Yao Zhidong, Li Liuxun, Zhang Peng, Yang Lei, Bai Xueling, Peng Songlin, Lai Yuxiao
Center for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
Orthopaedics/Department of Spine Surgery, the First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
J Orthop Res. 2023 Apr;41(4):875-883. doi: 10.1002/jor.25411. Epub 2022 Jul 12.
The sacroiliac joint (SIJ) constitutes the predominant pain source following lumbar or lumbosacral fusion. Although studies have investigated the biomechanical patterns of SIJ behaviors after lumbosacral fusion, the relationship between ligament strain and SIJ pain following lumbosacral fusion remains unclear. The present study developed a three-dimensional finite element model including L4, L5, sacrum, ilium, SIJ, and seven mainly ligaments. After successful validation, the model was used to investigate the biomechanics of SIJ and ligaments in simulating lumbosacral fusion process. Our results showed that small motion in a stable SIJ may significantly increases the contact pressure and stress of the SIJ, which increase the maximum contact pressure by 171%, 676%, 199%, and 203% and stress by 130%, 424%, 168%, and 241% for flexion, extension, bending, and axial rotation, respectively. An increase in contact pressure and stress in SIJ possibly causes pain at the SIJ, especially in extension and axial rotation. A comparison between the lumbosacral and intact models exhibited the maximum strain increase in the iliosacral ligament (ISL) and the ileal ligament (IL) under all loading conditions. The present study suggests that after lumbosacral fusion process, the ligament sudden increase or decrease is likely to lead sprain or strain ligament, especially ISL and IL thereby causing SIJ pain. This study may contribute to understand the relationship between SIJ ligaments and SIJ pain.
骶髂关节（SIJ）是腰椎或腰骶融合术后主要的疼痛来源。尽管已有研究探讨了腰骶融合术后骶髂关节的生物力学行为模式，但腰骶融合术后韧带应变与骶髂关节疼痛之间的关系仍不明确。本研究建立了一个包含L4、L5、骶骨、髂骨、骶髂关节和七条主要韧带的三维有限元模型。成功验证后，该模型用于研究骶髂关节和韧带在模拟腰骶融合过程中的生物力学。我们的结果表明，稳定的骶髂关节的微小运动可能会显著增加骶髂关节的接触压力和应力，在屈曲、伸展、侧弯和轴向旋转时，接触压力分别增加171%、676%、199%和203%，应力分别增加130%、424%、168%和241%。骶髂关节接触压力和应力的增加可能会导致骶髂关节疼痛，尤其是在伸展和轴向旋转时。腰骶模型与完整模型的比较显示，在所有加载条件下，骶髂韧带（ISL）和髂骨韧带（IL）的应变增加最大。本研究表明，腰骶融合术后，韧带的突然增加或减少可能会导致韧带扭伤或拉伤，尤其是骶髂韧带和髂骨韧带，从而引起骶髂关节疼痛。本研究可能有助于理解骶髂关节韧带与骶髂关节疼痛之间的关系。
