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Kou W, Liang Y, Wang Z, Liang Q, Sun L, Kuang S. An Integrated Method of Biomechanics Modeling for Pelvic Bone and Surrounding Soft Tissues. Bioengineering (Basel) 2023; 10:736. [PMID: 37370667 DOI: 10.3390/bioengineering10060736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The pelvis and its surrounding soft tissues create a complicated mechanical environment that greatly affects the success of fixing broken pelvic bones with surgical navigation systems and/or surgical robots. However, the modeling of the pelvic structure with the more complex surrounding soft tissues has not been considered in the current literature. The study developed an integrated finite element model of the pelvis, which includes bone and surrounding soft tissues, and verified it through experiments. Results from the experiments showed that including soft tissue in the model reduced stress and strain on the pelvis compared to when it was not included. The stress and strain distribution during pelvic loading was similar to what is typically seen in research studies and more accurate in modeling the pelvis. Additionally, the correlation with the experimental results from the predecessor's study was strong (R2 = 0.9627). The results suggest that the integrated model established in this study, which includes surrounding soft tissues, can enhance the comprehension of the complex biomechanics of the pelvis and potentially advance clinical interventions and treatments for pelvic injuries.
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Affiliation(s)
- Wei Kou
- Department of Mechanical and Electrical Engineering, Soochow University, Suzhou 215137, China
| | - Yefeng Liang
- Department of Mechanical and Electrical Engineering, Soochow University, Suzhou 215137, China
| | - Zhixing Wang
- Department of Mechanical and Electrical Engineering, Soochow University, Suzhou 215137, China
| | - Qingxi Liang
- Department of Mechanical and Electrical Engineering, Soochow University, Suzhou 215137, China
| | - Lining Sun
- Department of Mechanical and Electrical Engineering, Soochow University, Suzhou 215137, China
| | - Shaolong Kuang
- Department of Mechanical and Electrical Engineering, Soochow University, Suzhou 215137, China
- College of Health Science and Environment Engineering, Shenzhen Technology University, Shenzhen 518118, China
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Dąbrowski K, Ciszek B. Anatomy and morphology of iliolumbar ligament. Surg Radiol Anat 2023; 45:169-173. [PMID: 36592184 PMCID: PMC9899183 DOI: 10.1007/s00276-022-03070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE To address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe their insertions and morphology. METHODS The ligaments were removed during the standard autopsy procedures with a use of an oscillating saw, a chisel and a scalpel. The specimens were photographed before the extraction and measured alongside their anterior margin. Next, they were preserved in formaldehyde, stripped of other soft tissues and then examined, photographed and described. RESULTS The mean length of the ligaments was 31.7 mm. 44 specimens were described as single-banded, 13 as double-banded and 3 as other. In 24 cases costal process of LV has been fixed to the iliac plate by short ligamentous bands. In 38 cases there was a thick fibrous membrane connected to the ligament. No legitimate insertions on LIV vertebra were observed. CONCLUSIONS Typical iliolumbar ligament consists of a single ligamentous band. Most common variability of the ligament consist of two bands. In approximately 40% of cases the costal process of LV can be additionally stabilized to the iliac plate by short, strong ligamentous bands. In 63% of cases a connection between the iliolumbar ligament and a fibrous membrane placed in the frontal plane, superiorly to the ligament, has been observed. There seems to be no convincing proof of existence of the insertion of the iliolumbar ligament on the LIV vertebra.
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Affiliation(s)
- K. Dąbrowski
- grid.13339.3b0000000113287408Department of Descriptive and Clinical Anatomy, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland
| | - B. Ciszek
- grid.13339.3b0000000113287408Department of Descriptive and Clinical Anatomy, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland ,Department of Neurosurgery in Bogdanowicz Children’s Hospital, Warsaw, Poland
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Deferent Anatomical Presentations of Iliolumbar Ligament: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5992510. [DOI: 10.1155/2022/5992510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
This work was carried out to describe the detailed gross anatomy of the iliolumbar ligaments in human cadavers and to shed more light on these disputes regarding the configuration and direction of these ligaments. Twenty partially dissected human formalin-preserved cadavers originating from North America and Europe were investigated in this study. Blunt dissection was made through the ventral and dorsal aspects of the pelvic area of the cadavers. According to the current study, the anterior and posterior portions of the iliolumbar ligament most frequently attached to the 5th lumbar vertebra’s transverse process (70% and 80%, respectively). The body of the 4th lumbar vertebra with the 5th lumbar vertebra’ transverse process was the attachment of the anterior part (30%). The attachment of the posterior part was the body of the 5th lumbar vertebra (20%). The anterior and posterior parts of the iliolumbar ligament were inserted into the anterior tip of the iliac crest. There is an obvious variation in the morphological appearance of the iliolumbar ligament distinguished in attachments, length, width, thickness, number of bands, and the presence of accessory bands in the anterior part of the ligament. In addition, a new attachment for the anterior band was revealed in one-third of the specimens (body of the 4th lumbar vertebra) which have not been described before. Also, in one-fifth of the specimens, there was a new attachment for the posterior band (body of the 5th lumbar vertebra).
