will be more accurate andthorough, also will have a profound significance to the clinical work.Access to relevant information, the present study reports the foot finite element model ofhallux valgus seldom, the first metatarsal osteotomy and external fixation stability ofosteotomy healing effects not related research. The results of this study will enhance the understanding of the treatment of hallux valgus, and combined with the improvement of the treatment of hallux valgus and far-reaching impact to improve. This research method can also seek new ideas and scientific study of orthopedics and traumatology of Chinese medicine modernization guidance.Purpose1. To establish the finite element model of hallux valgus hallux valgus, and the model of integrated traditional Chinese and Western medicine with minimally invasive osteotomytechnique taxis, set up with the minimally invasive osteotomy after the restoration of three-dimensional finite element model of integrated traditional Chinese and Western medicine. Objective to explore the methods and significance of medical modeling and digital simulation;2. The finite element model for osteotomy in soft tissue contrast/displacement without the presence of osteotomy and the stress of the reliable data and research, and to observe the osteotomy end displacement and stress variation in the presence of soft tissue. It is a scientific basis for the "Jin Shu Gu" in the treatment of hallux valgus.Method:1. The establishment of hallux valgus osteotomy model minimally invasive osteotomy anaplasty western medicine and Chinese traditional medicine Materials and methods1) Hallux valgus selected young women volunteers, HAV angle of 24 degrees,13 degrees of angle IM, angle of 7 degrees PASA, DASA angle of 7 degrees, the body weight of 58kg,no other system diseases and other diseases. Using CT to the affected foot scanning,layer thickness lmm, interval lmm, scanning from toe to heel. CT image to get enough.Scan the subjects of ankle joint in neutral position, for patients with non weight bearing.2) Treatment of foot CT image using Mimics 10.0, boundaries to distinguish soft tissue, bone cortex, medullary cavity, the vector data to obtain the edge of bone contour, bone,cartilage, tendon, considering only the intrinsic muscle of foot, four kinds of organizationmodel. Three dimensional reconstruction of foot and ankle of 28 bones and surrounding soft tissues by threshold segmentation, into Geomagic Studio 12 software, structure,structure, fitting curved sided grid surface treatment on the model, and finally generateparts, then assembled the whole foot. Define material properties in ABAQUS. The solid element of solid bone, ligament as incompressible materials, for the truss unit, is set for a single isotropic linear elastic material. Meshing, global control of seed size was about 1.5-3, the free mesh generation of tetrahedron. There are 175711 points totally and 412557 units. All bone cartilage ligaments together. It built a cuboid model in ABAQUS, as a ground model dividing hexahedral mesh.3) Simulation of hallux valgus patients balance in feet when standing feet force, the definition of load of Achilles tendon force, friction, foot plantar pressure. The supporting structure and the plantar surface is defined as the surface contact, friction coefficient is 0.6. According to the load and the ground reaction force equivalent exchange principle,the pressure applied at the center to focus on the support structure of the force, ankle joint surface is completely constrained, in balance when standing neutral position. Another Footscan board testing technology, the static measurement of the subjects of foot force, according to the test results and finite element foot cloud pressure are concentrated in the calcaneus, second, the 3 metatarsal, the area roughly the same. 4) Simulation of the first metatarsal head neck osteotomy in hallux valgus model built using CATIA software. First of all, grinding out the head of the first metatarsal medialosteophyte, and then in the first metatarsal head neck osteotomy, osteotomy in the horizontal plane and the first metatarsal axis at an angle of 70 degrees, from the direction of the medial distal to proximal lateral; in the sagittal plane and the first metatarsal axis at an angle of 75 degrees, the direction from the dorsal distal to the the proximal end of metatarsal side. Simulation of manipulative reduction requirements, the distal osteotomy on the lateral 3mm, built with minimally invasive osteotomy anaplasty after hallux valgus osteotomy model of integrated traditional Chinese and Western medicine.2. Study on stress and there is no end in the soft tissue around the case of the osteotomy end displacement of minimally invasive osteotomy anaplasty after osteotomy model