1、PT-153 Lumbar Injury Biomechanics Lumbar Injury Biomechanics Jeffrey A. Pike Lumbar Injury Biomechanics Pike The amount of load that can be borne by the different components of the lumbar region is fairly well understood, as are resulting injuries from overloading. Less severe lumbar injuries involv
2、e a wide range of factors, including heredity, obesity, age, occupation, sports, cardiovascular risk factors, and depression. Some of the most painful conditions that require high levels of care involve lumbar spine fracture or soft tissue injury from falls, contact sports, vehicle collisions, aircr
3、aft ejection, and underbody blasts from roadway explosions (military injuries). Each of these injury scenarios elicits a different kinematic response of the spine as a result of load direction, magnitude, and duration. Updated from a popular earlier volume, this new compendium includes landmark pape
4、rs from 1994 through 2013 that focus exclusively on lumbar injuries. It also features an introductory chapter, “Blunt Lumbar Trauma,” that provides an overview of the anatomy of the lumbar region, injury, and injury mechanisms, as well as an extensive literature update. This edition is the third in
5、a series of biomechanics compendia edited by Mr. Pike. Earlier editions covered injuries of the neck and head. For this volume, Mr. Pike and the advisory panel selected 15 of the best papers from a variety of sources including SAE International, IRCOBI, Stapp, NHTSA, ESV, and the Association for the
6、 Advancement of Automotive Medicine. The book will be helpful to those studying lumbar injury from a broad range of causes, including transportation, falls, sports, personal violence, and blast-related. Professionals from a variety of disciplines will find the book useful: biomechanics, accident rec
7、onstruction, medical and rehabilitation, insurance, legal, and law enforcement. About the editor Jeffrey A. Pike is president of Biomechanics Consulting, Inc., which provides research, education, and forensic biomechanics consulting services. His previous experience includes senior technical special
8、ist, Ford Motor Company and adjunct professor, Wayne State University, Biomedical Engineering Department. He has been a consultant to the Centers for Disease Control, National Academy of Sciences, National Highway Traffic Safety Administration, Department of Justice, and state and local governments.
9、 His current projects include consulting on a CDC/NIOSH contract to develop restraint systems for providers of in-ambulance care. Jeffrey A. PikeLumbar Injury Biomechanics PT-153 book.indb 1 7/31/13 9:25 AMOther SAE books of interest: Integrated Automotive Safety Handbook By Ulrich Seiffert and Mark
10、 Gonter (Product Code: R-407) Neck Injury Biomechanics By Jeffrey A. Pike (Product Code: PT-141) Forensic Biomechanics: Using Medical Records to Study Injury Mechanisms By Jeffrey A. Pike (Product Code: R-379) For more information or to order a book, contact: SAE International 400 Commonwealth Drive
11、 Warrendale, PA 15096-0001 USA Phone: 877-606-7323 (U.S. and Canada only) or 724-776-4970 (outside U.S. and Canada) Fax: 724-776-0790; Email: CustomerServicesae.org; Website: books.sae.org PT-153 book.indb 2 7/31/13 9:25 AMLumbar Injury Biomechanics By Jeffrey A. Pike Warrendale, Pennsylvania, USA P
12、T-153 book.indb 3 7/31/13 9:25 AM Copyright 2013 SAE International. eISBN: 978-0-7680-8053-7 Copyright 2013 SAE International. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, distributed, or transmitted, in any form or by any means without the prior
13、written permission of SAE International. For permission and licensing requests, contact SAE Permissions, 400 Commonwealth Drive, Warrendale, PA 15096-0001 USA; e-mail: copyrightsae.org; phone: 724-772-4028; fax: 724-772-9765. ISBN 978-0-7680-7644-8 Library of Congress Catalog Number 2013941681 SAE O
14、rder Number PT-153 DOI 10.4271/PT-153 Information contained in this work has been obtained by SAE International from sources believed to be reliable. However, neither SAE International nor its authors guarantee the accuracy or completeness of any information published herein and neither SAE Internat
15、ional nor its authors shall be responsible for any errors, omissions, or damages arising out of use of this information. This work is published with the understanding that SAE International and its authors are supplying information, but are not attempting to render engineering or other professional
16、services. If such services are required, the assistance of an appropriate professional should be sought. To purchase bulk quantities, please contact SAE Customer Service e-mail: CustomerServicesae.org phone: 877-606-7323 (inside USA and Canada) 724-776-4970 (outside USA) fax: 724-776-0790 Visit the
17、SAE International Bookstore at books.sae.org 400 Commonwealth Drive Warrendale, PA 15096-0001 USA E-mail: CustomerServicesae.org Phone: 877-606-7323 (inside USA and Canada)724-776-4970 (outside USA) Fax: 724-776-0790 PT-153 book.indb 4 7/31/13 9:25 AMDedication To Debbie and the “kids,” Stacy, Adam,
