后半节段融合后骨骼肌模型动态模拟腰椎运动时骶髂关节负荷的研究

IF 6.3 1区 医学 Q1 DERMATOLOGY Burns & Trauma Pub Date : 2023-09-04 DOI:10.22141/1608-1706.2.24.2023.944
O. Barkov, R.V. Malyk, O. Karpinska
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引用次数: 0

摘要

背景。在考虑脊柱手术时,并发症是患者和外科医生主要关心的问题。胸腰椎节段以及融合后相邻节段并发症的危险因素之一是矢状面脊柱-骨盆平衡的改变。目的:探讨后半节段LIV-SI融合手术入路中发生的肌肉变化对骶髂关节髂嵴面负荷的影响。材料和方法。采用OpenSim软件进行动态运动仿真建模,并利用附加程序计算加载力。以完整的人体肌肉骨骼系统模型为基础。为了比较载荷力,我们建立了四种模型:1 -基本模型,所有脊柱运动节段功能齐全,2 -固定不改变脊柱解剖曲线,3 -固定在脊柱前凸部位;4 .固定伴前凸过度再生产。对于模型2-4,肌肉的变化与手术后路进入腰椎进行后路内固定LIV-SI融合的效果相对应。在感兴趣的区域上的负载被测量为力向量的投影值,这取决于躯干倾斜的角度占体重的百分比。结果。所有类型的器械脊柱融合术的肌肉力量和功能是相同的,并且不考虑入路过程中的创伤。在模型1(法向)中,竖直位置,载荷力的投影落在椎体的重心上。当倾斜时,矢状方向的载荷力仅作用于前髂骨,向前轻微移动10%。在正常张力和前凸过度固定中,直立位置时髂后嵴上的负荷力投射发生变化,并随着倾斜向中心移位。在正张力固定中,负荷中心与直立位置的位移与一些伸肌在纤维计算中被排除有关,这降低了它们的总强度,导致矢状面不平衡,并增加了前凸。低倾角固定(模型4)使直立位置的载荷力投射略微偏移(偏移3%),倾斜位置时接近模型1的正常值。关于垂直负荷,对于所有肌肉完整性受损的模型(模型2、3、4),直立位置的负荷大大增加——与正常位置相比平均增加60%,倾斜位置时体重减少40 - 45%。结论。经证实,骶髂关节内髂骨表面的载荷与器械融合术的角度有关。在矢状方向直立站立时,载荷中心的位移变化最大。在背肌力下降的正常张力和高前凸固定中,有一个负荷转移到髂嵴后部。在低椎弓背固定中,载荷中心保持靠近中心位置。负荷在垂直方向上的分布主要受背部肌肉力量减少的影响,背部肌肉力量的减少使负荷增加了60%。
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Study of load in the sacroiliac joint during dynamic simulation of movements in the lumbar spine on skeletal muscle models after posterior bisegmental fusion
Background. Complications are the main concern of patients and surgeons when considering spine surgery. One of the risk factors for complications in the thoracic and lumbar spinal segments, as well as segments adjacent to those with fusion, is changes in sagittal spinal-pelvic balance. Objective: to determine the effect of muscle changes that occur during surgical access for posterior bisegmental LIV-SI fusion on the load of the iliac crest surface in the sacroiliac joint. Materials and methods. Dynamic motion simulation modeling was performed using OpenSim software with the use of additional programs to calculate loading forces. The complete model of the human musculoskeletal system was taken as a basis. To compare the load force, four models were created: 1 — basic, all spinal motion segments are fully functional, 2 — fixation without changing the anatomical curves of the spine, 3 — fixation in the position of hyperlordosis; 4 — fixation with reproduction of hyperlordosis. For models 2–4, changes in the muscles were made that correspond to the effects of surgical posterior access to the lumbar spine for posterior instrumented fusion LIV-SI. The load on the area of interest was measured as the value of the projection of the force vector depending on the angle of torso inclination as a percentage of body weight. Results. Muscle strength and function were the same for all types of instrumental spinal fusion, and trauma during access was not taken into account. In model 1 (normal) with the upright position, the projection of the load force falls on the center of gravity of the vertebra. When tilted, the load force in the sagittal direction acts exclusively on the anterior ilium with a slight shift of 10 % forward. In normosthenic and hyperlordotic fixation, there is a shift in the projection of the load force on the posterior iliac crest in the upright position and its displacement to the center with the tilt. The displacement of the load center with the upright position in normosthenic fixation is associated with the exclusion of some extensor muscles from the calculation of fibers, which reduces their total strength and leads to sagittal imbalance with an increase in lordosis. Hypolordotic fixation (model 4) slightly shifts the projection of the load force in the upright position (by 3 %) and approaches the normal values of model 1 when tilted. Regarding vertical loads, for all models with muscle integrity impairment (models 2, 3, 4), the load in the upright position is greatly increased — on average by 60 % compared to the norm, with a decrease in body weight by 40–45 % when tilted. Conclusions. It has been proved that the load force on the surface of the iliac crest in the sacroiliac joint depends on the angle of instrumental fusion performed. The greatest changes are observed with the displacement of the load center during upright standing in the sagittal direction. In normosthenic and hyperlordotic fixation with decreased back muscle strength, there is a load shift to the posterior part of the iliac crest. In hypolordotic fixation, the center of the load remains close to the central position. The distribution of the load in the vertical direction is primarily influenced by the reduced strength of the back muscles, which increases the load by 60 %.
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来源期刊
Burns & Trauma
Burns & Trauma 医学-皮肤病学
CiteScore
8.40
自引率
9.40%
发文量
186
审稿时长
6 weeks
期刊介绍: The first open access journal in the field of burns and trauma injury in the Asia-Pacific region, Burns & Trauma publishes the latest developments in basic, clinical and translational research in the field. With a special focus on prevention, clinical treatment and basic research, the journal welcomes submissions in various aspects of biomaterials, tissue engineering, stem cells, critical care, immunobiology, skin transplantation, and the prevention and regeneration of burns and trauma injuries. With an expert Editorial Board and a team of dedicated scientific editors, the journal enjoys a large readership and is supported by Southwest Hospital, which covers authors'' article processing charges.
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