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Steinke H, Saito T, Kuehner J, Reibetanz U, Heyde CE, Itoh M, Voelker A. Sacroiliac innervation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2831-2843. [PMID: 36029360 DOI: 10.1007/s00586-022-07353-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate the innervation pattern of the sacroiliac region, especially with regard to the sacroiliac joint (SIJ). Dorsal SIJ innervation was analyzed and described. Our main hypothesis was that nerves reach the SIJ dorsally, passing ligamental compartments, as this would explain dorsal SIJ pain. METHODS To examine sacroiliac innervation, we followed the nerves in over 50 specimens over several years. Plastinated slices were evaluated, nerves in the region were stained histologically, and the data were summarized as 3D models. RESULTS The Rami communicans and posterior branches of the spinal nerves and their branches that form a dorsal sacral plexus and communicating branches, together with corresponding vessels, were observed to form neurovascular bundles embedded by tiny fatty connectives in gaps and tunnels. Branches of L5-S1 pass the inner sacroiliac ligaments (the interosseous sacroiliac ligament and axial interosseous ligament). The outer sacroiliac ligaments (posterior sacroiliac ligaments, long posterior sacroiliac ligament, sacrotuberal ligament, thoracolumbar fascia) are passed by the S1-S4 branches. However, although the paths of these nerves are in the direction of the SIJ, they do not reach it. It is possible that impingement of the neurovascular bundles may result in pain. Moreover, the gaps and tunnels connect to the open dorsal SIJ. CONCLUSION Our findings suggest that Bogduk's term "sacroiliac pain" correlates to "sacroiliac innervation", which consists of "inner-" and "outer sacroiliac ligament innervation", and to ventral "SIJ pain". The watery gaps and tunnels observed could play a significant role in innervation and thus in the origins of SIJ pain. LEVEL OF EVIDENCE Individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Hanno Steinke
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany.
| | - Toshiyuki Saito
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Janne Kuehner
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany
| | - Uta Reibetanz
- Department of Biophysics, University Leipzig, Härtelstr. 16-18, 04107, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Anna Voelker
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Völker A, Steinke H, Heyde CE. The Sacroiliac Joint as a Cause of Pain - Review of the Sacroiliac Joint Morphology and Models for Pain Genesis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:507-516. [PMID: 33940639 DOI: 10.1055/a-1398-6055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In recent years, the sacroiliac joint has become increasingly important as a generator of low back pain with and without pseudo-radicular pain in the legs. Up to 27% of reported back pain is generated by disorders in the sacroiliac joint. METHOD This review is based on a selective literature search of the sacroiliac joint (SIJ) as a possible pain generator. It also considers the anatomical structures and innervation of the sacroiliac joint. RESULTS The SIJ is a complex joint in the region of the posterior pelvis and is formed by the sacrum and the ilium bones. The SIJ is very limited in movement in all three planes. Joint stability is ensured by the shape and especially by strong interosseous and extraosseous ligaments. Different anatomical variants of the sacroiliac joint, such as additional extra-articular secondary joints or ossification centres, can be regularly observed in CT scans. There is still controversy in the literature regarding innervation. However, there is agreement on dorsal innervation of the sacroiliac joint from lateral branches of the dorsal rami of the spinal nerves S I-S III with proportions of L III and L IV as well S IV. Nerve fibres and mechanoreceptors can also be detected in the surrounding ligaments. CONCLUSION A closer look at the anatomy and innervation of the SIJ shows that the SIJ is more than a simple joint. The complex interaction of the SIJ with its surrounding structures opens the possibility that pain arises from this area. The SIJ and its surrounding structures should be included in the diagnosis and treatment of back and leg pain. Published literature include a number of plausible models for the sacroiliac joint as pain generator. The knowledge of the special anatomy, the complex innervation as well as the special and sometimes very individual functionality of this joint, enhance our understanding of associated pathologies and complaints.
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Affiliation(s)
- Anna Völker
- Orthopaedic, Trauma Surgery and Plastic Surgery Clinic, Leipzig University Clinics, Germany
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Li J, Li Y, Ping R, Zhang Q, Chen HY, Lin D, Qi J. Biomechanical analysis of sacroiliac joint motion following oblique-pulling manipulation with or without pubic symphysis injury. Front Bioeng Biotechnol 2022; 10:960090. [PMID: 36204470 PMCID: PMC9530983 DOI: 10.3389/fbioe.2022.960090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Oblique-pulling manipulation has been widely applied in treating sacroiliac joint (SIJ) dysfunction. However, little is known about the biomechanical mechanism of the manipulation. This study aims to analyze the SIJ motion under oblique-pulling manipulation, in comparison with compression and traction loads. Methods/Study Design: A total of six specimens of embalmed human pelvis cadavers were dissected to expose the SIJ and surrounding ligaments. Through a servo-hydraulic testing system, biomechanical tests were performed on the stable pelvis and the unstable pelvis with pubic symphysis injury (PSI). A three-dimensional (3D) photogrammetry system was employed to determine the separation and nutation in three tests: axial compression (test A), axial traction (test B), and oblique-pulling manipulation (test C). Results: After applying the testing loads, the range of nutation was no more than 0.3° (without PSI) and 0.5°(with PSI), separately. Except for test B, a greater nutation was found with PSI (p < 0.05). Under both conditions, nutation following test A was significantly greater than that of other tests (p < 0.05). SIJ narrowed in test A and separated in tests B and C, where the range of motion did not exceed 0.1 mm (without PSI) or 0.3 mm (with PSI) separately. Under both conditions, the separation of SIJ in test C was not as apparent as the narrowness of SIJ in test A (p < 0.05). Compared to SIJ, a more significant increasing displacement was found at the site of the iliolumbar ligament (p < 0.05). Nevertheless, when the force was withdrawn in all tests, the range of nutation and separation of SIJ nearly decreased to the origin. Conclusion: Pubic symphysis is essential to restrict SIJ motion, and the oblique-pulling manipulation could cause a weak nutation and separation of SIJ. However, the resulting SIJ motion might be neutralized by regular standing and weight-bearing load. Also, the effect on SIJ seems to disappear at the end of manipulation. Therefore, the stretching and loosening of surrounding ligaments need to be paid more attention to.
