cervical spine의 구조, 생체역학 그리고 촉진 palpation technique - 꼭 다시 정리해야

[문형철]

용어에 익숙하다고 해서 내가 아는 것이라고 착각하지 말자

정말 제대로 알고 있는 것일까? 

뻔한 것도 촉진 못하면서 정말 안다고 할 수 있을까? 

어떤 해부학적 구조물을 알았다는 것은 구조를 알고, 조직을 알고, 기능을 알고, 손상시 문제를 알고, 회복을 알아야 한다.

우리는 무엇을 알았다고 할 수 있을 것인가? 

panic bird.....

The wide laminae are well developed (being approximately as wide as an index finger) and can be palpated underneath the muscles. They are located at the level of the spinous processes. The articular processes protrude from the end of the laminae.

- 넓은 laminae는 두번째 손가락만큼이나 넓게 잘 발달해서 경추 근육아래서 촉진이 가능함. laminae 는 극돌기 level에 위치하고, laminae의 끝에 후관절이 돌출되어 있음. 

두부의 중력중심과 경추

경추는 대략 인체 무게의 1/10정도의 머리를 지지하고 있어야 하는데, 두부의 중력중심은 sella turcica부근임. 

C0-C1과 C1-C2 관절보다 약간 앞에 있음

그래서 우리가 서있는 자세일때, 경추는 항상 약간 긴장된 상태임. 

The cervical spine supports the head (approximately 10% of the weight of the body). The head's center of gravity is found at the level of the sella turcica ( Fig. 1 2.1 ) and is therefore positioned slightly anterior to the CO/Cl and Cl/C2 joints so that the neck muscles are always slightly tensed when in an upright posture (Kapandji, 2006).

경추는 특히 회전에 특화되어 진화함

During evolution, the cervical spine became vertical and resulted in rotation being the most important movement  for human beings and the movement with the largest range. In comparison, the most important movement for quadrupeds is lateral flexion. The human head has to turn very precisely and often quickly. This requires fine coordination as well as strength to accelerate and decelerate movements.

- 진화하는 동한 경추는 직립하게 되고, 인간을 위해 가장 중요한 움직임은 회전이 됨. 

- 네발동물에게 가장 중요한 움직임은 측굴임. 

- 인간의 머리는 정확하고 때로는 빠르게 돌림. 이는 세밀한 협응성뿐 아니라 가속과 감속을 위한 강한 근력이 필요함. 

경추 3-4번이 수평

The physiological curvature of the cervical spine is lordotic, with the C3/C4 segment usually positioned horizontally

(White and Pandjabi, 1990).

- 경추는 기본적으로 전만임. 3-4번 분절이 수평임. 

Cervico-cephalic symptom

두통, 이명, 난청, 미식거림, 어지러움

The neuroanatomical relationship between the nuclei of various cranial nerves and the enormous proprioceptive innervation of the upper cervical muscles and joints is an essential aspect linking the cervical spine to symptoms in the head.

- cranial nerve 와 상부 경추 근육, 관절은 많은 고유수용감각신경과 관련을 맺고 있기 때문에 머리에서 경추문제에 의한 증상이 필수적으로 나타날 수 있음. 

Symptoms associated with the cervical spine are a special challenge for therapists when planning and conducting treatment. Therapists must be well versed in anatomy and biomechanics if they wish to work professionally and

effectively.

- 경추와 연관된 증상은 치료사에게 특별한 도전임. 치료사는 해부학과 생체역학에 매우 정통해야 함. 

Manual therapeutic assessment and treatment of this region i s divided into global and local techniques, as is also the case in the other sections of the vertebral column.

- 수기치료적 진단과 치료는 local and global 테크닉으로 나누어야

Local assessment techniques that provoke pain and assess mobility are of great importance in the cervical spine due to the difficulties in relating, for example, a restriction in rotational mobility to the proper level. 

 - 국소적 검사테크닉으로 통증악화 검사와 움직임 검사는 회전문제가 있는 상부 경추를 치료하는데 매우 중요함. 

Long-term irritation of a facet joint causes pain felt in other areas (referred pain). It is not possible to link the patient's reported area of referred pain with a specific level in the cervical spine. In 1994, Dreyfuss et al. wrote that referred pain arising from the CO/Cl segment can extend quite a way up onto the occiput ( Fig. 1 2.2 ).

- 경추의 오래된 후관절 장애는 연관통을 유발함. 경추 통증레벨을 정하는데 주의해야

A good knowledge of topography and the ability to palpate reliably are the basis for confident hand placements during local assessment and treatment.

global technique - 머리, 얼굴, 목까지 함께 치료해야

하부경추  고전적 마사지와 기능적 마사지 치료 테크닉

Classical massage and functional massage (Fig.12.3) are important forms of treatment used to obtain localized and general relaxation. Neck, head, and face massages belong to the most effective manual techniques available for relaxation. 

- 고전적 마사지와 기능적 마사지는 국소적 그리고 일반적 이완을 얻기 위해 매우 중요한 치료법임. 두부, 경추, 얼굴마사지는 충분한 이완을 얻기위한 효과적인 수기치료임. 

Functional massage is the first, and often initially the only, form of treatment that can be applied to a painful neck. 

- 기능적 마사지는 통증이 있는 목에 적용될 수 있는 첫번째 치료방법

Manual lymphatic drainage targets the large number of lymph nodes in the head and throat region. It can be used to generally stimulate the motor function in lymph vessels or to drain fluid in the neck, face, and head. The sternocleidomastoid, the descending part of the trapezius, and the supraclavicular fossa are important guiding structures here.

- 수기 임파순환법은 두부와 목에 있는 수많은 임파절을 타겟을 시행. 

- 흉쇄유돌근, 승모근, 상슬개와는 중요한 구조물임. 

Required Basic Anatomical and Biomechanical Knowledge

Sections of the Cervical Spine

Due to its morphology, biomechanics, and the presence or absence of intervertebral disks, the cervical spine is divided anatomically and functionally into (Fig. 1 2.4):

- 형태와 생체역학, 추간판의 존재 또는 비존재때문에 경추는 해부학적, 기능학적으로 나누어짐. C1-2, C3-7번 상부, 하부경추

• Upper cervical spine: 상부경추

- anatomically: atlas and axis

- functionally: CO/C1 and C1 /C2 segments; also called the segments without intervertebral disks.

• Lower cervical spine: 하부경추

- anatomically: C3-C7

- functionally: C2/C3 to T3/T4 segments; also called the segments with intervertebral disks.

