아주아주 오랫동안 척추의 가성전방전위증 pseudospondylolithesis의 메카니즘을 이해하기 힘들었다.
후관절은 90도, 45도 각도를 이루고 있어서 앞으로 전방전위될 수 없는 구조인데..
척추분리증 없이 어떻게 전방 전위될까? 오랫동안 궁금함으로 남아있었다.
facet tropism
그렇구나! 인체 물리학(생체역학)은 정확한 물리학 법칙에서 벗어나는 것은 하나도 없구나!!
panic bird..
Tropism is developmental abnormality of the spine.
If you have reoccurring pain on one side of your lower back when you bend or twist in certain motions, you may have facet tropism. This is a developmental abnormality of the small joints of the lower lumbar spine. A child can be born with a slight alignment issue to the spinal joints, and the problem persists into adulthood. Surgery is not generally a good option for most people. Conservative measures (like chiropractic care) can greatly reduce the frequency, duration, and intensity of pain associated with facet tropism.
- 만약 허리를 구부리거나 회전하는 동작에서 허리가 반복적으로 아프다면, 당신은 후관절 tropism일 수 있음. 이것은 하부 요추의 작은 관절(후관절)의 비정상적인 발달임. 아이가 척추관절에 약간 비정상인 배열로 태어나 어른이 되어 문제가 지속될 수 있음.
Spinal joints have a direction.
The facet normally splits the coronal and sagittal planes.
In the normal lumbar spine, the facet joints have a predictable orientation. The plane of the paired facets should match up and allow for smooth, even motion. At the bottom of the lumbar spine, the facet is optimized for bending forward as well and sideways bending. The two joints have the same orientation. Typically, the alignment of the facet is about half-way between the coronal plane and the sagittal plane of the body. Having the plane angles equal and mirrored reduces stress to the joint by spreading weight-bearing forces evenly.
정상척추에서, 후관절은 당연한 배열을 가짐. 쌍으로 된 후관절면은 움직임이 있더라도 잘 맞아야 하고, 부드러운 움직임을 허용해야 함. 하부요추에서 후관절은 측굴뿐 아니라 굴곡에 최적화되어 있음. 두개의 후관절은 같은 배열을 가짐. 전형적으로 후관절 정열은 관상면과 시상면사이에 정확히 절반 45도 각도를 이룸. 체중부하가 주어질때, 후관절이 같은 각도를 가져야 부하가 줄어듬.
Tropism is improper alignment of the joint.
Asymmetry of the facet joint is called tropism. This is an example of sagittal tropism.
If the facet joints do not have proper orientation, stresses are applied to the structures. These joint stresses can cause sharp pain as well as promoting inflammation. When inflammation is allowed to persist, the joint surfaces erode. This leads to arthritis of the facet joint. It’s just like a car-tire out of alignment causing a slow, steady wear on the tire.
만약 후관절이 적절한 방향을 갖지 못한다면, 부하는 후관절에 적용됨. 이러한 관절의 부하는 염증뿐 아니라 날카로운 통증의 원인이 됨. 염증이 지속될때, 관절면은 미란됨. 이는 후관절의 관절염을 야기함. 이는 차량 타이어가 배열에서 벗너난 것과 비슷함.
Tropism can occur when the facet is aligned in either the coronal or sagittal plane. I have seen cases when one facet is coronal and the other is sagittal. Those patients have considerable pain since both sides are misaligned.
- 후관절 tropism은 후관절이 관상면이나 시상면배열 이상임.
Patients are often unaware of the condition.
Frequently, patients are unaware of the alignment tropism until they reach adulthood. As a young person, the bones are more pliable and can tolerate the mechanical stresses better. As we age, the bones and joint surfaces become less tolerant.
- 자주, 환자는 성인이 될때까지 후관절 tropism을 알지 못함. 젊은 환자에게서 뼈는 좀더 잘 휘고, 기계적 부하를 좀더 잘 견딤. 나이가 들어감에 따라 뼈와 관절은 부하를 잘 견디지 못함.
A chiropractor can identify a tropism on x-ray. X-rays are fairly inexpensive and provide a tremendous amount of information for the small amount of resources invested. The x-ray below is one that I took a few months ago.
- 카이로프랙틱 의사는 엑스레이를 통해 후관절 tropism을 확인할 수 있음. 엑스레이는 매우 싸고 많은 정보를 제공함.
Treatment involves management of the pain and movement.
Surgery is not a realistic option for most people. The risk/benefit ratio does not pan out. Most people benefit by conservative measures involving inflammation reduction and improved joint biomechanics. Because this is a life-long issue, pain medications are generally a bad idea. Pain medications are not to be used long-term.
- 생체역학적 이로움 치료를 시행해야...