Relação entre os músculos masseter e esternocleidomastoideo nas situações de flexão e rotação da coluna cervical, em mastigação e máxima intercuspidação habitual, analisados através da atividade eletromiográfica / Relationship between the masseter and sternocleidomastoid muscles in the flexion and rotation functions of the cervical, chewing and maximum habitual intercuspation, analyzed by the electromyographic activity

Na atualidade, com as frequentes inovações tecnológicas agregadas aos telefones celulares favorecendoseu uso excessivo, altos níveis de estresse e o ritmo acelerado da vida, inconscientemente, as pessoas têmadotado novas e diferentes posturas corporais, que direta ou indiretamente interferem na posição da colunavertebral. Um importante músculo postural do pescoço é o esternocleidomastoideo, cuja relevante função éa de estabilizar. Objetivo: analisar a possível relação entre os músculos masseter e esternocleidomastoideo,em diferentes posições da cabeça e da coluna cervical, nas situações de mastigação, repouso e máximaintercuspidação habitual. Metodologia: os dados foram coletados inicialmente com cabeça e coluna eretas,em repouso e em máxima intercuspidação habitual. Em seguida, coletou-se, sempre em mastigação, com acabeça e a coluna eretas, inclinadas para frente, para trás, para direita, para esquerda, giradas para direita epara esquerda. Todos os momentos de coleta de dados ocorreram por 5 segundos em cada posição. Resultados:nota-se um aumento na atividade elétrica do músculo esternocleidomastoideo quando a mastigaçãoacontece com a cabeça e a coluna fora da posição ereta. Em algumas posições da cabeça, esse aumento, emvalores absolutos, não é observado de forma relevante no sexo feminino, sendo notado no masculino. Conclusões:existe uma relação de trabalho entre os músculos masseter e esternocleidomastoideo. Essa relaçãosugere que o segundo músculo trabalha na tentativa de estabilizar a cabeça para otimizar o ato mastigatório,ação essa notadamente encontrada no sexo masculino e de forma menos ativa no sexo feminino.(AU)

Nowadays, with the frequent technological innovations added to cell phones favoring their excessive use, high levels of stress and the fast pace of life, people have unconsciously adopted new and different body postures that directly or indirectly interfere in the position of the spine. An important postural muscle of the neck is the sternocleidomastoid, whose important function is to stabilize it. Objective: to analyze the possible relationship between the masseter and sternocleidomastoid muscles, in different positions of the head and cervical spine, in situations of chewing, resting and maximum habitual intercuspation. Methodology: data were collected initially with head and spine erect, at rest and at maximum habitual intercuspation. Then, it was collected, always chewing, with the head and column erect, tilted forward, backward, right, left, turned to the right and turned to the left. All moments of data collection occurred for 5 seconds in each position. Results: An increase in the electrical activity of the sternocleidomastoid muscle is observed when chewing occurs with the head and spine out of the upright position. In some positions of the head this increase, in absolute values, is not observed in a relevant way in the female sex, being noticed in the male. Conclusions: there is a working relationship between the masseter and sternocleidomastoid muscles. This relationship suggests that the second muscle works in an attempt to stabilize the head to optimize the masticatory act, an action that is notably found in men and less actively in women.(AU)

Use of Models of Finite Elements in the Biomechanics of the Lumbar Spine

The same correspondence between general mechanics and civil engineering is true for biomechanics and surgical implants. Currently, numerous mechanical processes are required until a prosthesis is offered to its target audience. These processes typically require human or animal vertebrae, as well as all the complexity involving such tissues, for example, an ethics committee, the availabilityofmaterials, etc. Thus,finite elementmodels (FEMs) havebecome a great option to carry out biomechanical tests independently from anatomical specimens, and, at the same time, to obtain mathematical data to assist in the general physical understanding. The present review discusses the mechanical principles involved in bioengineering, clarifies the steps for the development of FEMs, and shows application scenarios for thesemodels. To the knowledge of the authors, the present paper is the first review study in Portuguese aimed to health care professionals in a language accessible to them.

