神经根型颈椎病X线片表现的临床研究及旋提手法作用机理研究
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摘要
研究背景
颈椎病属于骨科常见病。我国颈椎病患病率约达3.8%～17.5%,并呈迅速增加和年轻化趋势。神经根型颈椎病占各型颈椎病总数的60%以上。旋提手法是治疗神经根型颈椎病重要的中医手段。该手法经过国家十五攻关课题、国家十一五支撑计划及国家自然科学基金的立项研究,已证明了其有效性及安全性,并已被国家中医药管理局立项向全国推广应用。但该手法作用机理的基础研究一直滞后,不能满足临床的需要。
在前期临床研究中发现神经根型颈椎病的X线片表现可能与其他类型颈椎病的X线片表现存在一定的差异。回顾既往文献发现,关于神经根型颈椎病影像学表现的总结性分析较为多见,但甚少进行神经根型颈椎病与其他类型颈椎病影像学表现的对比研究。
在前期基础研究中,通过小样本的旋提手法在体力学研究,初步总结了旋提手法的力学参数,发现旋提手法的操作具有一定的规律性,并通过模拟旋提手法的离体生物力学研究证明了该手法具有降低颈椎髓核内压力的作用。延续既往实验成果,进一步搞清楚旋提手法施加于颈椎的力学状态、力在颈椎内的传导变化及力引起颈椎空间结构的变化情况,将有助于揭示旋提手法的作用机理。
研究目的
1、分析神经根型颈椎病(CSR)与椎动脉型颈椎病(VCS)X线片表现的异同；
2、分析不同状态旋提手法对下颈椎椎体三维位移、髓核内压力及椎间孔变化的影响,探讨旋提手法的生物力学作用机理；
研究内容
1、神经根型颈椎病与椎动脉型颈椎病X线片表现的对比分析
采用盲法设计,应用ImageJ软件测量和记录60例神经根型颈椎病及60例椎动脉型颈椎病患者的颈椎侧位及功能位X线片表现,包括颈椎曲度、寰枕关节间角、寰枢关节间角、C2/C3间角、寰枕关节后方间距、寰枢关节后方间距、关节间角前屈活动度、关节间角后伸活动度及下颈椎失稳节段和分布,破盲后进行数据分析,比较两组间差异。
2、旋提手法对下颈椎椎体位移及髓核内压力影响的的离体生物力学研究
采用MTS材料机在7具新鲜颈段标本上进行模拟牵引、不同作用力及不同定位角度的旋提手法,同时利用运动捕捉技术对下颈椎椎体的三维位移进行动态测量以及利用微型压力传感器实测法对颈椎(C2/3、C3/4、C4/5、C5/6、C6/7)髓核内压力进行动态测量。通过分析及比较模拟不同状态旋提手法对颈椎椎体位移及髓核内压力的力学影响,探讨旋提手法的生物力学作用机理。
3、基于虚拟现实互动技术对旋提手法作用下颈椎间孔结构变化的动态分析
应用螺旋CT薄层扫描颈椎标本,运用mimics软件进行三维颈椎实体重建,依据旋提手法过程下颈椎椎体的运动轨迹通过Autodesk maya软件进行多模医学图像三维配准实现动态虚拟现实仿真,随后进行动态图像处理,然后分别采用ImageJ软件及Adobe photoshop软件测量旋提手法前后下颈椎椎间孔的纵径及面积的变化,研究旋提手法对下颈椎椎间孔的力学作用。
研究结果
1、神经根型颈椎病与椎动脉型颈椎病X线片表现的对比分析
(1)在前屈位X线片中,VCS组的颈椎曲度小于CSR组,统计学具有显著性差异(P<0.05)；
(2)VCS组寰枕关节间角的后伸活动度明显大于CSR组,统计学具有极显著性差异(P<0.01)；
(3)在侧位X线片中,VCS组寰枢关节间角小于CSR组,统计学具有显著性差异(P<0.05)；
(4)VCS组寰枢关节间角的前屈度小于CSR组,统计学具有显著性差异(P<0.05)；
(5)VCS组及CSR组的下颈椎失稳发生比例及节段分布均没有显著性统计学差异。
2、旋提手法对下颈椎椎体三维位移及髓核内压力影响的的离体生物力学研究
(1)中立位牵引后C4-7各椎体中点的位移均大于定位牵引后的位移(P<0.05)；
(2)定位牵引后C4右侧横突的位移大于左侧横突的位移(P<0.01)；
(3)定位牵引后C4右侧横突的位移明显大于C5、C6及C7右侧横突的位移(P<0.01)
(4)模拟50N、150N及250N扳动力组预牵引后C4右侧横突的位移明显大于同节段左侧横突位移(P<0.01),而C5左侧横突的位移明显大于同节段右侧横突位移(P<0.01)；
(5)模拟50N、150N及250N扳动力组预牵引后C4右侧横突的位移明显大于C5、C6及C7右侧横突的位移(P<0.05)；
(6)模拟50N扳动力组扳动后下颈椎各椎体双侧横突及椎体中点的位移均明显小于模拟150N扳动力组及模拟250N扳动力组同节段的位移(P<0.01)。
(7)模拟前屈0度、10度及20度旋提手法组预牵引后C4右侧横突的位移明显大于同节段左侧横突位移(P<0.01),而C5左侧横突的位移明显大于同节段右侧横突位移(P<0.01)；
(8)模拟前屈0度、10度及20度旋提手法组预牵引后C4右侧横突的位移明显大于C5、C6及C7右侧横突的位移(P<0.01)；
(9)模拟前屈0度旋提手法组预牵引后C6及C7椎体中点位移均分别明显大于模拟前屈10度组和模拟前屈20度组C6及C7椎体中点位移(P<0.05)。
