不同负重方式对腰椎生物力学的影响

doi:10.6040/j.issn.1671-7554.0.2022.1102

摘要/Abstract

摘要： 目的结合骨骼肌肉模型及腰椎有限元模型研究直立状态下不同背包方式对椎旁肌收缩和腰椎各节段椎间盘应力分布的影响。方法建立无负重和使用双肩包、单肩包和手提包的4种骨骼肌肉模型以及腰椎的有限元模型。使用骨骼肌肉模型分析站立位下使用3种负重方式时的肌肉收缩力和腰椎椎间压力,并将其施加在腰椎有限元模型中来分析腰椎椎体、间盘和韧带的应力分布。结果与无负重模型相比,双肩包、单肩包和手提包的平均椎旁肌收缩力增加了31.0%、43.4%和105.1%。双肩包模型的椎旁肌收缩力左右均衡,单肩包模型中负重侧的总体椎旁肌收缩力较大,而在手提包模型中非负重侧的椎旁肌收缩力较大。多裂肌在不同负重条件下的收缩力均有统计学差异(P<0.05)。与无负重模型相比,双肩包、单肩包和手提包模型中T12~S1平均椎间压力分别增加了37%、45%和64%。双肩包、单肩包及手提包模型的椎体平均峰值应力分别增加了71.6%、122.3%和146.6%。双肩包、单肩包及手提包模型的纤维环峰值应力分别增加了155.6%、183.4%、195.8%;髓核峰值应力分别增加了95.2%、146.9%、161.5%。结论左右平衡的负重方式对肌肉和腰椎间盘的产生负荷最小。当使用非平衡负重方式时,肌肉的收缩使得躯体保持平衡,但同时也使得腰椎应力增加。

关键词: 腰椎, 椎旁肌, 骨骼肌肉模型, 有限元, 应力分布

Abstract: Objective Based on the musculoskeletal model and the lumbar finite element model, to investigate the effects of different knapsack models on paraspinal muscle contraction and lumbar intervertebral disc stress distribution in the upright state. Methods The unloaded, backpack, shoulder-bag and handbag musculoskeletal models and finite element model were established. Muscle force and joint compression force were calculated in the musculoskeletal model, and input into the lumbar finite element model to analyze the stress distribution on lumbar spine. Results Compared with that in the unloaded model, average muscle force in the backpack, shoulder-bag and handbag model increased by 31.0%, 43.4% and 105.1%, respectively. The muscle force was balanced between right and left in the backpack model; however, it was higher in the loaded side in the shoulder-bag model, and was higher in the unloaded side in the handbag model. The force of multifidus muscle was statistically different in the four loading conditions(P<0.05). The average joint compression force on T12-S1 in the backpack, shoulder-bag and handbag models increased by 37%, 45% and 64%, respectively. The peak stress on the lumbar vertebral bodies in the three models increased by 71.6%, 122.3% and 146.6%, respectively; the peak stress on the annulus fibrosus increased by 155.6%, 183.4% and 195.8%, respectively; the peak stress on the nucleus pulposus increased by 95.2%, 146.9% and 161.5%, respectively. Conclusion The balanced way of load-carrying can reduce the activation of muscles and the burden of lumbar spine, which has a protective effect on the body. When a shoulder-bag or handbag is carried, the trunk keeps balance due to muscle contraction, which increases the stress on intervertebral discs.

Key words: Lumbar spine, Paraspinal muscle, Musculoskeletal model, Finite element, Stress distribution

中图分类号:

R681.5

赵赓,王连雷,王宏卫,刘新宇. 不同负重方式对腰椎生物力学的影响[J]. 山东大学学报 (医学版), 2023, 61(6): 70-78.

ZHAO Geng, WANG Lianlei, WANG Hongwei, LIU Xinyu. Biomechanical effects of different load-carrying ways on lumbar spine[J]. Journal of Shandong University (Health Sciences), 2023, 61(6): 70-78.

