Sakai Tatsuya, Fujii Masanori, Kitamura Kenji, Tanaka Hirofumi, Mawatari Masaaki
Orthopedic Surgery, Saga University, Saga, JPN.
Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN.
Cureus. 2024 Feb 7;16(2):e53803. doi: 10.7759/cureus.53803. eCollection 2024 Feb.
The biomechanical effect of distal tibial oblique osteotomy (DTOO) on osteoarthritic ankles has not been investigated. Using finite element (FE) models, we aimed to elucidate the effect of DTOO on the ankle contact pressure (CP) distribution.
This study included two patients with ankle osteoarthritis who underwent DTOO and one asymptomatic control. Patient-specific FE models were reconstructed by matching standing radiographs with supine computed tomography scans. The joint contact area (CA) and maximum CP on the articular surface of the talus were calculated before and after DTOO and compared with those of the control.
In the control, the CA was 584 mm and the maximum CP was 2.6 MPa. In case 1, the CA increased by 125% from 166 mm preoperatively to 375 mm postoperatively, accompanied by a 36% decrease in the maximum CP from 9.8 MPa to 6.3 MPa. Similarly, in case 2, the CA increased by 46% from 301 mm to 439 mm, accompanied by a 27% decrease in the maximum CP from 6.7 MPa to 4.9 MPa.
This study suggests DTOO improves the biomechanics of the ankle, but not sufficiently compared to the control. This analytical approach may enhance understanding of ankle pathophysiology and assist in the design of the ideal corrective osteotomy.
胫骨远端斜行截骨术（DTOO）对踝骨关节炎的生物力学影响尚未得到研究。我们旨在通过有限元（FE）模型阐明DTOO对踝关节接触压力（CP）分布的影响。
本研究纳入了2例接受DTOO的踝骨关节炎患者和1例无症状对照者。通过将站立位X线片与仰卧位计算机断层扫描相匹配，重建了患者特异性FE模型。计算DTOO前后距骨关节表面的关节接触面积（CA）和最大CP，并与对照者进行比较。
在对照者中，CA为584平方毫米，最大CP为2.6兆帕。在病例1中，CA从术前的166平方毫米增加了125%，至术后的375平方毫米，同时最大CP从9.8兆帕下降了36%，至6.3兆帕。同样，在病例2中，CA从301平方毫米增加了46%，至439平方毫米，同时最大CP从6.7兆帕下降了27%，至4.9兆帕。
本研究表明DTOO可改善踝关节生物力学，但与对照者相比改善程度不足。这种分析方法可能会增强对踝关节病理生理学的理解，并有助于理想矫正截骨术的设计。
