臺灣博碩士論文加值系統

本文利用人體足部骨骼CT圖，以InVesalius軟體重組斷層掃描圖像，建立骨骼結構，並使用FreeCAD建立軟組織，包括：關節軟骨、韌帶和足底筋膜。使用ANSYS有限元軟體分析步行推進對蹠骨應力性骨折的影響，以及脛骨內旋對第五蹠骨應力分佈的情況。其中探討雙足靜止站立與步態推進的足部內的應力分布情況。從臨床的蹠骨應力性骨折之文獻與本文的結果進行比較，本文的模擬分布結果與文獻一致。有限元素分析成功模擬出右前足於推進期階段之運動行為。因此本文的模擬結果可提供臨床在預防蹠骨應力性骨折的參考依據。

The CT image of human foot bones is taken, the tomographic scan image is reconstructed by InVesalius software, and the bone structure is built. The other necessary soft tissues are built by FreeCAD, including articular cartilage, ligament and plantar fascia, the entitative foot tissue structure is generated. The 3D foot finite element model is built, the ANSYS finite element software is used to research the effect of walking movement velocity on the metatarsal stress fracture, and the effect of tibia vara on the 5th metatarsal stress distribution. Probing into the force transmission principle of foot bone system contributes to understanding the cause of foot disease and proposing treatment improvement. This paper uses two-foot static standing and gait push-off simulation as validation for numerical convergence analysis, the stress distribution in the foot is discussed. The literatures of clinical metatarsal stress fracture are compared with our finite element analysis results, based on ANSYS finite element analysis software, the validated foot finite element model can predict the plantar pressure distribution and the stress and strain of bones and soft tissues in foot. The foot model built in this experiment provides a relatively ideal method for the biomechanical research on metatarsal stress fracture, providing a theoretical basis for clinical prevention of metatarsal fracture.

謝誌 i
摘要 ii
Abstract iii
目錄 iv
圖目錄 vi
表目錄 ix
第一章 緒論 1
1.1 前言 1
1.2 研究動機與目的 2
第二章 基礎理論 5
2.1 足部應力性骨折文獻回顧 5
2.2 足部生物力學的發展概況 7
2.3 骨骼的組織結構及力學特性 11
2.4 骨折癒合之生物力學探討 14
2.5 足部之解剖生理學 15
2.6 步態分析 20
2.7 異常步態-下肢內旋 30
2.8 蹠骨應力性骨折 31
2.9 有限元素分析理論 35
2.10有限元素軟體 ANSYS 37
第三章 模型建立方法與步驟 38
3.1 建立步驟 39
3.2 樣本取得及 INVESALIUS 影像處理 40
3.3 消除雜訊與修補網格 42
3.4 建立簡化的韌帶與足底筋膜 45
3.5 導入材料特性，建立足部之網格模型 48
3.6 靜止站立之有限元模型 49
3.7 模擬正常步態前足推進期的足部受力 52
3.8 模擬脛骨內旋之推進 55
第四章 足部有限元素模型之收斂測試結果 57
4.1 靜態有限元模型驗證 57
4.2 模擬正常步態前足推進期的足部受力 65
4.2.1 以0.96m/s正常步態推進 67
4.2.2 以1.15m/s正常步態推進 78
4.3 模擬脛骨內旋之前足推進期的第五蹠骨受力分布 70
第五章 數值結果與討論 72
5.1步態推進時第一蹠骨受力分析 72
5.2步態推進時第二蹠骨受力分析 73
5.3步態推進時第三蹠骨受力分析 74
5.4步態推進時第四蹠骨受力分析 75
5.5步態推進時第五蹠骨受力分析 77
5.6討論 78
第六章 結論 81
參考文獻 82

1. J. B. Hartley, “Stress or fatigue fractures of bone”, Br J Radiol Suppl, 1943; 16(189):255-262.
2. H. J. Burrows , “Fatigue fractures of the fibula”, J Bone Joint Surg Br, 1948; 30:266-279.
3. E. Wilson, and F. Katz, “Stress fractures an analysis of 250 consecutive cases”, Radiology, 1969; 92:481–486.
4. M. J. Lucas, and D. E. Baxter, “Stress fracture of the first metatarsal”, Foot Ankle Int, 1977; 18:373–374.
5. A. Köhler, E. A. Zimmer, and B. Roentgenologia, “Stress fractures of the first metatarsal”, AM J Roentgend, 1978; 130: 679–681.
