대퇴근막장근과 중둔근의 관계가 만들어내는 고관절 외전의 biomechanics 그리고 고관절의 생체역학

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고관절 외전의 생체역학에 관한 논문

요것도 참 재미있는 논문이네.. 고관절의 힘의 역학관계

고관절 역학의 세가지 관점

1. 척추에서 골반에 가해지는 힘이 고관절 양측으로 분산되는 역학적 과정

2. 중둔근과 대퇴근막장근의 짝힘으로 만들어내는 고관절 외회전의 생체역학적 관점

3. 대퇴근막장근, 장경인대와 연관된 긴장-띠 원리(tension band principle)에 의한 생체역학적 관점.

The functional anatomy of tensor fasciae latae and gluteus .pdf

INTRODUCTION

The accurate anatomical description of the musculoskeletal system has been the precursor and basis for the understanding of the biomechanics and functional anatomy of the different parts of the human body. This has not been the case for the hip abductor mechanism.

- 정확한 해부학적 묘사

- 고관절 외전 메카니즘에 대한 탐구

The conventional description of the anatomy of the gluteus medius is a broad, thick radiating muscle on the outer surface of the pelvis. Its attachment is described as being between the iliac crest and the gluteal line. The fibres are said to converge to a strong flattened tendon which is inserted into the oblique ridge on the lateral surface of the greater trochanter, with a bursa separating the tendon from the surface of the trochanter (Clemente, 1985; Romanes, 1981). Similarly, the gluteus minimus is fanshaped, arising from the outer surface of the ilium, and its fibres converge into a tendon that inserts at the anterior border of the greater trochanter.

- 중둔근 해부학의 전통적인 묘사는 넓고, 두꺼운 근육이 골반외측면을 연결함.

- 기시 종지, 점액낭 존재

In the standard descriptions of the nerve supply to these muscles, the superior gluteal nerve is said to provide branches to innervate the muscles. The gluteus medius is described as a strong abductor and medial rotator of the thigh. During the stance phase of gait, the gluteus medius is supposed to prevent the sagging of the pelvis on the unsupported side. The action of gluteus minimus is said to be similar to that of gluteus medius.

- 중둔근은 고관절의 강한 외전근, 내회전 근육

- 보행 입각기 동안 중둔근은 한쪽으로 틀어짐을 방지. 

The widely accepted mathematical models of the mechanics of the gluteus medius and minimus are those based on the model originally described by Fick in 1910 (Bombelli, 1983) and later adopted by Pauwels (1976) and Maquet (1985). These are static two-dimensional models that substitute an arbitrary force vector for the total action of gluteus medius and minimus. The vectors originate at an arbitrary point on the outer surface of the iliac bone at the level of the gluteal line and end at the proximal part of the lateral surface of the greater trochanter. 

The abductor moment arms that have been calculated, based on these models, are not accurate as they do not take into

account the overall shape and action of the muscles. Consequently the theoretical predictions of these models are not always borne out by the clinical findings. 

In the past two decades several papers on anatomy, mechanics and functional performance of the hip muscles and abductor mechanism have been published (Bombelli, 1983; Borja, Latta, Stinchfield & Obreron, 1985; Crowninshield, Johnston, Andrews & Brand, 1978; Dostal & Andrews, 1981; Dostal, Soderberg & Andrews, 1986; Inman, 1947; Kelikian, Tachdjian, Askew & Jasty, 1983; Maquet, 1985). Some of the experimental studies reported by these authors present observations that reveal the disparity between the functional reality and the biomechanical model of the system. The studies by Jensen & Davy (1975) on the muscle lines of action, Clark & Haynor (1987) on the anatomy of abductor muscles and Soderberg & Dostal (1978), Lyons et al. (1983) and Wilson, Capen & Stubbs (1976) on fine wire electromyographic investigation of the abductor muscles provide new information on the anatomy, mechanics and functions of these muscles. 

However, review of these papers revealed the absence of a satisfactory anatomical and dynamic model to explain adequately the findings of these studies, and thus did not allow those authors to draw valid conclusions. The attempt by some of the authors to explain and interpret the data and observations according to the accepted static two-dimensional model resulted in contradictory statements (Kelikian et al. 1983; Nutton & Checketts, 1984). In numerous clinical and surgical texts it has been stated that the glutei abduct the hip or prevent the pelvis from sagging (Clemente, 1985; Borja et al. 1985; Dostal & Andrews, 1981; Inman, 1947; Hardcastle & Nade, 1985; Heath, 1984; Kelikian et al. 1983). 

In addition, it has been stated that a valgus osteotomy (increasing angle of femoral neck) will increase the muscle length and shorten the lever arm, and conversely, that a varus osteotomy (decreasing angle of femoral neck) will shorten the

muscle but that this is offset by lengthening the lever arm (Maquet, 1985; Schneider, 1984). A careful examination of the reported clinical experiences of these procedures shows that in the majority of those cases, the valgus osteotomy will do better than the varus osteotomy of the hip when assessed over a period of time. Frequently, the poor results after varus osteotomy are noticed within a few months, whereas the valgus osteotomies may function satisfactorily for several years (Bombelli, 1983; Maquet, 1985; Schneider, 1984). The purpose of this study was to define the functional anatomy of the hip abductor mechanism and correlate the findings with a biomechanical model.

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와우 완전 대박 ㅎㅎㅎ

[육동일]

couple force(짝힘) : 흔히 정 반대 방향의 동일한 힘 <-- 짝힘에 대해서 이렇게 정의를 내리고 있는데 고관절 역학의 관점중 2번째 관점에서 중둔근과 TFL은 어떻게 짝힘의 작용을 하게되는 건가요 교수님...? TFL의 내회전과 중둔근 후부의 외회전 기능이 짝힘인 건가요?? 고관절 역학의 2번째 관점에 대해서 간단한 설명좀 ... 부탁드립니다 !^^;

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저도 그게 좀 이상했어요 ㅎㅎ