하부경추의 해부학

The physiological curvature of the cervical spine is lordotic, with the C3/C4 segment usually positioned horizontally

(White and Pandjabi, 1990). The vertebral body's end plate is very narrow, favoring rotation. 

- 경추는 약간 전만을 유지. 경추 3-4번 분절이 수평. 경추체의 end plate는 매우 좁아서 회전에 유리함.

넓고 긴 laminae의 생체역학

The vertebral foramen is very large due to the long laminae of the vertebral arches. The spinal cord only occupies approximately 50% of the vertebral foramen's very wide diameter. The large vertebral foramina provide the dural sac with a generous amount of space to move in during large cervical movements (White and Pandjabi, 1990).

-  척추아치의 긴 lamiane 때문에 추공(vertebral foramen)은  매우 크다. 척수는 추공의 50%를 차지할만큼 크다. 넓은 추공은 경추의 큰 움직임 동안 충분한 공간을 만들고 dural sac의 공간을 제공함.

경추 극돌기, laminae, 후관절의 촉진

The wide laminae are well developed (being approximately as wide as an index finger) and can be palpated underneath the muscles. They are located at the level of the spinous processes. The articular processes protrude from the end of the laminae.

- 넓은 laminae는 두번째 손가락만큼이나 넓게 잘 발달해서 경추 근육아래서 촉진이 가능함. laminae 는 극돌기 level에 위치하고, laminae의 끝에 후관절이 돌출되어 있음. 

경추의 후관절(zygapophysial joint)

The zygapophysialjoints (ZAjs) form the "articular column" (see Fig. 1 2.4) that is almost as wide as the row of transverse processes. The vertebrae, as a whole, have very wide bases due to the extremely lateral position of the joints, which results in the lower cervical spine being not particularly ideal for movement into lateral flexion. A narrow base (less distance between the left and right ZAjs), as is seen in the lumbar spine, is more conducive to lateral flexion.

- 경추 후관절은 articular column을 만듬. 

- 경추 후관절은 경추측굴 움직임을 제한하는 결과를 야기함. 

갈라진 경추 극돌기의 생체역학

The spinous processes are bifurcated down to C6. The bifurcation at C2 is very large and extremely asymmetrical. The spinous processes decrease in size down to C6. A large spinous process is seen again at C7 and is not bifurcated

at this level. The asymmetrical bifurcations in the spinous processes interlock during extension and optimize the range of motion for the lordosis.

- 경추 극돌기는 C6번까지 두가지로 갈라져 있고(bifurcated), C2에서 가장 크게 갈라져 있고, 비대칭임. 경추극돌기는 C6번으로 내려오면서 크기가 작아짐. C7번 극돌기는 갈라짐이 사라지고 하나의 극돌기 형태임. 

- 경추 극돌기의 비대칭적 갈라짐은 경추 전만을 위한 움직임을 최적화하고, 신전움직임동안 Interlock 서로 맞물리게 함. 

참고) 다른 책에서는 근육부착부를 좀더 효율적으로 하게 하기 위함이라고 기록됨. 

경추 횡돌기의 생체역학

The transverse process is composed of two tubercles that connect laterally and form a hole at one point. This foramen transversarium has a diameter of approximately 4.5-5 mm, which almost corresponds to the diameter of the vertebral artery.

경추 횡돌기는 두개의 돌기로 이루어지고 하나의 구멍을 만듬. 이 구멍은 대략 4.5~5mm이고, 척추동맥을 위한 구멍. 

The anterior tubercle is a rudiment of a rib, while the posterior tubercle represents the actual transverse process. These two tubercles turn the transverse process into more of a groove than a process. The groove runs diagonally and is oriented anterolaterally ( Fig. 12.5).

- 경추 횡돌기의 전방돌기는 늑골을 위한 기초이고, 후방돌기가 실제로 횡돌기 역할을 수행함. 

- 그래서 두개의 tubercles은 돌기라기보다는 groove임. 

참고) 경판상근, 견갑거근, 사각근, longus colli, longus capitus 등이 경추 횡돌기에 부착함. 

The groove is at its narrowest in its medial section and is bordered by bones on all sides. The uncinate process forms the anterior border; the superior articular process of the ZAj the posterior border. The artery and the ventral ramus of the spinal nerve cross paths at this bony constriction ( Fig. 12.6). 

- 아래 그림과 같이 횡돌기 구로 경추 신경근이 지나가고, 횡돌기 구멍으로 vertebral artery가 지나감. 

Both of these conductive pathways can be compressed and irritated by protruding osteophytes associated with severe degenerative changes in the segment. Of all the sections of the vertebral column, stenosis of the intervertebral foramen most often irritates nerves in the cervical spine.

- 경추 퇴행성변화에 의해서 추간공이 좁아지면서 신경이 압박됨. 

구상돌기 관절  - 가장 중요한 부위....

The uncinate process (also called the uncus of body) deserves a special mention. This process forms the side rim of the vertebral body's end plate and its size increases in the more superior vertebrae. The uncinate processes are the largest on the C3 end plate. They develop between the ages of 2 and 24 and later form the uncovertebral joint with the more superiorly positioned vertebral body. During this development, the intervertebral disks tear on the outer sides from approximately the age of 10 onward ( Fig.1 2.7). 

- 구상돌기관절은 C3 end plate에서 가장 큼. 

- 구상돌기는 2~24세에 발달하여 구상돌기관절을 이룸. 

- 대략 10세 이후에 경추 디스크의 바깥쪽 부위 tear가 발생함. 

This can lead to bisection of the disk (Rauber and Kopsch, 1987). When this occurs, the contents of the nucleus

pulposus neither leak out nor does the segment become thinner. This bisectioning is complete between the

ages of 45 and 50. This is a natural adaption of the intervertebral disks in response to the large translation of the vertebra during cervical spine flexion and extension. The uncinate processes act as rails and guide this translation movement. The bisectioning of the disk is the reason why whiplash can cause height to increase by up to 2.5 cm (abnormal ability to separate) within seconds and is especially seen in the C2/C3 segment.

- 경추간판의 바깥쪽 tear는 추간판의 bisection을 일으킬 수 있음. 이렇게 되면 수핵물질이 새어나가지 않으면서 얇아짐. 이러한 추간판의 bisection은 45-50세에 끝남. 

- 경추 굴곡신전동안 척추의 큰 앞쪽이동에 반응하여 추간판은 자연적인 적응이 일어남. 

- 구상돌기는 기차의 레일처럼 작용하여 전후방이동을 안내함. 

- 추간판의 bisectioning은 편타증에서 몇초동안 2.5cm키가 증가하는 이유가 될 수 있음. 그것은 대개 경추 2-3번에서 일어남. 