6. S. Roy, and R. Irvin, “The Athletic Conditioning Program, Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation”, Englewood Cliffs, NJ, Prentice-Hall , 1983; 195:32.
7. D. B. Clement, D. C. Mckenzie, J. E. Taunton, D. R. Lloyd-Smith, and J. G. “Macintyre Stress fractures in athletes. A study of 320 cases”, Am J Sports Med, 1987; 15: 46–58.
8. W. Albisetti, D. Perugia, O. De Bartolomeo, L. Tagliabue, E. Camerucci, and G.M. Calori, “Stress fractures of the base of the metatarsal bones in young trainee ballet dancers”, Int Orthop, 2010; 34(1):51-5.
9. D. K. Ostlie, and S. M. Simons, “Tarsal navicular stress fracture in a young athlete:case report with clinical,radiologic,pathophysiologic correlations”, J Am Board Fam Med, 2001; 14(5):381-385.
10. R. B. Anderson, K. J. Hunt, and J. J. McCormick, “Management of common sports-related injuries about the foot and ankle”, J Am Acad Orthop Surg, 2010; 18(9): 546-556.
11. K. M. Rongstad, J. Tueting, M. Rongstad, K. Garrels, and R. Meis, “Fourth metatarsal base stress fractures in athletes: a case series”, Foot Ankle Int, 2013; 34(7):962–968.
12. R. M. Gehrmann, and R. L. Renard, “Current concepts review: stress fractures of the foot”, Foot Ankle Int, 2006; 27:750-757.
13. R. Korpelainen, S. Orava, J. Karpakka, P. Siira, and A. Hulkko, “Risk factors for recurrent stress fractures in athletes”, Am J Sports Med, 2001; 29:304-310.
14. D. Vashishth, K. E. Tanner, W. Bonfield , “Fatigue of cortical bone under combined axial-torsional loading”, J Orthop Res, 2001; 19(3): 414–420.
15. C. Milgrom, A. Finestone, N. Sharkey, A. Hamel, V. Mandes, D. Burr, and A. Arndt, I. Ekenman, “Metatarsal strains are sufficient to cause fatigue fracture during cyclic overloading”, Foot Ankle Int, 2002; 23(3):230-235.
16. R. Raspay, “Common stress fractures”, Am Fam Physician, 2003; 68(8):1527–1532.
17. Y. P. WU, L. YUAN, and W. ZHAO, “Design of Human Metatarsal Fatigue Fracture Model and Biomechanics Analysis”, Trace Elements Science, 2003.
18. J. B. Saunders, V. T. Inman, and H. D. Eberhart, “The major determinants in normal and pathological gait”, JBJS, 1953; 35-A:543-58.
19. J. H. Hicks, “The mechanics of the foot. II. The plantar aponeurosis and the arch”, J Anat, 1954; 88:25-30.
20. D. A. Iaremenko, “Methods of study of the “transverse arch” of the foot”, Ortop Travmatol Protez, 1967;28:20-24.
21. W. A. Brekelmans, H. W. Poort, and T. J. Slooff, “A new method to analyse the mechanical behaviour of skeletal parts”, Acta Orthop Scand, 1972; 43(5):301-317.
22. P. R. Cavanagh, and M. A. Lafortune, “Ground reaction forces in distance running”, J Biomechanics, 1980;13:397–406.
23. B. M. Nigg, “Biomechanics load analysis and sport injuries in the lower extremities”, Sports Medicine, 1985; 2: 367-379.
24. S. Siegler, R. Seliktar, and W. Hyman, “Simulation of human gait with the aid of a simple mechanical model”, J Biomechanics, 1982; 15:415-425.
25. T. M. Chu, N. P. Reddy, and J. Padovan, “Three-dimensional finite element stress analysis of the polypropylene,ankle-foot orthosis：static analysis”, Med Eng Phys,1995;5:372-9.
26. S. Jacob, K. M. Patil, and L. H. Braak, “A. Huson,Stresses in a 3D two arch model of a normal human foot,Mech”, Res Commun, 1996; 23:387–393.
27. W. P. Chen, F. T. Tang, C. W. Ju, “Stress distribution of the foot during mid-stance to push-off in barefoot gait: a 3-D finite element analysis”, Clinical Biomechanics, 2001; 16(7): 614-620.