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Affiliation(s)
- Jing Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Ruiyue Ping
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Qing Zhang
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai-Yun Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| | - Dingkun Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| | - Ji Qi
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Postdoctoral Research Station, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
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Venayre B, Koyama Y, Kurosawa D, Hammer N, Lingslebe U, Murakami E, Ozawa H, Ohashi T. Quantitative evaluation of the sacroiliac joint fixation in stress reduction on both sacroiliac joint cartilage and ligaments: A finite element analysis. Clin Biomech (Bristol, Avon) 2021; 85:105350. [PMID: 33878625 DOI: 10.1016/j.clinbiomech.2021.105350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The sacroiliac joint fixation is the last resort for patients with prolonged and severe joint pain. Although the clinical results of anterior fixations are conclusive, there exist several inevitable drawbacks with the surgical method such as the difficulty performing the surgery due to the presence of many organs. The posterior fixation technique has thus been developed to overcome those inconveniences. This study aims to assess in silico the mechanical environment following posterior and anterior fixations, focusing on stresses in both the sacroiliac cartilage and dorsal ligamentous part, as well as loads experienced by the pelvic ligaments. METHODS Sacroiliac joint cartilage, dorsal ligamentous part stresses and pelvic ligaments loads were evaluated with three types of fixation models. A vertical load of 600 N was applied, equally distributed via both acetabula when standing and sitting. FINDINGS Results show that the anterior sacroiliac joint fixation reduced von Mises stresses in the cartilage and dorsal ligamentous part and decreased ligaments loads more extensively than the posterior fixation when compared to the untreated model as a reference. However, the posterior fixation still remains the desirable and preferential treatment. INTERPRETATION The anterior sacroiliac joint fixation showed better performances compared to the posterior one; however, the lower invasive aspect of the latter is a fundamental clinical advantage which also has the possibility to be improved by considering various screws and cages configurations. This study provides a beneficial suggestion to improve the current fixation technique.
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Affiliation(s)
- Brice Venayre
- Division of Human Mechanical Systems and Design, Graduate School of Engineering, Hokkaido University, Sapporo, Japan
| | - Yuichiro Koyama
- Division of Human Mechanical Systems and Design, Graduate School of Engineering, Hokkaido University, Sapporo, Japan
| | - Daisuke Kurosawa
- Department of Orthopaedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan
| | - Niels Hammer
- Department of Clinical and Macroscopic Anatomy, Medical University of Graz, Graz, Austria; Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Fraunhofer IWU, Dresden, Germany
| | | | - Eiichi Murakami
- Department of Orthopaedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan
| | - Toshiro Ohashi
- Division of Mechanical and Aerospace Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan.
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Poilliot A, Doyle T, Kurosawa D, Toranelli M, Zhang M, Zwirner J, Müller-Gerbl M, Hammer N. Computed tomography osteoabsorptiometry-based investigation on subchondral bone plate alterations in sacroiliac joint dysfunction. Sci Rep 2021; 11:8652. [PMID: 33883625 PMCID: PMC8060288 DOI: 10.1038/s41598-021-88049-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/22/2021] [Indexed: 11/09/2022] Open
Abstract
Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect long-term adaptations to the loading of the joint. Mineralization densitograms of 27 SIJD patients and 39 controls, were obtained using CT osteoabsorptiometry. Hounsfield unit (HU) values of the SCB mineralization of superior, anterior and inferior regions on the iliac and sacral auricular surfaces were derived and statistically compared between SIJD-affected and control cohorts. Healthy controls showed higher HU values in the iliac; 868 ± 211 (superior), 825 ± 121 (anterior), 509 ± 114 (inferior), than in the sacral side; 541 ± 136 (superior), 618 ± 159 (anterior), 447 ± 91 (inferior), of all regions (p < 0.01). This was similar in SIJD; ilium 908 ± 170 (superior), 799 ± 166 (anterior), 560 ± 135 (inferior), sacrum 518 ± 150 (superior), 667 ± 151 (anterior), 524 ± 94 (inferior). In SIJD, no significant HU differences were found when comparing inferior sacral and iliac regions. Furthermore, HU values in the inferior sacral region were significantly higher when compared to the same region of the healthy controls (524 ± 94 vs. 447 ± 91, p < 0.01). Region mineralization correlated negatively with age (p < 0.01). SIJD-affected joints reflect a high mineralization of the sacral inferior region, suggesting increased SIJD-related mechanical stresses. Age-related SCB demineralization is present in all individuals, regardless of dysfunction.
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Affiliation(s)
- A Poilliot
- Department of Anatomy, University of Otago, 270 Great King Street, Dunedin, 9016, New Zealand. .,Anatomical Institute, University of Basel, Basel, Switzerland.
| | - T Doyle
- University of Otago School of Medicine, Dunedin, New Zealand
| | - D Kurosawa
- Department of Orthopaedic Surgery / Low Back Pain and Sacroiliac Joint Centre, JCHO Sendai Hospital, Sendai, Japan
| | - M Toranelli
- Anatomical Institute, University of Basel, Basel, Switzerland
| | - M Zhang
- Department of Anatomy, University of Otago, 270 Great King Street, Dunedin, 9016, New Zealand
| | - J Zwirner
- Department of Anatomy, University of Otago, 270 Great King Street, Dunedin, 9016, New Zealand
| | - M Müller-Gerbl
- Anatomical Institute, University of Basel, Basel, Switzerland
| | - N Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria. .,Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany. .,Fraunhofer IWU, Dresden, Germany.
