Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Biomedical Engineering, Jungwon University, Chungcheongbuk-do, Republic of Korea.
Clin Biomech (Bristol). 2023 Jul;107:106027. doi: 10.1016/j.clinbiomech.2023.106027. Epub 2023 Jun 8.
While the concept of a safe zone, which can minimize the hinge fracture when performing opening wedge high tibial osteotomy, has been introduced, there is a lack of understanding of the biomechanical environment at the lateral tibial cortex. This study aimed to evaluate the effect of the hinge level on the biomechanical environment at the lateral cortex of the tibia with heterogeneous finite element models.
Finite element models of biplanar opening wedge high tibial osteotomy based on computed tomography images of a control subject and three patients with medial compartment knee osteoarthritis were created. In each model, three different hinge levels (proximal, middle, and distal) were set. The process of opening the gap during the operation was simulated, and the maximum von Mises stress values at the lateral tibial cortex were calculated for each hinge level and correction angle.
The maximum von Mises stress value at the lateral tibial cortex was the lowest when the hinge was at the middle, while the value was the highest when the hinge was at the distal level. Furthermore, it was demonstrated that a higher correction angle yielded a higher probability of lateral tibial cortex fracture.
The findings of this study demonstrate that the hinge at the point where the upper end of the articular cartilage of the proximal tibiofibular joint is located provides the least possibility of lateral tibial cortex fracture, as this is an anatomically independent position from the fibula.
虽然已经提出了安全区域的概念，即在进行开放式楔形胫骨高位截骨时可以最小化铰链骨折，但对于外侧胫骨皮质的生物力学环境仍缺乏了解。本研究旨在使用异性有限元模型评估铰链位置对胫骨外侧皮质生物力学环境的影响。
基于一名对照受试者和三名内侧间室膝骨关节炎患者的计算机断层扫描图像，创建了双平面开放式楔形胫骨高位截骨的有限元模型。在每个模型中，设置了三个不同的铰链位置（近端、中间和远端）。模拟了手术中打开间隙的过程，并计算了每个铰链位置和校正角度下外侧胫骨皮质的最大 von Mises 应力值。
当铰链位于中间时，外侧胫骨皮质的最大 von Mises 应力值最低，而当铰链位于远端时，该值最高。此外，还表明较高的校正角度会增加外侧胫骨皮质骨折的可能性。
本研究的结果表明，铰链位于胫骨腓骨关节近端关节软骨的上止点处，提供了外侧胫骨皮质骨折的可能性最小，因为这是一个与腓骨解剖上独立的位置。
