Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan.
Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Knee. 2022 Oct;38:62-68. doi: 10.1016/j.knee.2022.07.010. Epub 2022 Aug 2.
The purpose of this study was to investigate axial load resistance of the tibia depending on the thickness of tibial tuberosity osteotomy in medial open-wedge distal tuberosity proximal tibial osteotomy (OWDTO). The hypothesis is that a thin tibial tuberosity osteotomy shows high axial load resistance of the tibia.
The OWDTO model was constructed from imitation bones of the tibia. Distal tibial tuberosity osteotomy was performed with thicknesses of 7, 14, and 21 mm (n = 5 for each group). Cyclic axial-load fatigue tests were performed to investigate the strain at five measurement points on the OWDTO model. An axial-load failure test was also performed to investigate the maximum strain for failure.
The 7-mm OWDTO model showed a significantly lower stain range than the 14-mm model at the middle part of the lateral hinge (P = 0.0263, mean difference: -852.6 με), posterior part (P = 0.0465, mean difference: -1040.0 με), posterior tibial cortex (P < 0.0001, mean difference: -583.4 με), and plate (P = 0.0029, mean difference: -121.6 με). There were no significant differences in the strain at the tibial tuberosity between the groups. The axial load for complete failure was significantly higher in the 7-mm model than in the 21-mm model (P = 0.0010, mean difference: 2577.0 N). The failure points were at the lateral hinges.
Thinner distal tibial tuberosity osteotomy is more resistant to axial load and may be recommended for the prevention of tibial and lateral hinge fractures after OWDTO.
本研究旨在探讨内侧开口楔形胫骨近端截骨术（OWDTO）中胫骨结节切开厚度对胫骨轴向负荷阻力的影响。假设胫骨结节切开较薄可提高胫骨的轴向负荷阻力。
采用胫骨模拟骨构建 OWDTO 模型。胫骨结节切开厚度分别为 7、14 和 21mm（每组 5 例）。进行循环轴向负荷疲劳试验，以研究 OWDTO 模型五个测量点的应变。还进行了轴向负荷失效试验，以研究失效时的最大应变。
7mm OWDTO 模型在外侧铰链中部（P=0.0263，平均差异：-852.6 με）、后部（P=0.0465，平均差异：-1040.0 με）、胫骨后皮质（P<0.0001，平均差异：-583.4 με）和钢板（P=0.0029，平均差异：-121.6 με）处的应变范围明显低于 14mm 模型。各组胫骨结节处的应变无显著差异。完全失效时的轴向负荷在 7mm 模型中明显高于 21mm 模型（P=0.0010，平均差异：2577.0 N）。失效点位于外侧铰链处。
胫骨结节切开较薄可提高胫骨的轴向负荷阻力，对于预防 OWDTO 后胫骨和外侧铰链骨折可能是有益的。
