坐位腰椎旋转手法治疗退行性腰椎滑脱症的临床及在体运动力学研究
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摘要
研究背景：
退行性腰椎滑脱症是骨科临床常见疾病之一,随着电脑和机动车的广泛普及,本病的患病群日趋年轻化。该病属于祖国医学中“痹症,痿证”范畴,其病理机制主要与“骨错缝、筋出槽”有关。中医正骨手法是治疗退行性腰椎滑脱症的重要手段,其中,坐位腰椎旋转手法在临床使用最为广泛,其操作具有稳、准、轻、巧的特点,临床疗效显著。目前该手法已被国家中医药管理局立项为“中医药行业科研专项”项目,而本研究的临床内容即为该项目的一部分。本研究将采用多中心随机对照的循证医学研究方法验证坐位腰椎旋转手法治疗退行性腰椎滑脱症的有效性,并通过影像学资料探讨该手法的部分作用机制。
然而,坐位腰椎旋转手法是一项技巧性强的医疗操作技术,虽然已经规范了该手法操作的步骤,但尚无客观的技术指标作为参考,使得临床上经验化的手法操作无法很好的转化为一系列标准化、数量化的运动力学指标。同时,既往的研究中对于坐位腰椎旋转手法的力学探索也不够充分,尤其缺乏对于影响因素的量化研究,除此之外,对于该手法的运动学研究也处于空白,因此尚未形成可信赖的运动力学评价方法。
整个手法操作的过程可通过力学量化手段,将其手法特征进行数据化的提取及分析,可作为客观的评价方法运用于临床。因此,为将基础研究更好的应用于临床,本研究的实验部分将选择临床研究中经验丰富的手法操作者,首次采用自行研制的坐位腰椎旋转手法力学测量仪结合运动捕捉技术进行在体运动力学实测,对坐位腰椎旋转手法的操作特征、影响因素等进行研究,并为今后的运动力学评价提供量化支持依据。
研究目的：
1研究坐位腰椎旋转手法治疗退行性腰椎滑脱症的临床疗效及部分作用机制,为下一步实验研究奠定临床基础。
2研究坐位腰椎旋转手法操作的运动力学参数及其相互关系,并总结坐位腰椎旋转手法操作的运动力学特征,同时探讨对本手法操作可能的影响因素,使得手法的量化操作具有临床意义。
研究内容：
1临床研究：采用多中心随机对照的循证医学研究方法(治疗组为坐位腰椎旋转手法加腰椎康复操,对照组为仰卧位腰椎牵引法加腰围制动),对66例确诊为退行性腰椎滑脱症的患者进行对比研究,验证坐位腰椎旋转手法治疗退行性腰椎滑脱症的有效性,同时通过比较两组患者治疗前后影像学上滑脱腰椎的平行、角度位移,探讨该手法的部分作用机制,为下一步实验研究奠定临床基础。
2实验研究：采集受试者对坐位腰椎旋转手法可能的影响指标(年龄、身高、体重、体重指数),通过自行研制的坐位腰椎旋转手法力学测量仪,实时测量同一手法操作者对31例受试者施行坐位腰椎旋转手法过程中的力学参数(预加载力、最大作用力、旋扳力、旋扳时间、拇指最大推扳力),同时首次应用运动捕捉技术对坐位腰椎旋转手法的操作过程进行动态描记以测量其运动学参数(最大速度、最大加速度、扳动前后角度变化)。通过数据分析,总结该手法操作的运动力学特征,并找出各个力学参数及与影响指标间的相关性,分析并探讨受试者个体特征对坐位腰椎旋转手法操作可能的影响因素。
结果：
1临床研究：
(1)两组患者治疗3周后、随访期的VAS积分与治疗前相比,差异极具统计学意义(P<0.01)。
(2)治疗组患者治疗3周后、随访期的VAS积分改善情况与对照组相比,差异极具统计学意义(P<0.01)。
(3)两组患者治疗3周后、随访期的JOA积分与治疗前相比,差异极具统计学意义(P<0.01)。
(4)治疗组患者的临床疗效与对照组相比,治疗3周后差异有统计学意义(P<0.05),随访期差异极具统计学意义(P<0.01)。
(5)治疗组患者治疗3周后滑脱腰椎在影像学上的角度位移与治疗前相比,差异有统计学意义(P<0.05)。
2实验研究：
(1)坐位腰椎旋转手法运动力学参数平均值如下：预加载力3.60±0.18kg,最大作用力8.17+0.26kg,旋扳力6.75±0.33kg,旋扳时间0.53±0.02s,拇指最大推扳力9.22+0.34kg,最大速度500.29±20.78mm/s,最大加速度3193.58±174.87mm/s2,扳动前后前屈角度变化5.47+1.10°,扳动前后侧弯角度变化12.09±1.16°,扳动前后旋转角度变化10.07±1.04°。
(2)操作者施行坐位腰椎旋转手法时,左、右手的运动力学参数均无显著性差异(P>0.05)。