28. D. L. Camacho, W. R. Ledoux, E. S. Rohr, B. J. Sangeorzan, and R. P. Ching, “A three-dimensional, anatomically detailed foot model: a foundation for a finite element simulation and means of quantifying foot-bone position”, J Rehabil Res Dev, 2002; 39(3):401-10.
29. A. Gefen, “Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot”, Med Eng Phys, 2003; 25: 491–499.
30. J. T. Cheung, M. Zhang, and K. N. An, “Effects of plantar fascia stiffness on the biomechanical responses of the ankle–foot complex”, Clin Biomech, 2004; 19 (8): 839–846.
31. A. Erdemir, A. J. Hamel, A. R. Fauth, S. J. Piazza, and N. A. Sharkey, “Dynamic loading of the plantar aponeurosis in walking”, J Bone Joint Surg Am, 2004;86-A(3):546-552.
32. S. P. Budhabhatti, A. Erdemir, M. Petre,al “Finite element modeling of the first ray of the foot: a tool for the design of interventions”, J Biomech Eng, 2007; 129 (11):750-756.
33. P. C. Liacouras, and J. S. Wayne, “Computational modeling to predict mec- hanical function of joints: application to the lower leg with simulation of two cadaver studies”, J Biomech Eng, 2007; 129(6):811-817.
34. H. Y. Cheng, C. L. Lin, H. W. Wang, and S. W. Chou, “Finite element analysis of plantar fascia under stretch-the relative contribution of windlass mechanism and Achilles tendon force”, J Biomech, 2008; 41(9):1937-44.
35. M. Ozen, O. Sayman, and H. Havitcioglu, “Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex”, Acta Bioeng Biomech, 2013; 15(3):19-27.
36. Snell, S. Richard，楊世吏 原譯，郭瑜良 該編（1991）臨床解剖學，合記圖書出版社。
37. Y. Khan, M. J. Yaszemski, A. G. Mikos, and C. T. Laurencin, “Tissue engineering of bone: material and matrix considerations”, J Bone Joint Surg Am, 2008;90:36-42.
38. D. R. Carter, and M. Wong, “Mechanical stresses and endochondral ossification in the chondroepiphysis”, J Orthop Res, 1988; 6:148-154.
39. D. R. Carter, D. P. Fyhrie, T. E. Orr, D. J. Schurman, and D. J. Rapperport, “Control of chondro-osseous skeletal biology by mechanical energy”, Biomechanics：Principles and Applications, 1987; 219-224.
40. 許世祥,「骨折癒合之現代觀」,慈濟醫學雜誌, 1990;5(2):414-417.
41. 陳學源、陳美森、陳綺華,「骨質疏鬆症治療藥物 - Teriparatide」,臨床藥物治療, 2008; 24(4):102-107.
42. D. R. Carter, D. P. Fyhrie, and R. T. Whalen, “Trabecular bone density and loading history：regulation of connective tissue biology by mechanical energy”, J Biomech, 1987; 20:785-794.
43. D. R. Carter, T. E. Orr, D. P. Fyhrie, and D. J. Schurman, “Influences of mechanical stress on prenatal and postnatal skeletal development”, Clin Orthop Relat Res, 1987;219:237-250.
44. D. R. Carter, P. R. Blenman, and G. S. Beaupré, “Correlations between mechanical stress history and tissue differentiation in initial fracture healing”, J Orthop Res, 1988; 6(5):736-48.
45. V. L. Giddings, G. S. Beaupré, R. T. Whalen, and D. R. Carter, “Calcaneal loading during walking and running”, MSSE, 2000; 32(3):627–34.
46. C. L. Saltzman, D. A. Nawoczenski, K. D. Talbot. “Measurement of the medial longitudinal arch”, Arch Phys Med Rehabil, 1995; 76:45-9.
47. D. H. Sutherland, K. R. Kaufman, and J. R. Moitoza, “Kinematics of normal human walking”, In: J. Rose, and J. G. Gamble, eds. Human walking, 2nd ed. Baltimore: Williams & Wilkins, 1994;2:23-45.
48. J. Perry, and J. M. Burnfield, GAIT ANALYSIS：Normal and Pathological Function, Second ed., 2010.
49. D. Sutherland, Development of mature walking. Philadelphia: MacKeith Press, 1988.
50. M. Michael, S. Verena, T. Stephan, R. T, William, N. Georg, Duda, P. Carsten, O. Markus, and Heller, “The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach”, ARCH ORTHOP TRAUM SU, 2012; 132(5):725-731.