(10)经单因素方差分析,各组间扳动后髓核内压力值及扳动前后的髓核内压力差值均有极显著性统计学差异(P<0.01)；经SNK组间比较,模拟50N扳动力组与其他手法组比较有显著性统计学差异(P<0.05)；模拟250N旋提手法及模拟前屈0度旋提手法与模拟150N旋提手法、模拟50N旋提手法及模拟前屈20度旋提手法比较有显著性统计学差异(P<0.05)；
(11)因扳动前后的髓核内压力差值的组间方差不齐,故行Dunnett T3分析。结果如下：模拟150N旋提手法与模拟50N旋提手法比较有极显著性统计学差异(P<0.01)：模拟50N旋提手法与模拟150N旋提手法、模拟50N旋提手法、模拟250N旋提手法及模拟前屈20度旋提手法比较均有极显著性统计学差异(P<0.01)；模拟250N旋提手法与模拟50N旋提手法比较有极显著性统计学差异(P<0.01)；模拟前屈20度旋提手法与模拟50N旋提手法比较有极显著性统计学差异(P<0.01)；
(12)经秩和检验,各状态旋提手法组内的牵引差值明显大于扳动差值(P<0.01)。
3、基于虚拟现实互动技术对旋提手法作用下颈椎间孔结构变化的动态分析
(1)采用虚拟现实互动技术成功获取并测量了旋提手法过程下颈椎双侧椎间孔纵径及面积的动态变化；
(2)实验所获得的椎间孔数据与既往文献报道较为一致。
(3)旋提手法的扳动力越小,下颈椎椎间孔的纵径及面积的增加幅度也越小。
(4)随着颈椎前屈度的增加,下颈椎椎间孔纵径及面积的数值会随之增加,但旋提手法后下颈椎椎间孔纵径及面积的增加幅度会随之减少。
研究结论
1、临床研究
(1)枕颈部屈伸活动障碍、颈椎曲度变直及下颈椎失稳是神经根型颈椎病及椎动脉型颈椎病共有的X线片表现。
(2)神经根型颈椎病主要表现在寰枕关节后伸活动障碍,而椎动脉型颈椎病主要表现在寰枢关节前屈活动障碍,这种差别与其病理机制密切相关。
2、基础研究
(1)中立位牵引时下颈椎受力由上向下递减,C7受力最少。
(2)颈部旋转定位状态时应力主要集中于同侧C4/5之间。
(3)旋提手法具有调整颈椎椎体位移的力学作用。
(4)不同的颈椎定位状态将影响手法作用力对下颈椎的力学影响。
(5)在临床操作中,150N左右的扳动力对于大多数患者是较为合适的,可有效地调整下颈椎椎体位移以及降低颈椎髓核内压力。
(6)虚拟现实互动技术可以实现颈椎间孔结构的动态分析；
(7)旋提手法后双侧下颈椎椎间孔的纵径及面积均有一定程度的增加,其中对侧椎间孔的面积变化较大,可能有助于减轻神经根的挤压,从而缓解神经根刺激症状。
Background
Cervical spondylosis is the common orthopedics and traumatology disease,which the prevalence in China amounted to about3.8%～17.5%and is increasing rapidly recently. Cervical spondylotic radiculopathy account for above60%of the total. Rotation-traction manipulation(RTM), which has been proven its efficacy and safety by the researches of the clinical research of "eleven-five" support project of the ministry of science and technology of the People's Republic of China and the National Natural Science Foundation issue, is the first choice of traditional Chinese medicine to treat for Cervical spondylotic radiculopathy, and has been the project of State Administration of Traditional Chinese Medicine to promote its use all around the country. However, the basic research cannot satisfy the clinical wants and needs.
In preliminary clinical study, we found that there are some differences of x-ray signs between cervical spondylotic radiculopathy and other types of cervical spondylosis. By retrospect literature, we found that there are many summative analysis of imaging findings on cervical spondylotic radiculopathy, but little contrast studies between cervical spondylotic radiculopathy and other types of cervical