2014년 12월 28일 ... 여전히 어려운 분야구나..
panic bird...
무릎 부정렬 측정.pdf
- 58페이지 역학적 자료
knee valgus and biomechanics.pdf
- 8페이지 논문자료
절대 잊지 말아야 할 것은 분석이 아니라 대안이다.
치료적 대안!!
knee valgus and varus는 대퇴골의 회전, 경골의 회전, 족궁의 변화, 골반 관골구의 변화, lumbopelvichip complex의 구조적 변화를 초래한다.
그 변화에 맞게 근육, 근막이 길이와 장력을 맞춘다. 그 속에서 인체는 움직이고 통증이 발생하고, 손상이 발생한다.
우리는 어떤 대안을 가지고 있는가?
숨이 막혀온다.
Lower Extremity Alignment Terminology
A standard method for determining normal alignment of the knee is by drawing a line in the A/P plane that begins at the center of the femoral head, passes through the center of the knee, and continues to the center of the ankle (Figure 1.1). This line is often referred to as the mechanical axis of the lower extremity (MA-LE). If the line passes medially to the knee center, a varus deformity is present; if the line passes laterally to the knee center or center of the distal femur, a valgus
deformity exists.
Distinctions can be made between the knee center and center of the distal femur. In cases of medial or lateral
subluxation of the knee, for example, they may represent 2 different points. They may also be different from the
center of the proximal tibia. Figure 1.2 shows a lateral tibial subluxation, where the center of the distal femur
and the center of the knee at different points.
1. Mechanical axis of the femur (MAF):
A line from the center of the femoral head to the center of the distal femur or center of the knee (Figure 1.3).
2. Femoral shaft axis (FShA):
A line drawn from the center of the proximal femur to the center of the distal femur or center of the knee, indicating the overall position of the femoral shaft(Figure 1.4).
3. Tibial shaft axis (TShA) and Mechanical axis of the tibia (MAT):
These 2 terms are often used interchangeably, and both describe a line extending from the center of the proximal tibia to the center of the ankle (Figure 1.5).
o다리와 x다리
knee valgus
Medial Lateral Tibiofemoral Translation – Subluxation
Additional elements to knee pathology and deformity are clearly present when viewing a radiograph with medial-lateral tibiofemoral subluxation. Clinical implications are dependent on how this translation is quantified. In general, we are asking how this translation affects various measurement conventions. Specifically, we want to know if the various lines drawn that reference the center of the knee are going to give similar, mildly different, or significantly different determinations with
respect to tibiofemoral angle measurements and deformity assessments.
This question is addressed in Figure 3.1. The choices implied are to draw the femoral and tibial axes connected
to the middle point (K), the center or ‘midpoint’ of the knee), or to the distal femoral (F) or proximal tibial (T) point.
Extra-articular Deformity
It is sometimes necessary to analyze X-rays with significant extra-articular deformity secondary to fracture or developmental considerations (Figure 4.1). The previous analyses largely ignored the intermediate shape of the respective tibial and femoral shafts.
These cases can be analyzed using modern computer programs, tracing paper, or basic trigonometry/geometry,
which is explained below.
Extra-articular approximation theorem:
A tibial or femoral shaft extra-articular deformity of a certain angular amount creates a corresponding deformity at the knee in approximate proportion to the percentage of the way that deformity is located toward the knee.
Example 1 (Figure 4.1-A):
A 10° varus deformity 80% of the way from the hip to the knee, or 20% of the way above the knee, would impart an approximately 8° varus deformity at the knee, which would be 100% on the femoral side.
Example 2 (Figure 4.1-B):
A 10° varus deformity 80% of the way from the ankle to the knee, or 20% of the way below the knee, would
impart an approximately 8° varus deformity at the knee, which would be 100% on the tibial side.
첫댓글 감사합니다~
감사합니다.^^