(3)经Pearson相关分析,最大作用力、旋扳力、最大速度、最大加速度之间存在极显著的正相关性(R>0.8,P<0.01)；预加载力与最大作用力、旋扳力、最大速度、最大加速度之间存在较强的正相关性(R>0.6,P<0.01)。
(4)经多元线性回归分析,受试者的身高、体重、体重指数与操作者的预加载力有显著的相关性(R>0.4,P<0.05)；受试者的身高、年龄对操作者的旋扳力与最大作用力有显著的相关性(R>0.4,P<0.05)；受试者的年龄对操作者的旋扳时间有显著的相关性(R>0.4,P<0.01)；受试者的身高对操作者的最大速度与最大加速度有显著的相关性(R>0.4,P<0.01)。
结论：
1临床研究：
(1)坐位腰椎旋转手法能有效改善退行性腰椎滑脱症的临床症状,且随访期疗效稳定。
(2)坐位腰椎旋转手法对于滑移腰椎椎体的角度位移具有调整作用。
2实验研究：
(1)较全面的得出坐位腰椎旋转手法的运动力学参数值,填补该手法运动学研究方面的空白,为今后临床上的教学培养及进一步的基础研究提供了可供参考的量化支持依据：预加载力3.60+0.18kg,最大作用力8.17±0.26kg,旋扳力6.75±0.33kg,旋扳时间0.53±0.02s,拇指最大推扳力9.22±0.34kg,最大速度500.29±20.78mm/s,最大加速度3193.58±174.87mm/s2,扳动前后前屈角度变化5.47±1.10°,扳动前后侧弯角度变化12.09±1.16°,扳动前后旋转角度变化10.07±1.04°。
(2)左右手施行坐位腰椎旋转手法时的运动力学参数(预加载力、最大作用力、旋扳力、旋扳时间、拇指最大推扳力、最大速度、最大加速度、扳动后前屈、侧弯、旋转角度变化)是相近的。因此在临床上,左右手的手法操作应无明显区别。
(3)总结坐位腰椎旋转手法的操作特征,即在手法操作时,预加载力越大,则旋扳力越大,继而加速度也越大,预加载力在一定程度上决定了旋扳力及加速度的大小。
(4)经过研究发现,受试者的年龄、身高、体重、体重指数等个体特征是坐位腰椎旋转手法操作的重要影响因素,这在既往的研究中很少提及。
创新点：
1自行研制适合于坐位腰椎旋转手法的在体力学测量仪,并应用于临床实测,首次全面分析坐位腰椎旋转手法临床操作的力学参数。
2采用运动捕捉技术,首次进行坐位腰椎旋转手法临床操作的运动学分析,填补该研究领域空白。
3本研究将采集受试者对坐位腰椎旋转手法可能的影响指标,并分析影响指标与各个参数间的相关关系,探讨受试者的个体特征对坐位腰椎旋转手法操作可能的影响因素,这在既往的文献中很少提及。
Background:
Degenerative lumbar spondylolisthesis (DLS) is one of the common diseases in orthopaedic. Traditional Chinese medicine (TCM) know it for a long time, and which belongs to "bone malposition" and "tendon displacement" in TCM and can be treated by manipulation. Seated lumbar rotation manipulation, which is widely used in the clinical, has features of stable, accurate, light and artful, and the process of treatment for spinal has truly achieving minimally invasive, even noninvasive, above all, it's effective in treatment. This study will adopt the methods of multicenter randomized control to test the clinical curative effect of DLS, and then discuss part of mechanism of manipulation through imaging data.
