{"title":"通过生物力学研究预测腓骨上截骨术(带或不带附加腓骨截骨术)的预后:有限元分析。","authors":"Jung-Min Lee, Wen-Ming Chen, Chul Hyun Park, Seung Jae Cho, Inha Woo","doi":"10.1007/s13534-024-00394-z","DOIUrl":null,"url":null,"abstract":"<p><p>Supramalleolar osteotomy (SMO) is a representative procedure to restore a malalignment in the varus ankle deformity by shifting the concentrated pressure on the medial ankle joint to the lateral area. Additionally, fibula osteotomy (FO) is selectively selected and performed according to the surgeon's preference. However, it is controversial whether FO is effective in shifting the abnormal pressure from the medial to the lateral area on the ankle joint. Some cadaveric studies have been performed to prove this. However, it is difficult to consistently reconstruct amount of the varus ankle deformities angle in cadavers and to guarantee reliable contact pressure between the ankle joint. Thus, the aim of this study was predicted and quantitatively compared a peak pressure between single SMO and SMO with FO procedure by using a finite element analysis as a powerful biomechanical tool to those limitations of cadaveric study. This study reconstructed total 4 3D foot and ankle models including a normal and pre-op model and 2 post-op models. The pre-op model was modified by assigning 10° varus tilting corresponding to stage 3b in the classification of varus ankle osteoarthritis based on the validated normal model. Also, the post-op models were reconstructed by applying single SMO and SMO with FO, respectively. All of the models were assumed as one-leg standing position and to mimic smooth ankle joint motion. Peak contact pressure change was predicted at the medial ankle joint by using computational simulation. As a result, 2 post-op models showed a remarkably peak pressure reduction by up to 5.5 times on the medial tibiotalar joint. However, a comparison between single SMO and SMO with FO model showed no appreciable differences. In conclusion, this study predicted that single SMO may be as effective as SMO with FO in reducing peak contact pressure on the medial tibiotalar joint in varus ankle osteoarthritis.</p>","PeriodicalId":46898,"journal":{"name":"Biomedical Engineering Letters","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362411/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prediction of prognosis in supramalleolar osteotomy with or without additional fibula osteotomy by approaching a biomechanical study: a finite element analysis.\",\"authors\":\"Jung-Min Lee, Wen-Ming Chen, Chul Hyun Park, Seung Jae Cho, Inha Woo\",\"doi\":\"10.1007/s13534-024-00394-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Supramalleolar osteotomy (SMO) is a representative procedure to restore a malalignment in the varus ankle deformity by shifting the concentrated pressure on the medial ankle joint to the lateral area. Additionally, fibula osteotomy (FO) is selectively selected and performed according to the surgeon's preference. However, it is controversial whether FO is effective in shifting the abnormal pressure from the medial to the lateral area on the ankle joint. Some cadaveric studies have been performed to prove this. However, it is difficult to consistently reconstruct amount of the varus ankle deformities angle in cadavers and to guarantee reliable contact pressure between the ankle joint. Thus, the aim of this study was predicted and quantitatively compared a peak pressure between single SMO and SMO with FO procedure by using a finite element analysis as a powerful biomechanical tool to those limitations of cadaveric study. This study reconstructed total 4 3D foot and ankle models including a normal and pre-op model and 2 post-op models. The pre-op model was modified by assigning 10° varus tilting corresponding to stage 3b in the classification of varus ankle osteoarthritis based on the validated normal model. Also, the post-op models were reconstructed by applying single SMO and SMO with FO, respectively. All of the models were assumed as one-leg standing position and to mimic smooth ankle joint motion. Peak contact pressure change was predicted at the medial ankle joint by using computational simulation. As a result, 2 post-op models showed a remarkably peak pressure reduction by up to 5.5 times on the medial tibiotalar joint. However, a comparison between single SMO and SMO with FO model showed no appreciable differences. 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引用次数: 0
摘要
踝上截骨术(SMO)是一种具有代表性的手术,通过将内侧踝关节的集中压力转移到外侧区域来恢复外翻踝关节畸形的错位。此外,腓骨截骨术(FO)可根据外科医生的偏好选择性地进行。然而,腓骨截骨术是否能有效地将踝关节的异常压力从内侧转移到外侧,目前还存在争议。一些尸体研究证明了这一点。然而,很难在尸体上一致地重建踝关节屈曲畸形角的大小,也很难保证踝关节之间有可靠的接触压力。因此,本研究的目的是利用有限元分析这一强大的生物力学工具,预测并定量比较单一 SMO 和 SMO 与 FO 程序之间的峰值压力,以解决尸体研究的局限性。这项研究共重建了 4 个三维足踝模型,包括一个正常和术前模型以及两个术后模型。术前模型是根据经过验证的正常模型,按照曲踝骨关节炎分类中的 3b 阶段,将 10° 曲踝倾斜度进行修改的。此外,术后模型也分别通过应用单一 SMO 和 SMO 加 FO 进行了重建。所有模型均假定为单腿站立姿势,并模拟平滑的踝关节运动。通过计算模拟预测了内侧踝关节的峰值接触压力变化。结果显示,两个术后模型的内侧胫腓关节峰值压力明显降低了 5.5 倍。然而,单一 SMO 与 SMO 加 FO 模型之间的比较并未显示出明显差异。总之,本研究预测,在降低曲踝骨关节炎患者胫腓骨内侧关节的峰值接触压力方面,单一 SMO 与 SMO 加 FO 一样有效。
Prediction of prognosis in supramalleolar osteotomy with or without additional fibula osteotomy by approaching a biomechanical study: a finite element analysis.
Supramalleolar osteotomy (SMO) is a representative procedure to restore a malalignment in the varus ankle deformity by shifting the concentrated pressure on the medial ankle joint to the lateral area. Additionally, fibula osteotomy (FO) is selectively selected and performed according to the surgeon's preference. However, it is controversial whether FO is effective in shifting the abnormal pressure from the medial to the lateral area on the ankle joint. Some cadaveric studies have been performed to prove this. However, it is difficult to consistently reconstruct amount of the varus ankle deformities angle in cadavers and to guarantee reliable contact pressure between the ankle joint. Thus, the aim of this study was predicted and quantitatively compared a peak pressure between single SMO and SMO with FO procedure by using a finite element analysis as a powerful biomechanical tool to those limitations of cadaveric study. This study reconstructed total 4 3D foot and ankle models including a normal and pre-op model and 2 post-op models. The pre-op model was modified by assigning 10° varus tilting corresponding to stage 3b in the classification of varus ankle osteoarthritis based on the validated normal model. Also, the post-op models were reconstructed by applying single SMO and SMO with FO, respectively. All of the models were assumed as one-leg standing position and to mimic smooth ankle joint motion. Peak contact pressure change was predicted at the medial ankle joint by using computational simulation. As a result, 2 post-op models showed a remarkably peak pressure reduction by up to 5.5 times on the medial tibiotalar joint. However, a comparison between single SMO and SMO with FO model showed no appreciable differences. In conclusion, this study predicted that single SMO may be as effective as SMO with FO in reducing peak contact pressure on the medial tibiotalar joint in varus ankle osteoarthritis.
期刊介绍:
Biomedical Engineering Letters (BMEL) aims to present the innovative experimental science and technological development in the biomedical field as well as clinical application of new development. The article must contain original biomedical engineering content, defined as development, theoretical analysis, and evaluation/validation of a new technique. BMEL publishes the following types of papers: original articles, review articles, editorials, and letters to the editor. All the papers are reviewed in single-blind fashion.