combination of Chinese traditional and Western MedicineMaterials and methods:1) Using the established three-dimensional finite element of hallux valgus osteotomy model,simulation model of osteotomy without soft tissue around the working conditions. The metatarsal osteotomy of proximal was set to distal to the fixed end, free end, the broken end of the friction coefficient according to the actual measuring set. As the observation points weremarked on the distal osteotomy, inner and outer edge of the upper and lower four points.Don’t consider the osteotomy and soft tissue (muscle abductor hallucis muscle, flexorextensor hallux toe length, length and the influence of the thumb).2) Constraints and loading of the model:the model with constraints and load conditions.3)The calculated data of finite element model:Calculation and analysis of osteotomy four node stress distribution, size and direction, size and displacement of the osteotomysurface between the M and the total stress value (Miles Stress) and the total displacement of V value.3. Combination of traditional Chinese and Western medicine displacement osteotomy and soft tissue around the model of minimally invasive osteotomy manipulation case after osteotomy and stress change researchMaterials and methods:1) Using the established three-dimensional finite element of hallux valgus osteotomy model,simulation model of osteotomy and soft tissue around the working conditions. Around theend of the cut bone and soft tissue (muscle abductor hallucis muscle, flexor extensorhallux toe length, length and thumb tendon) define material properties as isotropic elastic material and the material, the 2 node linear element COMBIN14 spring damping element(spring-damper 14) to simulate the tendon, the damping coefficient is set to 0. The definition of passive muscle tension nonlinear hyper elastic material. The other set at same conditions.2) Constraints and loading of the model:the model with constraints and load conditions.3) The calculated data of finite element model:stress distribution calculation and analysis ofthe osteotomy surface of four nodes, the size and the direction, magnitude anddisplacement of the osteotomy surface and total stress (Miles Stress) and total displacement.4) Data collection and statistical analysis:data acquisition with/without the presence of thedisplacement of the soft tissue of two cases of the osteotomy end and stress finite elementnumerical calculation were compared to observe and study the influence of osteotomy andsoft tissue of the osteotomy end stability. The experimental data were analyzed by one-way ANOVA with SPSS 13.0 software.Results1) The establishment of hallux valgus foot finite element model, the model contains 30 bones,27 ligaments, cartilage. Bone, ligament for truss solid entity unit unit. Articular contact was defined as no frictional elastic contact. Ligament as incompressible material.According to the project needs to simplify the model, the first metatarsal metatarsalphalange in addition to other fusion between the first metatarsal joint fusion. Tibia fibular fusion. Retention of calcaneus and talus, navicular bone, cuboid, the first metatarsal joint.V. total points 175711, unit number 412557.2) The model is built to simulate the hallux valgus of integrated traditional Chinese and Western medicine combined with minimally invasive treatment of hallux valgus osteotomytechnique taxis. Combined with minimally invasive osteotomy was built after the restoration of hallux valgus osteotomy model of integrated traditional Chinese and Western medicine.3) By means of the finite element model of osteotomy in soft tissue contrast/ displacement without the presence of osteotomy and the stress of the reliable data and found that the end of the cut bone, the stress and displacement change is more conducive to the osteotomy was stable in the presence of soft tissue.Conclusion1) This research using human foot CT data by means of Mimics10.0, Geomagic, Studio12.0, ABAQUS and other software, establish the finite element model of hallux valgus foot, then simulating osteotomy on the model. The model mesh uniform, unit of high quality, so the calculation result in the analysis are more accurate. Through the establishment of hallux valgus osteotomy model, diagnosis, treatment, surgery can and rehabilitation of hallux valgus, bring more scientific guidance for clinical.2) By means of the finite element model of osteotomy in soft tissue contrast/ displacement without the presence of osteotomy and the stress of the reliable data and found that the end of the cut bone, the stress and displacement change is more conducive to the osteotomy was stable in the presence of soft tissue. "Scientific proof of tendon bone" for the treatment of hallux valgus. |
PDF Full Text Request