51. Braddom, L. Randall, Physical medicine and rehabilitation, 2nd ed, W. B. Saunders company.
52. Z. T. Kota, and J. S. Steven, “Mechanical energy profiles of the combined ankle–foot system in normal gait: Insights for prosthetic designs”, Gait & Posture, 2013; 38(4):818-823.
53. M. P. Castro, S. Abreu, V. Pinto, R. Santos, L. Machado, M. Vaz, “Influence of pressure-relief insoles developed for loaded gait (backpackers and obese people) on plantar pressure distribution and ground reaction forcesOriginal Research Article”, Appl Ergon, 2014; 45(4):1028-1034.
54. 數學模型（第三版）．姜啟源 謝金星 葉俊 編．北京．高等教育出版社．2003.
55. D. F. Rosenbaum, “Foot loading patterns can be changed by deliberately walking with in-toeing or out-toeing gait modifications”, Gait & Posture, 2013; 4:1067-1069.
56. W. M. Chen, T. Lee, V. S. Lee, J. W. Lee, and S. J. Lee, “Effects of internal stress concentrations in plantar soft-tissue—A preliminary three-dimensional finite element analysis”, Med Eng Phys, 2010; 32(4):324-331.
57. C. Milgrom, A. Finestone, and S. Segev, “Are overground or treadmill runners more likely to sustain tibial stress fracture?”, Br J Sports Med, 2003; 37(2):160-163
58. I. Ekenman, C. Milgrom, and A. Finestone, “The role of biomechanical shoe orthoses in tibial stress fracture prevention”, AM J SPORT MED, 2002; 30(6):866-870.
59. B. Steven, Weinfeld, S. L. Haddad, and M. S. Myerson, “Metatarsal stress fractures”, Clin Sports Med, 1997; 16:319–338.
60. Rockwood, and Green''s, Fractures in Adults, 7th edition, 2010
61. J. Iwamoto, Y. Sato, T. Takeda, and H. Matsumoto, “Analysis of stress fractures in athletes based on our clinical experience”, World J Orthop, 2011 1( 18).
62. R. Chang, A. Pedro, Rodrigues, E. A. Richard, V. Emmerik, and J. Hamill, “Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis”, J Biomech, 2014; 47(11):2571–2577.
63.A.G. Schneiders, S.J. Sullivan, P.A. Hendrick, B.D.G.M. Hones, A.R. Mcmaster, B.A. Sugden, “The ability of clinical tests to diagnose stress fractures: a systematic review and meta-analysis”, J Orthop Sports Phys Ther, 2012;42(9):760–771.
64. B. A. Petrisor, I. Ekrol, and C. C. Brown, “The epidemiology of metatarsal fractures”, Foot Ankle Int, 2006; 27:172–174.
65. M. D. Montse, Ponce, M. D. Ana, Balius, M. D. Ramon, Til, and M. D. Luis, “Stress fracture of the first metatarsal in a fencer: typical appearance on bone scan and pinhole imaging, minoves”, Clin Nucl Med, 2011; 36(10):150-152.
66. D. K. Lee, G. D. Mulder, A. K. Schwartz, “Hallux, Sesamoid, and First Metatarsal Injuries Review Article”, Clin Podiatr Med Surg, 2011; 28(1):43-56.
67. R. B. Anderson, K. J. Hunt, and J. J. McCormick, “Management of common sports-related injuries about the foot and ankle”, J Am Acad Orthop Surg, 2010; 18(9): 546-556.
68. P. Peris, “Stress fractures”, Best Pract Res Clin Rheumatol, 2003; 17:1043–1061.
69. K. Fujitaka, A. Taniguchi, S. Isomoto, T. Kumai, S. Otuki, M. Okubo, and Y. Tanaka, “Pathogenesis of fifth metatarsal fractures in college soccer players”, Orthop J Sports Med, 2015;3(9).
70. M. Robin, Queen, E. Mark, Easley, and A. James, “Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal bavornrit chuckpaiwong”, Nunley Clin Orthop Relat Res, 2008; 466(8):1966–1970.
71. G. E. Quill, “Fractures of the proximal fifth metatarsal”, Orthop Clin North Am, 1995; 26:353-361.
72. G. J. Roehrig, E. G. Mcfarland, A. J. Cosgarea, J. R. Martire, and K. W. Farmer, “Unusual stress fracture of the fifth metatarsal in a basketball player”, Clin J Sport Med, 2001; 11:271–273.
