不同截骨角度下胫骨内侧开放楔形高位截骨未植骨和植骨的有限元分析研究  

Finite element analysis of open and wedge-shaped high-position tibial osteotomy with bone graft or not under different osteotomy angles

作　　者：程邦君[1] 黄燕峰[1] 罗轶[1] CHENG Bang-jun;HUANG Yan-feng;LUO Yi(Department of Orthopedics,Jinshan Branch Hospital of the Sixth People’s Hospital of Shanghai,Shanghai,201599,China)

机构地区：[1]上海市第六人民医院金山分院骨科,201599

出　　处：《中国骨与关节杂志》2021年第12期943-947,共5页Chinese Journal of Bone and Joint

基　　金：上海市金山区卫生和计划生育委员会科研课题(JSKJ-KTMS-2018-21);上海健康医学院运动医学临床研究中心科研课题(20MC2020003)。

摘　　要：目的通过计算机三维有限元技术分析研究胫骨内侧不同截骨角度下楔形截骨处未植骨和植骨的生物力学特性。方法通过计算机三维有限元技术建立胫骨内侧不同截骨角度下楔形截骨处未植骨和植骨的内固定胫骨近端模型,然后将胫骨远端固定,分别在胫骨近端内外侧加载480 N和720 N的载荷应力,比较胫骨内侧截骨角度在8°、10°、12°、14°和16°下楔形截骨处未植骨和植骨的生物力学状态。结果在楔形截骨处未植骨时,当截骨角度在8°、10°和12°时,其总体应力和位移及接骨板应力和位移都比较接近,差别不大;当截骨角度超过12°,在14°和16°时,其总体应力和位移及接骨板应力和位移都随着截骨角度的增大而增大。在楔形截骨处植骨时,在5个不同的截骨角度下,其总体应力和位移及接骨板应力和位移都比较接近,差别不大。结论在胫骨内侧开放楔形高位截骨手术时,当截骨角度≤12°,临床可以不植骨,术后患肢可以早日行功能锻炼;当截骨角度>12°,建议楔形截骨处行植骨以增强胫骨近端稳定性,降低手术失败风险。Objective To analyze the biomechanical characteristics of the non-grafted and grafted bone at the wedge-shaped osteotomy at different osteotomy angles on the medial tibia using three-dimensional finite element technology.Methods The internal fixation model of the proximal tibia with bone grafting or not at the wedge-shaped osteotomy at different osteotomy angles was established by three-dimensional finite element technology.The distal tibia was fixed.Stress of 480 N and 720 N was loaded on the inner and outer sides of the proximal tibia.Biomechanical state of the wedge-shaped osteotomy at 8°,10°,12°,14°and 16°under the load stress was compared.Results The overall and plate stress and displacement were relatively close with little difference when there was no bone graft at the wedge-shaped osteotomy at 8°,10°and 12°;the overall and plate stress and displacement increased with the enlargement of the osteotomy angle(>12°,14°-16°);the overall and plate stress and displacement were relatively close when there was bone graft at the wedge-shaped osteotomy at 5 different osteotomy angles.Conclusions In the open wedge-shaped high-position osteotomy on the inner side of the tibia,bone grafting is not necessary in clinic when the osteotomy angle≤12°.Bone grafting is recommended when the osteotomy angle>12°to enhance the stability of the proximal tibia and reduce the risk of surgical failure.

关 键 词：截骨术 胫骨 骨关节炎 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]