Etude experimentale du rachis cervical : comportement mecanique in vitro et cinematique in vivo

L'etude experimentale du rachis cervical est essentielle pour la comprehension de son fonctionnement normal et pour discerner les roles fonctionnels des divers elements. En outre, la mise en place de systeme d'evaluation du rachis lese et instrumente est primordiale pour s'assurer d'une bonne stabilisation des pathologies par les differentes osteosyntheses. Cette etude a donc pour objectif d'augmenter la base de donnees concernant le comportement du rachis cervical. Pour cela, nous avons realise des essais in vitro sur segments cadaveriques de l'occiput a t1. Les mobilites intervertebrales sous chargement physiologique ont ete analysees pour chaque unite fonctionnelle. Les sollicitations sont des couples de purs de flexion/extension, inflexion laterale et torsion axiale. Plusieurs dispositifs d'osteosyntheses ont aussi ete etudies dans cette etude en comparant le comportement de segments sains puis leses et instrumentes. L'objectif de ces essais consiste a s'assurer d'une bonne stabilisation post-operatoire de la colonne. Parallelement, la cinematique du rachis cervical de 120 personnes saines a ete analysee. Pour cela, chaque sujet a realise des cycles de deplacement en flexion/extension, inclinaison et rotation axiale. L'analyse des deplacements tridimensionnels a ete faite a l'aide d'un dispositif optique de reconstruction tridimensionnelle compose de cameras. In vitro, les courbes de comportement des unites fonctionnelles sont fortement non lineaires. Aux alentours du point d'equilibre, nous avons une zone de tres faible rigidite (zone neutre), suivi d'une zone rigide, quasi asymptotique en fin de chargement. C'est sous torsion axiale que les mobilites sont les plus importantes, suivi par la flexion/extension et par l'inflexion laterale. Sous torsion axiale, plus de 50% de la mobilite totale du cou est obtenue au niveau c1/c2. In vivo, nous observons d'autre part une decroissance de la mobilite avec l'age, particulierement importante pour les hommes.

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