Tillmann B
Norm Pathol Anat (Stuttg). 1978;34:1-50.
The variations of the joint shape are first analyzed in the acetabulum and the ulnar trochlear notch of man. Then an attempt is made to explain the basic shape of the lunate surface and the types of articular surface diverging from it with regard to causal histogenesis and the general theory of joint stress (Pauwels), as well as the theoretical distribution of stress in the perfect ball and socket joint (Kummer). Certain statements are made about the position, size, changes in direction and course of the resultant forces at the joint, statements which seem very likely to be accurate when compared to facts already known about the hip joint in man. Under these preconditions, the various forms of the observed articulating surfaces may be theoretically reconstructed in every case. In this connection, it is first shown that the preservation of the joint cartilage is also dependent on the period of time during which the resultant force is effective in the various areas of the articular surface. The term "relative constancy" is used to express this time factor. Two functional explanations are given for the presence of incisions and divisions in the lunate surface and in the trochlear notch: 1. It is assumed that the "relative constancy" of the resultant forces is of varying magnitude in the different areas of the articular surface. The incisions and divisions in the joint cartilage are thus seen as areas in which the resultant joint stress does not rise above the minimum value for preservation of the articular cartilage. 2. The radius of the convex articular surface can be slightly larger than the radius of the concave articular surface. Because of this incongruity no pressure will be transmitted in an area of the lunate surface or of the trochlear notch because of the defective contact. It follows that the cartilage-preserving stimulating pressure is also absent from this area. According to Pauwels, the magnitude and distribution of the stresses arising in the articulating surfaces may be determined from the varying density distribution of the subchondral bony tissue, as seen in x-rays. The density distribution of the subchondral bone at the ulnar socket shows clear basic parallels to the extent of the surface covered by joint cartilage. The relatively low density in the area of the notch is seen as being the result of lower stress, in accordance with the functional explanation of division of the cartilage surfaces. In photoelastic model experiments, the dependence of the degree of relative stress on the form of the articular surface is illustrated by means of the number of isochromes. Here, the distribution of density of the subchondral bony tissue corresponds to the local magnitude of stress in the corresponding model joint. Functional analysis of the tangential fiber layer of the joint cartilage at the femoral head and the elbow joint, shows basic agreement between the split line patterns and the trajectoral pattern, as described in articulating surfaces examined by Pauwels, Konermann and Molzberger...
首先分析人类髋臼和尺骨滑车切迹处关节形状的变异情况。接着尝试从因果组织发生学以及关节应力的一般理论(鲍威尔理论)的角度,解释月状面的基本形状以及与其不同的关节面类型,同时也依据完美球窝关节的应力理论分布(库默理论)进行解释。关于关节处合力的位置、大小、方向变化及走向做出了某些阐述,与已知的人类髋关节实际情况相比,这些阐述似乎很可能是准确的。在这些前提下,理论上可以在每种情况下重建所观察到的各种关节面形式。在此方面,首先表明关节软骨的保存也取决于合力在关节面各个区域起作用的时间段。用“相对恒定”一词来表示这个时间因素。针对月状面和滑车切迹处切口与分隔的存在给出了两种功能方面的解释:1. 假定合力在关节面不同区域的“相对恒定”程度不同。因此关节软骨中的切口和分隔被视为关节合力未超过保存关节软骨所需最小值的区域。2. 凸关节面的半径可能略大于凹关节面的半径。由于这种不匹配,在月状面或滑车切迹的某个区域,由于接触不良不会传递压力。由此可知该区域也不存在保存软骨的刺激性压力。根据鲍威尔的理论,从X射线所见的软骨下骨组织密度分布变化中,可以确定关节面中产生的应力大小和分布。尺骨窝处软骨下骨的密度分布与关节软骨覆盖范围在基本程度上呈现明显的平行关系。根据软骨表面分隔的功能解释,切迹区域相对较低的密度被视为较低应力的结果。在光弹性模型实验中,通过等色线数量说明了相对应力程度对关节面形状的依赖性。在此,软骨下骨组织的密度分布与相应模型关节中的局部应力大小相对应。对股骨头和肘关节处关节软骨切线纤维层的功能分析表明,劈裂线模式与轨迹模式基本一致,这与鲍威尔、科内曼和莫尔茨贝格所研究的关节面情况相符……