Pope M H, Novotny J E
Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington 05405-0068.
J Biomech Eng. 1993 Nov;115(4B):569-74. doi: 10.1115/1.2895542.
The lumbar spine is a source of disability due to low back pain (LBP), yet the precise diagnosis is unknown in 80-90 percent of patients. The lifetime prevalence is 75 percent with a cost to the U.S. economy as high as 80 billion dollars. The problem is partly caused by mechanical overloading of the tissues and thus, there is some potential for both primary and secondary prevention. Biomechanical techniques have been effective in improving our understanding of the loading conditions leading to LBP, and in developing techniques for improved diagnosis and more effectual methods of treatment. Much progress has been made through the use of biomechanical models. Most models assume that the external moments are balanced by trunk musculature. Multiple muscle system models, employing agonist and antagonists, now are available to define 3D spine reaction forces. The static indeterminacy is taken care of either by simplification of the model or by linear or nonlinear optimization. Dynamic analysis has shown that vibrational and impact conditions (such as vehicle driving) can excite the natural frequency of the spine and lead to high spinal loadings. In vivo measurements have shown the resonant frequency of the lumbar spine to be 4-5 Hz and many vehicles excite those frequencies. New biomechanical techniques employing electromyography can estimate muscle load and muscle fatigue. Stereo photogrammetric techniques for establishing segmental kinematics have great potential for improving the diagnosis of spinal problems. These techniques are solidly based on prior in-vitro measurements of spinal kinematics. Mechanical fixation techniques, such as pedicle fixation, show great promise in improving the treatment of spinal problems. These have been extensively analyzed by both finite element techniques and in-vitro simulation so as to improve design as well as surgical technique.
腰椎是导致腰痛（LBP）的致残原因之一，然而80% - 90%的患者病因尚不明确。其终生患病率为75%，给美国经济造成的损失高达800亿美元。该问题部分是由组织的机械性过载引起的，因此，一级和二级预防都存在一定潜力。生物力学技术在增进我们对导致腰痛的负荷状况的理解，以及开发改进诊断技术和更有效的治疗方法方面发挥了作用。通过使用生物力学模型已取得了很大进展。大多数模型假定外部力矩由躯干肌肉组织平衡。现在有多种肌肉系统模型，采用主动肌和拮抗肌来定义三维脊柱反作用力。静态不定性问题可通过简化模型或线性或非线性优化来解决。动态分析表明，振动和冲击条件（如车辆驾驶）可激发脊柱的固有频率并导致高脊柱负荷。体内测量表明腰椎的共振频率为4 - 5赫兹，许多车辆会激发这些频率。采用肌电图的新生物力学技术可估计肌肉负荷和肌肉疲劳。用于确定节段运动学的立体摄影测量技术在改善脊柱问题诊断方面具有巨大潜力。这些技术牢固地基于先前对脊柱运动学的体外测量。机械固定技术，如椎弓根固定，在改善脊柱问题治疗方面前景广阔。已通过有限元技术和体外模拟对其进行了广泛分析，以改进设计和手术技术。