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Toyohara R, Kurosawa D, Hammer N, Werner M, Honda K, Sekiguchi Y, Izumi SI, Murakami E, Ozawa H, Ohashi T. Finite element analysis of load transition on sacroiliac joint during bipedal walking. Sci Rep 2020; 10:13683. [PMID: 32792529 PMCID: PMC7426964 DOI: 10.1038/s41598-020-70676-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
The sacroiliac joint (SIJ) is burdened with variant loads. However, no methods have allowed to measure objectively how the SIJ deforms during bipedal walking. In this study, in-vivo walking conditions were replicated in a kinematic model combining the finite element method with 3D walking analysis data divided into five phases in order to visualize the load transition on the SIJ and clarify the role of the SIJ. Both models with and without inclusion of the SIJ were investigated. In models with bilateral SIJs, the displacement differed greatly between the sacrum and both hip bones on the SIJ as the boundary. The movements of the sacrum involved a nutation movement in the stance phase and a counter-nutation in the swing phase relative to the ilium. In models without SIJs, the displacement of the pelvis and loads of pelvic ligaments decreased, and the equivalent stress of the SIJs increased compared to the model with SIJs. The walking loads cause distortion of the entire pelvis, and stress concentration at the SIJ are seen due to the morphology of the pelvic ring. However, the SIJs help dissipate the resulting stresses, and the surrounding ligaments are likewise involved in load transmission.
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Affiliation(s)
- Ryota Toyohara
- Division of Human Mechanical Systems and Design, Graduate School of Engineering, Hokkaido University, Kita 13, Nishi 8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan.
| | - Daisuke Kurosawa
- Department of Orthopedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan
| | - Niels Hammer
- Department of Clinical and Macroscopic Anatomy, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Fraunhofer IWU, Medical Branch, Dresden, Germany
| | - Michael Werner
- Fraunhofer IWU, Medical Branch, Dresden, Germany
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Eiichi Murakami
- Department of Orthopedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshiro Ohashi
- Division of Mechanical and Aerospace Engineering, Faculty of Engineering, Hokkaido University, Sapporo, Japan
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10
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Subchondral bone strength of the sacroiliac joint-a combined approach using computed tomography osteoabsorptiometry (CT-OAM) imaging and biomechanical validation. J Mech Behav Biomed Mater 2020; 111:103978. [PMID: 32866917 DOI: 10.1016/j.jmbbm.2020.103978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/03/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Abstract
Bone mineral density distribution patterns at the sacroiliac joint (SIJ) may reflect long-term adaptation patterns to the loading the joint endures. This study aims to display bone mineralisation patterns of the articular SIJ subchondral lamella using computed tomography (CT) osteoabsorptiometry and mechanical indenting, to determine whether a relationship exists between mineralisation and mechanical strength. Twenty hemipelves were CT-scanned before osteoabsorptiometry densitograms were derived. Each articular side of eleven SIJs was mechanically indented following a 10-mm grid scheme. The sacral surface displayed lower Hounsfield unit (HU) values (≤ 700 HU) than the iliac side (> 700 HU). The apex, superior corner and borders yielded the highest HU scores (> 700 HU). Penetration strength was significantly higher on the iliac side (p < 0.04). Mineral density correlated positively with penetration strength of the subchondral bone layer (p < 0.05). No correlations were found between the HU values, nor between penetration strength of corresponding sides of the same SIJ in the majority of cases (p > 0.05). The iliac subchondral lamella is mechanically denser than the sacral aspect. The non-correlation between density and bone strength of articulating sides indicates biomechanical non-conformity. Loading throughout the SIJ may follow a complex distribution pattern involving the surrounding soft tissues, suspending the sacrum between the ilia.
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11
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Poilliot A, Doyle T, Tomlinson J, Zhang M, Zwirner J, Hammer N. Quantification of fat in the posterior sacroiliac joint region: fat volume is sex and age dependant. Sci Rep 2019; 9:14935. [PMID: 31624283 PMCID: PMC6797796 DOI: 10.1038/s41598-019-51300-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022] Open
Abstract
Fat is appreciated as a structural component of synovial joints. It may serve a shock-absorbing function for the incongruent surfaces, vessels and ligaments, but has not been investigated in the posterior sacroiliac joint (PSIJ). Sixty-six cadaveric hemipelves were serially-sectioned and photographed. The amount of visible fat in the PSIJ was quantified using a modified version of Cavalieri’s method. Total volume, fat volume and fat percentage of the PSIJ were calculated in predefined sub-regions. Fat is consistently present in the PSIJ (1.9 ± 1.3 cm3). Fat volume correlates with the PSIJ total volume (p < 0.0001; r = 0.73) and age (p = 0.024; r = 0.24), and is smaller in males (1.4 ± 0.8 cm3) than females (2.4 ± 1.5 cm3). Fat volumes in the middle and inferior sub-regions of the PSIJ show side- (p < 0.0001) and sex-differences (p = 0.013 females, middle sub-region). Age and PSIJ total volume correlate between sexes in various sub-regions (p = 0.05 females superior sub-region; males inferior sub-region). Fat percentage differs between sexes and sub-regions (p = 0.018 females, superior sub-region) but is independent of age and sides. The presence of fat within the PSIJ is a normal finding and shows sex-dependant and age-related differences. It is unclear whether fat is linked to age-related degeneration or has a shock-absorbing role in stress- and load-dissipation in the PSIJ.
