Biomechanics of high tibial osteotomy
Biomechanics of high tibial osteotomy
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DOI：
10.1007/s00167-012-2122-3
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发表时间：
2013-01-01
影响因子：
3.8
通讯作者：
Amis, Andrew A.
中科院分区：
文献类型：
--
作者：
Amis, Andrew A.
本文综述了支持膝关节周围截骨的肢体再排列手术的生物力学原理，主要是膝关节高位截骨。（近端）胫骨截骨术。已经描述了基本的生物力学原理，并且检查了相关文献以获得支持所提出建议的证据。行走时膝关节上的力被示出为导致大部分载荷通过内侧间室作用，膝关节最常见的退化部位，这是由于在负重阶段作用的内收力矩。重新调整肢体移动机械轴到一个所需的点内的膝盖进行了说明，并由此产生的关节接触压力在内侧和外侧隔室被证明是较高的不太一致的外侧关节时，负载通过膝盖的中心。同时，胫骨平台的后倾角可能发生变化，当膝关节力为3倍体重时，10度的倾角可引起0.5倍体重的剪切力，该剪切力拉伸ACL。胫骨或股骨甚至双截骨术的选择与关节线的内外侧倾斜度有关。副作用，如改变侧副韧带张力或高度的patella.Critical审查出版物支持截骨手术表明，许多公认的“规则”几乎没有科学证据表明，他们代表的最佳做法，为长期保存的联合。
This paper is a review of the biomechanical principles that support limb realignment surgery via osteotomy around the knee, principally high (proximal) tibial osteotomy.The basic biomechanical principles have been described, and the related literature examined for evidence to support the recommendations made.The forces on the knee when walking are shown to lead to most of the load acting through the medial compartment, the most frequent site of degeneration of the knee, due to the adduction moment that acts during the weight-acceptance phase. Realignment of the limb to move the mechanical axis to a desired point within the knee is described, and the resulting joint contact pressures in the medial and lateral compartments are shown to be higher in the less-congruent lateral articulation when the load passes through the centre of the knee. At the same time, there can be changes of the posterior slope of the tibial plateau, and a slope of ten degrees can induce a shearing force, which stretches the ACL, of 0.5 body weight when the knee force is 3 times body weight. The options regarding tibial or femoral or even double osteotomies are discussed in relation to medial-lateral slope of the joint line. Secondary effects such as alteration of collateral ligament tension or of the height of the patella are described.Critical review of the publications supporting osteotomy surgery suggests that many of the accepted 'rules' have little scientific evidence to show that they represent the best practise for long-term preservation of the joint.