spondylosis.In preliminary basic research, the mechanical parameters of rotation-traction manipulation have been preliminarily summary through a small sample mechanical research and a certain regularity during operation of RTM have been found. And the effect of reducing pressure in the cervical nucleus pulposus have been proved through the biomechanical simulation studies about the RTM in vitro.
Objective
1. To analysis the differences and similarities of X-ray signs between cervical spondylotic radiculopathy (CSR) and vertebral artery type of cervical spondylosis(VCS).
2. To analysis the influence of different rotation-traction manipulation (RTM) on three dimensional displacement of lower cervical vertebral body, the pressures of the cervical nucleus pulposus and the structure changes of cervical intervertebral foramen so as to explore the biomechanical mechanism of rotation-traction manipulation.
Method
1. Comparative analysis of x-ray signs of CSR and VCS.
A blinded design research. The X-ray signs both60cases of VCS and60cases of NCS in the cervical lateral、flexion and extension films, including cervical curvature, atlanto-occipital joint angle, atlanto-axial joint angle, C2/C3angle, the rear distances of atlanto-occipital joint, the rear distances of atlanto-axial joint, flexion activities of Joint angles, extension activities of Joint angles and lower cervical instability segment, were measured and recorded. The data were analyzed and compared between the two groups after unblended.
2. The in vitro biomechanical study of RTM on cervical vertebral body three dimensional displacement and cervical nucleus pulposus pressures.
To use Material Test System on fresh cervical specimens to simulate different RTM, while motion capture system was adopted to dynamically measure the three dimensional displacement of lower cervical vertebrae and micro pressure sensors were used to measure the cervical(C2/3,C3/4,5C4/5,C5/6,C6/7) nucleus pulposus pressures during force loading. To explore the biomechanics mechanism of RTM by analyzing and comparison the mechanical influence of the three dimensional displacement of cervical vertebral body and cervical nucleus pulposus pressures during different simulated RTM.