경추의 촉진

- C2, C7 극돌기 촉진

- C2 laminae촉진, facet joint 촉진

In the cervical spine, a relatively large number of bony structures, joints, and muscles can be reached and differentiated  from one another using palpation. Important reference points include the accessible spinous processes (C2, C5-C7) and the laminae of every cervical vertebra inferior to C2.  The fact that the spinous process and laminae of a vertebra are located at the same level is very convenient for palpatory orientation. This is of assistance when the exact level of structures, for example, the ZAJ and the transverse process, is being determined.

- 경추의 뼈, 관절, 근육은 촉진을 통해서 정확히 감별될 수 있음. 

- 가장 중요한 기준은  spinous process(C2, C5-7) 그리고 C2아래의 lamina. 

- 경추극돌기와 laminae는 촉진접근방향에서 같은 레벨에 위치하다는 사실이 중요함.

- 경추후관절과 횡돌기의 정확한 레벨을 결정하는데 중요한 역할을 함. 

 The laminae can be used to fix a vertebra during certain manual-therapy techniques.  When all accessible ZAJs (articular column) are palpated from superior to inferior, the protruding processes and the more concave sections between the processes have an undulating shape ( Fig. 1 2.8).

- laminae는 경추 수기치료동안 중요한 구조물임. 촉진하기 쉬운 후관절은 위에서 아래로 촉진할때, 돌출부위를 잘 찾아낼 수 있음. 

The cervical transverse processes are aligned diagonally in an anterolateral direction so that the ventral rami and the brachial plexus can be palpated between the sternocleidomastoid and the descending part of the trapezius (see "Supraclavicular Triangle of the Neck" below, p. 358).

- 완신경총은 SCM과 상부승모근사이에서 촉진할 수 있음. 

하부 경추의 생체역학

The range of motion in the cervical spine is dependent on age and gender ( Penning, 2000). Young women are the  most mobile. The largest range of motion is seen with rotation, followed by flexion and extension. Lateral flexion has the smallest range of motion. Lateral flexion is quite complicated in the cervical spine and is mainly used in association with rotation (coupled movement).

- 경추의 움직임은 나이와 성별에 달려 있음. 젊은 여성은 좀더 잘 움직임. 

- 경추의 가장 큰 움직임은 회전이고, 다음은 굴곡, 다음은 신전임. 경추의 측굴 움직임은 가장 작음. 

- 경추에서 측굴은 복잡한 움직임으로 항상 회전과 동반된 Coupled movement가 일어남. 

The alignment of the ZAJ surfaces is crucial for determining how rotation and lateral flexion are conducted. The joint surfaces are large and flat and are aligned at an average angle of 45° anteriorly and superiorly toward the end plate ( Fig. 1 2.9; Dvorak, 2008). Penning (2000,p. 89) reported a large variation in angles. 

- 구상돌기관절면의 정열은 경추가 어떻게 회전, 측굴을 하는가를 위해 중요함. 구상돌기 관절면은 크고, 편평하겨 평균각도는 앞, 위로 45도임. 

In connection with cervical lordosis, therapists can note that the joint surfaces are generally aligned anteriorly and superiorly toward the eye socket. Almost all lower cervical joint spaces are aligned horizontally in the frontal plane. Only the C2/C3 segment is angled in a superior direction (Fig. 12. 10 ) . Due to the alignment of the joint surfaces, rotation is inevitably coupled with lateral flexion and  the axis of rotation is tilted ( Fig. 12.11 ). 

- 아래 그림 참조) 거의 모든 하부경추 관절면은 수평면에 수평하게 배열되어 있음. 오직 C2-3번 분절이 위 방향으로 배열됨. 

이러한 관절면의 배열덕분에 경추의 회전은 불가피하게 외측 굴곡과 회전축이 틀어진 상태에서 일어남. 

Corresponding to this, rotation to the right is accompanied by lateral flexion to the right,  regardless of whether the cervical spine is positioned in flexion or extension. Lateral flexion to the right is also accompanied by rotation to the right. The  range of of the coupled motion is surprisingly large in the cervical spine.

- 경추의 회전은 경추굴곡 또는 신전자세라 하더라도 외측굴곡과 함께 동반되어 일어남. 

- 우측으로 측굴은 우측회전과 함께 일어남. 경추에서 짝움직임의 범위는 놀랍게도 큼. 

Lysell ( 1969) has stated that approximately 8° of lateral flexion at the 2/3 segment is connected with approximately 6° of coupled rotation. During lateral flexion to the right and the associated ipsilateral rotation, the joint surfaces on the right glide together ( convergence), just as they do during extension. The joint surfaces on the left glide away from one another (divergence), similar to the movement during flexion ( Fig. 1 2. 1 2).

- 리셀에 의하면 경추 2-3번 분절에서 외측 굴곡의 8도, 회전의 6도가 이어져 발생함. 우측으로 외측측굴하는 동안 동측의 회전이 발생하고, 우측관절면이 함께 활주함(Convergence 수렴) ... 경추 신전동안 마찬가지 현상이 나타남...

반대측 관절면은 좌측 활주가 일어나면서 멀어짐(divergence), 경추굴곡과 유사한 움직임...

How Does this Affect Palpation?

Therapists use the two previously described relationships to their advantage when palpating the lower cervical facet joints (inferior to 2/3 ) during movement: the degree of coupling and the movement of the joint surfaces as they converge.

- 치료사는 이러한 경추의 짝 움직임(측굴동안 회전이 일어나고, 회전동안 측굴이 일어나는)을 잘 이해하여 촉진해야 함. 

Therapists aim to feel the posteroinferiorly directed swaying of the joint processes as the ZAJ moves ( see "Facet Joints" below. p. 339). They therefore facilitate lateral flexion with rotation to the right when they are palpating the right side, so that the joint process moves toward the palpating finger. Movement is facilitated via lateral flexion and causes the segment to rotate extensively. 

- 치료사는 우측회전과 함께 일어나는 외측굴을 이해하면서 촉진해야..

If rotation was facilitated first, it would take quite a while for 1/2 to reach end-range rotation and for rotation to be transferred onto the inferior segments. 

Penning (2000) has explained the kinematics during flexion and extension very well. His study results describe the momentary rotation axes for flexion and extension and were radiologically determined for every 5° of movement. The investigators discovered a relationship between the superior joint processes and the end plate, which determines the position of the axis for rotation.

In the upper intervertebral disk segments the axis is 10-cated in the inferior vertebra and results in the superior vertebra undergoing a large translation movement in addition to tilting during flexion and extension ( Fig. 1 2. 1 3).