18、 Blair, and Emily. PT-153 book.indb 5 7/31/13 9:25 AMPT-153 book.indb 6 7/31/13 9:25 AMvii Table of Contents Preface . ix Acknowledgments xi Blunt Lumbar Trauma .1 List of Papers Begeman PC, Visarius H, Nolte L-P , et al., Viscoelastic shear responses of the cadaver and hybrid III lumbar spine, Pape
19、r 942205, Proc. 38 Stapp Car Crash Conf., Society of Automotive Engineers, Warrendale, 1994 23 Belwadi A, Yang K, Response of the cadaveric lumbar spine to flexion with and without anterior shear displacement, Proc International Research Conference on the Biomechanics of Impact (IRCOBI), Zurich, 200
20、8 . 37 Compigne S, Bouquet R, Caire Y, et al., Human spine behaviour under thoracic and pelvic lateral impacts comparison with WorldSID dummy behaviour, IRCOBI, Zurich, 2004 . 51 Demetropoulos CK, Yang KH, Grimm MJ, et al., Mechanical properties of the cadaveric and hybrid III lumbar spines, Paper 9
21、83160, Proc. 42 Stapp Car Crash Conf., Society of Automotive Engineers, Warrendale, 1998 67 Dokko Y, Kanayama Y, Ito O, et al., Development of human lumbar spine FE models for adult and the elderly, Paper 2009-01-0382, SAE International, Warrendale, 2009 77 Gates D, Bridges A, Welch DJ, et al., Lumb
22、ar loads in low to moderate speed rear impacts, paper 2010-01-0141, SAE International, Warrendale, 2010 85 Heller MF, Watson HN, Ivarsson BJ, et al., Using national databases to evaluate injury patterns in pedestrian impacts, Paper 2009-01-1209, SAE International, Warrendale, 2009 101 Huelke DF, Ost
23、rom M, Mackay GM, et al., Thoracic and lumbar spine injuries and the lap shoulder belt, Paper SAE 930640, Society of Automotive Engineers, Warrendale, 1993 . 117 Kemper A, McNally C, Manoogian S, et al., Stiffness properties of human lumbar intervertebral discs in compression and the influence of st
24、rain rate, Paper 07-0471, 20 Intl Tech Conf Enhanced Safety of Vehicles (ESV), National Highway Traffic Safety Administration, Washington, DC, 2007 . 127 Manoogian SJ, Funk JR, Cormier JM, et al., Evaluation of thoracic and lumbar accelerations of volunteers in vertical and horizontal loading scenar
25、ios, Paper 2010-01-0146, SAE International, Warrendale, 2010 . 135 PT-153 book.indb 7 7/31/13 9:25 AMviii Osvalder A-L, Biomechanical experimental studies of the lumbar spine under static and dynamic loading conditions, Paper 950661, Society of Automotive Engineers, Warrendale 1995 153 Parenteau C,
26、Holcombe S, Zhang P , et al., The effect of age on fat and bone properties along the vertebral spine, paper 2013-01-1244, SAE International, Warrendale, 2013 165 Pellettiere JA, Moorcroft D, Olivares G, Anthropomorphic test dummy lumbar load variation, Paper 11-0157 , 22 Intl Tech Conf Enhanced Safe
27、ty of Vehicles (ESV), National Highway Traffic Safety Administration, Washington DC, 2011 . 181 Pintar FA, Yoganandan N, Scarboro M, Thoracolumbar spine fractures in frontal impact crashes, Annu Proc Assoc Adv Automot Med, 2012;56:277-283 . 191 Yang N, Lam T, Dainty D, et al., Lumbar spine injuries
28、in rear impacts of different severities, paper 2013-01-0221, SAE International, Warrendale, 2013 199 About the Editor .207 PT-153 book.indb 8 7/31/13 9:25 AMix Preface An earlier SAE compendium (Backaitis 1995), provided a collection of papers from the early 1960s through the early 1990s; this compe
29、ndium focuses on the early 1990s through the present (2013). In addition, a “Blunt Lumbar Trauma” chapter provides a literature update as well as an overview of the regional anatomy, injury, and injury mechanisms. The chapter includes more than 150 citations, and the volume includes reprints of 15 p
30、reviously published papers, spanning the period from 1994 through 2013. PT-153_front_matter.indd 9 8/15/13 10:03 AMPT-153 book.indb 10 7/31/13 9:25 AMxi Acknowledgments First and foremost, it is my pleasure to acknowledge the role of the Advisory Panel. Once again, I have been very fortunate to have
31、 been assisted by a truly outstanding panel. Panel members include several PhD researchers, two physician engineers, a neurosurgeon, an orthopedic surgeon, and a radiologist. I thank them for deciding that this book was worthy of their participation and for following through on that commitment; they
32、 have all been very generous with their time and with sharing their expertise. Their contribution to paper selection, material review, and assorted other tasks was invaluable. Ultimately, injury biomechanics is not about papers and books but about reducing morbidity and mortality from biomechanical
33、trauma. I hope this volume will help others to continue these efforts. Advisory Panel Craig A. Beyer Illinois SW Orthopedics, ltd. Glen Carbon, IL John M. Cavanaugh Professor and Assoc. Chair Biomedical Engineering Wayne State UniversityDavid Fessell Associate Professor Musculoskeletal Radiology Uni
