有限元分析确认了内侧开口楔形高胫骨截骨术中避免外侧铰链骨折的最佳顶点位置

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-16 DOI:10.1002/jeo2.70042

Humza T. Osmani, Radhika Gupta, Rosemary Earl, Stanisław Tomaszczyk, Tom Turmezei, Neil A. Segal, Michael Sutcliffe, Joel Melton

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引用次数: 0

摘要

目的外侧铰链骨折是内侧开口楔形高胫骨截骨术的一个重要并发症。虽然骨折风险与截骨顶点位置密切相关，但文献中的最佳位置仍不尽相同。我们的假设是，通过有限元分析预测的截骨顶点应力可用于确定将术中和术后骨折风险降至最低的顶点位置。方法研究了一个有限元模型，以探讨在给定骨骼几何形状下，改变铰链位置对骨折风险和严重程度的影响；分析的变量包括应力、应变和微动水平。另外还研究了九个膝关节模型，以评估患者骨骼特性之间的差异，并检查顶点位置对应变的影响。结果侧铰链宽度和高度对术中应力、应变和骨折风险有显著影响，而铰链宽度则主要决定术后稳定性。更宽的铰链能提高术后稳定性，但会增加关节内骨折的可能性。将顶点对准腓骨头高度可将应变降至最低。截骨顶点的位置应使铰链宽度等于内外侧宽度的13%，以将顶点应力和骨折风险降至最低，同时在铰链处保留足够的骨量以保证稳定性。顶点距胫骨平台的高度应保持在内外侧宽度 16% 的最小值，以避免关节内骨折，必要时顶点应低于腓骨头。胫骨的尺寸不会改变最佳位置，因此我们的研究结果适用于所有尺寸的胫骨。结论我们的研究基于骨折风险预测和截骨顶点的微动，调查并验证了所提出的最佳顶点位置。这在临床上非常有用，因为在计划手术时可能会使用术前二维X光片上的顶点。证据级别不适用。

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Finite element analysis confirms the optimal apex position in medial opening wedge high tibial osteotomy to avoid lateral hinge fracture

Purpose

Lateral hinge fracture is a significant complication of medial opening wedge high tibial osteotomy. While fracture risk is closely associated with the osteotomy apex position, the optimum position remains variable within the literature. Our hypothesis is that stresses at the osteotomy apex predicted by finite element analysis can be used to identify an apex position which minimises intra and postoperative fracture risks.

Methods

A finite element model was studied to investigate the effect of varying the hinge position on fracture risk and severity for a given bone geometry; variables analysed included stress, strain and micromotion levels. Nine further knee models were studied to assess the variability between patients' bone properties and examine the effect of apex location on strains.

Results

Lateral hinge width and height significantly influence intra-operative stress, strain, and fracture risk, while hinge width predominately determines postoperative stability. Wider hinges improve postoperative stability, but increase the likelihood of intra-articular fractures. Aiming the apex at the fibular head height minimises strain. The osteotomy apex should be located such that the hinge width is equal to 13% of the medial-lateral width to minimise apex stress and fracture risk while preserving sufficient bone at the hinge for stability. The height of the apex from the tibial plateau should maintain a minimum value of 16% of the medial-lateral width to avoid intra-articular fracture, with the apex below the fibula head if necessary. The size of the tibia does not alter the optimal location, making our findings applicable across all tibia sizes.

Conclusions

Our study has investigated and verified a proposed optimal apex position, based upon fracture risk prediction and micromotion at the osteotomy apex. This is clinically useful due to the potential use of the apex point on preoperative 2D radiographs when planning surgery.