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Affiliation(s)
- Amélie Poilliot
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
| | - Terence Doyle
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joanna Tomlinson
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria.,Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
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Zaharie DT, Phillips ATM. Pelvic Construct Prediction of Trabecular and Cortical Bone Structural Architecture. J Biomech Eng 2019; 140:2678341. [PMID: 29801165 DOI: 10.1115/1.4039894] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 11/08/2022]
Abstract
The pelvic construct is an important part of the body as it facilitates the transfer of upper body weight to the lower limbs and protects a number of organs and vessels in the lower abdomen. In addition, the importance of the pelvis is highlighted by the high mortality rates associated with pelvic trauma. This study presents a mesoscale structural model of the pelvic construct and the joints and ligaments associated with it. Shell elements were used to model cortical bone, while truss elements were used to model trabecular bone and the ligaments and joints. The finite element (FE) model was subjected to an iterative optimization process based on a strain-driven bone adaptation algorithm. The bone model was adapted to a number of common daily living activities (walking, stair ascent, stair descent, sit-to-stand, and stand-to-sit) by applying onto it joint and muscle loads derived using a musculoskeletal modeling framework. The cortical thickness distribution and the trabecular architecture of the adapted model were compared qualitatively with computed tomography (CT) scans and models developed in previous studies, showing good agreement. The sensitivity of the model to changes in material properties of the ligaments and joint cartilage and changes in parameters related to the adaptation algorithm was assessed. Changes to the target strain had the largest effect on predicted total bone volumes. The model showed low sensitivity to changes in all other parameters. The minimum and maximum principal strains predicted by the structural model compared to a continuum CT-derived model in response to a common test loading scenario showed good agreement with correlation coefficients of 0.813 and 0.809, respectively. The developed structural model enables a number of applications such as fracture modeling, design, and additive manufacturing of frangible surrogates.
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Affiliation(s)
- Dan T Zaharie
- The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London SW7 2AZ, UK.,Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, Skempton Building, South Kensington Campus, London SW7 2AZ, UK e-mail:
| | - Andrew T M Phillips
- The Royal British Legion Centre for Blast Injury Studies, , London SW7 2AZ, UK.,Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, , London SW7 2AZ, UK e-mail:
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In Silico Pelvis and Sacroiliac Joint Motion: Refining a Model of the Human Osteoligamentous Pelvis for Assessing Physiological Load Deformation Using an Inverted Validation Approach. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3973170. [PMID: 30729122 PMCID: PMC6343175 DOI: 10.1155/2019/3973170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023]
Abstract
Introduction. Computational modeling of the human pelvis using the finite elements (FE) method has become increasingly important to understand the mechanisms of load distribution under both healthy and pathologically altered conditions and to develop and assess novel treatment strategies. The number of accurate and validated FE models is however small, and given models fail resembling the physiologic joint motion in particular of the sacroiliac joint. This study is aimed at using an inverted validation approach, using in vitro load deformation data to refine an existing FE model under the same mode of load application and to parametrically assess the influence of altered morphology and mechanical data on the kinematics of the model. Materials and Methods. An osteoligamentous FE model of the pelvis including the fifth lumbar vertebra was used, with highly accurate representations of ligament orientations. Material properties were altered parametrically for bone, cartilage, and ligaments, followed by changes in bone geometry (solid versus 3 and 2 mm shell) and material models (linear elastic, viscoelastic, and hyperelastic isotropic), and the effects of varying ligament fiber orientations were assessed. Results. Elastic modulus changes were more decisive in both linear elastic and viscoelastic bone, cartilage, and ligaments models, especially if shell geometries were used for the pelvic bones. Viscoelastic material properties gave more realistic results. Surprisingly little change was observed as a consequence of altering SIJ ligament orientations. Validation with in vitro experiments using cadavers showed close correlations for movements especially for 3 mm shell viscoelastic model. Discussion. This study has used an inverted validation approach to refine an existing FE model, to give realistic and accurate load deformation data of the osteoligamentous pelvis and showed which variation in the outcomes of the models are attributed to altered material properties and models. The given approach furthermore shows the value of accurate validation and of using the validation data to fine tune FE models.
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Hammer N, Klima S. In-silico pelvis and sacroiliac joint motion-A review on published research using numerical analyses. Clin Biomech (Bristol, Avon) 2019; 61:95-104. [PMID: 30544056 DOI: 10.1016/j.clinbiomech.2018.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/23/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Computational models of the human pelvis have become highly useful tools to assess mechanisms of injury, diagnostics and treatment options. The purpose of this systematic literature review was to summarize existing pelvic computer models, to assess their comparability and the measures taken for experimental validation. METHODS Research on virtual simulations of the posterior pelvis and sacroiliac joint available from the ISI Web of Knowledge, PubMed and Scopus databases available until January 2018 were included. FINDINGS From a total of 3938 articles, 33 studies matched the criteria. Thirteen studies reported on experimental biomechanics, of which seven were parametric. Thirteen studies focused on pelvic injury and surgery, three were clinical case reports. One study assessed the effects of lumbar surgery on the sacroiliac joint, three studies on diagnostics and the non-surgical treatment of the sacroiliac joint. The mode of load application, geometry, material laws and boundary conditions varied vastly between the studies. The majority excluded the lumbosacral transition as part of pelvic biomechanics, and used isotropic linear elastic material properties. Outcomes of the analyses were reported inconsistently with negative impact on their comparability, and validation was commonly conducted by literature with varying agreement of the loading conditions. INTERPRETATION Comparability and validation are two major issues of present computational biomechanics of the pelvis. These issues diminish the transferability of the in-silico findings into real-life scenarios. In-vitro cadaveric models remain the realistic standard to account for the present computational analyses which simplify the complex nature of musculoskeletal tissues of the pelvis.
