Abstract：Objective To investigate the mechanical changes of different heights of perfibular osteotomy and their influence on ankle joint and provide theoretical guidance for the selection of appropriate location of perfibular osteotomy for the repair of mandible defect. Methods The left-lower-limb computed tomography (CT) imaging data of 10 patients from the CT room of the First Affiliated Hospital of Bengbu Medical College from June 2020 to June 2022 were included (7 males and 3 females aged 20-60 years old, with a median age of 43 years old). Four patients had oral cancer, and six had right lower limb fracture. Based on the original CT scan data of patients, three-dimensional finite element models containing the tibia, fibula, and ankle joint were constructed using Mimics, Geomagic studio, SolidWorks, Abaqus, and other software. The models were divided into five groups based on the different heights of fibula osteotomy: group A included the bone models containing the complete tibia-fibula and ankle; group B to E comprised the bone models of tibia-fibula and ankle with the 8 cm long fibula intercepted upward at 5, 7, 9, and 11 cm from the lower end of the fibula. Constraints and loading conditions were set for the models to obtain stress distribution and changes. Group A was the control group, and groups B, C, D and E were the observation groups. In the finite element analysis software Abaqus 6.14, constraints and loading conditions were set for each group of models, and an analysis operation was established to obtain the stress distribution and changes. Statistical methods, such as variance analysis and Student-Newman-Keuls-q test, were used to compare the stress changes of the tibial talus articular, talus articular, calcantalus articular, and tibial articular surfaces in each group of models and changes in internal stress in tibia. Results The joint surface stress of group A was as follows in descending order: talocalcaneal joint surface, tibiotalar articular surface, talofibular articular surface, tibiofibular articular surface. The joint surface stress of groups B, C, D, and E was as follows in descending order: tibiofibular articular surface, talocalcaneal joint surface, talofibular articular surface, tibiofibular articular surface. The stress on tibiofibular articular and talofibular articular surfaces decreased significantly due to structural changes after osteotomy, the stress on medial tibia increased significantly, and that on the tibiotalobular articular surface shifted inward. Statistically significant differences were observed in the joint surface stress of the ankle joint model in five model groups and four observation groups compared with the control group (all P values <0.001). Compared with group A, the stress on the tibial talus articular and calcantalus articular surfaces in the four observation groups increased (group B had the highest stress), whereas the stress on the talofibular articular surface and the tibiofibulan joint surface decreased (group B had the lowest stress). The lower the osteotomy position, the more significant the stress change, with statistical significance (all P values <0.001). In the observation group, pairwise comparison among groups showed no statistical significance except the talocalcaneal joint surface between group C and group D (all P values >0.05), and the other groups had statistical significance (all P values <0.05). Conclusion The lower the position of peroneal osteotomy, the greater the stress change of the ankle joint surface. Therefore, in clinical operations, such as upward fibula transplantation, for the repair of mandibular defects, keeping more distal fibula as much as possible can minimize the influence of fibula osteotomy on ankle joint function under the premise of guaranteeing repair effect.
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Zong Kaiyang, Guo Yun, Li Jiancheng, Cui Wenjing, Hu Kai. Finite-element analysis of mechanical changes of ankle joint after peroneal osteotomy in different positions. Chinese Journal of Anatomy and Clinics, 2023, 28(8): 547-552.
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2023, Vol. 28 
