腓骨高位截骨术对胫骨平台的生物力学分析

Effects of proximal fibular osteotomy on tibial plateau:a biomechanical analysis

目的:采用三维有限元方法分析腓骨高位截骨对胫骨平台造成的生物力学改变,为腓骨高位截骨在伴有内翻畸形的膝关节炎中的应用提供生物力学数据参考。方法:根据一例健康志愿者的CT数据,采用Mimics、Geomagic Studio2013以及Abaqus6.13软件建立个体化的膝关节有限元模型,通过对模型设定边界条件、加载材料属性、载荷设置以及模拟腓骨高位截骨术,计算腓骨高位截骨术前后胫骨平台的不同截面上任意节点的应力大小。结果:经手术去除腓骨的支撑后,内侧胫骨平台的应力值变化情况不一致,内部的应力降低,中部的不变,外部的增大。而外侧胫骨平台的应力值均增加,且其内部的应力值最大。整个胫骨平台上应力呈现往中间集中的态势。结论:腓骨高位截骨术有助于减小胫骨平台内侧的应力,从而达到缓解膝关节炎病人的疼痛及活动不便的症状。由于术后应力的重新分布,故该术式的长期疗效及适应症等仍需观察。

Objective To investigate the biomechanical changes of the tibial plateau following proximal fibula osteotomy by three-dimensional finite element analysis for providing biomechanical evidences for the application of proximal fibular osteotomy in knee osteoarthritis with varus deformity.Methods Based on the CT data of a healthy volunteer,an individual knee joint finite element model was constructed by Mimics,Geomagic Studio 2013 and Abaqus 6.13 software.The stress of any node on different sections of the tibial plateau before and after proximal fibular osteotomy was calculated by setting the boundary conditions,loading material properties,applying loads and simulating proximal fibular osteotomy in the finite element model.Results After the surgical removal of the fibular support,the stress of the medial tibial plateau was inconsistent.The internal stress was reduced;and the middle remained unchanged;but the lateral was increased.However,the stress of the lateral tibial plateau was increased,and the internal stress was the maximum.There was a trend that the stress on the entire tibial plateau was concentrated in the middle.Conclusion Proximal fibular osteotomy is conductive to reducing the stress on the medial tibial plateau,thus alleviating the pain and inconvenience of patients with knee osteoarthritis.Due to the postoperative stress redistribution,the long-term efficacy and indications of the operation strategy still need to be further researched.