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Affiliation(s)
- Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Germany; Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany.
| | - Stefan Klima
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, Germany; Orthopaedicus Clinics, Leipzig, Germany
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15
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Hammer N, Scholze M, Kibsgård T, Klima S, Schleifenbaum S, Seidel T, Werner M, Grunert R. Physiological in vitro sacroiliac joint motion: a study on three-dimensional posterior pelvic ring kinematics. J Anat 2018; 234:346-358. [PMID: 30536830 DOI: 10.1111/joa.12924] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 12/28/2022] Open
Abstract
The sacroiliac joint (SIJ) is a well-known source of low back and pelvic pain, of increasing interest for both conservative and surgical treatment. Alterations in the kinematics of the pelvis have been hypothesized as a major cause of SIJ-related pain. However, definitions of both the range and the extent of physiological movement are controversial, and there are no clear baseline data for pathological alterations. The present study combined a novel biomechanical setup allowing for physiological motion of the lumbosacral transition and pelvis without restricting the SIJ movement in vitro, combined with optical image correlation. Six fresh human pelvises (81 ± 10 years, three females, three males) were tested, with bodyweight-adapted loading applied to the fifth lumbar vertebra and both acetabula. Deformation at the lumbopelvises was determined computationally from three-dimensional image correlation data. Sacroiliac joint motion under the loading of 100% bodyweight primarily consisted of a z-axis rotation (0.16°) and an inferior translation of the sacrum relative to the ilium (0.32 mm). Sacroiliac joint flexion-extension rotations were minute (< 0.02°). Corresponding movements of the SIJ were found at the lumbosacral transition, with an anterior translation of L5 relative to the sacrum of -0.97 mm and an inferior translation of 0.11 mm, respectively. Moreover, a flexion of 1.82° was observed at the lumbosacral transition. Within the innominate bone and at the pubic symphysis, small complementary rotations were seen around a vertical axis, accounting for -0.10° and 0.11°, respectively. Other motions were minute and accompanied by large interindividual variation. The present study provides evidence of different SIJ motions than reported previously when exerted by physiological loading. Sacroiliac joint kinematics were in the sub-degree and sub-millimeter range, in line with previous in vivo and in vitro findings, largely limited to the sagittal rotation and an inferior translation of the sacrum relative to the ilium. This given physiological loading scenario underlines the relevance of the lumbosacral transition when considering the overall motion of the lumbopelvis, and how relatively little the other segments contribute to overall motion.
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Affiliation(s)
- Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Germany.,Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Mario Scholze
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany
| | - Thomas Kibsgård
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - Stefan Klima
- Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Germany.,Orthopaedicus Clinics, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Germany
| | - Thomas Seidel
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Department of Anatomy, University of Leipzig, Germany
| | - Ronny Grunert
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Department of Neurosurgery, University of Leipzig, Leipzig, Germany
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Hammer N, Höch A, Klima S, Le Joncour JB, Rouquette C, Ramezani M. Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments. Clin Anat 2018; 32:231-237. [PMID: 30281852 DOI: 10.1002/ca.23291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/13/2018] [Accepted: 09/28/2018] [Indexed: 01/02/2023]
Abstract
The sacrospinous (SS) and sacrotuberous (ST) ligaments form a complex at the posterior pelvis, with an assumed role as functional stabilizers. Experimental and clinical research has yielded controversial results regarding their function, both proving and disproving their role as pelvic stabilizers. These findings have implications for strategies for treating pelvic injury and pain syndromes. The aim of the present simulation study was to assess the influence of altered ligament function on pelvis motion. A finite elements computer model was used. The two-leg stance was simulated, with the load of body weight applied via the fifth lumbar vertebra and both femora, allowing for nutation of the sacroiliac joint. The in-silico kinematics were validated with in-vitro experiments using the same scenario of load application following SS and ST transection in six human cadavers. Modeling of partial or complete ligament failure caused significant increases in pelvis motion. This effect was most pronounced if the SS and ST were affected with 164% and 182%, followed by the sacroiliac and iliolumbar ligaments with 123% and 147%, and the pubic ligaments with 113% and 119%, for partial and complete disruption, respectively. Simultaneous ligament transection multiplied the effects on pelvis motion by up to 490%. Unilateral ligament injury altered the motion at the pelvis contralaterally. The experiments presented here provide strong evidence for the stabilizing role of the SS and ST. A fortiori, the instability resulting from partial or complete SS and ST injury merits consideration in treatment strategies involving these ligaments as important stabilizers. Clin. Anat. 32:231-237, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic, Trauma and Plastic Surgery, University Clinics of Leipzig, Leipzig, Germany.,Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Andreas Höch
- Department of Orthopedic, Trauma and Plastic Surgery, University Clinics of Leipzig, Leipzig, Germany
| | - Stefan Klima
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic, Trauma and Plastic Surgery, University Clinics of Leipzig, Leipzig, Germany
| | - Jean-Baptiste Le Joncour
- Supméca-Institut Supérieur de Mécanique de Paris, Paris, France.,Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Corentin Rouquette
- Supméca-Institut Supérieur de Mécanique de Paris, Paris, France.,Department of Mechanical Engineering, Auckland University of Technology, Auckland, New Zealand
| | - Maziar Ramezani
- Supméca-Institut Supérieur de Mécanique de Paris, Paris, France
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Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5870875. [PMID: 28246600 PMCID: PMC5303600 DOI: 10.1155/2017/5870875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/02/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022]
Abstract
Introduction. The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods. Microcomputed tomography (μ-CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results. TFCC reconstruction was impossible using μ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach's usefulness as a diagnostic tool.