Desarrollo de tablas de evaluación y factores de ponderación del riesgo asociado a tipos de técnicas de manipulación en tareas con manipulación manual de cargas dinámico-asimétricas / Development of evaluation tables and weighting factors of risk associated to types of handling techniques in Manual handing tasks of dynamic-asymmetric Loads

OBJETIVO: Describir factor de ponderación de riesgo del factor técnica de manipulación combinada (5 técnicas), analizando sus diferencias en condición dinámico-asimétrica, considerando la carga biomecánica en los segmentos extremidades superiores y columna. MÉTODO: Estudio cuasiexperimental, analítico y transversal, muestra por conveniencia de 100 sujetos (hombres y mujeres) en edad laboral, de la comunidad universitaria de la Universidad de Chile, evaluando cinco técnicas de manipulación de carga, utilizando sistema optoelectrónico, 3D Static Strength Prediction Program, electromiografía de superficie y percepción de esfuerzo. RESULTADOS: En extremidades superiores, se describen diferencias significativas entre técnicas en todas las variables de análisis biomecánico: el patrón de torque, activación muscular y percepción de esfuerzo es mayor en la técnica simétrica sobre hombros y asimétrica que en las otras técnicas. A nivel de columna, la actividad electromiográfica a nivel de erectores espinales entre técnicas es estadísticamente significativa. CONCLUSIÓN: Las técnicas con mayor carga biomecánica son las técnicas "Simétrica sobre Hombro" y "Asimétrica". La técnica "Simétrica a nivel de caderas" genera una carga intermedia, las técnicas "Simétrica a nivel de tronco" y de "Una mano" tienden a ser similares y las menos exigentes.

To describe risk weighting factor of combined manipulation technique factor (5 Technical), analyzing their differences in dynamic-asymmetrical condition, considering the biomechanical load on the upper limbs and spine segments. METHOD: Quasi-experimental, analytical and cross-sectional study, convenience sample of 100 subjects (male and female) in working age, from University of Chile community, assessing five load-handling techniques using optoelectronic system, 3D Static Strength Prediction Program, surface electromyography and perceived exertion. RESULTS: in upper extremities, significant differences in all variables techniques of biomechanical analysis are described: the pattern of torque, muscle activation and perceived exertion is higher in the symmetric on shoulders and asymmetric technique than the other techniques. In a column level, the electromyographic activity in a spinal erector level between techniques is statistically significant. CONCLUSION: The techniques with more biomechanical loading are "Symmetric on Shoulder" and "asymmetric" techniques. The "symmetrical hips level" technique generates an intermediate charge, techniques "trunk level Symmetric" and "One hand" tend to be similar and less demanding.

Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes / Reestenose Clínica de Stent Coronariano: Seguimento após Tratamento com Análise de Desfechos Clínicos

Background: Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up. .

Fundamento: A Reestenose Intrastent Clínica (RISC) é a principal limitação da angioplastia coronariana com implante de stent. Objetivo: Descrever as características clínicas e angiográficas da RISC e os desfechos em seguimento de pelo menos doze meses após seu diagnóstico e tratamento. Métodos: Em 110 pacientes consecutivos com RISC, analisaram-se a apresentação clínica, as características angiográficas, o tratamento e os desfechos primário combinado (morte cardiovascular, Infarto Agudo Miocárdio não fatal [IAM]) e secundário combinado (angina instável com internação, revascularização de vaso alvo e lesão alvo) em seguimento mínimo de um ano. Resultados: A média de idade da amostra foi de 61 ± 11 anos (68,2% do sexo masculino). A apresentação clínica foi como Síndrome Coronariana Aguda (SCA) em 62,7%, com RIS proliferativa em 34,5% dos casos. O tratamento realizado foi o implante de Stent Farmacológico (SF) em 36,4%; de Stent Não Farmacológico (SNF) em 23,6%; cirurgia de revascularização em 18,2%; angioplastia por balão em 15,5%; e tratamento clínico em 6,4%. Com seguimento mediano de 19,7 meses, o desfecho primário ocorreu em 18 pacientes, com seis (5,5%) óbitos e 13 (11,8%) IAM, e o secundário em 24 pacientes. Foram preditores de desfecho primário a RISC em SF (HR = 4,36; [1,44 - 12,85], p = 0,009) e o tratamento clínico da RISC (HR = 10,66, [2,53 - 44,87], p = 0,001). O tratamento da RISC com SNF (HR = 4,08 [1,75 - 9,48], p = 0,001) e tratamento clínico (HR = 6,29 [1,35 - 29,38], p = 0,019) foram preditores do desfecho secundário. Conclusão: A RISC se apresenta como SCA na maioria dos casos e os pacientes apresentam elevada frequência de eventos adversos durante o seguimento de médio prazo. .

