Kalmanson Olivia A, Khayatzadeh Saeed, Germanwala Anand, Scott-Young Matthew, Havey Robert M, Voronov Leonard I, Patwardhan Avinash G
Loyola University Stritch School of Medicine, Maywood, IL, USA.
Edward Hines Jr. VA Hospital, Hines, IL, USA.
J Clin Neurosci. 2019 Jul;65:140-144. doi: 10.1016/j.jocn.2019.02.003. Epub 2019 Mar 12.
Chronic Forward Head Posture is associated with headaches, neck pain, and disability, though few studies have investigated the effects it has on the suboccipital triangle. The objective of this study was to quantitatively assess whether the biomechanical changes in the suboccipital triangle help explain the clinical manifestations of Forward Head Posture. Specifically, this study aimed to identify whether the Greater Occipital Nerve or C2 nerve root may be compressed in Forward Head Posture. Three-dimensional, specimen-specific computer models were rendered from thirteen cadaveric cervical spine specimens. The spines transitioned from neutral to Forward head posture while motion data was collected. This data was synced with the computer models to make precise measurements. In Forward Head Posture, occiput-C1, C1-C2, and occiput-C2 segments extended by 10.7 ± 4.6 deg, 4.6 ± 4.3 deg, and 15.3 ± 2.3 deg, respectively. The Rectus Capitis Posterior Major and Minor and Obliquus Capitis Superior muscles shortened by 20.0 ± 4.6%, 15.0 ± 7.6%, and 6.6 ± 3.3%, respectively. The Obliquus Capitis muscle inferior length did not change. The suboccipital triangle area decreased by 18.7 ± 6.4%, but the protective gaps surrounding the C2 nerve root and the Greater Occipital Nerve did not reveal clinically significant impingement. The C2 nerve root gap decreased by 1.0 ± 1.3 mm and the Greater Occipital Nerve gap by 0.2 ± 0.18 mm. These results demonstrate that the C2 nerve root and the Greater Occipital Nerve are protected by the bony landscape of the cervical spine. However, there is likely persistent contraction of the rectus muscles in Forward Head Posture, which suggests a secondary tension-type etiology of the associated headache.
慢性头部前倾姿势与头痛、颈部疼痛和功能障碍有关,尽管很少有研究调查其对枕下三角的影响。本研究的目的是定量评估枕下三角的生物力学变化是否有助于解释头部前倾姿势的临床表现。具体而言,本研究旨在确定在头部前倾姿势中,枕大神经或C2神经根是否可能受到压迫。从13个尸体颈椎标本构建了三维、特定标本的计算机模型。在收集运动数据时,脊柱从中立位转变为头部前倾姿势。该数据与计算机模型同步以进行精确测量。在头部前倾姿势中,枕骨-C1、C1-C2和枕骨-C2节段分别伸展了10.7±4.6度、4.6±4.3度和15.3±2.3度。头后大直肌、头后小直肌和头上斜肌分别缩短了20.0±4.6%、15.0±7.6%和6.6±3.3%。头下斜肌长度未改变。枕下三角面积减少了18.7±6.4%,但C2神经根和枕大神经周围的保护间隙未显示出具有临床意义的压迫。C2神经根间隙减少了1.0±1.3毫米,枕大神经间隙减少了0.2±0.18毫米。这些结果表明,C2神经根和枕大神经受到颈椎骨结构的保护。然而,在头部前倾姿势中,直肌可能持续收缩,这提示了相关头痛的继发性紧张型病因。
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