3. The Biomechanical study on the effect of RTM to cervical intervertebral foramen by interactive virtual reality technology.
To measure three dimensional movement of lower cervical vertebrae during rotation-traction manipulation with motion capture technique, then apply thin layer spiral CT to scan Cervical spine specimens, then use Mimics software to reconstruct three dimensional entity cervical spine. To realize the virtual reality simulation with multi mode three-dimensional medical image registration by Autodesk Maya software. Finally to measure the dynamic changes of cervical intervertebral foramen of longitudinal diameter and the area during RTM by using Adobe Photoshop software and ImageJ software and to find out the mechanical effects about the RTM.
Conclusion
1.Clinical research:
(1) The flexion and extension limitation of occipitalia and neck, cervical spine curvature straight and lower cervical instability was the X-ray signs of CSR and VCS.
(2) The atlanto-occipital joint extension movement disorder are always happened in CSR, and the atlanto-axial joint flexion movement disorder are mainly presented in VCS.This difference is closely related to its pathological mechanism.
2.Experiment research:
(1) During neutral traction, the force decrease from the bottom of the lower cervical vertebra. The7th cervical spine stress less.
(2) During rotated locating sate, the stress was concentrated in the cervical vertebra between the ipsilateral C4/5.
(3) Rotation-traction manipulation can adjust the cervical stress concentration.
(4) Different methods of cervical spine position status will affect the force effect of Rotation-traction manipulation on the lower cervical spine.
(5) In the clinical operation,150N thrust force for most patients is more appropriate, which can effectively adjust the lower cervical vertebral displacement, and reduced the cervical nucleus pulposus pressure.
(6) Interactive virtual reality technology enables dynamic analysis the structure of the cervical intervertebral foramen.