The locomotor system as seen in Brazilian medical journals: a restricted collection of papers / O sistema locomotor nos periódicos médicos Brasileiros: um grupo restrito de artigos

This review covers recent publications on the motor system (orthopedics and movement) in Brazilian journals recently admitted to the ISI-Thomson Journal of Citations Index. Two of these are still pleading for admission into PubMed which will eventually enhance their global visibility. We offer this contribution to experts on these areas who are regular readers of Revista da Associação Médica Brasileira. Full free copies of all of them are available at www.scielo.br. The main areas covered are orthopedics of limb articulations, fractures, movement, posture, gait, exercise and animal models.

Esta revisão abrange publicações recentes sobre o sistema locomotor (ortopedia e movimento) em periódicos brasileiros recentemente incluídos na plataforma de citações ISI-Thomson. Dois destes periódicos ainda estão pleiteando inclusão no PubMed o que aumentará sua visibilidade. Oferecemos esta contribuição para especialistas nestas áreas de interesse e que são leitores regulares da Revista da Associação Médica Brasileira. Cópias integrais dos artigos citados estão disponíveis gratuitamente no site www.scielo.br. Os principais temas cobertos são ortopedia e articulações dos membros, fraturas, movimento, postura, marcha e modelos animais.

Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar / Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis

OBJETIVO: Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar MÉTODO: 38 pacientes operados de estenose de canal lombar e submetidos à artrodese avaliados por meio de questionários (escala visual analógica - VAS e questionário de incapacidade Rolland Morris). Foram solicitadas radiografias para avaliação da fusão lombar. RESULTADOS: Foi observada uma efetiva melhora entre o momento pré-operatório e após um ano em relação ao VAS, tanto no grupo que obteve fusão óssea como no grupo com pseudartrose. Em relação ao questionário Rolland Morris houve uma tendência de melhora no grupo com fusão óssea e uma significante melhora no grupo com pseudoartrose. CONCLUSÃO: Não houve diferença entre os grupos (fusão óssea e pseudoartrose) em relação à dor e incapacidade. Nível de Evidência: Nível II, estudo prospectivo longitudinal.

OBJECTIVE: Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis METHODS: 38 patients operated on for lumbar spinal stenosis and submitted to arthrodesis were evaluated by the Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire. Radiographs were requested to evaluate spinal fusion. RESULTS: An effective improvement was observed between the preoperative period and one year after the operation, in relation to VAS, both in the group that received a bone fusion and in the group with pseudarthrosis. With regard to the Roland Morris questionnaire, there was a tendency towards an improvement in the bone fusion group and a significant improvement in the pseudarthrosis group. CONCLUSION: There was no difference between the groups (bone fusion and pseudarthrosis) in relation to pain and disability. . Level of Evidence: Level II, longitudinal prospective study.

Prevalencia de alteraciones posturales en niños de Arica -Chile: efectos de un programa de mejoramiento de la postura / Prevalence of postural alterations and effects of a program to improve the posture in children from Arica-Chile

Los objetivos de este trabajo fueron calcular el índice de prevalencia de alteraciones posturales en una muestra de 120 alumnos (10,4 por ciento del universo total), de 4 años de edad de la ciudad de Arica y determinar el efecto de un programa de mejoramiento postural. Las alteraciones posturales más frecuentes corresponden a: inclinación de hombros (86 por ciento), escápula alada y escápula descendida (82 por ciento), proyección anterior de hombros (79 por ciento), pie plano (58 por ciento), columna lumbar hiperlordótica (51 por ciento) e inclinación de cabeza (50 por ciento). Posteriormente, se aplicó al grupo experimental un programa de ejercicio muscular y de reeducación postural, por un período de 8 meses. Al final del tratamiento se realizó un análisis post test a todos los sujetos del estudio. Los resultados en el grupo experimental muestran una disminución significativa de los índices iniciales de prevalencia, en todas las alteraciones en estudio. Los diferenciales de recuperación muestran diferencias significativas entre los grupos de estudio, con un 31 por ciento para inclinación de hombros, seguida de hiperlordosis lumbar con un 29 por ciento e inclinación de cabeza con 20 por ciento. La recuperabilidad más baja se observó en pie plano con un 7 por ciento (p≤0,05). El alto porcentaje de alteraciones posturales presentes en niños de 4 años, de la ciudad de Arica, podría ser producto de actitudes viciosas que, a futuro producen una estructuración inadecuada del cuerpo, entonces la aplicación de un programa de ejercitación muscular y de reeducación postural, dirigido por un equipo de Salud multiprofesional disminuirían significativamente estas alteraciones.

