Background

The TomoFix plate has been extensively used in high tibial osteotomy surgery to stabilize the distracted tibial bones. However, distal pain related to plate irritation was considered one of the most relevant complications for this fixation device. This study aimed to correlate reports of distal pain with the profiles of the distracted tibia and initial plate and plate contour.

Methods

This study used the finite-element method to investigate the profile-, distraction-, and contour-induced effects on stress distribution of the distal tibia-plate contact. The associations of two tibia profiles (normal and concave), distraction angles, and two plate profiles (contoured and non-contoured) were discussed in this study. The areas and stresses of the distal tibia-plate contact were chosen as comparison indices.

Findings

Before weight-bearing, the non-contoured plates of the normal and concave tibia profiles consistently showed less contact area at the distal tibia-plate region. Consequently, the physiological loads make the non-contoured plate subject to more concentrated bone stresses and thus may induce more pain at the distal tibia-plate region than a contoured plate. When the distraction angle decreases, the tibia-plate gap increases. Prior to fixation, the tibia-plate gap can be evaluated by the profiles of the distracted tibia and non-contoured plate by use of anteroposterior radiograph and computer-aided simulation.

Interpretation

In the situations of a lower distraction angle or a large tibia-plate gap, the use of a plate bender or a lag screw is recommended in order to contour the plate for reducing the concentrated stress at the distal tibia-plate region.

中文翻译：

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等高和非等高高胫骨截骨板的集中应力作用：有限元研究。

背景

TomoFix板已广泛用于胫骨截骨手术，以稳定分散的胫骨。但是，与钢板刺激相关的远端疼痛被认为是该固定装置最相关的并发症之一。这项研究旨在将远端疼痛的报告与分散的胫骨轮廓以及初始板和板轮廓相关联。

方法

这项研究使用有限元方法来研究轮廓，分心和轮廓引起的对胫骨远端板接触应力分布的影响。在这项研究中讨论了两个胫骨轮廓（法向和凹面），撑开角和两个板轮廓（轮廓和非轮廓）的关联。选择胫骨远端板接触的面积和应力作为比较指标。

发现

在承重之前，正常的和凹入的胫骨轮廓的非轮廓板始终在胫骨远端板区域显示较小的接触面积。因此，生理负荷使无轮廓的板承受更集中的骨应力，因此与仿形板相比，在胫骨远端板区域可能引起更多的疼痛。当分散角度减小时，胫骨板间隙增加。固定前，可通过前后X线片和计算机辅助模拟，根据分散的胫骨和非等高板的轮廓评估胫骨板间隙。

解释

在较小的撑开角度或较大的胫骨板间隙的情况下，建议使用弯板机或方头螺钉，以使钢板轮廓化，以减少在胫骨远端板区域的集中应力。