MacLeod A R, Serrancoli G, Fregly B J, Toms A D, Gill H S
Department of Mechanical Engineering, University of Bath, Bath, UK.
Department of Mechanical Engineering, Polytechnic University of Catalonia, Barcelona, Catalunya, Spain.
Bone Joint Res. 2019 Jan 4;7(12):639-649. doi: 10.1302/2046-3758.712.BJR-2018-0035.R1. eCollection 2018 Dec.
Opening wedge high tibial osteotomy (HTO) is an established surgical procedure for the treatment of early-stage knee arthritis. Other than infection, the majority of complications are related to mechanical factors - in particular, stimulation of healing at the osteotomy site. This study used finite element (FE) analysis to investigate the effect of plate design and bridging span on interfragmentary movement (IFM) and the influence of fracture healing on plate stress and potential failure.
A 10° opening wedge HTO was created in a composite tibia. Imaging and strain gauge data were used to create and validate FE models. Models of an intact tibia and a tibia implanted with a custom HTO plate using two different bridging spans were validated against experimental data. Physiological muscle forces and different stages of osteotomy gap healing simulating up to six weeks postoperatively were then incorporated. Predictions of plate stress and IFM for the custom plate were compared against predictions for an industry standard plate (TomoFix).
For both plate types, long spans increased IFM but did not substantially alter peak plate stress. The custom plate increased axial and shear IFM values by up to 24% and 47%, respectively, compared with the TomoFix. In all cases, a callus stiffness of 528 MPa was required to reduce plate stress below the fatigue strength of titanium alloy.
We demonstrate that larger bridging spans in opening wedge HTO increase IFM without substantially increasing plate stress. The results indicate, however, that callus healing is required to prevent fatigue failure.: A. R. MacLeod, G. Serrancoli, B. J. Fregly, A. D. Toms, H. S. Gill. The effect of plate design, bridging span, and fracture healing on the performance of high tibial osteotomy plates: An experimental and finite element study. 2018;7:639-649. DOI: 10.1302/2046-3758.712.BJR-2018-0035.R1.
开放楔形高位胫骨截骨术（HTO）是治疗早期膝关节骨关节炎的一种成熟外科手术。除感染外，大多数并发症与机械因素有关，尤其是截骨部位愈合的刺激。本研究采用有限元（FE）分析来研究钢板设计和桥接跨度对骨折块间运动（IFM）的影响，以及骨折愈合对钢板应力和潜在失效的影响。
在复合胫骨上创建10°开放楔形HTO。利用成像和应变片数据创建并验证FE模型。针对实验数据对完整胫骨模型以及植入使用两种不同桥接跨度的定制HTO钢板的胫骨模型进行验证。然后纳入生理肌肉力量以及模拟术后长达六周的截骨间隙愈合的不同阶段。将定制钢板的钢板应力和IFM预测结果与行业标准钢板（TomoFix）的预测结果进行比较。
对于两种钢板类型，长跨度均增加了IFM，但并未显著改变钢板峰值应力。与TomoFix相比，定制钢板的轴向和剪切IFM值分别增加了高达24%和47%。在所有情况下，需要528兆帕的骨痂刚度才能将钢板应力降低至低于钛合金的疲劳强度。
我们证明，开放楔形HTO中更大的桥接跨度会增加IFM，而不会显著增加钢板应力。然而，结果表明需要骨痂愈合以防止疲劳失效。：A. R. 麦克劳德、G. 塞兰科利、B. J. 弗雷格利、A. D. 汤姆斯、H. S. 吉尔。钢板设计、桥接跨度和骨折愈合对高位胫骨截骨钢板性能的影响：一项实验和有限元研究。2018年；7:639 - 649。DOI: 10.1302/2046 - 3758.712.BJR - 2018 - 0035.R1
Zotero 插件