73. I. J. Alexander, E. Y. S. Chao, and K. A. Johnson, “The assesment of dynamic foot-to-ground contact forces and plantar pressure distribution: a review of the evolution of current techniques and clinical applications”, Foot Ankle, 1990;11:152–167.
74.S. Lundeen, K. Lundquist, M.W. Cornwall, and T.G. McPoil,“Plantar pressure during level walking compared with other ambulatory activities”, Foot Ankle Int, 1994;15:324–328.
75. S. W. Donahue, N. A. Sharkey, “Strains in the metatarsals during the stance phase of gait: implications for stress fractures”. J Bone Joint Surg Am, 1999 ; 81(9):1236-1244.
76. M. Viceconti, C. Zannoni, and L. Pierotti, “Tri2solid: an application of reverse engineering methods to the creation of CAD models of bone segments”, Comput Methods Programs Biomed, 1998; 56 (3):211–220.
77. J. T. M. Cheung, M. Zhang, and K. N. An, “Effect of Achilles tendon loading on plantar,fascia tension in the standing foot”, Clin Biomech, 2006; 21 (2):194–203.
78. J. T. Cheung, M. Zhang, A. K. Leung, and Y. B. Fan, “Three-dimensional finite element,analysis of the foot during standing–a material sensitivity study”, J Biomech, 2006; 38:1045–1054.
79. M. S. Redfern, B. Bidanda, “Slip resistance of the shoe-floor interface under biomechanically relevant conditions”, Ergonomics, 1994; 37:511-524.
80. F. L. Buczek, S. A. Banks, “High-resolution force plate analysis of utilized slip resistance in human walking”, Am Soc Test Master, 1996;24:353-358.
81. K. A. Ward, and R. W. Soames, “Contact patterns at the tarsal joints”, Clin Biomech, 1997;12(7/8):496-507.
82. J. Nilsson, A. Thorstensson, “Ground reaction forces at different speeds of human walking and running”, Acta Physiol Scand, 1989; 136(2):217-27.
83. B. Hintermann, and B. M. Nigg, “Pronation in runners”, Sports Medicine, 1998; 26(3):169–176.
84. M. A. Craigen, and N. M. Clarke, “Bilateral Jones fractures of the fifth metatarsal following relapse of talipes equinovarus”, Injury, 1996; 27:599–601.
85. B. M. Nigg, “The role of impact forces and foot pronation: a new paradigm”, Clin. J Sport Med, 2001; 11(1):2-9.
86. D. S. Williams, I. S. McClay, and J. Hamill, “Arch structure and injury patterns in runners”, Clin Biomech, 2001;16(4):341-347.
87. A. Manoli, “Male basketball player with a stress fracture of the fifth metatarsal and subtle cavus feet”, Sports Health, 2010; 2(6):495-502.
88. J. Patrick, Battaglia, A. Martha, Kaeser, and W. K. Norman, “Diagnosis and serial sonography of a proximal fifth metatarsal stress fracture”, J Clin Med, 2013; 12(3):196-200.
89. R. Biedert, B. Hintermann, “Stress fractures of the medial great toe sesamoids in athletes”, Foot Ankle Int, 2003; 24:137-141.
90. R. Pooja, C. Elena, “Role of teriparatide in accelerating metatarsal stress fracture healing: a case series and review of literature”, Clin Med Insights Endocrinol Diabetes, 2012; 5:39–45.
91. J. T. Bernhard, G. Mark, N. C. P. Victor, N. M. T. Prudencia, L. Radhesh., and S. Jaspreet, “Stress fracture of the pelvis and lower limbs including atypical femoral fractures—a review”, Insights Imaging, 2015; 6(1):97-110.
92. J. W. K. Harrison, and C. E. Bruce, “An unusual cause for metatarsal stress fractures”, Foot and Ankle Surgery, 2001;7(4):247-248.
93. T. S. Gross,R. P. Bunch, “A mechanical model of metatarsal stress fracture during distance running”, Am J Sports Med, 1989; 17:669-674.
94. J. Bernhard, G. Mark, N. Victor, P. Cassar, N. M. Prudencia, Tyrrell, L. Radhesh, and S. Jaspreet, “Stress fracture of the pelvis and lower limbs including atypical femoral fractures—a review”, Insights Imaging, 2014; 2:97-110.
95. J. Kenneth, R. Hunt, B. Robert, Anderson, “Fifth metatarsal fractures and refractures”, Sports Medicine, 2014; 22(4):305-312.