But, seated lumbar rotation manipulation needs strong skill. There is no objective technical indicator as reference, though we have already regulate the operation steps. In other words, experienced manipulation have not transformed into a series of quantitative standardized indicators yet. Meanwhile, owing to the insufficiency of research on kinematics and mechanics of seated lumbar rotation manipulation and quantitative research on its influencing factors, the reliable evaluation methodology on kinematics and mechanics still not be built up yet.
Mechanical quantification, through mathematical extraction and analysis of mechanical characteristics in the process of manipulation, can be put into practice as an objective evaluation methodology. Therefore, in order to apply fundamental research to clinical practice better, the study will select experienced operator from clinical research to make a real-time measurement of the in vivo kinematic and mechanical parameters by using mechanical measuring instrument that made by ourselves and motion capture technology, and study the mechanical characteristics and influencing factors of seated lumbar rotation manipulation so as to provide the basis for quantitative evaluation of kinematics and mechanics in future.
Objective:
1To study the clinical effects and partial mechanism of action of seated lumbar rotation manipulation in treating DLS, and provide experienced manipulation operator for the following experiment research.
2To study the kinematic and mechanical parameters and the correlation during seated lumbar rotation manipulation, summarize the kinematic and mechanical characteristics of seated lumbar rotation manipulation, and discuss the potential influencing factors of seated lumbar rotation manipulation.
Method:
1Clinical research:Through making a comparative study among60DLS patients by adopting the methods of multicenter randomized control, to test the clinical curative effect of the seated lumbar rotation manipulation in treating DLS and discuss partial mechanism of manipulation through imaging data, and provide experienced manipulation operator for the following experiment research.
2Experiment research:To collect the potential influencing factors during manipulation among patients (age, height, weight, body mass index (BMI)), and made a real-time measurement of mechanical parameters (preload force, peak force, rotary thrust force, rotary thrust duration, thumb thrust force) by using the mechanical measuring instrument that made by ourselves and kinematic parameters (peak velocity, peak acceleration, angular variation) by using motion capture technology when chief physician Gao conducted seated lumbar rotation manipulation to31subjects. Then summarized the kinematic and mechanical characteristics of seated lumbar rotation manipulation, and made an analysis of the correlativity of influencing indicators and the kinematic and mechanical parameters, and carried out a discussion of potential influencing factors on seated lumbar rotation manipulation among subjects with different traits.
Results:
1Clinical research:
(1) Compared with prior treatment,2groups had highly significant difference on VAS after3weeks treatment and follow-up period (P<0.01)
(2) Compared with control group, the treatment group had highly significant difference on VAS after3weeks treatment and follow-up period (P<0.01)
(3) Compared with prior treatment,2groups had highly significant difference on JOA after3weeks treatment and follow-up period (P<0.01)
(4) Compared with control group, the treatment group had significant difference on the clinical effect of JOA after3weeks treatment (P<0.05) and highly significant difference in follow-up period (P<0.01)
(5) Compared with prior treatment,, the treatment group had a significant difference on angular displacement after3weeks treatment (P<0.05)
2Experiment research:
(1) The average value of parameters during seated lumbar rotation manipulation were as follows:the preload force is3.60±0.18kg, the peak force is8.17±0.26kg, the rotary thrust force is6.75±0.33kg, the rotary thrust duration is0.53±0.02s, the thumb thrust force is9.22±0.34kg, the peak velocity is500.29±20.78mm/s, the peak acceleration is3193.58±174.87mm/s2, the variation of anteflexion is5.47±1.10°, the variation of lateral curvature is12.09±1.16°, the variation of rotation is10.07±1.04°.
(2) No significant difference (P>0.05) showed between the left and the right hand of the kinematic and mechanical parameters during seated lumbar rotation manipulation.
(3) By pearson correlation analysis, there was a prominent positive correlation (R>0.8, P<0.01) among the peak force, rotary thrust force, peak velocity, peak acceleration; a positive correlation (R>0.6, P<0.01) among the preload force and rotary thrust force, peak velocity, peak acceleration.
