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与颈部挥鞭伤相关的反射性下颌运动和下颌僵硬。

Reflex jaw motions and jaw stiffness pertaining to whiplash injury of the neck.

作者信息

Christensen L V, McKay D C

出版信息

Cranio. 1997 Jul;15(3):242-60. doi: 10.1080/08869634.1997.11746018.

DOI:10.1080/08869634.1997.11746018
PMID:9586504
Abstract

Because a so-called mandibular whiplash injury requires the absence of short-latency jaw-closing reflexes in order to explain the postulated mechanism of injury (excessive jaw opening); the authors studied the presence and absence and more importantly, the kinematics (duration, displacement, velocity, acceleration) of monosynaptic and possibly, polysynaptic myotatic (stretch) reflexes in the jaw elevator muscles. In six healthy adults jaw jerk maneuvers were elicited through a brisk tap on the chin, and surface electromyography identified elevator reflexes while translational electrognathography identified the kinematics of the reflexes. The maneuvers were done while maintaining the rest position (3% MVC) and moderate clenching of the teeth (30% MVC). Electromyography was also used to identify phasic elevator excitations during a passive brisk neck extension maneuver. A sudden and unexpected elongation of the jaw elevators released autogenic reflex responses that, in conjunction with augmented tissue elasticity (stiffness), elevated the mandible into centric occlusion within approximately 150 milliseconds. In 86% of trials, the responses occurred regardless of the prevailing resting and clenching contractile activities. There was no evidence of a depressor force that consistently would and could anchor the mandible in a position of extreme or moderate depression, the theoretical linchpin of the mandibular whiplash injury. It was concluded that the mandibular locomotor system is very efficient in maintaining the rest and intercuspal positions of the mandible. This study found no evidence corroborating the mechanism claimed to release a so-called mandibular whiplash injury.

摘要

由于所谓的下颌挥鞭样损伤需要不存在短潜伏期的闭口反射,才能解释假定的损伤机制(过度张口);因此,作者研究了下颌升肌中,单突触以及可能的多突触肌伸张(牵张)反射的有无,更重要的是其运动学特征(持续时间、位移、速度、加速度)。在六名健康成年人中,通过轻敲下巴引发颌反射动作,表面肌电图确定升肌反射,而平移式下颌电图确定反射的运动学特征。这些动作是在保持休息位(3%最大随意收缩)和适度咬紧牙关(30%最大随意收缩)的情况下进行的。肌电图还用于识别被动快速颈部伸展动作期间的阶段性升肌兴奋。下颌升肌突然且意外的伸长会引发自主性反射反应,该反应与增强的组织弹性(刚度)一起,在大约150毫秒内将下颌提升至正中咬合位。在86%的试验中,无论当时的休息和咬紧牙关的收缩活动如何,都会出现这种反应。没有证据表明存在一种能持续且可靠地将下颌固定在极度或中度下压位置的下压力量,而下颌挥鞭样损伤的理论关键就在于此。研究得出结论,下颌运动系统在维持下颌的休息位和牙尖交错位方面非常高效。本研究没有发现证据支持所谓的下颌挥鞭样损伤的发病机制。

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