参考文献

[1] Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action[J]. Lancet, 2018, 391(10137): 2384-2388.
[2] Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the global burden of disease 2010 study[J]. Ann Rheum Dis, 2014, 73(6): 968-974.
[3] Erdem MN, Erken HY, Aydogan M. The effectiveness of non-surgical treatments, re-discectomy and minimally invasive transforaminal lumbar interbody fusion in post-discectomy pain syndrome[J]. J Spine Surg, 2018, 4(2): 414-422.
[4] Maniadakis N, Gray A. The economic burden of back pain in the UK[J]. Pain, 2000, 84(1): 95-103.
[5] Lee H, Hübscher M, Moseley GL, et al. How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain[J]. Pain, 2015, 156(6): 988-997.
[6] James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2018, 392(10159): 1789-1858.
[7] Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017[J]. Ann Transl Med, 2020, 8(6): 299-299.
[8] Chaffin DB, Ashton-Miller JA. Biomechanical aspects of low-back pain in the older worker[J]. Exp Aging Res, 1991, 17(3): 177-187.
[9] Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it?[J]. Spine(Phila Pa 1976), 2006, 31(18): 2151-2161.
[10] Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position[J]. Spine(Phila Pa 1976), 2005, 30(3): 346-353.
[11] Ruberté LM, Natarajan RN, Andersson GB. Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments-A finite element model study[J]. J Biomech, 2009, 42(3): 341-348.
[12] Zhu WY, Zang L, Li J, et al. A biomechanical study on proximal junctional kyphosis following long-segment posterior spinal fusion[J]. Brazilian J Med Biol Res, 2019, 52(5): 1-10.
[13] Schultz A, Andersson G, Ortengren R, et al. Loads on the lumbar spine. validation of a biomechanical analysis by measurements of intradiscal pressures and myoelectric signals[J]. J Bone Joint Surg Am, 1982, 64(5): 713-720.
[14] Kang KT, Koh YG, Son J, et al. Biomechanical evaluation of pedicle screw fixation system in spinal adjacent levels using polyetheretherketone, carbon-fiber-reinforced polyetheretherketone, and traditional titanium as rod materials[J]. Compos Part B Eng, 2017, 130: 248-256. doi:10.1016/j.compositesb.2017.07.052.
[15] LaFiandra M, Harman E. The distribution of forces between the upper and lower back during load carriage[J]. Med Sci Sports Exerc, 2004, 36(3): 460-467.
[16] Guo LX, Wang ZW, Zhang YM, et al. Material property sensitivity analysis on resonant frequency characteristics of the human spine[J]. J Appl Biomech, 2009, 25(1): 64-72.
[17] Wu Y, Wang Y, Wu J, et al. Study of double-level degeneration of lower lumbar spines by finite element model[J]. World Neurosurg, 2016, 86: 294-299. doi: 10.1016/j.wneu.2015.09.038.
[18] Rohlmann A, Zander T, Bergmann G. Comparison of the biomechanical effects of posterior and anterior spine-stabilizing implants[J]. Eur Spine J, 2005, 14(5): 445-453.
[19] Wang L, Zhang B, Chen S, et al. A validated finite element analysis of facet joint stress in degenerative lumbar scoliosis[J]. World Neurosurg, 2016, 95: 126-133. doi: 10.1016/j.wneu.2016.07.106.
[20] Hsieh YY, Chen CH, Tsuang FY, et al. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: a finite element analysis[J]. Clin Biomech, 2017, 43:115-120. doi:10.1016/j.clinbiomech.2017.02.011.
[21] Denozière G, Ku DN. Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc[J]. J Biomech, 2006, 39(4): 766-775.
[22] Kim HJ, Kang KT, Chun HJ, et al. The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion[J]. Eur Spine J,2015, 24(4): 827-837.
[23] Li SSW, Chow DHK. Effects of backpack load on critical changes of trunk muscle activation and lumbar spine loading during walking[J]. Ergonomics, 2018, 61(4): 553-565.
[24] Wilke H, Neef P, Hinz B, et al. Intradiscal pressure together with anthropometric data-a data set for the validation of models[J]. Clin Biomech(Bristol, Avon), 2001, 16(Suppl 1): S111-126. doi:10.1016/s0268-0033(00)00103-0.
[25] Rohlmann A, Graichen F, Kayser R, et al. Loads on a telemeterized vertebral body replacement measured in two patients[J]. Spine(Phila Pa 1976), 2008, 33(11): 1170-1179.
[26] Yamamoto I, Panjabi M, Crisco T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint[J]. Spine(Phila Pa 1976), 1989, 14(11): 1256-1260.
[27] Schmoelz W, Huber JF, Nydegger T, et al. Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment[J]. J Spinal Disord Tech, 2003, 16(4): 418-423.
[28] Panjabi MM, Oxland TR, Yamamoto I, et al. Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves[J]. J Bone Jt Surg- Ser A, 1994, 76(3): 413-424.
[29] Erbulut DU, Zafarparandeh I, Hassan CR, et al. Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol: a finite-element study[J]. J Neurosurg Spine, 2015, 23(2): 200-208.
[30] Chen CS, Cheng CK, Liu CL, et al. Stress analysis of the disc adjacent to interbody fusion in lumbar spine[J]. Med Eng Phys, 2001, 23(7): 485-493.

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