(4) By multivariate linear regression, we revealed that the preload force has prominent correlation (R>0.4, P<0.05) with height, weight and BMI; the peak force and rotary thrust force have prominent correlation (R>0.4,P<0.05) with age and height; the rotary thrust duration has prominent correlation (R>0.4, P<0.01) with age; the peak velocity and peak acceleration have prominent correlation (R>0.4, P <0.01) with height.
Conclusion:
1Clinical research:
(1) The seated lumbar rotation manipulation can significantly improve the clinical symptoms of DLS, and relapse rarely.
(2) The rotary lumbar can be adjusted by the seated lumbar rotation manipulation.
2Experiment research:
(1) The average value of parameters for clinical reference during seated lumbar rotation manipulation were as follows:the preload force is3.60±0.18kg, the peak force is8.17±0.26kg, the rotary thrust force is6.75±0.33kg, the rotary thrust duration is0.53±0.02s, the thumb thrust force is9.22±0.34kg, the peak velocity is500.29±20.78mm/s, the peak acceleration is3193.58±174.87mm/s2, the variation of anteflexion is5.47±1.10°, the variation of lateral curvature is12.09±1.16°, the variation of rotation is10.07±1.04°.
(2) The kinematic and mechanical parameters (preload force, peak force, rotary thrust force, rotary thrust duration, thumb thrust force, peak velocity, peak acceleration, angular variation) between the left and the right hand during seated lumbar rotation manipulation were approximate.
(3) During seated lumbar rotation manipulation, the more powerful preload force is, the greater rotary thrust force and peak acceleration are. The strength of rotary thrust force and peak acceleration partial depends on that of preload force, which is characterized by seated lumbar rotation manipulation.
(4) Age, height, weight and BMI are the influencing factors of seated lumbar rotation manipulation.
Innovation point:
1. To make a real-time measurement of mechanical parameters for the first time during manipulation by using the mechanical measuring instrument that made by ourselves.
2. To make a real-time measurement of kinematic parameters for the first time during manipulation by using motion capture technology.
3. To make an analysis of the correlativity of influencing indicators and the kinematic and mechanical parameters, and carried out a discussion of potential influencing factors on seated lumbar rotation manipulation among subjects with different traits. It is rarely mentioned in the past articles.
退行性腰椎滑脱症是骨科临床常见疾病之一,随着电脑和机动车的广泛普及,本病的患病群日趋年轻化。该病属于祖国医学中“痹症,痿证”范畴,其病理机制主要与“骨错缝、筋出槽”有关。中医正骨手法是治疗退行性腰椎滑脱症的重要手段,其中,坐位腰椎旋转手法在临床使用最为广泛,其操作具有稳、准、轻、巧的特点,临床疗效显著。目前该手法已被国家中医药管理局立项为“中医药行业科研专项”项目,而本研究的临床内容即为该项目的一部分。本研究将采用多中心随机对照的循证医学研究方法验证坐位腰椎旋转手法治疗退行性腰椎滑脱症的有效性,并通过影像学资料探讨该手法的部分作用机制。
然而,坐位腰椎旋转手法是一项技巧性强的医疗操作技术,虽然已经规范了该手法操作的步骤,但尚无客观的技术指标作为参考,使得临床上经验化的手法操作无法很好的转化为一系列标准化、数量化的运动力学指标。同时,既往的研究中对于坐位腰椎旋转手法的力学探索也不够充分,尤其缺乏对于影响因素的量化研究,除此之外,对于该手法的运动学研究也处于空白,因此尚未形成可信赖的运动力学评价方法。
整个手法操作的过程可通过力学量化手段,将其手法特征进行数据化的提取及分析,可作为客观的评价方法运用于临床。因此,为将基础研究更好的应用于临床,本研究的实验部分将选择临床研究中经验丰富的手法操作者,首次采用自行研制的坐位腰椎旋转手法力学测量仪结合运动捕捉技术进行在体运动力学实测,对坐位腰椎旋转手法的操作特征、影响因素等进行研究,并为今后的运动力学评价提供量化支持依据。
