족관절 원위 경비 인대 결합 손상에서 다양한 금속 나사 고정 방법의 생체역학적 비교

Abstract

Purpose : Screw fixation have been used most widely as a surgical methods for the syndesmosis injury, but the ideal screw diameter, number of cortices, position of the screw are still controversy. Although numerous biomechanical studies performed using of cadavaric model, correspondence between the results of the study using cadavar and the functional results seems to obscure. Also, many biomechanical studies have been performed comparing each screw diameters, number of cortices, position of screw or between two factors, however there is rarely studies that comparing biomechanical studies above three factors in our country. So, we evaluated the ideal screw fixation by setting a study model to compare a position of screw at the same time the screw diameter, number of cortices, after adding a load to the syndesmosis using a three-dimensional computer ankle model. Materials and Methods: Through the CT image data of the ankle joint, we reconstructed three-dimensional finite element model. We apply the 12 method of fixation by using screw(3.5mm or 4.5mm) and tricortical or quadricortical fixation and distance from the tibial plafond(20mm, 30mm, 40mm). And physiologic loads approximating those during both mid-stance and heel-off stats of stance phase of normal walking were applied to evaluate the stress in the screw and widening of the syndesmosis. Results: Among the 12 of fixation methods, von Mises load is lowest in the case of 30mm location from the ankle joint using 4.5mm diameter quadricortical fixation. And in the case of 30mm location from the ankle joint using 3.5mm diameter quadricortical fixation, diastasis of the syndesmosis is most small expenses 0.005mm. And in the case of 30mm location from the ankle joint using 4.5mm diameter quadricortical, diastasis at each position expenses 0.004mm. Conclusion: Through research, there is no great difference in screw diameter. Screw located 30-40mm from the ankle joint showed advantages in the case using quadricortical fixation.