Stemper Brian D, Yoganandan Narayan, Pintar Frank A
Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, VA Medical Center, Milwaukee, WI 53226, USA.
J Biomech. 2005 Jun;38(6):1313-23. doi: 10.1016/j.jbiomech.2004.06.013.
Although considerable biomechanical investigations have been conducted to understand the response of the cervical spine under whiplash (rear impact-induced postero-anterior loading to the thorax), studies delineating the effects of initial spinal curvature are limited. This study advanced the hypothesis that abnormal curvatures (straight or kyphotic) of the cervical column affect spinal kinematics during whiplash loading. Specifically, compared to the normal lordotic curvature, abnormal curvatures altered facet joint ligament elongations. The quantifications of these elongations were accomplished using a validated mathematical model of the human head-neck complex that simulated three curvatures. The model was validated using companion experiments conducted in our laboratory that provided facet joint kinematics as a function of cervical spinal level. Regional facet joint ligament elongations were investigated as a function of whiplash loading in the four local anatomic regions of each joint. Under the normal posture, greatest elongations occurred in the dorsal anatomic region at the C2-C3 level and in the lateral anatomic region from C3-C4 to C6-C7 levels. Abnormal postures increased elongation magnitudes in these regions by up to 70%. Excessive ligament elongations induce laxity to the facet joint, particularly at the local regions of the anatomy in the abnormal kyphotic posture. Increased laxity may predispose the cervical spine to accelerated degenerative changes over time and lead to instability. Results from the present study, while providing quantified level- and region-specific kinematic data, concur with clinical findings that abnormal spinal curvatures enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications.
尽管已经进行了大量的生物力学研究来了解颈椎在挥鞭伤(后向撞击导致胸部受到后前向负荷)下的反应,但描述初始脊柱曲度影响的研究却很有限。本研究提出了一个假说,即颈椎柱的异常曲度(变直或后凸)会影响挥鞭伤负荷期间的脊柱运动学。具体而言,与正常的前凸曲度相比,异常曲度改变了小关节韧带的伸长情况。这些伸长情况的量化是通过一个经过验证的人体头颈部复合体数学模型来完成的,该模型模拟了三种曲度。该模型通过我们实验室进行的配套实验进行了验证,这些实验提供了作为颈椎节段函数的小关节运动学。在每个关节的四个局部解剖区域,研究了局部小关节韧带伸长情况与挥鞭伤负荷的关系。在正常姿势下,最大伸长发生在C2-C3水平的背侧解剖区域以及从C3-C4到C6-C7水平的外侧解剖区域。异常姿势使这些区域的伸长幅度增加了高达70%。过度的韧带伸长会导致小关节松弛,尤其是在异常后凸姿势下的局部解剖区域。随着时间的推移,增加的松弛可能会使颈椎更容易发生加速退变并导致不稳定。本研究的结果在提供量化的节段和区域特异性运动学数据的同时,与临床发现一致,即异常的脊柱曲度会增加挥鞭伤的可能性,并且可能具有长期的临床和生物力学影响。