研究目的：
1研究坐位腰椎旋转手法治疗退行性腰椎滑脱症的临床疗效及部分作用机制,为下一步实验研究奠定临床基础。
2研究坐位腰椎旋转手法操作的运动力学参数及其相互关系,并总结坐位腰椎旋转手法操作的运动力学特征,同时探讨对本手法操作可能的影响因素,使得手法的量化操作具有临床意义。
研究内容：
1临床研究：采用多中心随机对照的循证医学研究方法(治疗组为坐位腰椎旋转手法加腰椎康复操,对照组为仰卧位腰椎牵引法加腰围制动),对66例确诊为退行性腰椎滑脱症的患者进行对比研究,验证坐位腰椎旋转手法治疗退行性腰椎滑脱症的有效性,同时通过比较两组患者治疗前后影像学上滑脱腰椎的平行、角度位移,探讨该手法的部分作用机制,为下一步实验研究奠定临床基础。
2实验研究：采集受试者对坐位腰椎旋转手法可能的影响指标(年龄、身高、体重、体重指数),通过自行研制的坐位腰椎旋转手法力学测量仪,实时测量同一手法操作者对31例受试者施行坐位腰椎旋转手法过程中的力学参数(预加载力、最大作用力、旋扳力、旋扳时间、拇指最大推扳力),同时首次应用运动捕捉技术对坐位腰椎旋转手法的操作过程进行动态描记以测量其运动学参数(最大速度、最大加速度、扳动前后角度变化)。通过数据分析,总结该手法操作的运动力学特征,并找出各个力学参数及与影响指标间的相关性,分析并探讨受试者个体特征对坐位腰椎旋转手法操作可能的影响因素。
结果：
1临床研究：
(1)两组患者治疗3周后、随访期的VAS积分与治疗前相比,差异极具统计学意义(P<0.01)。
(2)治疗组患者治疗3周后、随访期的VAS积分改善情况与对照组相比,差异极具统计学意义(P<0.01)。
(3)两组患者治疗3周后、随访期的JOA积分与治疗前相比,差异极具统计学意义(P<0.01)。
(4)治疗组患者的临床疗效与对照组相比,治疗3周后差异有统计学意义(P<0.05),随访期差异极具统计学意义(P<0.01)。
(5)治疗组患者治疗3周后滑脱腰椎在影像学上的角度位移与治疗前相比,差异有统计学意义(P<0.05)。
2实验研究：
(1)坐位腰椎旋转手法运动力学参数平均值如下：预加载力3.60±0.18kg,最大作用力8.17+0.26kg,旋扳力6.75±0.33kg,旋扳时间0.53±0.02s,拇指最大推扳力9.22+0.34kg,最大速度500.29±20.78mm/s,最大加速度3193.58±174.87mm/s2,扳动前后前屈角度变化5.47+1.10°,扳动前后侧弯角度变化12.09±1.16°,扳动前后旋转角度变化10.07±1.04°。
(2)操作者施行坐位腰椎旋转手法时,左、右手的运动力学参数均无显著性差异(P>0.05)。
(3)经Pearson相关分析,最大作用力、旋扳力、最大速度、最大加速度之间存在极显著的正相关性(R>0.8,P<0.01)；预加载力与最大作用力、旋扳力、最大速度、最大加速度之间存在较强的正相关性(R>0.6,P<0.01)。
(4)经多元线性回归分析,受试者的身高、体重、体重指数与操作者的预加载力有显著的相关性(R>0.4,P<0.05)；受试者的身高、年龄对操作者的旋扳力与最大作用力有显著的相关性(R>0.4,P<0.05)；受试者的年龄对操作者的旋扳时间有显著的相关性(R>0.4,P<0.01)；受试者的身高对操作者的最大速度与最大加速度有显著的相关性(R>0.4,P<0.01)。
结论：
1临床研究：
(1)坐位腰椎旋转手法能有效改善退行性腰椎滑脱症的临床症状,且随访期疗效稳定。
(2)坐位腰椎旋转手法对于滑移腰椎椎体的角度位移具有调整作用。
2实验研究：
(1)较全面的得出坐位腰椎旋转手法的运动力学参数值,填补该手法运动学研究方面的空白,为今后临床上的教学培养及进一步的基础研究提供了可供参考的量化支持依据：预加载力3.60+0.18kg,最大作用力8.17±0.26kg,旋扳力6.75±0.33kg,旋扳时间0.53±0.02s,拇指最大推扳力9.22±0.34kg,最大速度500.29±20.78mm/s,最大加速度3193.58±174.87mm/s2,扳动前后前屈角度变化5.47±1.10°,扳动前后侧弯角度变化12.09±1.16°,扳动前后旋转角度变化10.07±1.04°。
(2)左右手施行坐位腰椎旋转手法时的运动力学参数(预加载力、最大作用力、旋扳力、旋扳时间、拇指最大推扳力、最大速度、最大加速度、扳动后前屈、侧弯、旋转角度变化)是相近的。因此在临床上,左右手的手法操作应无明显区别。
(3)总结坐位腰椎旋转手法的操作特征,即在手法操作时,预加载力越大,则旋扳力越大,继而加速度也越大,预加载力在一定程度上决定了旋扳力及加速度的大小。
(4)经过研究发现,受试者的年龄、身高、体重、体重指数等个体特征是坐位腰椎旋转手法操作的重要影响因素,这在既往的研究中很少提及。
创新点：
1自行研制适合于坐位腰椎旋转手法的在体力学测量仪,并应用于临床实测,首次全面分析坐位腰椎旋转手法临床操作的力学参数。
2采用运动捕捉技术,首次进行坐位腰椎旋转手法临床操作的运动学分析,填补该研究领域空白。
3本研究将采集受试者对坐位腰椎旋转手法可能的影响指标,并分析影响指标与各个参数间的相关关系,探讨受试者的个体特征对坐位腰椎旋转手法操作可能的影响因素,这在既往的文献中很少提及。
Background:
Degenerative lumbar spondylolisthesis (DLS) is one of the common diseases in orthopaedic. Traditional Chinese medicine (TCM) know it for a long time, and which belongs to "bone malposition" and "tendon displacement" in TCM and can be treated by manipulation. Seated lumbar rotation manipulation, which is widely used in the clinical, has features of stable, accurate, light and artful, and the process of treatment for spinal has truly achieving minimally invasive, even noninvasive, above all, it's effective in treatment. This study will adopt the methods of multicenter randomized control to test the clinical curative effect of DLS, and then discuss part of mechanism of manipulation through imaging data.