- 상부 경추간판 분절은 굴곡신전동안 large translation이 일어남. 

In the lower intervertebral disk segments, the axis is  found near the intervertebral disk. The tilting movement is therefore very large and the translation minimal (Fig.1 2. 1 4).

- 하부 경추간판 분절은 tiliting movement가 크고,  translation은 적음. 

The large translation, for example, in the 2/3 segment, produces strong shear forces that act on the intervertebral disk. These forces must be seen as having a direct relationship with the bisectioning of the intervertebral disk and the development of the uncinate process. The uncovertebral joints control lateral flexion and ensure that the coupling of segmental rotation and lateral flexion is transferred quickly onto the next inferiorly located segment ( Fig. 1 2. 1 5). 

- 경추 2-3번 분절에서 large translatoin이 발생하여 강한 전단력을 추간판에 가함. 이러한 전단력은 추간판 bisectioning과 구상돌기 발달에 직접적으로 영향을 미침. 

- 구상관절은 측굴을 조절하고 회전동안 짝힘을 확실하게 함. 

As joints that develop with age, the uncovertebral joints can also cause local lateral cervical symptoms during lateral flexion when disorders are present. 

- 나이가 들어감에 따라 구상돌기관절은 국소적인 외측 cervical symptom을 야기함. 

Anatomy of the Occiput and the Upper Cervical Spine

The upper cervical spine is responsible for supporting the sense and balance organs (Herdmann, 2000), for example,

by coupling eye and head movements (cervico-ocular reflex) with the aim of stabilizing the field of vision.

- 상부경추(C0-C1-C2)는 시각영역 안정화 목적으로 눈과 머리의 동조움직임에 의해 균형을 잡는 역할을 수행함. 

The upper cervical spine "contains the most complex, unique, and highly specialized structures" in the vertebral

column (White and Pandjabi, 1 990, p. 82). Anatomy varies greatly at the junction between the head and the cervical

spine. These deviations from the norm affect the expected results of the local palpation of bony structures to a limited

extent only. 

- 상부경추는 복잡하고 독특하고 특히 특화된 구조임. 

- 두부와 경추사이에 큰 결함을 이룸. 

The effect of some anatomical variations is so extreme, and even pathological, that they are described as deformities. The following deformities directly influence palpation:

상부경추의 두가지 병리

• Minimal development of the occipital condyles causes the dens to protrude into the inner skull. The malformations are labeled "primary basilar impressions" (Lanz and Wachsmuth, 1 979, p. 309) and may result in neurological deficits. When condyles have a flattened form, it is difficult to palpate the transverse process of the atlas as the process is found directly underneath the occiput.

- 두부의 condyle이 퇴행화되어 flat되는 것..

• When the atlas and occiput are fused together, the CO/C1 segment is immobile (occipitalization; present in less than 1 % of the population).

- C0/C1의 fuse되어 함께 움직일때, c0-c1분절은 immobile

occiput

Superior nuchal line. 

This widely arched, convex line also travels laterally, extending from a position slightly inferior to the protuberance. Lanz  and Wachsmuth (1979. p. 3 1 4) estimate that approximately 37% of all superior nuchal lines are well developed. The large intrinsic muscles are noticeable directly below this line: semispinalis cervicis, splenius capitis. and the descending part of the trapezius.

- 상항선은 semispinalis cervicis, splenius capitis. and the descending part of the trapezius 부착부임. 

atlas 경추 1번 환추

The atlas has the special function of an adaptor or intermediate plate by transmitting the predominant movements

of flexion and extension in the CO/Cl segment onto the Cl/C2 segment in the form of rotation.

환추는 C0-C1에서 굴곡신전의 우세한 움직임을 중계하고, C1-C2 에서는 회전을 위한 움직임

The first cervical vertebra consists of a ring with delicate anterior and posterior arches ( Fig. 1 2. 1 8). The earlier  C1 vertebral body is now the C2 dens. The dens forms a joint with the anterior arch and is fixed at this point by a strong transverse ligament. The atlas also does not possess a spinous process. Only an anterior and a posterior tubercle can be found on the ring of the atlas. The atlas supports two very well-developed bony blocks on the lateral section of the ring, which support inferior and superior joint surfaces. 

- 환추는 링 형태이고 앞뒤로 아치로 이루어짐. C1 척추체와 C2 치돌기는 연결. 횡인대로 강하게 연결. 극돌기는 없고, ant post tubercle가 있음. 

The superior joint surfaces are biconcave and together with the occipital condyles form the upper cervical joints (CO/C1). Approximately 30% of the cartilage coating here has variable gaps in it. The occipital and atlantal articular surfaces have similar radiuses of curvature, which results in the high congruency and structural approximation seen in this segment. The inferior joint surfaces are rounded and the bone concave.

- C0-C1의 관절은 두부와 환추의 관절면 설명

- 환추는 오목하고 occiput은 볼록한 면이 서로 만남. 

 C1의 횡돌기는 길어 촉진에 기준점

A special feature of the atlas is its wide transverse processes. This makes the atlas the widest of all cervical vertebrae.

Lanz and Wachsmuth (1979) state that the distance between the tips of the transverse processes in male Central Europeans amounts to approximately 8.5 cm. This distance is approximately the same as the distance between the T1 transverse processes. The tip of a transverse process can be felt between the mastoid process and the ramus of the mandible. 

- 환추의 특성은 넓은 횡돌기에 있음. 횡돌기 간의 길이는 대략 8.5cm. 이 길이는 흉추 1번 횡돌기 거리와 비슷함. 

- 제 1번 경추 횡돌기는 유양돌기와 하악의 가지 사이에서 만질 수 있음. 

The variations in shape and length of the transverse processes can lead to incorrect conclusions when sides are compared during palpation. Dorhage et al. (2004) have once more confirmed the large variation in the anatomy of the upper cervical region in a large radiological study: "We eval‎uated 212 X-rays of the entire vertebral column and assessed the upper cervical joints and the cervical spine of test subjects who reported being free of symptoms. 

- 횡돌기의 형태와 길이의 변이는 촉진하는 동안 올바르지 않은 결론에 도달할 수 있게 하므로 주의해야. 

The asymmetrical position of the participating joint partners varied considerably. Symmetrical positioning of the occiput, atlas, and axis in relation to each other could only be observed in 6% of all cases." They also discovered that the difference in cervical mobility to the left and the right "did not correlate with the anatomical position of the upper cervical joints as radiologically determined." Naturally, this knowledge also influences the results expected when palpating the C1 transverse process. It is not expected that the transverse processes will be of the same length on both sides and should not be classified as abnormal without further assessment of movement.

