Medial açık kama yüksek tibial osteotomide lateral menteşeye yerleştirilen k-tellerinin lateral korteks kırığı üzerine etkisi
Yükleniyor...
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yüksek tibial osteotomi (YTO); diz eklemi medial kompartmanında
osteoartriti mevcut özellikle genç-orta yaş ve aktif bireylerin tedavisinde sık kullanılan
bir cerrahi tekniktir. Bu teknikle, devamlı yüke maruz kalan eklem bölgesinden geçen
yük hattının yönünü değiştirerek, yük dağılımını yeniden düzenlemek
hedeflenmektedir. YTO esnasında oluşan lateral korteks kırığının etkileri çok defa
araştırılmış ve uzun dönem sonuçları ile ilgili çalışmalar yapılmıştır. Bu çalışmada
amaç, medial açık kama yüksek tibial osteotomi tekniği esnasında oluşabilen lateral
korteks kırığına lateral menteşeye yerleştirdiğimiz k-tellerinin etkisini incelemektir.
Yöntem: Bu çalışma sonlu eleman analiziyle oluşturulmuş biyomekanik nümerik bir
çalışmadır. Çalışma bilgisayar üzerinden laboratuvar ortamında yürütülmüştür.
Çalışmada veri toplama aracı olarak, bilgisayarlı tomografi sonrası elde edilmiş
tibiadan katı model oluşturulmuştur. Lateral menteşeye birinci grupta k-tel
yerleştirilmemiş, ikinci grupta tek k-tel, üçüncü grupta ise iki k-tel yerleştirerek üç
grup oluşturulmuştur. Ardından sonlu eleman analiziyle osteotomi hattı açılarak lateral
menteşeye binen gerilmeler ölçülmüş, k telinin lateral menteşe gerilmesine ve
direncine etkisi karşılaştırılmıştır.
Bulgular: Her üç gruba da 10 N.’ dan başlayarak 500 N.’ a kadar kuvvet uygulandı.
500 N kuvvete ulaşıldığında kontrol grubu olan (k tel bulunmayan) grupta 12,6 derece
açılma ve 13,3 mm gap mesafesi ölçülürken, tek k tel bulunan grupta 10,5 derece
açılma ve 11,2 mm gap mesafesi, iki k tel bulunan grupta 8,8 derece açılma ve 9,6 mm
gap mesafesi ölçüldü. Bu sonuçlar bize lateral menteşeye gönderilen k tellerinin
osteotomi hattında daha yavaş ve kontrollü bir açılma sağladığını gösterdi. K tel
bulunmayan grupta kortikal kemik gerilmesinin k telli gruplara göre daha hızlı
yükseldiğini gördük.K tel bulunmayan grupta direnci 122 N/mm, tek k tel bulunan
grupta 132 N/mm, iki k tel bulunan grupta 142 N/mm şeklinde hesapladık. Lateral
menteşeye gönderdiğimiz k-teller menteşede kuvvete direnç gösteren eleman görevini
üstlendiğini ve lateral menteşe direncini artırdığını gözlemledik.
Sonuç: Lateral kortekse eklediğimiz k-tellerinin aynı kuvvette lateral korteksteki
gerilmeleri azalttığını, lateral korteksteki direnci artırdığını gösterdik. Lateral
menteşeye eklenen teller sayesinde osteotomi hattında aynı yer değiştirmeyi sağlamak
için daha fazla kuvvete ihtiyaç olduğu sonucuna ulaştık. Kontrolsüz uygulanabilecek
kuvveti tellerin absorbe ederek daha kontrollü bir açılma sağladığını ve lateral
kortekste kırık oluşumunun önüne geçebileceğini gördük.