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18
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Development of a Patient-Specific Finite Element Model for Predicting Implant Failure in Pelvic Ring Fracture Fixation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:9403821. [PMID: 28255332 PMCID: PMC5309420 DOI: 10.1155/2017/9403821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Abstract
Introduction. The main purpose of this study is to develop an efficient technique for generating FE models of pelvic ring fractures that is capable of predicting possible failure regions of osteosynthesis with acceptable accuracy. Methods. Patient-specific FE models of two patients with osteoporotic pelvic fractures were generated. A validated FE model of an uninjured pelvis from our previous study was used as a master model. Then, fracture morphologies and implant positions defined by a trauma surgeon in the preoperative CT were manually introduced as 3D splines to the master model. Four loading cases were used as boundary conditions. Regions of high stresses in the models were compared with actual locations of implant breakages and loosening identified from follow-up X-rays. Results. Model predictions and the actual clinical outcomes matched well. For Patient A, zones of increased tension and maximum stress coincided well with the actual locations of implant loosening. For Patient B, the model predicted accurately the loosening of the implant in the anterior region. Conclusion. Since a significant reduction in time and labour was achieved in our mesh generation technique, it can be considered as a viable option to be implemented as a part of the clinical routine to aid presurgical planning and postsurgical management of pelvic ring fracture patients.
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20
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Viehöfer AF, Shinohara Y, Sprecher CM, Boszczyk BM, Buettner A, Benjamin M, Milz S. The molecular composition of the extracellular matrix of the human iliolumbar ligament. Spine J 2015; 15:1325-31. [PMID: 24139866 DOI: 10.1016/j.spinee.2013.07.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/12/2013] [Accepted: 07/25/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The human iliolumbar ligament connects the transverse process of L5 to the iliac crest and contributes to lumbosacral stability and has been associated with low back pain. However, different opinions exist regarding the functional relevance of the ligament. PURPOSE In the present study, we analyze the regional molecular composition of the ligament extracellular matrix. STUDY DESIGN Special attention is given to the attachment sites, to determine whether the ligament is subjected to a certain mechanical environment. METHODS Iliolumbar ligament samples, extending from one enthesis to the other, were removed from 11 cadavers and fixed in methanol. Cryosections were immunolabeled with a panel of antibodies directed against collagens, glycosaminoglycans, proteoglycans, matrix proteins, and neurofilament. RESULTS The mid-substance of the ligament labeled for all the molecules normally found in dense fibrous connective tissue including types I, III, and VI collagen, versican, dermatan -, chondroitin 4 -, and keratan sulfate. However, both entheses were fibrocartilaginous and labeled for type II collagen, aggrecan, and chondroitin 6- sulfate. A common feature was fat between the fiber bundles near the entheses. Occasionally this fat contained nerve fibers. CONCLUSIONS The existence of fibrocartilaginous entheses suggests that the insertion sites of the ligament are subject to both tensile and compressive loading-probably because of insertional angle changes between ligament and bone during loading. Our findings support the suggestion that the iliolumbar ligament might play an important role in the stabilization of the lumbosacral junction.
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Affiliation(s)
- Arnd F Viehöfer
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, CH-7270 Davos, Switzerland
| | - Yasushi Shinohara
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, CH-7270 Davos, Switzerland; Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, 634-8522, Japan
| | - Christoph M Sprecher
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, CH-7270 Davos, Switzerland
| | - Bronek M Boszczyk
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre Campus, Derby Rd, West Block D Floor, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
| | - Andreas Buettner
- Institute of Legal Medicine, University of Rostock, St.-Georg-Straße 108, DE-18055 Rostock, Germany
| | - Mike Benjamin
- Cardiff School of Biosciences, Museum Ave, Cardiff, CF10 3AX, United Kingdom
| | - Stefan Milz
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, CH-7270 Davos, Switzerland; Anatomische Anstalt, Ludwig-Maximilians-University, Pettenkoferstr. 11, DE-80336 Munich, Germany.
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Böhme J, Lingslebe U, Steinke H, Werner M, Slowik V, Josten C, Hammer N. The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries--A computer study to gain insight into open book trauma. J Orthop Res 2014; 32:873-9. [PMID: 24664964 DOI: 10.1002/jor.22618] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/20/2014] [Indexed: 02/04/2023]
Abstract
Surgical stabilization of the pelvis following type II anteroposterior compression pelvic injuries (APCII) is based on the assumption that the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments disrupt simultaneously. Recent data on the ligaments contradict this concept. We aimed at determining the mechanisms of ligament failure in APCII computationally. In an individual osteoligamentous computer model of the pelvis, ligament load, and strain were observed for the two-leg stance, APCII with 100-mm symphyseal widening and for two-leg stance with APCII-related ligament failure, and validated with body donors. The anterior sacroiliac and sacrotuberous ligaments had the greatest load with 80% and 17% of the total load, respectively. APCII causes partial failure of the anterior sacroiliac ligament and the pelvis to become horizontally instable. The other ligaments remained intact. The sacrospinous ligament was negligibly loaded but stabilized the pelvis vertically. The interosseous sacroiliac and sacrotuberous ligaments are likely responsible for reducing the symphysis and might serve as an indicator of vertical stability. The sacrospinous ligament appears to be of minor significance in APCII but plays an important role in vertical stabilization. Further research is necessary to determine the influence of alterations in ligament and bone material properties.
