Trabzon Kanuni Research and Education Hospital, Trabzon, Turkey.
Private Hand Microsurgery Orthopedics Traumatology (EMOT) Hospital, Kahramanlar District, Street 1418, No:14, Konak, Izmir, Turkey.
J Orthop Surg Res. 2022 Jul 30;17(1):371. doi: 10.1186/s13018-022-03264-5.
We created patient-based 3D finite-element (FE) models that simulate the congruent-arc Latarjet (CAL) and traditional Latarjet (TL) procedures and then compared their stress distribution patterns with different arm positions and glenoid defects.
The computed tomography data of 10 adult patients (9 men and 1 woman, ages: 18-50 years) were used to develop the 3D FE glenohumeral joint models. Twenty-five and 35% bony defects were created on the anterior glenoid rim, and the coracoid process was transferred flush with the glenoid by the traditional and congruent-arc techniques using two half-threaded screws. A load was applied to the greater tuberosity toward the center of the glenoid, and a tensile force (20 N) was applied to the coracoid tip along the direction of the conjoint tendon. The distribution patterns of the von Mises stress in the traditional and congruent-arc Latarjet techniques were compared.
The mean von Mises on the graft was significantly greater for the TL technique than for the CAL. While the von Mises stress was greater in the distal medial part of the graft in the TL models, a higher stress concentration was observed in the distal lateral edge of the coracoid graft in the CAL models. The proximal medial part of the graft exhibited significantly lower von Mises stress than the distal medial part when compared according to technique, defect size, and arm position. Increasing the glenoid defect from 25 to 35% resulted in a significant increase in stress on the lateral side of the graft in both models.
The stress distribution patterns and stress magnitude of the coracoid grafts differed according to the procedure. Due to placing less stress on the proximal-medial part of the graft, the CAL technique may lead to insufficient stimulation for bone formation at the graft-glenoid interface, resulting in a higher incidence of graft osteolysis. Clinical relevance The CAL technique may lead to a higher incidence of graft osteolysis.
Basic Science Study; Computer Modeling.
我们创建了基于患者的三维有限元（FE）模型，模拟了一致弧形 Latarjet（CAL）和传统 Latarjet（TL）手术，并比较了它们在不同手臂位置和肩胛盂缺损下的应力分布模式。
使用 10 名成年患者（9 名男性和 1 名女性，年龄：18-50 岁）的计算机断层扫描数据来开发三维 FE 肩袖关节模型。在前肩胛盂缘上创建了 25%和 35%的骨缺损，并用传统和一致弧形技术将喙突转移至与肩胛盂平齐，使用两个半螺纹螺钉。将力施加到肱骨大结节朝向肩胛盂中心，将 20N 的张力施加到喙突尖端沿联合肌腱方向。比较了传统和一致弧形 Latarjet 技术中的冯米塞斯应力分布模式。
TL 技术的移植物冯米塞斯均值明显大于 CAL 技术。TL 模型中移植物的远端内侧部分的冯米塞斯应力较大，而 CAL 模型中喙突移植物的远端外侧边缘出现了更高的应力集中。与技术、缺损大小和手臂位置相比，移植物的近端内侧部分的冯米塞斯应力显著较低。当将肩胛盂缺损从 25%增加到 35%时，两种模型中移植物外侧的应力都显著增加。
根据手术方式、缺损大小和手臂位置的不同，喙突移植物的应力分布模式和大小不同。由于对移植物的近内侧部分施加的应力较小，CAL 技术可能导致移植物-肩胛盂界面的骨形成刺激不足，从而导致移植物骨溶解的发生率较高。
CAL 技术可能导致移植物骨溶解的发生率较高。
基础科学研究；计算机建模。
