10.脊柱模型及腰椎生物力学

1.SPINAL MODELING AND LUMBAR SPINAL BIOMECHANICS脊柱模型及腰椎的生物力学Ray Wiegand,D.C.Adjunct Faculty Logan College of Chiropractic2.INTRODUCTION介绍*The purpose of this presentation is to develop a geometric spinal model using frontal and sagittal plane radiographs.本讲座的目的是介绍用正面和侧面X-光片创立一个脊柱几何力学模型3.PURPOSE OF THE SPINAL MODEL脊柱模型的作用*Provide a method to record the architecture and geometry of the spinal pelvic system to investigate its organization and function.提供一个方法以记录和测定脊柱和骨盆系统的结构极其几何力学，用以研究其组成和功能*Identify abnormal segmental alignment for the purpose of spinal adjusting确定异常的关节排列以确定脊柱调整方案4.BIOMECHANICAL ORGANIZATION生物力学结构*All living organisms demonstrate optimum efficiency through structural and functional organization所有有生命的肌体组织都会通过其结构和功能组成来达到其最佳和最有效的生存方式*The human skeleton is structurally and functionally organized including the alignment of the bones and the symmetricalattachment of the ligaments and muscles人体的骨骼系统是以骨骼的排列、韧带和肌肉的对称附着来达到结构和功能的有机结合的*Any injury to the spine or pelvis causes functional compensation within the spine,pelvis and extremities所有对脊柱或骨盆的伤害都会引起脊椎、骨盆和四肢的功能代偿*For every action there is a reaction每一个作用都存在着一个相应的反应5.SPINAL REACTION TO INJURY(COMPENSATION)IS PREDICTABLE脊椎对损伤的代偿反应是可预见的*Once injured,the spinal system predictably reorganizes脊椎系统一旦受到伤害随即会发生可预见的重新整合*From Optimum form and function*To Organized compensation with reduced function从最佳形态功能到有组织的代偿并伴随功能下降*With repeated injury the spinal system moves*To Disorganization with dysfunction反复的伤害脊椎系统就会发展成组织紊乱伴随功能障碍*Patients usually have multiple injuries and the spine is disorganized and dysfunctional病人通常都是由于多次的损伤导致组织紊乱和功能障碍6.DEVELOPING THE SPINAL MODEL脊椎模型的建立使用X-线的投影原理7.SPINAL GEOMETRY脊椎的几何学*The spine demonstrates different geometry dependent on the viewing angle从不同的角度观察，脊椎呈现出不同的几何形态*The viewing angle is the positional relationship of the object to the observer.观察角度是物体与观察者之间的位置关系*There are usually two viewing angles of the spine,the frontal and sagittal planes通常有两种观察角度：正面和侧面8.THE OPTIMUM SPINE FRONTAL PLANE最佳状态脊柱正面观图形Optimum geometry produces maximum resistance to gravity最佳几何形态产生对重力的最大承受力*In the frontal plane the spine is从正面观察脊柱是Vertical垂直的Symmetrical对称的Balanced left to right左右平衡的9.THE OPTIMUM SPINE SAGITTAL PLANE最佳状态脊柱的侧面观*Optimum Geometry and Alignment Produces Optimum Joint Function最佳几何形态和排列产生最佳关节功能In the sagittal plane there are four reciprocating curves侧面观脊柱有四个弯曲曲线Three are functional curves有三个功能曲线Cervical颈椎Thoracic胸椎Lumbar腰椎One is a static curve一个静态曲线Sacral底部The head is positioned over the center of the pelvis头位于骨盆中心上方The spine is balanced front to back脊柱前后平衡10.PROJECTIONAL X-RAY GEOMETRY X-线投影几何学*Three Dimensional Objects Form Predictable Two Dimensional Images根据三维空间物体可预测出两维画面*When the true architectural shape is known只要我们知道其真实结构*When the effects of x-ray distortion are known知道X-线的变形影响*When the effects of the viewing angle are known知道观察角度的影响11.PRIMARY OBJECTS IN AN X-RAY FIELD X-线区域内的没有弧度的物体*Images of primary objects are not effected by central ray position物体的图形不受中心线位置的影响*Off centering of the central ray or object malposition results in magnification and displacement*The characteristic shape is maintained偏离中心线或物体位移导致图形的放大或位移但形状不会改变12.A SIMPLE CURVED OBJECT一个简单的弯曲物体*Curved objects demonstrate predictable shape characteristics in the弯曲物体表现出可预见的形态及特征A-P plane前后平面Lateral plane侧面The Cervical,thoracic and lumbar regions present as curved shaped objects in the sagittal plane.