«上一篇/Previous Article|本期目錄/Table of Contents|下一篇/Next Article»

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第26卷

期數(shù):

2014年01期

頁(yè)碼:

11-16

欄目:

基礎(chǔ)研究

出版日期:

2014-01-28

文章信息/Info

Title:

Effect of different lumbar vertebrae pulling method on intradiscal pressure

作者:

劉強(qiáng)¹; 張軍²; 張慧²; 喬杰²

1.沈陽體育學(xué)院,遼寧 沈陽 110101;
2.中國(guó)中醫(yī)科學(xué)院望京醫(yī)院,北京 100700

Author(s):

Liu Qiang^*; Zhang Jun; Zhang Hui; Qiao Jie.^*Shenyang

Sport University,Shenyang 110101,Liaoning,China

關(guān)鍵詞:

腰椎 椎間盤 椎間盤退變性變 舒筋整復(fù)手法 扳法 椎間盤內(nèi)壓

Keywords:

Lumbar vertebrae;  Intervertebral disk;  Intervertebral disc degeneration;  Muscle tendon relax reduction;  Pulling method;  Intradiscal pressure

摘要:

目的:測(cè)試不同扳法對(duì)腰椎間盤內(nèi)壓的影響,探討扳法治療椎間盤退變性疾病的作用機(jī)制。方法:截取12具新鮮濕潤(rùn)尸體的腰骶段,包埋所有標(biāo)本的L₁、L₂、S₁、S₂椎體,露出L₃～L₅。將微型壓力傳感器植入L_3～4、L_4～5、L₅S₁椎間盤,并與壓力測(cè)試數(shù)據(jù)采集系統(tǒng)相連接,收集不同體位、不同載荷下L_3～4、L_4～5、L₅S₁3個(gè)椎間盤的內(nèi)壓。將腰椎標(biāo)本固定在BOSE動(dòng)靜態(tài)材料試驗(yàn)機(jī)上,使用WinTest軟件控制扭矩和角度,編寫運(yùn)行程序,模擬坐位和臥位2種體位、4種不同載荷扳法。實(shí)驗(yàn)前進(jìn)行2次加載和卸載循環(huán)預(yù)處理,在第3次加載時(shí)進(jìn)行測(cè)試。測(cè)試模擬4種不同扳法的L_3～4、L_4～5、L₅S₁椎間盤內(nèi)壓基線值和扳法復(fù)位后椎間盤內(nèi)壓值; 模擬4種不同扳法7.5 Nm預(yù)加載相和25 Nm扳動(dòng)相L_3～4、L_4～5、L₅S₁椎間盤內(nèi)壓值; 模擬4種扳法7.5 Nm預(yù)加載相和25 Nm扳動(dòng)相的腰椎旋轉(zhuǎn)角度。結(jié)果:①4種載荷扳法椎間盤內(nèi)壓基線值的比較。4種不同載荷扳法椎間盤內(nèi)壓基線值比較,組間差異均有統(tǒng)計(jì)學(xué)意義[(0.2589±0.1256)MPa,(0.1757±0.0970)MPa,(0.0522±0.0645)MPa,(0.0348±0.0472)MPa,F=17.140,P=0.000;(1.0844±0.2180)MPa,(0.7119±0.2841)MPa,(0.1599±0.1243)MPa,(0.0944±0.0627)MPa,F=72.159,P=0.000;(0.4407±0.1691)MPa,(0.2843±0.1154)MPa,(0.0684±0.0653)MPa,(0.0458±0.0490)MPa,F=34.805,P=0.000)。L_3～4椎間盤內(nèi)壓基線值組間兩兩比較,-500 N載荷組與-300 N載荷組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.386); -500 N載荷組高于0 N、+100 N載荷組(P=0.001,P=0.000); -300 N載荷組高于0 N、+100 N載荷組(P=0.009,P=0.002); 0 N載荷組與+100 N載荷組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.968)。