(7) Rotation-traction manipulation have a certain influence to cervical intervertebral foramen area, especially to the contralateral vertebral foramen. After that, the nerve root may help to loosen adhesions, thus alleviating the symptoms.
颈椎病属于骨科常见病。我国颈椎病患病率约达3.8%～17.5%,并呈迅速增加和年轻化趋势。神经根型颈椎病占各型颈椎病总数的60%以上。旋提手法是治疗神经根型颈椎病重要的中医手段。该手法经过国家十五攻关课题、国家十一五支撑计划及国家自然科学基金的立项研究,已证明了其有效性及安全性,并已被国家中医药管理局立项向全国推广应用。但该手法作用机理的基础研究一直滞后,不能满足临床的需要。
在前期临床研究中发现神经根型颈椎病的X线片表现可能与其他类型颈椎病的X线片表现存在一定的差异。回顾既往文献发现,关于神经根型颈椎病影像学表现的总结性分析较为多见,但甚少进行神经根型颈椎病与其他类型颈椎病影像学表现的对比研究。
在前期基础研究中,通过小样本的旋提手法在体力学研究,初步总结了旋提手法的力学参数,发现旋提手法的操作具有一定的规律性,并通过模拟旋提手法的离体生物力学研究证明了该手法具有降低颈椎髓核内压力的作用。延续既往实验成果,进一步搞清楚旋提手法施加于颈椎的力学状态、力在颈椎内的传导变化及力引起颈椎空间结构的变化情况,将有助于揭示旋提手法的作用机理。
研究目的
1、分析神经根型颈椎病(CSR)与椎动脉型颈椎病(VCS)X线片表现的异同；
2、分析不同状态旋提手法对下颈椎椎体三维位移、髓核内压力及椎间孔变化的影响,探讨旋提手法的生物力学作用机理；
研究内容
1、神经根型颈椎病与椎动脉型颈椎病X线片表现的对比分析
采用盲法设计,应用ImageJ软件测量和记录60例神经根型颈椎病及60例椎动脉型颈椎病患者的颈椎侧位及功能位X线片表现,包括颈椎曲度、寰枕关节间角、寰枢关节间角、C2/C3间角、寰枕关节后方间距、寰枢关节后方间距、关节间角前屈活动度、关节间角后伸活动度及下颈椎失稳节段和分布,破盲后进行数据分析,比较两组间差异。
2、旋提手法对下颈椎椎体位移及髓核内压力影响的的离体生物力学研究
采用MTS材料机在7具新鲜颈段标本上进行模拟牵引、不同作用力及不同定位角度的旋提手法,同时利用运动捕捉技术对下颈椎椎体的三维位移进行动态测量以及利用微型压力传感器实测法对颈椎(C2/3、C3/4、C4/5、C5/6、C6/7)髓核内压力进行动态测量。通过分析及比较模拟不同状态旋提手法对颈椎椎体位移及髓核内压力的力学影响,探讨旋提手法的生物力学作用机理。
3、基于虚拟现实互动技术对旋提手法作用下颈椎间孔结构变化的动态分析
应用螺旋CT薄层扫描颈椎标本,运用mimics软件进行三维颈椎实体重建,依据旋提手法过程下颈椎椎体的运动轨迹通过Autodesk maya软件进行多模医学图像三维配准实现动态虚拟现实仿真,随后进行动态图像处理,然后分别采用ImageJ软件及Adobe photoshop软件测量旋提手法前后下颈椎椎间孔的纵径及面积的变化,研究旋提手法对下颈椎椎间孔的力学作用。
研究结果
1、神经根型颈椎病与椎动脉型颈椎病X线片表现的对比分析
(1)在前屈位X线片中,VCS组的颈椎曲度小于CSR组,统计学具有显著性差异(P<0.05)；
(2)VCS组寰枕关节间角的后伸活动度明显大于CSR组,统计学具有极显著性差异(P<0.01)；
(3)在侧位X线片中,VCS组寰枢关节间角小于CSR组,统计学具有显著性差异(P<0.05)；
(4)VCS组寰枢关节间角的前屈度小于CSR组,统计学具有显著性差异(P<0.05)；
(5)VCS组及CSR组的下颈椎失稳发生比例及节段分布均没有显著性统计学差异。
2、旋提手法对下颈椎椎体三维位移及髓核内压力影响的的离体生物力学研究
(1)中立位牵引后C4-7各椎体中点的位移均大于定位牵引后的位移(P<0.05)；
(2)定位牵引后C4右侧横突的位移大于左侧横突的位移(P<0.01)；
(3)定位牵引后C4右侧横突的位移明显大于C5、C6及C7右侧横突的位移(P<0.01)
(4)模拟50N、150N及250N扳动力组预牵引后C4右侧横突的位移明显大于同节段左侧横突位移(P<0.01),而C5左侧横突的位移明显大于同节段右侧横突位移(P<0.01)；
(5)模拟50N、150N及250N扳动力组预牵引后C4右侧横突的位移明显大于C5、C6及C7右侧横突的位移(P<0.05)；
(6)模拟50N扳动力组扳动后下颈椎各椎体双侧横突及椎体中点的位移均明显小于模拟150N扳动力组及模拟250N扳动力组同节段的位移(P<0.01)。
(7)模拟前屈0度、10度及20度旋提手法组预牵引后C4右侧横突的位移明显大于同节段左侧横突位移(P<0.01),而C5左侧横突的位移明显大于同节段右侧横突位移(P<0.01)；
