Department of Orthopedic, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, Jiangsu Province 215006, PR China; Department of Orthopedic, Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China.
Department of Ophthalmology,Taizhou Central Hospital (Taizhou University Hospital), No.999, Donghai Avenue, Jiaojiang District, Taizhou City, Zhejiang Province 318000, PR China.
Comput Methods Programs Biomed. 2023 Jan;228:107253. doi: 10.1016/j.cmpb.2022.107253. Epub 2022 Nov 19.
The application of wedge-shaped bone grafts can increase the biomechanical stability of knee during the medial open-wedge high tibial osteotomy (MOWHTO) by reducing the von Mises stress of the medial plate and lateral cortical hinge area. However, the optimal position of bone grafts it remains unclear, so we aimed to determine search for the optimal position of the bone grafts in MOWHTO by using finite element analysis.
In the finite element analysis, MOWHTO models were established with three different osteotomy distraction heights and assembled into four groups according to different conditions, including the no bone grafts (NBG) group, the anterior bone grafts (ABG) group, the middle bone grafts (MBG) group, and the posterior bone grafts (PBG) group. Based on previous studies, 600 N and 1800 N loads were applied to the knee joint to simulate the static forces during a double and single leg stance to measure the von Mises stress of the medial implant area and lateral hinge area, the maximum displacement of different models, the relative displacement of the osteotomy area and the stress distribution in the bone grafts.
Compared to the NBG and ABG groups, the stress of the lateral cortical hinge area and the medial implate area was significantly lower in the PBG group. For example, under the 600N force load, when the height of the osteotomy area was 10 mm, 15 mm, and 20 mm, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the NBG group were 140, 141, 172, and 53, 57, 60 MPa, respectively. Compared with the NBG group, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the PBG group were reduced by 45%, 56%, 63% and 14%, 39%, 68% at distraction height of 10 mm, 15 mm, and 20 mm, respectively. The bone grafts in the posterior parts provide the best stability,with the stress of the middle and posterior bone grafts are mainly concentrated in the edge.
The posterior part of the osteotomy area is the best position for bone graft placement since it provides optimal stability and reduces von Mises stress in the medial plate and lateral cortex hinge area, with the stress of the posterior bone grafts mainly concentrated in the edge. These findings guide bone graft placement sites in clinical surgery and are a basis for future research on bone graft materials and structures in MOWHTO.
通过减少内侧板和外侧皮质铰链区域的 von Mises 应力，楔形骨移植的应用可以增加内侧开放楔形胫骨高位截骨术（MOWHTO）过程中膝关节的生物力学稳定性。然而，骨移植的最佳位置尚不清楚，因此我们旨在通过有限元分析来确定 MOWHTO 中骨移植的最佳位置。
在有限元分析中，建立了三种不同截骨撑开高度的 MOWHTO 模型，并根据不同条件分为四组，包括无骨移植组（NBG）、前骨移植组（ABG）、中骨移植组（MBG）和后骨移植组（PBG）。基于先前的研究，施加 600 N 和 1800 N 的载荷于膝关节以模拟双腿站立时的静态力，测量内侧植入物区域和外侧铰链区域的 von Mises 应力、不同模型的最大位移、截骨区域的相对位移以及骨移植中的应力分布。
与 NBG 和 ABG 组相比，PBG 组的外侧皮质铰链区域和内侧植入物区域的应力明显更低。例如，在 600 N 力载荷下，当截骨区域高度为 10、15 和 20 mm 时，NBG 组内侧植入物区域和外侧皮质铰链区域的最大 von Mises 应力分别为 140、141、172 和 53、57、60 MPa。与 NBG 组相比，在截骨高度为 10、15 和 20 mm 时，PBG 组内侧植入物区域和外侧皮质铰链区域的最大 von Mises 应力分别降低了 45%、56%、63%和 14%、39%、68%。后部骨移植提供了最佳的稳定性，其中中后部骨移植的应力主要集中在边缘。
在截骨区域的后部放置骨移植是最佳位置，因为它提供了最佳的稳定性并降低了内侧板和外侧皮质铰链区域的 von Mises 应力，同时后部骨移植的应力主要集中在边缘。这些发现指导了临床手术中的骨移植放置部位，并为未来研究 MOWHTO 中的骨移植材料和结构提供了基础。
