Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study.
Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study.
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DOI：
10.22603/ssrr.2021-0231
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发表时间：
2022-11-27
影响因子：
1.2
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中科院分区：
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成人脊柱融合手术改善了腰椎对线和患者满意度。成人脊柱畸形手术不仅可以改善腰椎病变的矢状面平衡，而且可以覆盖髋关节。预期髋关节覆盖率提高，关节应力降低。然而，据报告，在X线研究中，成人脊柱融合术（包括骶髂关节固定）诱发了髋关节相邻关节疾病。其机制尚不清楚。我们的目的是研究腰骶融合术（包括骶髂关节固定）与髋关节接触应力之间的关系。 一位40岁的女性，腰椎完整，进行了计算机断层扫描。从L4椎骨到股骨构建了一个三维非线性有限元模型，皮质骨外表面采用三角形壳单元（厚度2 mm;尺寸3 mm），其余骨骼采用2 mm（腰椎）或3 mm（股骨）四面体实体单元。我们构建了以下四个模型：非融合模型（NF）、L4-5融合模型（L5 F）、L4-S1融合模型（S1 F）和L4-S2髂骨螺钉固定模型（S2 F）。向L4椎骨垂直施加400 N的压缩载荷，并向L4椎骨额外施加10 Nm的弯矩，以刺激屈曲、伸展、左侧弯曲和轴向旋转。分析了各模型髋关节的vonMises应力和角运动。 NF、L5 F、S1 F和S2 F的髋关节角运动逐渐增加，S2 F模型的角运动最大。 髋关节的平均和最大接触应力在S2 F模型中最高。因此，腰骶融合术联合骶髂关节固定会增加髋关节的应力。我们认为这是相邻关节脊髓骨盆固定的结果。腰椎-骨盆固定增加了髋关节的角运动和应力。
Adult spinal fusion surgery improves lumbar alignment and patient satisfaction. Adult spinal deformity surgery improves saggital balance not only lumbar lesion, but also at hip joint coverage. It was expected that hip joint coverage rate was improved and joint stress decreased. However, it was reported that adjacent joint disease at hip joint was induced by adult spinal fusion surgery including sacroiliac joint fixation on an X-ray study. The mechanism is still unclear. We aimed to investigate the association between lumbosacral fusion including sacroiliac joint fixation and contact stress of the hip joint. A 40-year-old woman with intact lumbar vertebrae underwent computed tomography. A three-dimensional nonlinear finite element model was constructed from the L4 vertebra to the femoral bone with triangular shell elements (thickness, 2 mm; size, 3 mm) for the cortical bone's outer surface and 2-mm (lumbar spine) or 3-mm (femoral bone) tetrahedral solid elements for the remaining bone. We constructed the following four models: a non-fusion model (NF), a L4-5 fusion model (L5F), a L4-S1 fusion model (S1F), and a L4-S2 alar iliac screw fixation model (S2F). A compressive load of 400 N was applied vertically to the L4 vertebra and a 10-Nm bending moment was additionally applied to the L4 vertebra to stimulate flexion, extension, left lateral bending, and axial rotation. Each model's hip joint's von Mises stress and angular motion were analyzed. The hip joint's angular motion in NF, L5F, S1F, and S2F gradually increased; the S2F model presented the greatest angular motion. The average and maximum contact stress of the hip joint was the highest in the S2F model. Thus, lumbosacral fusion surgery with sacroiliac joint fixation placed added stress on the hip joint. We propose that this was a consequence of adjacent joint spinopelvic fixation. Lumbar-to-pelvic fixation increases the angular motion and stress at the hip joint.