Soykan Baran, Vahabi Arman, Kaya Biçer Elcil, Uzun Bora, Aydoğdu Semih
Department of Orthopaedics and Traumatology Ege University School of Medicine Izmir Turkey.
Department of Biomechanics Dokuz Eylül University Izmir Turkey.
J Exp Orthop. 2024 Jul 6;11(3):e12086. doi: 10.1002/jeo2.12086. eCollection 2024 Jul.
Medial open wedge high tibial osteotomy is a biological procedure for treating unicompartmental knee osteoarthritis. The literature repeatedly highlights the significance of preserving an intact lateral hinge during this procedure. We investigated the temporal course of distraction forces during distraction at the osteotomy site, aiming to quantitatively measure and analyse temporal changes in distraction forces at different distraction points for intact and fractured lateral hinges.
This biomechanical study was conducted on 10 human cadavers, which were divided into two groups: one with preserved 1 cm intact lateral cortexes (ILCs) and the other with completely osteotomised fractured lateral cortexes (FLCs). An experimental setup was custom designed to facilitate the required force measurement during distraction. The distraction forces were recorded with a force gauge at 0.5-mm intervals throughout the distraction.
There was a significant difference between the ILC and FLC groups in distraction forces at all points (8-15 mm). The ILC group consistently exhibited higher distraction force values, with FLC recording values ranging from 8.8% to 13.2% of ILC's. Lateral hinge fractures caused an 86.7% reduction in the initial required force for distraction, significantly impacting the force required for distraction. The ILC group displayed a linear increase in the required distraction force up to 12.5 mm of distraction, which reached 3.7 times the initial value at 12.5 mm of distraction. The FLC group had lower baseline required distraction forces, following a relatively linear trend with more limited increases.
FLCs in medial opening wedge osteotomy are associated with significant reductions in the force required for distraction, and a sudden decrease in distraction force during distraction may indicate a lateral hinge fracture. Force measurement devices for use during distraction could offer valuable insights and provide surgeons with immediate warnings for LHFs.
Level IV.
内侧开放楔形高位胫骨截骨术是治疗单髁膝关节骨关节炎的一种生物学方法。文献反复强调了在该手术过程中保留完整外侧铰链的重要性。我们研究了截骨部位牵张过程中牵张力的时间进程，旨在定量测量和分析完整及骨折外侧铰链在不同牵张点时牵张力的时间变化。
本生物力学研究对10具人体尸体进行，分为两组：一组保留1厘米完整的外侧皮质（ILC），另一组外侧皮质完全截骨形成骨折外侧皮质（FLC）。定制了一个实验装置，以便在牵张过程中进行所需的力测量。在整个牵张过程中，每隔0.5毫米用测力计记录牵张力。
在所有牵张点（8 - 15毫米），ILC组和FLC组的牵张力存在显著差异。ILC组始终表现出较高的牵张力值，FLC记录值为ILC的8.8%至13.2%。外侧铰链骨折使初始牵张所需力降低了86.7%，对牵张所需力有显著影响。ILC组在牵张至12.5毫米时，所需牵张力呈线性增加，在12.5毫米牵张时达到初始值的3.7倍。FLC组的基线所需牵张力较低，呈相对线性趋势，增加幅度较为有限。
内侧开放楔形截骨术中的FLC与牵张所需力的显著降低相关，牵张过程中牵张力的突然下降可能表明外侧铰链骨折。牵张过程中使用的力测量装置可以提供有价值的见解，并为外科医生提供外侧铰链骨折的即时警告。
四级。