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Affiliation(s)
- Jörg Böhme
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Steinke H, Hammer N, Lingslebe U, HÖCh A, Klink T, BÖhme JÖ. Ligament-induced sacral fractures of the pelvis are possible. Clin Anat 2014; 27:770-7. [DOI: 10.1002/ca.22312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Hanno Steinke
- Universität Leipzig, Institut für Anatomie (Institute of Anatomy); Leipzig F.R. of Germany
| | - Niels Hammer
- Universität Leipzig, Institut für Anatomie (Institute of Anatomy); Leipzig F.R. of Germany
| | - Uwe Lingslebe
- Hochschule für Technik, Wissenschaft und Kunst (HTWK), (Leipzig University of Applied Sciences, HTWK); Leipzig F.R. of Germany
| | - Andreas HÖCh
- Universität Leipzig, Klinik für Unfall- und Wiederherstellungschirurgie, (Department of Trauma and Reconstructive Surgery); Leipzig F.R. of Germany
| | - Thomas Klink
- Hochschule für Technik, Wissenschaft und Kunst (HTWK), (Leipzig University of Applied Sciences, HTWK); Leipzig F.R. of Germany
| | - JÖrg BÖhme
- Universität Leipzig, Klinik für Unfall- und Wiederherstellungschirurgie, (Department of Trauma and Reconstructive Surgery); Leipzig F.R. of Germany
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23
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Hammer N, Steinke H, Lingslebe U, Bechmann I, Josten C, Slowik V, Böhme J. Ligamentous influence in pelvic load distribution. Spine J 2013; 13:1321-30. [PMID: 23755919 DOI: 10.1016/j.spinee.2013.03.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 01/03/2013] [Accepted: 03/20/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint (SIJ) pain are described being related to these ligaments. Computational approaches involving finite element (FE) modeling may aid to determine their influence. Previous FE models lacked in precise ligament geometries and material properties, which might have influence on the results. PURPOSE AND STUDY DESIGN The aim of this study is to investigate ligamentous influence in pelvic stability by means of FE using precise ligament material properties and morphometries. METHODS An FE model of the pelvis bones was created from computer tomography, including the pubic symphysis joint (PSJ) and the SIJ. Ligament data were used from 55 body donors: anterior (ASL), interosseous (ISL), and posterior (PSL) sacroiliac ligaments; iliolumbar (IL), inguinal (IN), pubic (PL), sacrospinous (SS), and sacrotuberous (ST) ligaments; and obturator membrane (OM). Stress-strain data were gained from iliotibial tract specimens. A vertical load of 600 N was applied. Pelvic motion related to altered ligament and cartilage stiffness was determined in a range of 50% to 200%. Ligament strain was investigated in the standing and sitting positions. RESULTS Tensile and compressive stresses were found at the SIJ and the PSJ. The center of sacral motion was at the level of the second sacral vertebra. At the acetabula and the PSJ, higher ligament and cartilage stiffnesses decrease pelvic motion in the following order: SIJ cartilage>ISL>ST+SS>IL+ASL+PSL. Similar effects were found for the sacrum (SIJ cartilage>ISL>IL+ASL+PSL) but increased ST+SS stiffnesses increased sacral motion. The influence of the IN, OM, and PL was less than 0.1%. Compared with standing, total ligament strain was reduced to 90%. Increased strains were found for the IL, ISL, and PSL. CONCLUSIONS Posterior pelvic ring cartilage and ligaments significantly contribute to pelvic stability. Their effects are region- and stiffness dependent. While sitting, load concentrations occur at the IL, ISL, and PSL, which goes in coherence with the clinical findings of these ligaments serving as generators of low back pain.
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Affiliation(s)
- Niels Hammer
- Faculty of Medicine, Institute of Anatomy, University of Leipzig, Liebigstraße 13, 04103 Leipzig, Germany; Department of Trauma and Reconstructive Surgery, Faculty of Medicine, University of Leipzig, Liebigstraße 13, 04103 Leipzig, Germany.
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Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012; 221:537-67. [PMID: 22994881 PMCID: PMC3512279 DOI: 10.1111/j.1469-7580.2012.01564.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/28/2022] Open
Abstract
This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure.
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Affiliation(s)
- A Vleeming
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME, USA
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25
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Böhme J, Shim V, Höch A, Mütze M, Müller C, Josten C. Clinical implementation of finite element models in pelvic ring surgery for prediction of implant behavior: a case report. Clin Biomech (Bristol, Avon) 2012; 27:872-8. [PMID: 22770881 DOI: 10.1016/j.clinbiomech.2012.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/19/2012] [Accepted: 06/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteosyntheses to stabilize pelvic-ring fractures were developed for younger patients, and are not universally indicated for elderly people. We present the results of parallel-arranged numerical simulations of fixation treatment that an elderly patient with a bagatelle-injured pelvic ring fracture received using a patient-specific finite element model. METHODS The clinical course of an osteosynthetic stabilized pelvic ring fracture, based on an actual case, was numerically simulated using a patient-specific finite element model. FINDINGS A previously validated finite element model of a human pelvis was customized with computed tomography data from a patient with a stabilized pelvic-ring fracture. Numerical simulation was used to analyze primary stability. The clinical process, represented by radiologic examinations, was compared with the results from the finite element simulation. Implant loosening as well as newly-occurring fractures were shown to coincide with regions with the highest stress levels. INTERPRETATION The results from the patient-specific finite element model closely resembled the actual clinical course especially in terms of the location of high strain concentration and subsequent implant loosening. This indicates that patient-specific finite element models have a potential to play an important role in planning osteosynthesis according to biomechanical stability.
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Affiliation(s)
- J Böhme
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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