34、versity of Michigan Robert S. Salzar Senior Scientist Center for Applied Biomechanics University of Virginia Alex Valadka CEO Seton Brain Association for the Advancement of Automotive Medicine (AAAM); National Highway Traffic Safety Association (NHTSA). Finally, this is my sixth volume for SAE Inter
35、nationalthe first three as author and the following three as editor. Perhaps the best acknowledgment that I can give to Martha Swiss and the crew at SAE is to mention that I am thinking about volume number seven. Jeffrey A. Pike SAE Fellow and Series Editor PT-153 book.indb 11 7/31/13 9:25 AMPT-153
36、book.indb 12 7/31/13 9:25 AM1 Blunt Lumbar Trauma By Jeffrey A. Pike Introduction Many of the constituent components that make up the lumbar spine have been characterized at vari- ous load rates, and their associated injury mecha- nism determined and scored. Studies focusing on the less severe end o
37、f the complaint/injury spectrum have reported a link between low back complaints and a wide range of factors, including heredity, obesity, age, occupational/sports activi- ties, cardiovascular risk factors, and depression. Some of the most painful and resource-intensive conditions involve lumbar spi
38、ne fracture or soft tissue failure from a variety of different insults to the body, including falls, contact sports, vehicle collisions, aircraft ejection, and underbody blasts from roadway explosions. Each of these environ- ments results in a different kinematic response of the spine as a consequen
39、ce of loading parameters, including direction, magnitude, and duration. This chapter will focus on vehicle-related lumbar injury, but when there is a natural link to other injury scenarios, mechanisms, or spinal regions, this chapter will seek commonality with those as well. It is hoped that this ap
40、proach will foster syn- ergistic efforts (and benefits) among the various disciplines and specialties. Anatomy The spine (vertebral column) may be described as a stack of small ringlike bones (vertebrae) that extends from the base of the skull to the tailbone (Figure 1). Each of these bones has an o
41、pening (foramen) at its center (Figure 2), and these open- ings are aligned to form a “canal” that houses the spinal cord. (The spinal cord, an extension of the brain stem, represents the lower portion of the central nervous system CNS (Figures 3, 4). The most superior (uppermost) region of the spin
42、al column is the cervical (neck) region, located be- tween the base of the skull and the shoulders. Im- mediately below this is the thoracic (chest) region, which corresponds to the upper torso, and below this is the lumbar (lower torso) region. Below this is the sacral region, which interconnects w
43、ith the rear of the hip bones, and finally, the bottom- most part of the vertebral column, the coccygeal (tailbone) region. The vertebrae, especially in the cervical, thoracic, and lumbar regions, share some of the same basic structural and functional quali- Figure 1. The vertebral column (Pike 1990
44、). Figure 2. L5 Vertebra. PT-153 book.indb 1 7/31/13 9:25 AM2 ties, with increased similarity among the vertebra of a particular region. The anterior part of a ver- tebra is the vertebral body, and the posterior part of a vertebra is the vertebral arch. Components of the vertebral arch include the p
45、edicles, laminae, articulating processes (facet), and the transverse processes. There is also a rearward projection from the arch in the midsagittal plane; this projec- tion is called the spinous process (Figure 2). Various soft tissues are closely associated with the vertebral column. Primary among
46、 these are the spinal cord inside the boney framework, the intervertebral discs between adjacent vertebra and the spinal ligaments attached to or contacting the outer surface of the column. The spinal cord is perhaps the most injury-relevant structure associ- ated with the vertebral column. The cord
47、 starts at the top of the vertebral column and extends downward, to the upper lumbar region (approxi- mately L1). An intervertebral disc (Figures 1, 5), a cushionlike pad, is located between each verte- bra in the cervical, thoracic, and lumbar regions (except between C1 and C2, which have structure
48、s that differ from each other and from the other vertebrae). Also located between the vertebrae are nerve roots, which connect the spinal cord with various parts of the body. The various ligaments (sinewy tissues that provide a flexible coupling between the vertebrae) run between individual vertebra
49、e and along the length of the column. The ligaments include anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), ligamentum flavum (LF), supraspinous (SSL) and interspinous ligament (ISL), and the facet capsular ligament (CL) (Figure 6). A frequently used shorthand system for designat- ing each vertebra uses the first letter of the name of the region in which the vertebra is located (e.g., L for lumbar), and, starting with the most superior vertebra in that region, the vertebrae are numbered consecutively until the most inferior vertebra in that region has