High tibial osteotomy (HTO) is a surgical technique commonly used in the treatment of young to middle-aged and active individuals with osteoarthritis in the medial compartment of the knee joint. The purpose of this technique is to reorganize the load distribution by redirecting the load line passing through the joint area that is subjected to continuous load. The effects of lateral cortical fracture during HTO have been investigated in several studies; in addition, its long-term effects have been examined. The aim of the present study was to investigate the effect of k-wires placed in the lateral hinge on lateral cortical fractures that may occur during medial open-wedge HTO technique. Method: The current study is an experimental finite-element study with biomechanical and numerical components. The study was conducted using a computerized method in a laboratory environment. As a data collection tool in the study, solid models were created from the tibia obtained after computed tomography; k-wires were then applied to the solid models to divide them into three groups. The first group included models without k-wires, the second group those with one k-wire, and the third group those with two k-wires. Infinite element analysis was performed in all three groups and a force starting from 10 N up to 500 N was subsequently applied from the distal face of the osteotomy line. The displacement (mm), correction angle (), and cortical and cancellous bone stresses (MPa) in the lateral hinge that occurred simultaneously with the applied force (N) were recorded instantaneously. A curve was constructed using the variation data of the applied force–gap distance. The slope of the linear section of this curve was used to individually determine the stiffness (N/mm) value of each model. Results: At 500 N of applied force, the control group (no k-wire) had 12.6 of opening and 13.3 mm of gap distance, the group with one k-wire had 10.5 of opening and 11.2 mm of gap distance, and the group with two k-wires had 8.8 of opening and 9.6 mm of gap distance. These results showed that the k-wires mounted onto the lateral hinge provided a more controlled opening of the osteotomy line. The cortical bone stress increased faster in the group without k-wire than in the groups with k-wire. The stiffness value was 122 N/mm in the group with no k-wire, 132 N/mm in the group with one k-wire, and 142 N/mm in the group with two k-wires. The k-wires applied onto the lateral hinge resisted the applied force in the hinge and increased the stiffness of the lateral hinge. Conclusion: The k-wires added to the lateral cortex decreased the stresses in the lateral cortex and increased the stiffness in the lateral cortex at the same force. Addition of wires to the lateral hinge demonstrated that more force is needed to achieve the same displacement at the osteotomy line than without k-wire. The wires absorbed the potentially uncontrolled forces, and provided a more controlled opening and prevented fractures that may occur in the lateral cortex.
High tibial osteotomy (HTO) is a surgical technique commonly used in the treatment of young to middle-aged and active individuals with osteoarthritis in the medial compartment of the knee joint. The purpose of this technique is to reorganize the load distribution by redirecting the load line passing through the joint area that is subjected to continuous load. The effects of lateral cortical fracture during HTO have been investigated in several studies; in addition, its long-term effects have been examined. The aim of the present study was to investigate the effect of k-wires placed in the lateral hinge on lateral cortical fractures that may occur during medial open-wedge HTO technique. Method: The current study is an experimental finite-element study with biomechanical and numerical components. The study was conducted using a computerized method in a laboratory environment. As a data collection tool in the study, solid models were created from the tibia obtained after computed tomography; k-wires were then applied to the solid models to divide them into three groups. The first group included models without k-wires, the second group those with one k-wire, and the third group those with two k-wires. Infinite element analysis was performed in all three groups and a force starting from 10 N up to 500 N was subsequently applied from the distal face of the osteotomy line. The displacement (mm), correction angle (), and cortical and cancellous bone stresses (MPa) in the lateral hinge that occurred simultaneously with the applied force (N) were recorded instantaneously. A curve was constructed using the variation data of the applied force–gap distance. The slope of the linear section of this curve was used to individually determine the stiffness (N/mm) value of each model. Results: At 500 N of applied force, the control group (no k-wire) had 12.6 of opening and 13.3 mm of gap distance, the group with one k-wire had 10.5 of opening and 11.2 mm of gap distance, and the group with two k-wires had 8.8 of opening and 9.6 mm of gap distance. These results showed that the k-wires mounted onto the lateral hinge provided a more controlled opening of the osteotomy line. The cortical bone stress increased faster in the group without k-wire than in the groups with k-wire. The stiffness value was 122 N/mm in the group with no k-wire, 132 N/mm in the group with one k-wire, and 142 N/mm in the group with two k-wires. The k-wires applied onto the lateral hinge resisted the applied force in the hinge and increased the stiffness of the lateral hinge. Conclusion: The k-wires added to the lateral cortex decreased the stresses in the lateral cortex and increased the stiffness in the lateral cortex at the same force. Addition of wires to the lateral hinge demonstrated that more force is needed to achieve the same displacement at the osteotomy line than without k-wire. The wires absorbed the potentially uncontrolled forces, and provided a more controlled opening and prevented fractures that may occur in the lateral cortex.
Açıklama
Anahtar Kelimeler
Lateral menteşe, Sonlu elemanlar analize, Lateral korteks kırığı, Medial açık kama yüksek tibial osteotomi, Lateral hinge, Medial open-wedge high tibial osteotomy, Lateral cortical fracture
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Erdem, T. E. (2022). Medial açık kama yüksek tibial osteotomide lateral menteşeye yerleştirilen k-tellerinin lateral korteks kırığı üzerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
