骶髂关节融合后步态中髋关节负荷的阶段性变化：来自有限元分析的结果。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-01 DOI:10.1016/j.clinbiomech.2025.106429

Yogesh Kumaran , Janice M. Bonsu , Sudharshan Tripathi , Sophia M. Soehnlen , Carmen E. Quatman

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引用次数: 0

摘要

背景：超过80%的成年人患有腰痛，其中骶髂关节功能障碍占15- 30%。骶髂融合术是一种治疗难治性关节疼痛的外科手术。虽然关节的生物力学及其与脊柱的融合是众所周知的，但融合后髋-脊柱的关系仍不清楚。了解融合后的生物力学状态可以提高患者的康复和优化手术效果。本研究采用有限元分析评估骶髂关节融合术后髋关节的生物力学。方法：利用一名55岁男性的ct建立生物力学模型，并通过尸体研究进行验证。三个三角形钛合金植入物以单侧和双侧的形式放置在骶髂关节上。该模型加载了一个步态周期内骨盆和髋关节的运动学，计算了不同步态阶段的关节反作用力、接触应力和髋关节面积。研究结果：髋关节接触应力随固定物配置和步态阶段而变化。单侧右侧融合使关节反作用力降低了2%，但接触应力增加了3.7%。双侧融合增加了6.7%的关节反作用力和3.25%的接触应力，与单侧固定相比，在足平和断跟阶段的应力更高。解释：在特定的步态阶段，融合改变了髋关节的负荷模式，双侧融合在平足和脱跟时产生最大的应力。这些发现可能表明需要特定的融合康复方案，并值得进一步研究长期关节健康结果。

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Phase-specific changes in hip joint loading during gait following sacroiliac joint fusion: Findings from a finite element analysis

Background

Low back pain affects over 80 % of adults, with sacroiliac joint dysfunction accounting for 15–30 % of these cases. Sacroiliac fusion is a surgical procedure for refractory joint pain. While the biomechanics of the joint and its fusion relative to the spinal column are well-known, the hip-spine relationship post-fusion remains unclear. Understanding the biomechanical state following fusion can enhance patient recovery and optimize surgical outcomes. This study uses finite element analysis to assess hip joint biomechanics following sacroiliac joint fusion.

Methods

CTs of a 55-year-old male were used to create a biomechanical model, validated against a cadaveric study. Three triangular titanium alloy implants were placed across the sacroiliac joint in a unilateral and bilateral configuration. The model, loaded with pelvis and hip joint kinematics during a gait cycle, calculated joint reaction forces, contact stress and area on the hip joint across various gait phases.

Findings

Hip joint contact stresses varied with fixation configurations and gait phases. Unilateral right fusion reduced joint reaction forces by 2 % but increased contact stress by 3.7 %. Bilateral fusion increased joint reaction forces by 6.7 % and contact stress by 3.25 %, with higher stress during foot flat and heel off phases compared to unilateral fixation.

Interpretation

Fusion alters hip loading patterns during specific gait phases, with bilateral fusion producing the highest stresses during foot flat and heel off. These findings may suggest the need for fusion-specific rehabilitation protocols and warrants further investigation of long-term joint health outcomes.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.