At present the educational institutions do not have an adequate system of Health to detect early changes in postural alteration in children. The aim of this study was to determine the most common postural changes in a sample of 120 students (10,4 percent of total universe), of 4 years old from Arica-Chile and to determine the effect of a program to improve the posture. The prevalence of the most frequent postural alterations relate to: inclination of shoulders (86 percent), winged scapula and descend scapula (82 percent), projection front shoulders (79 percent), flat feet (58 percent), lumbar hyperlordosis (51 percent) and inclination of head (50 percent). Subsequently in the experimental group was applied a program of exercise muscle and postural reeducation for a period of 8 months. At the end of treatment was applied a post-test to all children. The results in the experimental group showed a significant decrease in initial prevalence rates in all alterations. The differential recovery shows significant differences among the study groups, with 31 percent for inclination of shoulders, followed by lumbar hyperlordosis (29 percent) and inclination of head (20 percent). The recoverability lowest level was observed in flat feet with 7 percent (p≤0,05).The high percentage of postural disturbances in children aged 4 years in the city of Arica, could be the result of vicious attitudes that in the future produce an improper structuring of the body. Then the implementation of a program of exercise muscles and postural reeducation, led by a multiprofesional health team, decline rates of postural abnormalities present in children.

The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13 percent of the subjects had osteoporosis, while another 56 percent had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r=-0.229, p=0.001), breast feeding time (r=-0.064, p=0.001), and age at menarche (r=-0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- ...

Morphological variation in the seahorse vertebral system / Variaciones morfológicas en el sistema vertebral del caballo de mar

The vertebral system in Hippocampus hippocampus is highly specialised because of the vertical locomotion and tail prehensility. The vertebral elements represent a special case of morphological changes, being the metameric structures organised along a natural functional series. We investigated the shape changes along the vertebral spine in H. hippocampus through geometric morphometrics, in order to describe functional and structural patterns. Actually, the dorso-ventral tail bending ability in the genus Hippocampus is one of the most impressive morphological modifications in the evolutionary history of fishes. Vertebrae were analysed using a 2D configuration from the left lateral view. The variation along the vertebral series suggests the identification of cervical, abdominal, dorsal, and caudal groups. The first three (cervical) elements and the lOth (supra-dorsal) structure show peculiar morphologies and local adaptations, associated with neck angulation and dorsal fin muscles, respectively. The vertebral size decreases from the anteriormost element backward, with some local variation at the dorsal area. Major changes are related to allometric variation at the neural región. The caudal elements are characterised by a marked size decrease, with consequent allometric shape changes involving the rotation of the posterior vertebral opening. This allometric trajectory leads to a natural ventral bending of the tail, promoting its prehensile function. This morphological survey suggests an interesting structural network between posture, locomotion, and vertebral anatomy, underlying the main functional changes in the Hippocampus biomechanics. Geometric morphometrics is rather suitable to approach metameric studies in terms of serial variation and functional adaptations.