(8)模拟前屈0度、10度及20度旋提手法组预牵引后C4右侧横突的位移明显大于C5、C6及C7右侧横突的位移(P<0.01)；
(9)模拟前屈0度旋提手法组预牵引后C6及C7椎体中点位移均分别明显大于模拟前屈10度组和模拟前屈20度组C6及C7椎体中点位移(P<0.05)。
(10)经单因素方差分析,各组间扳动后髓核内压力值及扳动前后的髓核内压力差值均有极显著性统计学差异(P<0.01)；经SNK组间比较,模拟50N扳动力组与其他手法组比较有显著性统计学差异(P<0.05)；模拟250N旋提手法及模拟前屈0度旋提手法与模拟150N旋提手法、模拟50N旋提手法及模拟前屈20度旋提手法比较有显著性统计学差异(P<0.05)；
(11)因扳动前后的髓核内压力差值的组间方差不齐,故行Dunnett T3分析。结果如下：模拟150N旋提手法与模拟50N旋提手法比较有极显著性统计学差异(P<0.01)：模拟50N旋提手法与模拟150N旋提手法、模拟50N旋提手法、模拟250N旋提手法及模拟前屈20度旋提手法比较均有极显著性统计学差异(P<0.01)；模拟250N旋提手法与模拟50N旋提手法比较有极显著性统计学差异(P<0.01)；模拟前屈20度旋提手法与模拟50N旋提手法比较有极显著性统计学差异(P<0.01)；
(12)经秩和检验,各状态旋提手法组内的牵引差值明显大于扳动差值(P<0.01)。
3、基于虚拟现实互动技术对旋提手法作用下颈椎间孔结构变化的动态分析
(1)采用虚拟现实互动技术成功获取并测量了旋提手法过程下颈椎双侧椎间孔纵径及面积的动态变化；
(2)实验所获得的椎间孔数据与既往文献报道较为一致。
(3)旋提手法的扳动力越小,下颈椎椎间孔的纵径及面积的增加幅度也越小。
(4)随着颈椎前屈度的增加,下颈椎椎间孔纵径及面积的数值会随之增加,但旋提手法后下颈椎椎间孔纵径及面积的增加幅度会随之减少。
研究结论
1、临床研究
(1)枕颈部屈伸活动障碍、颈椎曲度变直及下颈椎失稳是神经根型颈椎病及椎动脉型颈椎病共有的X线片表现。
(2)神经根型颈椎病主要表现在寰枕关节后伸活动障碍,而椎动脉型颈椎病主要表现在寰枢关节前屈活动障碍,这种差别与其病理机制密切相关。
2、基础研究
(1)中立位牵引时下颈椎受力由上向下递减,C7受力最少。
(2)颈部旋转定位状态时应力主要集中于同侧C4/5之间。
(3)旋提手法具有调整颈椎椎体位移的力学作用。
(4)不同的颈椎定位状态将影响手法作用力对下颈椎的力学影响。
(5)在临床操作中,150N左右的扳动力对于大多数患者是较为合适的,可有效地调整下颈椎椎体位移以及降低颈椎髓核内压力。
(6)虚拟现实互动技术可以实现颈椎间孔结构的动态分析；
(7)旋提手法后双侧下颈椎椎间孔的纵径及面积均有一定程度的增加,其中对侧椎间孔的面积变化较大,可能有助于减轻神经根的挤压,从而缓解神经根刺激症状。
Background
Cervical spondylosis is the common orthopedics and traumatology disease,which the prevalence in China amounted to about3.8%～17.5%and is increasing rapidly recently. Cervical spondylotic radiculopathy account for above60%of the total. Rotation-traction manipulation(RTM), which has been proven its efficacy and safety by the researches of the clinical research of "eleven-five" support project of the ministry of science and technology of the People's Republic of China and the National Natural Science Foundation issue, is the first choice of traditional Chinese medicine to treat for Cervical spondylotic radiculopathy, and has been the project of State Administration of Traditional Chinese Medicine to promote its use all around the country. However, the basic research cannot satisfy the clinical wants and needs.
