Mühlhofer H, Ercan Y, Drews S, Matsuura M, Meissner J, Linsenmaier U, Putz R, Müller-Gerbl M
Anatomische Anstalt der Ludwig-Maximilians Universität, 80336, Munich, Germany.
Surg Radiol Anat. 2009 Apr;31(4):237-43. doi: 10.1007/s00276-008-0430-6. Epub 2008 Nov 5.
The implantation of total ankle prosthesis is one of the most challenging operations in orthopaedic surgery. The main problem that surgeons face is the fixation of the total ankle prosthesis on the tibial side. The subchondral bone plate of the distal tibia is considered the strongest region on the inferior tibial facies. Based on information about the mineralisation of the subchondral bone plate, conclusions can be made concerning the mechanical stress, age-related changes, post-surgical biomechanical situations and regions of fixation. The aim of this study was to determine the correlation between the mineralisation of the subchondral bone plate and the topical mechanical strength.
By means of CT-osteoabsorptiometry, the distribution of mineralisation in the subchondral bone plate in 18 distal Tibiae was investigated. After removal of the cartilage of the facies articularis inferior, the mechanical strength of the joint surface was measured with an indentation apparatus. The linear regression of the mineralisation density and the maximal mechanical strength to penetrate the subchondral bone plate was determined.
Our data showed a coefficient of determination between 0.75 and 0.97 and a coefficient of correlation between 0.86 and 0.97. The T test showed significance (P < 0.05). Furthermore, we demonstrated a bicentric distribution of mineralisation patterns. The maximal mineralisation was found ventromedially and mediolaterally on the joint surface.
Our study shows good correlation of mineralisation and mechanical property of the inferior tibial facies. Therefore, as the results provide information on the topographical distribution of bone quality, they could be useful for the development of new fixation methods for total ankle prosthesis.
全踝关节置换术是骨科手术中最具挑战性的手术之一。外科医生面临的主要问题是全踝关节假体在胫骨侧的固定。胫骨远端的软骨下骨板被认为是胫骨下表面最强的区域。基于软骨下骨板矿化的信息，可以得出关于机械应力、年龄相关变化、术后生物力学情况及固定区域的结论。本研究的目的是确定软骨下骨板矿化与局部机械强度之间的相关性。
通过CT骨吸收测量法，研究了18个胫骨远端软骨下骨板的矿化分布。去除下关节面软骨后，用压痕装置测量关节面的机械强度。确定矿化密度与穿透软骨下骨板的最大机械强度之间的线性回归。
我们的数据显示决定系数在0.75至0.97之间，相关系数在0.86至0.97之间。T检验显示具有显著性（P < 0.05）。此外，我们证明了矿化模式的双中心分布。在关节面的腹内侧和内外侧发现了最大矿化。
我们的研究表明胫骨下表面的矿化与机械性能具有良好的相关性。因此，由于研究结果提供了关于骨质地形分布的信息，它们可能有助于开发全踝关节假体的新固定方法。