El sistema vertebral en Hippocampus hippocampus es altamente especializado, debido a la locomoción vertical y la cola prehensible. Los elementos vertebrales representan un caso especial de cambios morfológicos, siendo estructuras metaméricas organizadas a lo largo de una serie funcional natural. Se investigaron los cambios en la forma, a lo largo de la columna vertebral en H. hippocampus a través de morfometría geométrica, con el fin de describir sus patrones funcionales y estructurales. Actualmente, la capacidad de flexión dorso-ventral de la cola en el género Hippocampus es una de las más impresionantes modificaciones morfológicas en la historia evolutiva de los peces. Las vértebras se analizaron mediante una configuración 2D de la vista lateral izquierda. La variación a lo largo de la serie vertebral sugiere la identificación de grupos cervicales, abdominales, dorsales, caudales. Los tres primeros elementos (cervicales) y la 10ª (supra-dorsal) muestran una estructura morfológica peculiar y adaptaciones locales, asociadas con la angulación del cuello y los músculos de la aleta dorsal, respectivamente. El tamaño vertebral disminuye desde elemento más anterior hacia atrás, con algunas variaciones locales en la zona dorsal. Los principales cambios están relacionados con la variación alométrica en la región neural. Los elementos caudales se caracterizan por una marcada disminución de tamaño, con los consiguientes cambios en la formas aloméricas de rotación de la abertura vertebral posterior. Esta trayectoria alométrica conduce a una flexión ventral natural de la cola, promoviendo su función prensil. Este estudio morfológico sugiere una interesante red estructural entre postura, locomoción y la anatomía vertebral junto a los principales cambios funcionales en la biomecánica de Hippocampus. La morfometría geométrica es bastante adecuada para los estudios con enfoques metaméricos, en términos de variación de serie y adaptaciones funcionales.

Aparatos de estabilización y de reemplazo de uso corriente en artrodesis y artroplastías de la columna cervical / Stabilization and replacement devices currently used in arthrodesis and arthroplasties of the cervical spine

Continuous advances in diagnosis and treatment of cervical spine diseases have modified their surgical indications. Complex degenerative cervical disease not responding to conservative treatment is its main indication, with an important increase in these types of surgical procedures, also including trauma, scoliosis/deformities and neoplasm. Having knowledge of devices currently used in arthroplasty and arthrodesis, their general indications, biomechanics and complications enables radiologists to get accurate image interpretation as well as to render adequate radiology reports.

Los avances diagnósticos y terapéuticos de las enfermedades de la columna vertebral modificaron sus indicaciones quirúrgicas. La enfermedad degenerativa complicada sin respuesta al tratamiento conservador, es su principal indicación y va en aumento; también incluye traumatismos, escoliosis/ deformidades y neoplasias. Conocer los tipos generales de elementos utilizados en artroplastías y artrodesis, las indicaciones generales, biomecánica y complicaciones, permite a los radiólogos una mejor evaluación de estas imágenes y la elaboración de un informe radiológico adecuado.

Relación entre actitud postural y disgnacias maxilares en adolescentes de la ciudad de Corrientes / Relationship between postural attitude and maxillary malocclusions in adolescents from Corrientes city

Estudios epidemiológicos demuestran la alta prevalencia de disgnacias maxilares en adolescentes interviniendo en su etiología, elementos que dan características especiales al aspecto general, funcional y estético. Las fuerzas musculares actúan y modifican maxilares, cara, cuello, nuca y hombros. Duarante el crecimiento, una actitud postural alterada compromete el equilibrio cefálico y mandibular, adoptando ésta diferentes posiciones y relaciones maxilares anómalas. POr lo tanto, una actitud postural incorrecta es un factor etiológico de disgnacia. El objetivo de este estudio fue evaluar y correlacionar actitudes posturales y maloclusiones en 70 adolescentes. Se observó que el 77 por ciento de los mismos presentó anomalías posturales, predominando la cifo-escoliosis. El 80 por ciento presentó anomalías de oclusión, predominando la distorrelación mandibular y observándose una estrecha relación entre actitud postural alterada y maloclusiones, siendo la relación más frecuente la cifosis-distorrelación. Esta situación determina un desequilibrio morfofuncional que afecta la calidad de vida. Se considera al binomio postura/relación de maxilares muy importante en el diagnóstico de las disgnacias maxilares, para tratarlas adecuadamente en la niñez temprana y prevenir anomalías posturales y disgnacias severas en la dolescencia, ratificando el concepto de integridad. La modificación de funciones y actitudes musculares es el medio más poderoso que pone en nuestras manos la naturaleza para corregir la forma.

Spine revisited: principles and parlance redefined.

A revised appreciation of the evolution and the nature of bone in general and of vertebrae in particular, allows revisiting the human spine to usher in some new principles and more rational parlance, that embody spine's phylogeny, ontogeny, anatomy and physiology. Such an approach accords primacy to spine's soft-tissues, and relegates to its bones a secondary place.