- 관절의 비대칭성은 흔함. 

- 두부, 환추, 축추아 완벽하게 대칭적인 경우는 6%에 불과함. 

Axis 축추 

The second cervical vertebra is the transitional vertebra (Fig. 1 2. 1 9). Its superior section belongs to the vertebrae

of the upper cervical spine, while its inferior side has a similar shape to vertebrae found in the lower cervical spine.

The dens of C2 is 1.5 cm long on average, has a rounded tip, and is tilted 11 -14° posteriorly in relation to the vertebral body (Lanz and Wachsmuth, 1 979). 

- 제 2번경추는 축추. C2의 치돌기는 1.5cm이고, 끝이 둥글고, 척추체와 관련하여 뒤로 11~14도 기울어짐. 

It is the most reliable bony orientation point in radiographs of the  upper cervical spine. The axis for extensive rotation at

C1/C2 is found here. The anterior side of the dens articulates with the anterior arch of the atlas. Its posterior side articulates with the transverse ligament of the atlas. The superior joint surfaces are found directly adjacent to the dens. They have a biconvex shape and, together with the inferior joint surfaces of the atlas, form the lateral atlantoaxial joints, the real facet joints of C1/C2. 

- 축추는 C1-C2에세 극단의 회전이 관찰됨. 

- 모두 활액관절 ....

The most important feature of the axis for palpation is its particularly prominent bifid spinous process. This is the most important reference point in the upper cervical region. It is found at the level of the laminae of the vertebral arches and the vertebral body. 

- 축추 극돌기가 두갈래로 갈라져 있다는 특성이 중요한 촉진을 위한 지침. 

- 상부경추에서는 라미나, 경추의 추체가 같은 Level에 있음. 

The transverse processes are considerably shorter when compared with the atlas. The vertebral foraminae of the atlas and axis are large and offer a large amount of space for the dural sac and the spinal column to move in during extensive cervical movements. The dural sac is located near the axis for rotation at C 1 /C2 and is therefore only mildly deformed during large rotational movements and is not compressed by bone(White and Pandjabi, 1990).

- 축추의 횡돌기는 환추와 비교하여 상대적으로 짧음. 환추와 축추의 척추관은 크고 dural sac를위한 충분히 넓은 공간을 가지고 움직임. 

- dural sac은 C1-2에서 회전을 위한 축 근처에 위치하고, 큰 회전움직임동안 약간의 변형이 일어나면서 뼈에 의해 압박받지 않음. 

경추의 인대

1. ligementum nuchae 항인대

This long ligament extends from the C7 spinous process to the occipital protuberance and assumes the role of the supraspinous ligament (Fig. 1 2.20). It has deep laminar and superficial funicular (ligamentlike) sections and connects

the occiput directly with the C5-C7 spinous processes. The laminar section is a thin partition (septum) made of elastic fibers. The funicular, thin, superficial section is shaped like a ligament. It is formed by the following muscles as they merge to form an aponeurosis:

• Trapezius.

• Splenius capitis.

• Serratus posterior superior.

• Rhomboid minor.

- 항인대는 경추7번 극돌기에서 후두골융기까지 이어진 긴 인대로 극상인대 역할을 수행함. 

- 항인대는 deep laminar와 superficial funicular section 을 가지고 C5-7번 극돌기와 함께 후두부로 이어짐. 

- laminar section은 탄력섬유의 얇은 부분으로 만들어짐. 

- funicular section은 얇고 전층에 있고, 인대형태임. 아래근육에 의해서 형성되고 건막을 만듬. 

It can be palpated during extensive cervical flexion. The ligamentum nuchae pulls the head back slightly when the

cervical spine is maximally flexed, preventing the upper cervical joints from moving into their maximal end position. This presumably helps to protect the spinal cord. It is also placed under tension when the head is retracted and pulls the more inferior vertebra posteriorly so that real extension is produced.

- 항인대는 극단적인 경추굴곡동안 촉진할 수 있음. 

- 항인대는 경추 완전굴곡시 항인대는 머리를 뒤로 약간 당겨, 상부경추관절이 과도하게 움직여지는 것을 막아줌. 

- 이것은 척수를 보호하기 위함. 또한 머리가 제한될때 그리고 척추가 아래로 당겨질때 긴장상태에 놓여짐.  

2. 환추의 횡인대 transverse ligament

This ligament forms the transverse part of a cross-shaped ligament ( Fig. 1 2.21 ). It originates from the inner side of

the lateral mass of the atlas and is 2 cm long. It is approximately 2 mm thick in the middle and approximately 1 cm

in height. It is made of very taut connective tissue and is very firm. 

- 환추의 횡인대는 환추의 외측 mass 양측을 잇는 인대로 2cm 길이. 대략 2mm두깨. 1cm높이의  매우 단단한 결합조직

In the past, anatomists have performed studies demonstrating that this ligament has a tensile strength of approximately 130 kg ( M acalister, 1 893 in Lanz and Wachsmuth, 1 979). It is covered by thin hyaline cartilage on its anterior side and forms part of the median atlantoaxial joints with the dens.

- 횡인대는 대략 130킬로그램의 장력부하를 견딤. 

- 횡인대는 dens에서 환축추관절의 일부의 전면부 초자연골부위를 덮고 있음. 

It is found on the posterior aspect of the dens in a circular depression beneath the tip (similar to a scarf wrapped around the neck). The dens is therefore positioned in an osteofibrotic funnel that tapers downward. Even massive tensile forces ( up to 40-50 kg) are not able to separate C1 from C2 when the ligament is intact. This means that it is impossible to apply traction therapeutically at this joint.

- 횡인대는 dens의 후면부에 있어 neck의 후면부를 스카프로 둘러싼것과 비슷함. 

- dens는 그래서 osteofibrotic funnel에 위치함. 

- 횡인대가 정상일때, 심지어 40-50킬로그램의 강력한 장력이 C1-2를 분리시키지 못함. 이것은 C1-2에서 견인치료효과는 불가능하다는 것을 의미함. 

The main function of the ligament is to keep the dens away from the dural sac (with the spinal cord). Physical therapists are familiar with several tests assessing the stability of this important ligament. The ligament also controls the biomechanics between the atlas and axis during flexion and extension and stabilizes the atlantoaxial joints by approximating the joint surfaces with the strength of its tissues.

- 횡인대의 주요기능은 Dural sac(척수)으로부터 dens가 떨어져 있도록 하는 것임. 

- 물리치료사는 이 중요한 인대의 안정성 평가에 익숙해야 함. 

- 횡인대는 또한 굴곡, 신전동안 환추와 축추의 생체역학기능을 조절하고, 환축추관절을 안정화시킴. 

