Bullock Matthew W, De Gregorio Michael, Danelson Kerry A, Willey Jeffery S, Seem Michael E, Plate Johannes F, Lang Jason E, Shields John S
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157-1050, USA.
BioRec, 602 S Perry Ln, Tempe, AZ 85281, USA.
Clin Biomech (Bristol). 2018 Oct;58:69-73. doi: 10.1016/j.clinbiomech.2018.07.013. Epub 2018 Jul 20.
Total hip arthroplasty is one of the most successful and cost effective procedures in orthopedics. The purpose of this study is to investigate force transmission through the sacroiliac joint as a possible source of post-operative pain after total hip arthroplasty through the following three questions: Does the ipsilateral sacroiliac joint, contralateral sacroiliac joint, or pubic symphysis experience more force during placement? Does the larger mallet used to seat the implant generate a higher force? Does the specimen's bone density or BMI alter force transmission?
A solid design acetabular component was impacted into five human cadaver pelves with intact soft tissues. The pressure at both sacroiliac joints and the pubic symphysis was measured during cup placement. This same procedure was replicated using an existing pelvis finite element model to use for comparison.
The location of the peak force for each hammer strike was found to be specimen specific. The finite model results indicated the ipsilateral sacroiliac joint had the highest pressure and strain followed by the pubic symphysis over the course of the full simulation. The heft of the mallet and bone mineral density did not predict force values or locations. The largest median force was generated in extremely obese specimens.
Contrary to previous ideas, it is highly unlikely that forces experienced at the pelvic joints are large enough to contribute post-operative pain during impaction of an acetabular component. These results indicate more force is conveyed to the pubic symphysis compared to the sacroiliac joints.
全髋关节置换术是骨科领域最成功且性价比最高的手术之一。本研究的目的是通过以下三个问题来探究经骶髂关节的力传递情况，其可能是全髋关节置换术后疼痛的一个来源：在假体植入过程中，同侧骶髂关节、对侧骶髂关节或耻骨联合哪一个承受的力更大？用于安装假体的较大骨锤是否会产生更大的力？样本的骨密度或体重指数是否会改变力的传递？
将一个实体设计的髋臼组件打入五具软组织完整的人体尸体骨盆中。在髋臼杯植入过程中，测量双侧骶髂关节和耻骨联合处的压力。使用现有的骨盆有限元模型重复相同的操作以作比较。
发现每次锤击的峰值力位置因样本而异。有限元模型结果表明，在整个模拟过程中，同侧骶髂关节的压力和应变最高，其次是耻骨联合。骨锤的重量和骨矿物质密度无法预测力的值或位置。极度肥胖的样本产生的最大中位力最大。
与之前的观点相反，在髋臼组件植入过程中，骨盆关节所承受的力大到足以导致术后疼痛的可能性极小。这些结果表明，与骶髂关节相比，耻骨联合传递的力更大。
