| 旋转手法对颈椎髓核内压力影响的实验研究 |
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Received:December 14, 2009
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| 作者 | Author | 单位 | Unit | E-Mail |
| 孙树椿 |
SUN Shu-chun |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
sunshuchun01@163.com |
| 张军 |
ZHANG Jun |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 王立恒 |
WANG Li-heng |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 赵宜军 |
ZHAO Yi-jun |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 刘秀芹 |
LIU Xiu-qin |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 张淳 |
ZHANG Chun |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 于栋 |
YU Dong |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 王德龙 |
WANG De-long |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 武震 |
WU Zhen |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 陈朝晖 |
CHEN Zhao-hui |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 赵忠民 |
ZHAO Zhong-min |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 韩磊 |
HAN Lei |
中国中医科学院望京医院,北京 100700 |
Wangjing Hospital,China Academy of Chinese Medical Science,Beijing 100700,China |
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| 期刊信息：《中国骨伤》2010年23卷，第1期，第34-38页 |
| DOI：10.3969/j.issn.1003-0034.2010.01.011 |
| 基金项目:国家自然科学基金资助项目，项目批准号：30672705 |
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目的：通过模拟不同旋转手法，测量新鲜人体颈椎标本髓核内压力的变化。
方法：选取6例新鲜男性颈椎标本，利用生物力学材料实验机对标本进行力学加载。加载方案为：模拟头部重量及颈伸肌力加载100 N压力(5 s),然后分别以150 、200、300 N力量对标本进行不同顺序的牵引和旋转以及扳动。加载状态有A、B、C 3种。A状态：对标本先牵引，再加载旋转至最大角度，再向后扳动15°；B状态：对标本先加载旋转至最大角度，再加载牵引力，再向后扳动15°；C状态：同时加载牵引和旋转至最大角度，再向后扳动15°。力学加载同时利用微型压力传感器采集标本C3,4、C4,5、C5,6和C6,7髓核内如下指标的变化：模拟头部重量及颈伸肌力加载100 N压力(5 s)后髓核内压力变化；加载不同牵引力后对髓核内压力的变化；加载不同顺序牵引和旋转力后髓核内压力的变化；加载不同状态后进行扳动时髓核内压力的变化；加载不同力量的扳动时髓核内压力的变化。
结果：模拟头部重量及颈伸肌力加载100 N压力(5 s)后，C5,6,C6,7较C3,4,C4,5髓核内压力高(P<0.05);加载不同牵引力后，标本髓核内压力可随牵引力的增加而下降(P<0.05);加载不同顺序牵引和旋转力后，所有标本髓核内压力均出现升高，A状态髓核内压力随着加载牵引力的增加，压力升高的数值越小(P<0.05),加载B状态髓核内压力值随加载力量的增加而升高(P<0.05),加载C状态髓核内压力均升高不明显(P>0.05);加载不同牵引和旋转顺序后的扳动，所有标本髓核内压力均出现一过性地升高(P<0.05),A状态髓核内压力明显高于B、C状态(P<0.05);加载不同力量的扳动后，所有标本髓核内压力均出现一过性地升高(P<0.05),150 N扳动后髓核内压力明显高于200、300 N(P<0.05).
结论：在临床进行旋转手法操作时应尽量避免使用先旋转后牵引的手法，以避免造成髓核进一步突出的危险；同时应配合足够的牵引力来降低因旋转和扳动带来的髓核压力升高。 |
| [关键词]:手法，骨科 颈椎 髓核内压力 非治疗性人类实验 |
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| The influence of rotary manipulation on the internal pressure of cervical nucleus pulposus |
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Abstract:
Objective: To measure the pressure changes inside the cervical nucleus pulposus in fresh human cervical specimen by imitating different rotary manipulations.
Methods: The load of 100 N was applied for 5 second on the six fresh male cervical samples by using material test system,which imitated the human head weight and the strength of cervical extensor muscle. After that,traction,rotation and pulling on the samples were performed in different sequence under the force of 150,200,300 N respectively. Three states were included in adding the load state A:samples were loaded with traction and then rotation to the biggest angle, pulling backward for 15°；state B:samples were loaded with rotary stress to the biggest angle and then loaded with traction,pulling backward for 15°；state C:samples were loaded simultaneously with traction and rotary stress to the biggest angle,pulling backward for 15°。 The internal pressure of cervical nucleus pulposus at segment of C3,4,C4,5,C5,6,and C6,7 was measurred by micro-pressure sensors for state A,B,C and for the imitation of head weight and the strength of cervical extensor muscle.
Results: The pressure inside the cervical nucleus pulposus at segments C5,6,C6,7 was higher than that at segments C3,4 and C4,5(P<0.05) by loading stress with 100 N for 5 seconds. The internal pressure of the nucleus pulposus decreased with the increase of traction (P<0.05),and increased when traction and rotary force were loaded. State A,the value of increased pressure within the nucleus pulposus became smaller and smaller while increasing of the traction force loaded(P<0.05). State B,the increase of internal pressure in nucleus pulposus became obvious as loading pressure increased (P<0.05). State C,the internal pressure in nucleus pulposus was not increased obviously (P>0.05). There was a transitional pressure raise inside all cervical nucleus pulposus when pulling added after different sepuence traction and rotary strength was applied, however,the internal pressure of state A was significantly higher than that of state B or C(P<0.05). There was also a transitional pressure raise inside all cervical nucleus pulposus when pulling added in different strength (P<0.05),the internal pressure by pulling with 150 N was obviously higher than that with 200 N and 300 N(P<0.05).
Conclusion: The order of rotation first and traction second should be avoided when practice of rotary manupuplation in case protrusion of the nucleus pulposus. Meanwhile,proper traction should be applied along with rotary manipulation in order to increase its safety. |
| KEYWORDS:Manipulation,orthopedic Cervical vertebrae Pressure inside nucleus pulposus Nontherapeutic human experimentation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙树椿,张军,王立恒,赵宜军,刘秀芹,张淳,于栋,王德龙,武震,陈朝晖,赵忠民,韩磊.旋转手法对颈椎髓核内压力影响的实验研究[J].中国骨伤,2010,23(1):34~38 |
| 英文格式: | SUN Shu-chun,ZHANG Jun,WANG Li-heng,ZHAO Yi-jun,LIU Xiu-qin,ZHANG Chun,YU Dong,WANG De-long,WU Zhen,CHEN Zhao-hui,ZHAO Zhong-min,HAN Lei.The influence of rotary manipulation on the internal pressure of cervical nucleus pulposus[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(1):34~38 |
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