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骨盆入射角与腰椎前凸不匹配会导致未融合和已融合腰椎节段关节负荷增加。

Pelvic incidence-lumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine.

作者信息

Senteler Marco, Weisse Bernhard, Snedeker Jess G, Rothenfluh Dominique A

机构信息

Department of Orthopedics Balgrist, University of Zurich, Zurich, Switzerland.

出版信息

Eur Spine J. 2014 Jul;23(7):1384-93. doi: 10.1007/s00586-013-3132-7. Epub 2014 Mar 20.

Abstract

PURPOSE

Symptomatic adjacent segment disease (ASD) has been reported to occur in up to 27 % of lumbar fusion patients. A previous study identified patients at risk according to the difference of pelvic incidence and lordosis. Patients with a difference between pelvic incidence and lumbar lordosis >15° have been found to have a 20 times higher risk for ASD. Therefore, it was the aim of the present study to investigate forces acting on the adjacent segment in relation to pelvic incidence-lumbar lordosis (PILL) mismatch as a measure of spino-pelvic alignment using rigid body modeling to decipher the underlying forces as potential contributors to degeneration of the adjacent segment.

METHODS

Sagittal configurations of 81 subjects were reconstructed in a musculoskeletal simulation environment. Lumbar spine height was normalized, and body and segmental mass properties were kept constant throughout the population to isolate the effect of sagittal alignment. A uniform forward/backward flexion movement (0°-30°-0°) was simulated for all subjects. Intervertebral joint loads at lumbar level L3-L4 and L4-L5 were determined before and after simulated fusion.

RESULTS

In the unfused state, an approximately linear relationship between sagittal alignment and intervertebral loads could be established (shear: 0° flexion r = 0.36, p < 0.001, 30° flexion r = 0.48, p < 0.001; compression: 0° flexion r = 0.29, p < 0.01, 30° flexion r = 0.40, p < 0.001). Additionally, shear changes during the transition from upright to 30° flexed posture were on average 32 % higher at level L3-L4 and 14 % higher at level L4-L5 in alignments that were clinically observed to be prone to ASD. Simulated fusion affected shear forces at the level L3-L4 by 15 % (L4-L5 fusion) and 23 % (L4-S1 fusion) more for alignments at risk for ASD.

CONCLUSION

Higher adjacent segment shear forces in alignments at risk for ASD already prior to fusion provide a mechanistic explanation for the clinically observed correlation between PILL mismatch and rate of adjacent segment degeneration.

摘要

目的

据报道,有症状的相邻节段疾病(ASD)在高达27%的腰椎融合患者中出现。先前的一项研究根据骨盆入射角和腰椎前凸的差异确定了有风险的患者。已发现骨盆入射角与腰椎前凸的差异>15°的患者发生ASD的风险高20倍。因此,本研究的目的是使用刚体模型研究与骨盆入射角-腰椎前凸(PILL)不匹配相关的作用于相邻节段的力,作为脊柱-骨盆对线的一种测量方法,以解读作为相邻节段退变潜在因素的潜在作用力。

方法

在肌肉骨骼模拟环境中重建81名受试者的矢状位形态。对腰椎高度进行归一化处理,并在整个人群中保持身体和节段的质量特性不变,以分离矢状位对线的影响。对所有受试者模拟了一个均匀的前屈/后伸运动(0°-30°-0°)。在模拟融合前后测定L3-L4和L4-L5腰椎节段的椎间关节负荷。

结果

在未融合状态下,矢状位对线与椎间负荷之间可建立近似线性关系(剪切力:0°屈曲时r = 0.36,p < 0.001;30°屈曲时r = 0.48,p < 0.001;压缩力:0°屈曲时r = 0.29,p < 0.01;30°屈曲时r = 0.40,p < 0.001)。此外,在临床上观察到易发生ASD的对线中,从直立姿势到30°屈曲姿势转变过程中L3-L4节段的剪切力变化平均高32%,L4-L5节段高14%。对于有ASD风险的对线,模拟融合对L3-L4节段的剪切力影响更大,L4-L5融合时增加15%,L4-S1融合时增加23%。

结论

在融合前,有ASD风险的对线中相邻节段的剪切力较高,这为临床上观察到的PILL不匹配与相邻节段退变率之间的相关性提供了一个力学解释。

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