A Single Lateral Hinge Screw Increased Resistance to Varus Stress After Medial Opening-Wedge High Tibial Osteotomy in a Synthetic Bone Model: A Biomechanical Analysis.
Te-Feng Arthur Chou, Andrew Wright, Pooyan Abbasi, Wiemi A Douoguih
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引用次数: 0
Abstract
Purpose: To determine whether use of a tibial screw placed across the lateral tibial hinge results in significantly greater failure load compared with no lateral screw after medial opening wedge high tibial osteotomy (MOWHTO).
Methods: Twelve Sawbone tibias were used for the study. A MOWHTO was performed in each specimen using a computed tomography-based patient specific correction guide, and 6 specimens received a lateral hinge screw. Cantilever varus bending load was applied to failure, and failure load, displacement at failure, and stiffness of the osteotomy before hinge failure were recorded.
Results: Failure load was statistically higher in the hinge screw group compared to the control group, 437.0 ± 82.0 N vs 336.0 ± 55.9 N, P = .046 (mean ± standard deviation). This load to failure was 30% greater in MOWHTO using a hinge screw versus the control.
Conclusions: Using a Sawbone model, the current data showed that placement of a lateral hinge screw significantly increased resistance to varus stress following MOWHTO compared with a construct having no tibial screw. Additionally, no significant difference in displacement or stiffness was observed between the hinge screw and the control groups.
Clinical relevance: The current biomechanical findings suggest that the use of a laterally based proximal tibial screw can potentially reduce the risk of lateral hinge fracture and its associated morbidity after MOWHTO.
目的：确定内侧开口楔形高位胫骨截骨术（MOWHTO）后，与不使用外侧螺钉相比，在胫骨外侧铰链上放置胫骨螺钉是否会导致更高的破坏负荷。方法：采用12块锯骨胫骨进行研究。使用基于计算机断层扫描的患者特异性矫正指南对每个标本进行MOWHTO， 6个标本接受外侧铰链螺钉。破坏时施加悬臂内翻弯曲载荷，记录破坏载荷、破坏时的位移和铰破坏前截骨刚度。结果：铰链螺钉组失效负荷显著高于对照组，分别为437.0±82.0 N和336.0±55.9 N, p = 0.046（平均值±标准差）。与对照组相比，使用铰链螺钉的MOWHTO组的故障负荷高30%。结论：使用Sawbone模型，目前的数据显示，与没有胫骨螺钉的结构相比，放置外侧铰链螺钉可显著增加MOWHTO后内翻应力的抵抗力。此外，在铰链螺钉和对照组之间没有观察到位移或刚度的显着差异。临床相关性：目前的生物力学研究结果表明，使用外侧胫骨近端螺钉可以潜在地降低MOWHTO后外侧铰链骨折及其相关发病率的风险。
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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