In preliminary clinical study, we found that there are some differences of x-ray signs between cervical spondylotic radiculopathy and other types of cervical spondylosis. By retrospect literature, we found that there are many summative analysis of imaging findings on cervical spondylotic radiculopathy, but little contrast studies between cervical spondylotic radiculopathy and other types of cervical spondylosis.In preliminary basic research, the mechanical parameters of rotation-traction manipulation have been preliminarily summary through a small sample mechanical research and a certain regularity during operation of RTM have been found. And the effect of reducing pressure in the cervical nucleus pulposus have been proved through the biomechanical simulation studies about the RTM in vitro.
Objective
1. To analysis the differences and similarities of X-ray signs between cervical spondylotic radiculopathy (CSR) and vertebral artery type of cervical spondylosis(VCS).
2. To analysis the influence of different rotation-traction manipulation (RTM) on three dimensional displacement of lower cervical vertebral body, the pressures of the cervical nucleus pulposus and the structure changes of cervical intervertebral foramen so as to explore the biomechanical mechanism of rotation-traction manipulation.
Method
1. Comparative analysis of x-ray signs of CSR and VCS.
A blinded design research. The X-ray signs both60cases of VCS and60cases of NCS in the cervical lateral、flexion and extension films, including cervical curvature, atlanto-occipital joint angle, atlanto-axial joint angle, C2/C3angle, the rear distances of atlanto-occipital joint, the rear distances of atlanto-axial joint, flexion activities of Joint angles, extension activities of Joint angles and lower cervical instability segment, were measured and recorded. The data were analyzed and compared between the two groups after unblended.
2. The in vitro biomechanical study of RTM on cervical vertebral body three dimensional displacement and cervical nucleus pulposus pressures.
To use Material Test System on fresh cervical specimens to simulate different RTM, while motion capture system was adopted to dynamically measure the three dimensional displacement of lower cervical vertebrae and micro pressure sensors were used to measure the cervical(C2/3,C3/4,5C4/5,C5/6,C6/7) nucleus pulposus pressures during force loading. To explore the biomechanics mechanism of RTM by analyzing and comparison the mechanical influence of the three dimensional displacement of cervical vertebral body and cervical nucleus pulposus pressures during different simulated RTM.
3. The Biomechanical study on the effect of RTM to cervical intervertebral foramen by interactive virtual reality technology.
To measure three dimensional movement of lower cervical vertebrae during rotation-traction manipulation with motion capture technique, then apply thin layer spiral CT to scan Cervical spine specimens, then use Mimics software to reconstruct three dimensional entity cervical spine. To realize the virtual reality simulation with multi mode three-dimensional medical image registration by Autodesk Maya software. Finally to measure the dynamic changes of cervical intervertebral foramen of longitudinal diameter and the area during RTM by using Adobe Photoshop software and ImageJ software and to find out the mechanical effects about the RTM.
Conclusion
1.Clinical research:
(1) The flexion and extension limitation of occipitalia and neck, cervical spine curvature straight and lower cervical instability was the X-ray signs of CSR and VCS.
(2) The atlanto-occipital joint extension movement disorder are always happened in CSR, and the atlanto-axial joint flexion movement disorder are mainly presented in VCS.This difference is closely related to its pathological mechanism.
2.Experiment research:
(1) During neutral traction, the force decrease from the bottom of the lower cervical vertebra. The7th cervical spine stress less.
(2) During rotated locating sate, the stress was concentrated in the cervical vertebra between the ipsilateral C4/5.
(3) Rotation-traction manipulation can adjust the cervical stress concentration.
(4) Different methods of cervical spine position status will affect the force effect of Rotation-traction manipulation on the lower cervical spine.
(5) In the clinical operation,150N thrust force for most patients is more appropriate, which can effectively adjust the lower cervical vertebral displacement, and reduced the cervical nucleus pulposus pressure.
(6) Interactive virtual reality technology enables dynamic analysis the structure of the cervical intervertebral foramen.
(7) Rotation-traction manipulation have a certain influence to cervical intervertebral foramen area, especially to the contralateral vertebral foramen. After that, the nerve root may help to loosen adhesions, thus alleviating the symptoms.
引文
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