But, seated lumbar rotation manipulation needs strong skill. There is no objective technical indicator as reference, though we have already regulate the operation steps. In other words, experienced manipulation have not transformed into a series of quantitative standardized indicators yet. Meanwhile, owing to the insufficiency of research on kinematics and mechanics of seated lumbar rotation manipulation and quantitative research on its influencing factors, the reliable evaluation methodology on kinematics and mechanics still not be built up yet.
Mechanical quantification, through mathematical extraction and analysis of mechanical characteristics in the process of manipulation, can be put into practice as an objective evaluation methodology. Therefore, in order to apply fundamental research to clinical practice better, the study will select experienced operator from clinical research to make a real-time measurement of the in vivo kinematic and mechanical parameters by using mechanical measuring instrument that made by ourselves and motion capture technology, and study the mechanical characteristics and influencing factors of seated lumbar rotation manipulation so as to provide the basis for quantitative evaluation of kinematics and mechanics in future.
Objective:
1To study the clinical effects and partial mechanism of action of seated lumbar rotation manipulation in treating DLS, and provide experienced manipulation operator for the following experiment research.
2To study the kinematic and mechanical parameters and the correlation during seated lumbar rotation manipulation, summarize the kinematic and mechanical characteristics of seated lumbar rotation manipulation, and discuss the potential influencing factors of seated lumbar rotation manipulation.
Method:
1Clinical research:Through making a comparative study among60DLS patients by adopting the methods of multicenter randomized control, to test the clinical curative effect of the seated lumbar rotation manipulation in treating DLS and discuss partial mechanism of manipulation through imaging data, and provide experienced manipulation operator for the following experiment research.
2Experiment research:To collect the potential influencing factors during manipulation among patients (age, height, weight, body mass index (BMI)), and made a real-time measurement of mechanical parameters (preload force, peak force, rotary thrust force, rotary thrust duration, thumb thrust force) by using the mechanical measuring instrument that made by ourselves and kinematic parameters (peak velocity, peak acceleration, angular variation) by using motion capture technology when chief physician Gao conducted seated lumbar rotation manipulation to31subjects. Then summarized the kinematic and mechanical characteristics of seated lumbar rotation manipulation, and made an analysis of the correlativity of influencing indicators and the kinematic and mechanical parameters, and carried out a discussion of potential influencing factors on seated lumbar rotation manipulation among subjects with different traits.