3. alar ligament 익상인대

The four alar ligaments are also very firm (stiff and rigid) and are mostly comprised of type I collagen. The ligamental

columns are divided into two groups ( Fig. 1 2.22):  

- 4개의 익상인대는 매우 단단하고 Type 1 collagen으로 구성됨. occipital section과 atals section 2개 그룹으로 나뉘어짐. 

Alar ligaments, occipital sections. 

These sections directly connect the posterior upper side of the dens with the occiput. They are 11 -13 mm long, 3.5-6 mm thick, and approximately 8 mm wide. These sections transfer lateral flexion of the head directly onto C2.

- 익상인대 occipital section

- 이것은 dens의 윗부분에서 후두부와 직접 연결하는 인대. 

- 11-13mm 길이, 3.5-6mm 두깨, 대략 8mm 넓이임. 

- 익상인대 occipital section은 C2에서 두부의 외측굴힘을 전달함. 

• Alar ligaments, atlas sections. 

These are found at the level of the transverse ligament of the atlas. They connect the side of the dens with the anterior arch and are therefore only approximately 3 mm long.

- 익상인대 Atlas section

- 환추의 횡인대부위에서 발견됨. 그것은 dens의 앞쪽 아치에서 연결하고 대랴 3mm길이임. 

Their functions include moving the dens during cervical flexion and extension, limiting the atlantoaxial rotation, and passing lateral flexion of the head onto the axis by rotating C2. The alar ligaments therefore control the central biomechanics in the upper cervical region.

- 익상인대는 경추굴곡신전동안 움직임을 포함하고, 회전을 제한함.

- 익상인대는 상부경추부위에서 중심의 생체역학적 기능을 가짐. 

Biomechanics of the Upper Cervical Spine

Atlantooccipital Joints (CO/C1 )

The atlantooccipital joints mainly move in the sagittal plane (Fig. 12.23). The range of flexion and extension amounts to approximately 27°. This range can be further divided into 7.2° flexion and 20.2° extension. CO/C1 should be viewed as an "extensor." Approximately 5 ° of rotation and lateral flexion is possible to each side. Another sideways movement is also possible: an "offset" of the atlas. When the upper cervical spine laterally flexes, the atlas shifts a few millimeters to the same side. This offset can be assessed using palpation and provides information on the mobility of CO/C1 (see the section "Tips for Assessment" below, p. 360).

-  C0-1관절인 환축추 관절은 주로 시상면에서 움직임. C0-C1 관절은 주로 굴곡신전 작용으로 약 27도 움직임. 굴곡 7.2도와 신전 20.2도. 5도 회전과 측굴이 가능함. 

- C0-1관절은 신전구조물로 봐야 함. 대략 5도 회전과 측굴이 각각의 방향으로 가능함. 

- 다른 방향으로 움직임 또한 가능함. 

- 상부경추가 외측으로 측굴할때, 환추는 같은 방향으로 몇밀리 움직임. 이러한 Offset은 촉진으로 측정될 수 있고, C0-1의 움직임에 정보를 제공함. 

Lateral Atlantoaxial Joints

The lateral osseous atlantoaxial joint surfaces tend to be either flatter in the sagittal plane or have a concave shape(Fig. 1 2.24). The cartilage is particularly thick in the middle, forming two convexities that face each other and only come into contact with each other in places. This unstable position results in low friction and allows movements to be performed quickly. However, tissues must be quite strong to maintain joint surface contact. The joint capsule is very large as a whole, allowing all movements to be performed.

- 환축추 관절표면의 외측뼈 구조는 시상면에서 좀더 flatter한 경향이 있고, concave 모양임. 

- 연골은 중앙에서 특히 두껍고 서로 만나는 면이 two convexity함. -- 아래 그림 참조. 

- 이러한 불안정한 구조는 낮은 마찰을 야기하고 빠른 움직임을 허용함. 

- 하지만 조직은 반드시 관절면 접촉을 유지하기 위해 강해야 함. 관절낭은 매우 넓고 움직임을 허용함. 

The incongruent joint surfaces are balanced out by the meniscal invagination of the joint capsule. It is well known that axial rotation is the main movement performed at the C1/C2 segment. Details regarding axial rotation and lateral flexion vary in the literature. 

- 조화되지 않은 관절면은 관절낭의 meniscal invagination에 의해서 균형을 유지함. 

- C1-2분절에서 주요 움직임은 축성방향으로 잘 알려져 있음. 축성 회전과 측굴.....

When C2 is fixed, approximately 20° of rotation is available to each side. When C2 is free to move, the range of motion amounts to approximately 40°. The range of flexion and extension adds up to approximately 20°, with this range being evenly divided between flexion and extension. If this were not the case, the range of rotation would differ. The documented range of lateral flexion varies between 0° and 6.5".

- C2가 고정될때, 대략 회전의 20도가 양측으로 가능함.

- C2가 자유롭게 움직일때 회전은 40도로 늘어남. 

- 굴곡과 신전범위는 대략 20도를 추가함. 

Coupling of Movements during Lateral Flexion of the Upper Cervical Spine

Lateral flexion to the left initially places the occipital section of the right alar ligaments under tension ( Fig. 1 2 .25). This causes the posterior side of the dens to move simultaneously and the axis rotates immediately to the left. This transmission of movement is the strongest form of coupling in the musculoskeletal system. It can be recognized by observing the C2 spinous process as it moves to the right. The movement of the spinous process is used to assess the stability of the alar ligaments (see the section "Test for the Alar Ligaments" below, p. 347).

- 특히 상부경추는 짝움직임이 중요함. 

- 좌측으로 측굴하는 초기에 우측 익상인대의 occipital section이 긴장에 놓여짐. 

- 이것은 축추가 자동적으로 뒷방향으로 움직이고, 환추는 즉시 좌측으로 회전함. 

- 움직임의 전달은 근골격계에서 강한 짝힘의 형태임. 

- 이것은 C2극돌기가 우측으로 이동한다는 의미임. 극돌기의 움직임은 익상인대의 안정성을 측정하는데 이용됨. 

  However. therapists are not allowed to draw conclusions regarding the coupling of movements at individual segments based on the relationship between movements at the occiput and C2. The coupling of lateral flexion and rotation is individual here and must therefore be assessed on each patient separately. The variable anatomical shape of the joint surfaces is the presumed cause of these differences.

- 하지만 치료사는 각각의 분절에서 C0와 C2사이의 움직임 관계에 기초한 짝움직임과 관련한 설익은 결론을 내면 안됨. 

