Biomechanical characteristics of ligament injury affecting lumbar spine stability

doi:10.12307/2024.070

Abstract

Abstract: BACKGROUND: Ligaments are important structures in maintaining the stability of the lumbar spine, and these structures are prone to degradation due to the generated mechanical stress. However, there are few studies on ligament injuries.
OBJECTIVE: To determine the range of motion and stress of each ligament in the state of motion based on a three-dimensional finite element model, and to systematically explore the influence of ligament injury on the stability of the lumbar spine and its biomechanical significance.
METHODS: The L4-L5 lumbar finite element model was established. All free forces on the lower surface of L5 were constrained, and a torque of 5 N·m was applied to simulate the motion states of the lumbar spine. Progressive ligament damage was simulated by changing Young’s modulus of the ligament.
RESULTS AND CONCLUSION: (1) The extension range of motion of most ligament injuries increased significantly. In contrast, there was no significant change in the lateral bending range of motion. (2) The range of motion of capsular ligament injury increased significantly in flexion, extension and lateral bending. The extension range of motion increased significantly after the anterior longitudinal ligament injury. Intertransverse ligament injury resulted in a significant increase in the lateral bending range of motion. (3) After a single ligament injury, the most significant change in range of motion was observed during extension. After a single ligament injury, the stress of the remaining ligaments increased, especially the capsular ligament. The stress changes of the interspinous ligament and ligamentum flavum were the least obvious. Ligament stress changes least in lateral bending and most in torsion. (4) Ligament damage did not result in major changes in disc pressure, indicating that ligament injury leads to an increased range of motion of the lumbar spine and affects the stability of the lumbar spine. (5) Capsular ligament was stable in flexion, extension and lateral bending. The anterior longitudinal ligament showed a stable extension; the intertransverse ligament stabilizes the lateral curve. (6) Extension exercise is sensitive to a ligament injury, and the pathological changes of the ligament can be examined by extension exercise. (7) Stress compensation was given to the remaining ligaments to maintain the stability of the lumbar spine after a single ligament injury. (8) Interspinous ligament and ligamentum flavum injuries have the least impact on the peripheral ligaments, while capsular ligament injuries have the greatest impact on the peripheral ligaments. (9) The ligament injury has the least effect on the residual ligament stress during lateral bending exercise, while it has the greatest effect on the ligament stress during the twisting exercise. Patients with ligament injury should avoid twisting exercises. Ligament injuries do not affect disc pressure.

Key words: finite element, lumbar vertebrae, ligament, progressive injury, biomechanics

CLC Number:

Li Yinqian, Lyu Jie, Ding Lijun, Wang Duoduo, Guo Panjing, Cao Jinfeng, Zhou Nan, Lyu Qiang. Biomechanical characteristics of ligament injury affecting lumbar spine stability[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(21): 3286-3292.

Figures/Tables 3

此外，这些单元格中的文本表示4种运动状态下的活动度随韧带受损程度的加深而增大。其中，后伸时活动度变化趋势最为明显，大部分韧带损伤后活动度都出现了明显的增大；相比之下侧弯活动度无明显变化，大部分韧带受损后活动度几乎不变，整体来看侧弯最不容易受韧带损伤的影响。关节囊韧带受损导致前屈的最大变化的发生，相比健康韧带，关节囊韧带受损程度50%的情况下活动度增加9.65%。对于后伸而言，关节囊韧带和前纵韧带受损对活动度影响最大，其变化百分比分别为32.37%和8.95%。扭转变化最为明显只发生在关节囊韧带受损后，活动度增大10.16%。侧弯活动度的变化最不明显，最大变化发生在关节囊韧带受损后，为6.15%。 2.2 韧带应力结果韧带的损伤通常会导致剩余韧带最大应力增加。图6显了每组模拟结果，受损韧带显示在每个“T形图”的中心。在T型图上，表示了图表中每个分支的加载模式(横向弯曲和轴向旋转的左右运动取平均值)，列出了不同程度上由于韧带受损而导致的剩余韧带最大应力的变化百分比。每个单元格显示了某运动状态下该韧带损伤一定程度时的剩余韧带最大应力变化百分比。比如，T型图中标记为“XALL”，这意味着这一组实验中受损韧带为前纵韧带。这些单元格中的文本表明，在前屈状态下，前纵韧带损伤10%-50%时关节囊韧带最大应力变化百分比为0.55%-2.98%。结果显示一种韧带受损将导致剩余韧带应力增加。任何一种韧带受损都会在扭转期间导致关节囊韧带最大应力明显增大。关节囊韧带受损会在扭转期间增大棘上韧带、棘间韧带和黄韧带的应力(24.56%，15.39%，12.99%)；在前屈和后伸期间则增大所有韧带应力。韧带受损后棘间韧带在侧弯运动状态下出现了不同程度的应力减小，然而棘间韧带应力明显增大发生在横突韧带受损后的侧弯状态下。棘上韧带在后纵韧带受损50%时的扭转状态下有一个明显应力的突变，由-0.31%增加到20.32%。整体来看韧带应力在侧弯状态下最不容易受影响，最大应力变化百分比大部分都不超过1%。而扭转状态下的剩余韧带最大应力变化最大。"

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