侧面观：颈椎，胸椎和腰椎表现出曲线物体的特征13.MALPOSITION OF A CURVED SHAPED OBJECT TO THE CENTRAL RAY曲线物体相对中心线的位移*Left rotation produces a left convex curve左旋产生出左凸曲线*Right rotation produces a right convex curve右旋产生右凸曲线*The amplitude of the convex curve is proportional to the amount of rotation凸形曲线幅度大小与旋转度有关14.RADIOGRAPHIC ANALYSIS OF THE LUMBAR SPINE腰椎X-线分析15.PURE PLANE AND HYBRID PROJECTIONS单纯平面和复合投影Off axis patient placement produces a hybrid X-ray projection病人的位置偏离轴心会产生复合X-线投影Hybrid:an x-ray view that is mostly A-P plane with partial projection of the sagittal plane architecture复合的：X-线观，大部分位前后平面，小部分为矢状结构16.THE HYBRID A-P X-RAY复合前后位X-线*Produced from a partial projection of the lateral plane into the A-P Plane.产生于一部分侧位面投影于前后平面的结果*Contributing factors include产生因素包括True lateral bending真有侧弯Rotational malposition旋转性错位Lateral Offset to the central ray中心线的侧偏移All the above包括上述所有因素17.THE EFFECTS OF ROTATIONAL MALPOSITION旋转错位的结果最佳位5度旋转10度旋转*The amplitude of the convex curve is proportional to the amount of rotation旋转度与外凸曲线成正比18.MEASURING VERTEBRAL BODY ROTATION测定椎体旋转Graphical Display图形表示*Measured as an offset of the interlamina junction to the centerline测量点为椎板间到中心线的差*Displayed as a proportional horizontal bar graph用一个成比例的水平板块图形表示19.BIOMECHANICAL ORGANIZATION生物力学组织*Once injured,the spinal system predictably reorganizes一旦受损脊椎系统必然重组From Optimum form and function从最佳形态与功能To Organized ideal compensation到理想的有组织的代偿To Disorganized stabilization with subluxation组织错位紊乱20.VERTEBRAL BODY ROTATIONS ARE ORGANIZED有组织的椎体旋转*Organized rotations indicate有组织的旋转显示Normal coupling正常偶合Functional efficiency好的功能效率Normal neurological transmission正常神经传导21.DISORGANIZED ROTATIONS AND ROTATIONAL DIFFERENCES无组织的旋转及旋转差*Abrupt misalignment of one vertebra to another(subluxation)produces两个椎体间产生突然的位移（错位）Loss of normal coupling失去正常偶合Loss of functional efficiency失去功能效率Functional stenosis at the IVF神经孔功能性狭窄Functional stenosis at the central canal中心管功能性狭窄Neurological and physiological compromise神经和生理功能异常22.DISORGANIZED ROTATIONS AND SUBLUXATION无组织的旋转和错位*Abrupt rotational misalignment,rotational differences can be measured and displayed graphically to mathematically identifyvertebra for adjustment突然的旋转性位移，其旋转差可以测量并以图形显示出来以数学方式确定椎体的调整23.CORRECTION OF SUBLUXATION纠正错位*Correction of L5from left rotation to right rotation with spinal adjusting脊椎的调整纠正腰5椎的左旋24.ABRUPT SPINAL MISALIGNMENTS陡然的脊椎位移*Abrupt vertebral misalignments can occur throughout the spine in the陡然的脊椎位移可发生于脊椎的任何部位Cervical region颈部Thoracic region胸部Lumbar region腰部25.ABRUPT VERTEBRAL MISALIGNMENT陡然的椎体位移produces neurological and vascular disturbances导致神经和血管的功能紊乱26.PREDICTABLE SPINAL PATTERNS可预见的脊椎模式10ºRotation of the Optimum Spine最佳脊柱的10度旋转*System rotation produces predictable regional and global spinal configurations系统旋转产生可预见的区域或整体脊椎形态*A-P Stress Lines/lateral bending前后压力线侧弯*Vertebral Body Rotations椎体旋转*Disc Angles椎间盘角度27.PROJECTED ORGANIZATION OF THE OPTIMUM SPINE最佳脊椎组织的投影Demonstrates显示出Regional lateral bending区域性侧弯Organized vertebra rotation有序的椎体旋转Global balance整体的平衡性28.THE PROJECTED GEOMETRIC ORGANIZATION OF AN OPTIMUM SPINE最佳脊椎组织投影的几何学*A10right torso rotation of the optimum spine produces a projected image of a balanced scoliosis完美脊椎的10度旋转产生一个平衡的侧弯影象投影*This occurs as the sagittal plane spinal curves project into the frontal plane这个现象的发生是由于侧面的脊椎弯曲影象投影于正面影象*The spinal system demonstrates segmental,regional and global organization脊椎系统展现出节段性，区域性和整体性组织结构*These geometric characteristics provide an optimum reference for patient comparison这些几何学特征提供了与病人进行比较的理想参数29.SPINAL COMPENSATION IS PREDICTABLE脊柱代偿是可以遇见的*When the spinal system is injured it compensates with torso rotation,regional lateral bending and segmental rotation.