Biomechanische Prinzipien in Diarthrosen und Synarthrosen - Teil IV: Zur Mechanik der Wirbelsäule im Lendenbereich. Eine Pilotstudie

Autor: A. Rossow, H. Cotta, J. Fanghänel, Hans Nägerl, Stefan Spiering, D. Kubein-Meesenburg
Rok vydání: 2008
Předmět:
Zdroj: Zeitschrift für Orthopädie und ihre Grenzgebiete. 133:481-491
ISSN: 1438-941X
0044-3220
DOI: 10.1055/s-2008-1039927
Popis: UNLABELLED Theoretical considerations help define the requirements for an apparatus that is to localize the instantaneous helical axes (IHA) of axial rotations of lumbar segments. RESULT Since the range of axial rotation of an L3/4 segment is in only approximately +/- 1.5 degrees the rotational angle intervals have to be smaller than 0.3 degree with an resolution less than 0.03 degree in order to be able to determine the loci of the IHAs. For the first time in vitro measurements are presented that satisfy this requirement. The data prove that the guidance by the artt. zygapophysiales critically influence the possible positions of the IHA. Comparatively, ligaments and intervertebral disk play a marginally role. During axial torques Tz the IHAs lie dorsal to the intervertebral disk and migrate from one joint to the other depending on axial rotation (length of migration: approximately 3-4 cm). The IHAs lie almost parallel to the axial torque vector. When the joints are removed the IHA is stationary and almost perpendicular to the intervertebral disk and intersects the disk's central region. The screw inclination (pitch) of the instantaneous screw movement is proportional to the rotational angle. Therefore, depending on the direction of rotation, one obtains left or right handed screw movements. This means: axial torsional load leads to an increase in thickness of the intervertebral disk. During preloads that produces extensions the fixed centrodes (paths of axis migration) of intact segments are dorsally beaten out, whereas during flexional loads they are ventrally beaten out. Then, the IHAs migrate through the canalis vertebralis. By the concept "dimeric link chain" the different shapes of the fixed centrode are traced back to the morphology of curvature of the articulating surfaces. The measurements suggest the hypothesis that the distinct nonlinearity of the load displacement curves (s-shape of alpha = alpha (Tz) funktion is an affection of IHA migration. Comparatively, the influence of ligaments can be neglected. The measurements suggest the hypothesis that the hysteresis of the load displacement curves (neutral zone) is an artefact that does not appear in vivo. Altogether, the experiments prove that the loci of the IHAs are determined by the interplay of preload, structure of the applied force system and morphology of curvature of the articulating surfaces. By that the possibility is clinically given to calculate the multitude of possible movements as function of muscle activity when in the individual the shape and the position of the articulating surfaces are measured in vivo (by NMR-methods e.g.). A physically based classification of pathological cases seems to be possible.
Databáze: OpenAIRE
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