Análise de parâmetros de força e resistência dos músculos eretores da espinha lombar durante a realização de exercício isométrico em diferentes níveis de esforço / Analysis of strength and resistance parameters of the lumbar spinae erector muscles during isometric exercise at different effort levels

A dor lombar tem demonstrado ser um achado comum em atletas e, particularmente, a sobrecarga na coluna lombar em conseqüência de um comprometimento da força ou resistência isométrica de músculos desse segmento, como resultado da fadiga muscular, tem sido considerada como importante fator etiológico para o seu desenvolvimento. Nesse sentido, destacam-se testes utilizados para a avaliação e treinamento dos músculos eretores da espinha lombares. No presente estudo, a análise de parâmetros de força e resistência isométrica foi utilizada com o objetivo de avaliar as respostas desses músculos durante contrações isométricas voluntárias máximas (CIVM) e submáximas em duas situações: com fadiga e sem fadiga, induzida por exercício isométrico realizado até a exaustão. Nove voluntários do gênero masculino e saudáveis realizaram CIVM antes e após exercícios de extensão da coluna vertebral sustentando 5 por cento, 10 por cento, 15 por cento e 20 por cento da CIVM. Em cada uma dessas situações foi registrado o sinal eletromiográfico (EMG) dos músculos iliocostal e multífido, assim como o nível de força gerado nas CIVM. A fadiga muscular foi identificada pela verificação do declínio dos valores de CIVM e freqüência mediana (FM) do sinal EMG obtidos após os exercícios isométricos. Os resultados demonstraram que, enquanto a força não foi capaz de evidenciar a fadiga muscular, a FM demonstrou de forma estatisticamente significante a fadiga dos músculos iliocostal e multífido, sendo observado neste último maior nível de fadiga muscular. De forma interessante, cargas entre 5 por cento e 20 por cento da CIVM induziram um mesmo nível de fadiga muscular. Assim, embora a força gerada durante a extensão da coluna vertebral após a exaustão induzida por exercício isométrico permaneça inalterada, provavelmente pela ação de músculos acessórios desse movimento, a sobrecarga sobre a coluna vertebral desenvolve-se como conseqüência do comprometimento da sua estabilidade decorrente da fadiga...

Análise cefalométrica de Rocabado para avaliação da postura da cabeça, mandíbula e região cervical / Rocabado cephalometric analysis for the evaluation of head, mandible and cervical region

O objetivo deste trabalho é apresentar o método da tomada radiográfica, do traçado cefalométrico preconizado por Rocabado e os valores considerado normais na correta postura de cabeça e mandíbula. Esta análise cefalométrica contribui, fortemente, para uma boa e correta avaliação da postura da cabeça em relação à postura cervical. Em qualquer análise biomecânica e funcional do contexto crânio cérvico facial é preciso levar em consideração, além dos sinais clínicos, a correta análise radiográfica da posição hióidea, posição normal da cabeça e sua relação com as vértebras cervicais.

The midpedicular and interpedicular distance of thoracolumbar vertebrae.

OBJECTIVES: 1. To introduce the measurement of the midpedicular distance (MPD) as an alternative to the interpedicular distance (IPD). 2. To measure the IPD and MPD of T11, T12, L1 and L2 vertebrae on anteroposterior (AP) plain film of the normal spine. 3. To study the relationship of the IPD and MPD of T11 to L2 of the normal spine. STUDY DESIGN: Thoracolumbar AP plain film of 89 subjects (39 males, 50 females) with an average age of 47.6 years (range 21-78 years) from the roentgenographic files were included. Both the IPD and MPD of T11, T12, L1 and L2 were measured by two observers. The mean difference of IPD and MPD at these four levels were compared by using a one-way ANOVA. The relationship of the IPD and MPD measured from the T11 to L2 levels were evaluated using the simple linear regression model. RESULTS: The mean IPD was progressively wider (p = 0.000) from the T11 to L1 level, but no significant difference (p = 0.308) was found between the mean IPDs of L1 and L2. The mean MPD of each level was significantly different from the others (p = 0.000) except the mean MPDs of T12 and L1 (p = 1.000). Both the IPD and MPD had a statistically significant linear relationship with the level of the vertebrae from T11 to L2 (p = 0.000) with the coefficients of determination (R2) of 0.39 and 0.28, respectively. CONCLUSION: More care should be taken in clinical practice when measuring the IPD of a fractured vertebra relative to those of adjacent lower levels in order to determine whether or not widening has occurred, especially IPD L1 vis-à-vis IPD L2. MPD measurement has no advantage over the IPD measurement but is a useful alternative when a comparison of the pedicular distance of L1 and L2 is needed.