Results:
1Clinical research:
(1) Compared with prior treatment,2groups had highly significant difference on VAS after3weeks treatment and follow-up period (P<0.01)
(2) Compared with control group, the treatment group had highly significant difference on VAS after3weeks treatment and follow-up period (P<0.01)
(3) Compared with prior treatment,2groups had highly significant difference on JOA after3weeks treatment and follow-up period (P<0.01)
(4) Compared with control group, the treatment group had significant difference on the clinical effect of JOA after3weeks treatment (P<0.05) and highly significant difference in follow-up period (P<0.01)
(5) Compared with prior treatment,, the treatment group had a significant difference on angular displacement after3weeks treatment (P<0.05)
2Experiment research:
(1) The average value of parameters during seated lumbar rotation manipulation were as follows:the preload force is3.60±0.18kg, the peak force is8.17±0.26kg, the rotary thrust force is6.75±0.33kg, the rotary thrust duration is0.53±0.02s, the thumb thrust force is9.22±0.34kg, the peak velocity is500.29±20.78mm/s, the peak acceleration is3193.58±174.87mm/s2, the variation of anteflexion is5.47±1.10°, the variation of lateral curvature is12.09±1.16°, the variation of rotation is10.07±1.04°.
(2) No significant difference (P>0.05) showed between the left and the right hand of the kinematic and mechanical parameters during seated lumbar rotation manipulation.
(3) By pearson correlation analysis, there was a prominent positive correlation (R>0.8, P<0.01) among the peak force, rotary thrust force, peak velocity, peak acceleration; a positive correlation (R>0.6, P<0.01) among the preload force and rotary thrust force, peak velocity, peak acceleration.
(4) By multivariate linear regression, we revealed that the preload force has prominent correlation (R>0.4, P<0.05) with height, weight and BMI; the peak force and rotary thrust force have prominent correlation (R>0.4,P<0.05) with age and height; the rotary thrust duration has prominent correlation (R>0.4, P<0.01) with age; the peak velocity and peak acceleration have prominent correlation (R>0.4, P <0.01) with height.
Conclusion:
1Clinical research:
(1) The seated lumbar rotation manipulation can significantly improve the clinical symptoms of DLS, and relapse rarely.
(2) The rotary lumbar can be adjusted by the seated lumbar rotation manipulation.
2Experiment research:
(1) The average value of parameters for clinical reference during seated lumbar rotation manipulation were as follows:the preload force is3.60±0.18kg, the peak force is8.17±0.26kg, the rotary thrust force is6.75±0.33kg, the rotary thrust duration is0.53±0.02s, the thumb thrust force is9.22±0.34kg, the peak velocity is500.29±20.78mm/s, the peak acceleration is3193.58±174.87mm/s2, the variation of anteflexion is5.47±1.10°, the variation of lateral curvature is12.09±1.16°, the variation of rotation is10.07±1.04°.
(2) The kinematic and mechanical parameters (preload force, peak force, rotary thrust force, rotary thrust duration, thumb thrust force, peak velocity, peak acceleration, angular variation) between the left and the right hand during seated lumbar rotation manipulation were approximate.
(3) During seated lumbar rotation manipulation, the more powerful preload force is, the greater rotary thrust force and peak acceleration are. The strength of rotary thrust force and peak acceleration partial depends on that of preload force, which is characterized by seated lumbar rotation manipulation.
(4) Age, height, weight and BMI are the influencing factors of seated lumbar rotation manipulation.
Innovation point:
1. To make a real-time measurement of mechanical parameters for the first time during manipulation by using the mechanical measuring instrument that made by ourselves.
2. To make a real-time measurement of kinematic parameters for the first time during manipulation by using motion capture technology.
3. To make an analysis of the correlativity of influencing indicators and the kinematic and mechanical parameters, and carried out a discussion of potential influencing factors on seated lumbar rotation manipulation among subjects with different traits. It is rarely mentioned in the past articles.
引文
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