The Study of Biomechanics and Clinical Anatomy on a Novel Plate Designed for Posterolateral Tibial Plateau Fractures via Anterolateral Approach.
The Study of Biomechanics and Clinical Anatomy on a Novel Plate Designed for Posterolateral Tibial Plateau Fractures via Anterolateral Approach.
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新型前外侧入路胫骨平台后外侧骨折钢板的生物力学和临床解剖学研究
DOI：
10.3389/fbioe.2022.818610
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发表时间：
2022
影响因子：
5.7
通讯作者：
Xu W
中科院分区：
文献类型：
--
作者：
Ren W;Zhang W;Jiang S;Peng J;She C;Li L;Mao Y;Zhou H;Xu W
对于治疗胫骨平台后外侧骨折的最佳内固定选择，目前尚无共识。本研究描述了一种通过前外侧入路治疗后外侧胫骨平台骨折（PTPF）的新型钢板。我们评估了一种新型钢板和两种传统内植入物的生物力学性能，并研究了新型钢板的解剖可行性。将骨折模型随机分为6组：A ~ C组为后外侧劈裂骨折模型组，分别采用后路支撑钢板、外侧锁定钢板和新型钢板固定。D ~ E组为后外侧凹陷骨折模型组，分别采用后路支撑钢板、外侧锁定钢板和新型钢板固定。通过生物力学测试和有限元分析，对6个模型组的生物力学性能进行评价。通过使用定制的压头在250-750 N载荷下将逐渐增加的轴向压缩载荷施加到每个合成骨折模型。同时解剖12例新鲜冰冻膝关节标本，经前外侧入路将新型钢板固定。我们记录了新钢板与重要解剖结构的相邻关系。生物力学测试表明，在后外侧劈裂骨折中，新型钢板移位最少，后支撑钢板次之，外侧钢板移位最多。在后外侧凹陷骨折中，新型钢板和外侧钢板在不同载荷下的位移无显著差异。后支撑钢板移位最多。在有限元分析中，A、B和C组在750 N载荷下的最大应力值分别为383.76、414.63和305.07 MPa。在750 N载荷下，D、E和F组的最大应力值分别为474.28、436.31和413.4 MPa。在解剖学研究中，放置新型钢板对膝关节后外侧角重要解剖结构的损伤风险较低。新型钢板具有更好的生物力学性能和易于操作，是治疗PTPF的理想选择。
There is no consensus about the optimal internal fixation selection for treatment of posterolateral tibial plateau fracture. This study described a novel plate through an anterolateral approach for posterolateral tibial plateau fractures (PTPFs). We evaluated the biomechanical performance of a novel plate and two conventional internal implants and investigated the anatomic feasibility of the novel plate. The fracture models were randomly assigned into six groups: Groups A–C were the model groups of posterolateral split fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. Groups D–E were the model groups of posterolateral depression fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. We evaluated the biomechanical performance of six model groups by the biomechanical testing and finite element analysis. Progressively increasing axial compressive loads were applied to each synthetic fracture model by using a customized indentor under 250–750 N loads. Meanwhile, we dissected 12 fresh frozen knee specimens and fixed them with the novel plate through the anterolateral approach. We recorded the adjacency of the novel plate to important anatomic structures. Biomechanical testing showed that the novel plate had the least displacement, followed by the posterior buttress plate, and the lateral plate had the most displacement in posterolateral split fracture. There was no significant difference in the displacement between the novel plate and the lateral plate at different loads in posterolateral depression fractures. And the posterior buttress plate showed the most displacement. In the finite element analysis, the maximum stress values of Groups A, B, and C were 383.76, 414.63, and 305.07 MPa under the load of 750 N, respectively. The maximum stress values of Groups D, E, and F were 474.28, 436.31, and 413.4 MPa under the load of 750 N, respectively. In the anatomic study, the placement of the novel plate had a low risk of damage to the important anatomic structures of knee posterolateral corner. The novel plate could be a great choice for the treatment of PTPFs due to better biomechanical performance and easy manipulation.