- 외측굴과 회전은 개별적임 그리고 반드시 각각의 환자에게서 분리되어서 측정되어야 함. 

- 관절면의 다양한 해부학적 형태는 이러한 차이점을 당연한 원인으로 제공함. 

경추 후부 근육

1. Extrinsic muscle

The extrinsic muscles of the cervical spine are also defined as muscles that can no longer be found in their original position and are supplied by the ventral rami of the spinal nerves.

- 경추의 외재근 다음과 같이 정의함

- 근육의 원래위치에서 발견되지 않고, 척추신경의 ventral rami에 의해서 지배받는 근육. 

The following muscles are of importance (Fig. 1 2.26):

• Descending part of the trapezius. Extends from the superior nuchal line and ligamentum nuchae onto

the lateral third of the clavicle. 상부승모근은 상항선과 항인대에서 시작하여 쇄골의 외측 1/3부위에 부착. 

• Levator scapulae. Extends from the  C1 -C4 transverse processes onto the superior angle of the scapula.

• Scaleni muscles. See the section "Anterior and Lateral Muscles" below. page 329 for a description of their course.

• Sternocleidomastoid. Extends from the mastoid process to the manubrium of the sternum and to the medial third of the clavicle.

2.  경추 내재근 Intrinsic muscle

When considered from an evolutionary point of view, we observe that a number of elementary muscles also exist in

the cervical spine, which are innervated by the dorsal rami of the spinal nerves.

The fol lowing large intrinsic muscles (cervical or occipital) are of importance:

• Semispinalis cervicis and capitis (Fig. 1 2.27). The course of the semispinalis capitis: from the C3-T3 transverse processes to the insertion between the superior and inferior nuchal lines. According to Lanz and Wachsmuth ( 1 979) this area is approximately 3 cm wide and 2 cm high.

• Splenius cervicis and capitis (Fig. 1 2.27). The course of splenius capitis: from ligamentum nuchae and the C3-

T3 spinous processes to the superior nuchal line.

• longissimus cervicis and capitis. The course of the longissimus capitis: transverse processes of the lower cervical spine and the upper thoracic spine up to the mastoid process.

• longus colli and capitis. See the section "Anterior and Lateral M uscles" below. page 330 for a description of their course.

경추 근육의 촉진법

An entire group of muscles is encountered when therapists use palpation for orientation. The superficial muscles are the only muscles that can be palpated reliably ( Fig. 1 2.28). Therapists are able to do this by orienting themselves either immediately adjacent to the row of spinous processes or on the edge of the occiput and by instructing their patients to tense the appropriate muscle to confirm‎ its position.

- 천층근육은 오직 신뢰할만하게 측정가능함. 

The multisegmental muscle belly of the semispinalis is found near the spinous processes and is one of the oblique intrinsic muscles. It occupies the space between the midline and the laminae of the vertebrae. Its insertion is located immediately inferior to the superior nuchal line. where half of its width is covered by the descending part of the trapezius before it attaches itself onto the superior nuchal line. The anterior edge of the muscle can be palpated by starting at its insertion on the clavicle and moving in a superomedial direction. The insertion of the semispinalis capitus occupies approximately a third of a widely curved line on the edge of the occiput between the mid-line and the tip of the mastoid process. 

The splenius capitis inserts into the middle third of this line. This strong rotator and extensor belongs to the superficial

layer of the intrinsic muscles of the back. The lateral third of the line is occupied by the sternocleidomastoid.

This muscle does not only insert onto the mastoid process, but also somewhat posterior to it. This can be easily recognized

in the lateral view of this region (Fig. 1 2.29). The sternocleidomastoid aids orientation when the (1-0 transverse processes are being palpated. The  C1 transverse  process is usually found anterior to the muscle, the C2 transverse process directly posterior to the muscle, and the C3 transverse process along its posterior edge.

This muscle is a helpful guiding structure for therapists who wish to correctly locate the transverse processes. The sternocleidomastoid must often be pushed to the side so that therapists can pal pate closer to the transverse processes.

상부 경추 근육 upper cervical muscle

The following deep. short suboccipital muscles are of importance:

• Rectus capitis posterior major and minor:

- Rectus capitis posterior major extends from the C2 spinous process and travels obliquely in a superior direction where it inserts into the inferior nuchal line.

- Rectus capitis posterior minor extends from the C1 posterior tubercle to the inferior nuchal line.

• Obliquus capitis superior and inferior:

- Obliquus capitis inferior extends from the anterior surface of the C2 spinous process. travels in a super or and quite lateral direction. and inserts onto the Cl transverse process.

- Obliquus capitis superior extends from the Cl transverse process in an almost lateral direction in the sagittal plane and inserts into the inferior nuchal line   (retromastoid process, see the section "Anatomy of the Occiput and the Upper Cervical

Spine" above, p. 322).

• Rectus capitis lateralis and anterior:

- See the section "Anterior and Lateral Muscles" below for a description of their course.

The upper cervical muscles ( Figs. 1 2.30 and 1 2.31 ) are supplied by a very large proprioceptive innervation and

are important for the fine control of upper cervical movements. These muscles, in combination with the short

anterior muscles, form the upper cervical spine's own muscle apparatus. This muscle apparatus takes advantage of the special anatomical features (e.g., using the long lever of the Cl transverse process and the C2 spinous process) and the special biomechanics found in the upper cervical region, and ensures that the upper cervical joints are approximated using the strength of their tissues. Together with the mechanoreceptors in the CO{Cl to C2{C3 joint capsules, the muscle spindles of these muscles form the third organ for balance.

상부경추 근육촉진

The upper cervical muscles are covered completely by superficial muscles, making it difficult to reliably locate these structures using palpation. the deep transverse deformation of the functional massage techniques (see the section "Functional Massage" below, p. 349) can be used to easily access the muscles and to relieve tension. 

경추의 앞쪽 옆쪽의 근육들

The anterior muscles in the cervical spine are divided into two systems according to their position:

• Superficial, prevertebral muscles found anterior to the organs of the throat.

• Deep, prevertebral muscles found directly anterior to the vertebral bodies.

The superficial prevertebral muscles are further divided topographically into the following:

• Suprahyoid muscles: these muscles are found in the floor of the mouth and connect the hyoid bone with the mandible. 

They belong functionally to the muscles of mastication (Rauber and Kopsch, 1 987, p. 659).

• Infrahyoid muscles, also called the strap muscles: these muscles connect the hyoid bone with the larynx (thyroid

cartilage) and the sternum. According to Rauber and Kopsch ( 1987, p. 659), they participate in complex actions such as "chewing, swallowing, and phonation."

