【摘要】 背景:推拿手法中踩跷法的用力方式简洁,因此,对其力学治疗机制以及力学参数与生物力学效应的量效关系的研究具有可行性和实用价值。目的:通过模拟踩跷腰部加压,应用螺旋CT三维重建方法观测腰部解剖结构变化,分析踩跷对腰椎椎间孔及椎管的力学效应。设计、时间及地点:自身前后对比观察,于2006-06/2007-05在成都中医药大学附属医院脊柱力学及电生理实验室完成。参试者:身体健康的成人志愿者8名,男、女不限。方法:利用自行研发的踩跷模拟装置,以踩跷用力模式为基础确定加压量程,分别对8名健康受试者进行L4～5椎间隙靠棘突部位定点加压,同时以螺旋CT扫描采集影像数据,进行CT三维重建。主要观察指标:在三维重建模型上测量L4～5椎间孔最大横径、对侧面积和高度,及L4上缘椎管内切圆面积在不同压力时的动态变化,分析压力变化与腰椎及周围附属结构动态变化的量效关系。结果:压力大小对L4～5左右侧椎间孔最大横径变化有显著影响(P<0.05),对侧面积和高度影响不显著(P>0.05)。各级压力状态与静息状态时L4～5右侧椎间孔最大横径比值、L4上缘椎管内切圆面积比值与相对压力呈正相关(P<0.05);L4上缘椎管内切圆面积比值分别与L4～5椎后肌群矢径、横径呈负相关和正相关(P<0.01)。结论:踩跷能改善腰椎椎间孔横径,并对L4～5椎管容积有明显影响,这对改善脊柱生物力学平衡,促进受压神经根松解,修复损伤有积极作用。更多还原

【Abstract】 BACKGROUND:Stepping lumbus is one of commonly used clinical chirismus with simple manipulation.It is feasible and valuable to study the dose-effect relationship of the mechanics parameter and mechanics therapeutic mechanism.OBJECTIVE:Through simulating pressure on the lumbar part,changes in the dissection structure were observed on spiral CT,and the mechanical effect relationship between trampling mechanics and biomechanical parameters.DESIGN,TIME AND SETTING:Self-comparison was performed at Spinal Mechanics and Electrophysiology Laboratories of hospital of Chengdu University of Traditional Chinese Medicine between June 2006 and May 2007.PARTICIPANTS:Eight healthy volunteers,irrespective of gender were selected.METHODS:Using the self-simulated trampling equipment,the trampling quantity was confirmed by the pressure when trampling.Certain points of L4-5 intervertebral space adjacent to spinal process of 8 healthy participants were pressed.At the same time,spiral CT was used to collect the image data for CT three-dimensional reconstruction.MAIN OUTCOME MEASURES:On the three-dimensional reconstructed model,L4-5 intervertebral foramen maximum transverse diameter,opposite side area and height;L4 superior border vertebral canal inner tangent circle area;dose-effect relationship of pres-sure alterations and dynamic changes in lumbar and surrounding accessory structures.RESULTS:The pressure showed significant influences on L4-5 intervertebral foramen maximum transverse diameter(P < 0.05),but minimal influences on opposite side area and height(P > 0.05).At each pressure level and quiescent condition,the maximum trans-verse diameter ratio of L4-5 was positively correlated with ratio of L4 superior border vertebral canal inner tangent circle area and with correponding pressure(P < 0.05).Ratio of L4 superior border vertebral canal inner tangent circle area had positive correlation with radius vector and negative correlation with transverse diameter of L4-5 posterior muscle group(P < 0.01).CONCLUSION:Stepping lumbus can improve intervertebral foramen transverse diameter of lumbar vertebra,and significantly influence capability of L4-5.It plays a positive effect on improving spinal biomechanical balance,promoting oppressed nerve root recovery and injury repairing.更多还原