Enhancing biomechanical outcomes in proximal femoral osteotomy through optimised blade plate sizing: A neuromusculoskeletal-informed finite element analysis

IF 4.9 2区 医学 Q1 COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS Computer methods and programs in biomedicine Pub Date : 2024-10-28 DOI:10.1016/j.cmpb.2024.108480
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Abstract

Proximal femoral osteotomy (PFO) is a frequently performed surgical procedure to correct hip deformities in the paediatric population. The optimal size of the blade plate implant in PFO is a critical but underexplored factor influencing biomechanical outcomes. This study introduces a novel approach to refine implant selection by integrating personalized neuromusculoskeletal modelling with finite element analysis. Using computed tomography scans and walking gait data from six paediatric patients with various pathologies and deformities, we assessed the impact of four distinct implant width-to-femoral neck diameter (W-D) ratios (30 %, 40 %, 50 %, and 60 %) on surgical outcomes. The results show that the risk of implant yield generally decreases with increasing W-D ratio, except for Patient P2, where the yield risk remained below 100 % across all ratios. The implant factor of safety (FoS) increased with larger W-D ratios, except for Patients P2 and P6, where the highest FoS was 2.60 (P2) and 0.49 (P6) at a 60 % W-D ratio. Bone-implant micromotion consistently remained below 40 µm at higher W-D ratios, with a 50 % W-D ratio striking the optimal balance for mechanical stability in all patients except P6. Although interfragmentary and principal femoral strains did not display consistent trends across all patients, they highlight the need for patient-specific approaches to ensure effective fracture healing. These findings highlight the importance of patient-specific considerations in implant selection, offering surgeons a more informed pathway to enhance patient outcomes and extend implant longevity. Additionally, the insights gained from this study provide valuable guidance for manufacturers in designing next-generation blade plates tailored to improve biomechanical performance in paediatric orthopaedics.
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通过优化刀板尺寸提高股骨近端截骨术的生物力学效果:以神经肌肉骨骼为基础的有限元分析。
股骨近端截骨术(PFO)是矫正儿童髋关节畸形的一种常用手术方法。股骨近端截骨术中刀板植入物的最佳尺寸是影响生物力学结果的关键因素,但这一因素尚未得到充分探索。本研究引入了一种新方法,通过将个性化神经-肌肉-骨骼建模与有限元分析相结合来完善植入物的选择。利用六名患有不同病理和畸形的儿科患者的计算机断层扫描和步行步态数据,我们评估了四种不同的植入物宽度与股骨颈直径(W-D)比(30%、40%、50% 和 60%)对手术效果的影响。结果显示,随着 W-D 比值的增加,植入物脱落的风险通常会降低,但患者 P2 除外,其脱落风险在所有比值下均低于 100%。种植体安全系数(FoS)随着 W-D 比值的增大而增大,但 P2 和 P6 患者除外,在 W-D 比值为 60% 时,这两名患者的安全系数最高,分别为 2.60(P2)和 0.49(P6)。在较高的 W-D 比值下,骨-种植体微动始终保持在 40 µm 以下,在除 P6 以外的所有患者中,50 % 的 W-D 比值达到了机械稳定性的最佳平衡。虽然所有患者的股骨片间应变和主要股骨应变并没有显示出一致的趋势,但它们强调了针对患者的方法的必要性,以确保有效的骨折愈合。这些发现凸显了在选择植入物时考虑患者具体情况的重要性,为外科医生提供了一条更明智的途径,以提高患者的治疗效果并延长植入物的使用寿命。此外,这项研究还为制造商提供了宝贵的指导,帮助他们设计下一代刀板,以改善儿童骨科的生物力学性能。
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来源期刊
Computer methods and programs in biomedicine
Computer methods and programs in biomedicine 工程技术-工程:生物医学
CiteScore
12.30
自引率
6.60%
发文量
601
审稿时长
135 days
期刊介绍: To encourage the development of formal computing methods, and their application in biomedical research and medical practice, by illustration of fundamental principles in biomedical informatics research; to stimulate basic research into application software design; to report the state of research of biomedical information processing projects; to report new computer methodologies applied in biomedical areas; the eventual distribution of demonstrable software to avoid duplication of effort; to provide a forum for discussion and improvement of existing software; to optimize contact between national organizations and regional user groups by promoting an international exchange of information on formal methods, standards and software in biomedicine. Computer Methods and Programs in Biomedicine covers computing methodology and software systems derived from computing science for implementation in all aspects of biomedical research and medical practice. It is designed to serve: biochemists; biologists; geneticists; immunologists; neuroscientists; pharmacologists; toxicologists; clinicians; epidemiologists; psychiatrists; psychologists; cardiologists; chemists; (radio)physicists; computer scientists; programmers and systems analysts; biomedical, clinical, electrical and other engineers; teachers of medical informatics and users of educational software.
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