From a mechanical point of view, they form a kinematic flexor chain when the mouth is closed and the jaw closers

( masseter and temporalis) are active, producing some strength when the cervical spine i s flexed.

How Does this Affect Palpation?

The correct localization of the hyoid bone and the prominent sections of the larynx is used to confirm‎ the level of

the cervical vertebrae. The palpation of posterior structures is very difficult in the supine position, for example, when locating the exact position of the C4 lamina. The anterior structures are used as a further aid here.

The hyoid bone is mostly found deep in the angle between the floor of the mouth and the vertical surface of the throat, at approximately the level of C3. Its position varies a lot. It is quite often found at the level of the mandible and i s then difficult to reach. Please refer to the section "Anterior Palpation Techniques" below, page 362.

The deep prevertebral muscles include:

• Rectus capitis lateralis and anterior:

- Rectus capitis lateralis extends superiorly from the C1 transverse process onto the lateral part of the occiput.

- Rectus capitis anterior extends i n a superomedial direction from the anterior aspect of the C1 transverse process to the basilar part of the occiput.

• Longus colli and capitis:

- Course of longissimus capitis: this muscle is divided into several sections. Its vertically and transversely oriented fibers extend from approximately T3 to the atlas and rest against the vertebral bodies on both sides.

- Course of longus capitis: from the C3-C6 transverse processes, traveling in the depression between the transverse process and vertebral bodies, and inserting onto the basilar part of the occiput.

The recti muscles and longus capitis, in combination with the short posterior muscles of the neck, ensure that the

upper cervical joints are approximated. These muscles should be trained when the upper cervical region is unstable. 

The "longus group" of muscles is known clinically as the stabilizers of the cervical spine. Physical therapy treatment for instability, particularly in the lower cervical spine, should aim to recruit the longus colli muscle. Falla et al. (2004) proved in their EMG study how important the longus colli and longus capitis muscles (deep flexors of the neck) are. These muscles were shown to be less active during craniocervical flexion i n patients with chronic cervical symptoms compared with people who were free of symptoms. The patients' symptoms responded positively to the training of these muscles.

The deep prevertebral muscles ( Fig. 1 2.32) cannot be palpated. They have only been included in this chapter due to their great importance in clinical practice.

• Scaleni muscles. 

According to Rauber and Kopsch (1987, p. 665), these muscles belong to the deep lateral muscles of the neck and are the continuation of the intercostal muscles in the cervical region. Due to this, the scaleni muscles also originate on the anterior tubercle of the transverse process, the rudiments of the cervical ribs. Their muscle bellies form a cone-shaped covering

over the pleural dome, with nerves and vessels being able to pass through two gaps in the muscles (scalenus gaps) ( Fig. 1 2.33). 

It is obvious that their suitability as respiratory aid muscles is based on their position and their site of origin :

- Course of scalenus anterior: extends anterolaterally from the C3-C4 transverse processes onto the first rib. The phrenic nerve accompanies it for part of its course.

- Course of scalenus medius: from the C3-C7 transverse processes down onto the first rib.

- Course of scalenus posterior: travels more posteriorly from the C5-C7 transverse process down onto the second rib.

The scaleni muscles can be reached well using palpation. They cover the anterolateral region of the throat and are only partially covered by the sternocleidomastoid. The anterior scalenus gap ( Fig. 1 2.34) is formed by the  sternocleidomastoid and scalenus anterior. The subclavian vein and the phrenic nerve pass through here.

The posterior scalenus gap ( Fig. 1 2 .34) is formed by the scalenus anterior and scalenus medius. The subclavian artery

and the brachial plexus pass through this gap. The constriction of these structures as they pass through this gap in the muscles is known as "scalenus syndrome" or a form of "thoracic outlet syndrome."

경추의 신경과 혈관들

대후두 신경과 소후두 신경

- 대후두 신경은 semispinalis captis와 splenius capitis사이를 지나 후두부로 올라 감

- 소후두 신경은 scm과 splenius capitis사이를 지나 후두부로 올라감. 

[heoss]

감사합니다.

[09정해천]

1.두부의 중력중심은 sella turcica부근(C0-C1과 C1-C2 관절보다 약간 앞에 있음)이다. 그래서 우리가 서있는 자세일때, 경추는 항상 약간 긴장된 상태이다.
2.cranial nerve 와 상부 경추 근육, 관절은 많은 고유수용감각신경과 관련을 맺고 있기 때문에 머리에서 경추문제에 의한 증상이 필수적으로 나타날 수 있다.
3.경추 극돌기의 비대칭적 갈라짐은 경추 전만을 위한 움직임을 최적화하고, 신전 움직임동안 Interlock 서로 맞물리게 한다.
4.경추는 굴곡, 신전이 크다.
=> 구상돌기가 rail처럼 작용하여 움직임을 가능하게 한다.
=> 디스크의 갈라짐이 구조적으로 구상돌기가 잘 맞물리도록 해준다.

[09정해천]

5.거의 모든 하부경추 관절면은 수평면에 수평하게 배열되어 있고 오직 C2-3번 분절이 위 방향으로 배열된다. 이러한 관절면의 배열덕분에 경추의 회전은 불가피하게 외측 굴곡과 함께 일어나고 회전축은 틀어진 상태이다.
6.상부경추(C0-C1-C2)는 시각영역 안정화 목적으로 눈과 머리의 동조움직임(cervico-ocular reflex)에 의해 균형을 잡는 역할을 수행한다.
7.환추는 C0-C1에서 굴곡,신전의 우세한 움직임을 중계하고, C1-C2 에서는 회전을 위한 움직임을 중계한다.

[순수호랑]

감사합니다!!

[인이]

감사합니다. ^^

[아아]

안녕하세요! 아트 아나토미를 공부하는 학생입니다! 혹시 구상돌기가 c3에서 가장 크다고 하셨는데 제가 공부하면서 본 논문의 지표에서는 c3이 가장 작은경우가 더러 있었습니다. 물론 사람마다 경추 구상돌기 크기 순서 다르겠지만 c3의 구상돌기가 가장 크다는 내용에 빨간글로 표시하셔서 c3의 구상돌기가 가장 커야하는 이유가 있는겁니까? 또 이 자료들의 출처를 여쭤봐도 될까요??

[문형철]

http://www.yes24.com/Product/Goods/15707771

해부학에서 이유는 없습니다.
이유를 굳이 말한다면 '200만년' 진화의 결과물이겠습니다.

Form follow function
구조는 기능을 따른다..

그러한 기능을 위해서 그러한 구조가 필요한거라고 말할 수있습니다 ㅎㅎㅎ

[아아]

ㅎㅎ 감사합니다!