Normal value of bone mineral density of lumbar spine, proximal femur, and distal forearm of women in different age groups.

The cross sectional, descriptive study was conducted to find the reference data for bone mineral density (BMD) in normal women in the area around Thammasat University Hospital. The study population consisted of 806 women aged 15-80 years. BMD of different parts of the body were measured by dual energy photon absorptiometer. The results showed that mean (+/- SD) BMD of the lumbar spine 2, 3, 4, neck of femur, Ward's triangle of femur, greater trochanter of femur, ultradistal part of radius, and distal ulnar averaged from all age groups were 0.954 +/- 0.144, 1.027 +/- 0.151, 1.059 +/- 0.147, 0.898 +/- 0.114, 0.774 +/- 0.165, 0.777 +/- 0.103, 0.412 +/- 0.073, and 0.585 +/- 0.096 g/cm2 respectively. Overall, the peak BMD was between the age of 40-44 years old. It started decreasing from the age of 45 and decreased remarkably after the age of 50. The data is shown to be a database for our hospital's health policy, but the authors believe that it could also be used as reference data for future studies in Thailand. It is suggested that normal values in different areas should be available in the future in order to provide more specific and better health care according to demographic variation.

Differences in bone mineral density and lifestyle factors of postmenopausal women living in Bangkok and other provinces.

Decreased bone mineral density (BMD) with age is an increasing health problem, especially for postmenopausal women. Multiple factors have been reported to affect BMD including both genetic and environmental factors such as calcium intake and physical activity. For Thailand, people residing in different regions may differ in BMD due to these factors. However, there is a paucity of data concerning this issue. The objectives of this study were to identify the lifestyle factors which may influence BMD and to investigate the association between BMD and these factors in postmenopausal women who have been living in Bangkok and other provinces in Thailand. Subjects consisted of 466 postmenopausal women aged 46-90 years including 236 Bangkokians (116 early postmenopausals and 120 late postmenopausals) and 230 non-Bangkokians (134 early postmenopausals and 96 late postmenopausals). All were healthy and ambulatory. BMD was measured by dual energy X-ray absorptiometry (DEXA, Expert XL). Calcium intake was assessed by food-frequency questionnaire. Data were expressed by mean + /- SEM. There were 22 per cent (n=52), 5.9 per cent (n=14), and 4.2 per cent (n=10) of postmenopausal Bangkokians while 13.9 per cent (n=32), 4.3 per cent (n=10), and 2.2 per cent (n=5) of postmenopausal non-Bangkokians who had low BMD at spine, femoral neck, and at both sites, respectively. Spine BMD (SPBMD) and femoral neck BMD (FNBMD) increased significantly across the quartiles of calcium intake in both groups of subjects (P<0.05) and a significant difference was found between the lowest and the highest quartiles of calcium intake (P<0.05). Moreover, BMD at both regions was shown to be correlated with calcium intake, exercise and sunlight exposure in these subjects (P<0.001). Further analysis revealed higher BMD at spine (0.992 + 0.02 vs 0.945 +/- 0.02 g/cm2, P<0.05) and at femur (0.780 +/- 0.01 vs 0.740 +/- 0.01 g/cm2, P<0.05), calcium intake (348.9 +/- 12.7 vs 316.3 +/- 8.0 mg/day, P<0.05), exercise (2.8 +/- 0.1 vs 2.4 +/- 0.1 h/wk, P<0.001) and sunlight exposure (2.9 +/- 0.06 vs 1.9 +/- 0.04 h/day, P<0.001) were found in late postmenopausal women in other provinces than their counterparts in Bangkok. Nevertheless, no significant difference of BMD at both sites, calcium intake and exercise was found in the early postmenopausal groups of these two areas. CONCLUSIONS: There were significant differences in BMD and lifestyle factors between late postmenopausal women in Bangkok and other provinces. Environmental factors especially calcium intake, exercise and sunlight exposure, may influence BMD in late postmenopausal Thai women.