Belaid D, Vendeuvre T, Bouchoucha A, Brémand F, Brèque C, Rigoard P, Germaneau A
Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers - Constantine, P.O. Box 325, Ain-El-Bey Way, Constantine 25017, Algeria; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.
Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Department of Orthopaedic Surgery and Traumatology, CHU Poitiers, Poitiers, France; Spine & neuromodulation functional unit, Department of neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France.
Clin Biomech (Bristol). 2018 Jul;56:27-35. doi: 10.1016/j.clinbiomech.2018.05.002. Epub 2018 May 8.
Treatment for fractures of the tibial plateau is in most cases carried out by stable fixation in order to allow early mobilization. Minimally invasive technologies such as tibioplasty or stabilization by locking plate, bone augmentation and cement filling (CF) have recently been used to treat this type of fracture. The aim of this paper was to determine the mechanical behavior of the tibial plateau by numerically modeling and by quantifying the mechanical effects on the tibia mechanical properties from injury healing.
A personalized Finite Element (FE) model of the tibial plateau from a clinical case has been developed to analyze stress distribution in the tibial plateau stabilized by balloon osteoplasty and to determine the influence of the cement injected. Stress analysis was performed for different stages after surgery.
Just after surgery, the maximum von Mises stresses obtained for the fractured tibia treated with and without CF were 134.9 MPa and 289.9 MPa respectively on the plate. Stress distribution showed an increase of values in the trabecular bone in the treated model with locking plate and CF and stress reduction in the cortical bone in the model treated with locking plate only.
The computed results of stresses or displacements of the fractured models show that the cement filling of the tibial depression fracture may increase implant stability, and decrease the loss of depression reduction, while the presence of the cement in the healed model renders the load distribution uniform.
胫骨平台骨折的治疗在大多数情况下通过稳定固定来进行，以便能早期活动。诸如胫骨成形术或锁定钢板稳定、骨增强及骨水泥填充（CF）等微创技术近来已被用于治疗此类骨折。本文的目的是通过数值建模并量化损伤愈合对胫骨力学性能的力学影响，来确定胫骨平台的力学行为。
已建立一个来自临床病例的胫骨平台个性化有限元（FE）模型，以分析经球囊成形术稳定的胫骨平台中的应力分布，并确定注入骨水泥的影响。在术后不同阶段进行应力分析。
术后即刻，在钢板上，采用和未采用CF治疗的骨折胫骨所获得的最大冯·米塞斯应力分别为134.9MPa和289.9MPa。应力分布显示，在采用锁定钢板和CF治疗的模型中，小梁骨中的应力值增加，而在仅采用锁定钢板治疗的模型中，皮质骨中的应力降低。
骨折模型的应力或位移计算结果表明，胫骨凹陷骨折的骨水泥填充可能会增加植入物稳定性，并减少凹陷复位丢失，而在愈合模型中骨水泥的存在使载荷分布均匀。