脊椎受到损伤后躯干会发代偿性旋转，区域性侧弯以及节段性旋转*The compensated spine has the same distortion characteristics on x-ray as the projected hybrid view of the optimum spine代偿后的脊椎在X-线上具有与理想脊椎相同的图形特征*The compensated spine has real biomechanical distortion and physical findings但代偿后的脊椎发生了真正的生物力学改变和临床改变30.PHYSICAL FINDINGS OF COMPENSATED SPINE代偿后脊椎的临床改变Right Compensatory Pattern Associated with Right Torso Rotation右侧代偿模式与躯体右旋转有关right inferior sacrum骶骨右下旋right ilium rotated posterior(PI)右髂骨后旋Resulting in functional right short leg导致功能性右侧腿短Left ilium rotated anterior(AS)左侧髂骨前旋Right lumbar curve腰椎呈右凸曲线Right lumbar vertebral body rotations腰椎椎体右旋转Left thoracic convex curve胸椎呈左凸曲线Right cervical convex curve颈椎呈右凸曲线31.ASSESSING SPINAL ORGANIZATION OF THE INJURED SPINE评价损伤脊椎的颈椎组织结构*Abnormal spinal alignment can be identified in the injured spine by overlaying the organized patterns associated with the hybridprojection of the optimum spine受损脊椎的异常排列可以通过与最佳脊椎复合投影的对比而查出*The hybrid projection of the optimum spine is represented by either aRight torso rotation or a Left torso rotation最佳脊柱复合投影表现为躯体右旋转或躯体左旋转*The patient organization is identified with a best fit of the optimum pattern to the patient findings通过和最佳形态可以确定病人的组织结构32.ANALYZING THE PATIENT WITH COMPUTER GRAPHICS用计算机制图对病人的进行分析The patientthe x-raycomputer graphics33.PATIENT SPINAL CONFIGURATION SHOWING THE VERTEBRAL BODY ROTATIONS AND LATERAL BENDING病人脊柱图示表示锥体旋转和脊柱侧弯The view is standing behind the patient这是从病人的后面观34Overlaying Ideal Left Torso Rotation Pattern(omit)35.OVERLAYING IDEAL RIGHT ROTATION TORSO PATTERN覆盖理想的躯体右旋图示Right ideal vertebral body rotation pattern illustrated with hatched pattern理想的椎体右旋图示以阴影线表示Right ideal lateral bending pattern with dotted line理想的侧弯图示以虚线表示This example is a good match of the patient distortion pattern and the right torso rotational pattern这一案例病人的变形图示与躯体右旋的图示很吻合36.SPINAL ADJUSTMENTS DETERMINED BY COMPARING PATIENT TO IDEAL COMPENSATORY PATTERN通过比较病人和理想代偿图示，确定脊柱的调整Adjust VBR to match ideal pattern调整脊椎使其吻合理想图示Rotate lumbar vertebra left to match ideal left alignment pattern向左旋转腰椎使其与左排列的图示吻合Rotate thoracic vertebra left to match ideal left alignment pattern向左旋转胸椎使其与左排列的图示吻合Rotate cervical vertebra right to match ideal right alignment pattern向右旋转颈椎使其与右排列的图示吻合37.THE SPINAL MODEL DEVELOPS OBJECTIVE BASE LINE PARAMETERS脊柱模型提供了直观的参考基础*When restoration of normal spinal biomechanics are the clinical goal the spinal model当恢复正常脊柱物理学为临床目标时.脊柱模型*Establishes the patients departure from normal提供了病人与正常脊椎差别*Evaluates the ongoing success or failure of clinical intervention评估临床治疗的成功与失败*Demonstrates maximum improvement,stationary and permanent揭示最大的改进,没有改进以及无法改进*Establishes residual deficits which may require future care确定还可以进一步改善的部分38.RAYMOND WIEGAND,D.C.636-329-8774HCPC02@B.S.Physics1974Doctor of Chiropractic1984Private practice1984-2004Research Logan University1999-2004Published22papersDeveloped Software for Spinal AnalysisAnalyzed more than100,000x-rays。