L_4～5椎間盤內(nèi)壓基線值組間兩兩比較,-500 N載荷組高于-300 N、0 N、+100 N載荷組(P=0.010,P=0.000,P=0.000); -300 N載荷組高于0 N、+100 N載荷組(P=0.000,P=0.000); 0 N載荷組與+100 N載荷組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.507)。L₅S₁椎間盤內(nèi)壓基線值組間兩兩比較,-500 N載荷組與-300 N載荷組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.087); -500 N載荷組高于0 N、+100 N載荷組(P=0.000,P=0.000); -300 N載荷組高于0 N、+100 N載荷組(P=0.000,P=0.000); 0 N載荷組與+100 N載荷組比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.909)。-500 N載荷組內(nèi)兩兩比較,L_3～4椎間盤內(nèi)壓基線值低于L_4～5、L₅S₁(P=0.000,P=0.021),L_4～5椎間盤內(nèi)壓值高于L₅S₁(P =0.000); 0 N載荷組內(nèi)兩兩比較,L_3～4椎間盤內(nèi)壓基線值低于L_4～5、L₅S₁(P =0.000,P=0.048),L_4～5椎間盤內(nèi)壓值高于L₅S₁(P=0.000)。②椎間盤內(nèi)壓基線值和扳法復(fù)位后椎間盤內(nèi)壓值的比較。L_3～4、L_4～5、L₅S₁在-500 N、-300 N、0 N、+100N載荷下,椎間盤內(nèi)壓基線值與扳法復(fù)位后椎間盤內(nèi)壓值比較,差異均無統(tǒng)計(jì)學(xué)意義[(0.2589±0.1256)MPa,(0.2659±0.1238)MPa,t=-0.223,P=0.828;(1.0844±0.2180)MPa,(1.0444±0.2807)MPa,t=0.409,P=0.690;(0.4407±0.1691)MPa,(0.5155±0.3420)MPa,t=-0.633,P=0.539;(0.1757±0.0970)MPa,(0.1747±0.0966)MPa,t=0.207,P=0.839;(0.7119±0.2841)MPa,(0.7128±0.2647)MPa,t=-0.010,P=0.992;(0.2843±0.1154)MPa,(0.3469±0.2551)MPa,t=-0.880,P=0.398;(0.0522±0.0645)MPa,(0.0495±0.0623)MPa,t=0.367,P=0.720;(0.1599±0.1243)MPa,(0.1404±0.1249)MPa,t=0.500,P=0.627;(0.0684±0.0653)MPa,(0.0603±0.0651)MPa,t=0.609,P=0.555;(0.0348±0.0472)MPa,(0.0346±0.0484)MPa,t=0.042,P=0.967;(0.0944±0.0627)MPa,(0.1003±0.0731)MPa,t=-0.314,P=0.760;(0.0458±0.0490)MPa,(0.0575±0.0443)MPa,t=0.204,P=0.842]。③7.5 Nm預(yù)加載相和25 Nm扳動(dòng)相腰椎旋轉(zhuǎn)角度及椎間盤內(nèi)壓值的比較。25 Nm扳動(dòng)相腰椎旋轉(zhuǎn)角度大于7.5 Nm預(yù)加載相腰椎旋轉(zhuǎn)角度[(19.5692°±0.6969°),(14.6475°±0.6471°),t=-40.694,P=0.000]。在0 N和+100 N載荷下,25 Nm扳動(dòng)相L_3～4椎間盤內(nèi)壓值高于7.5 Nm預(yù)加載相[(0.1168±0.1153)MPa,(0.1020±0.1091)MPa,t=3.902,P=0.002;(0.0879±0.1107)MPa,(0.0746±0.0962)MPa,t=2.678,P=0.022]; 在-500 N、-300 N載荷下25 Nm扳動(dòng)相L_3～4椎間盤內(nèi)壓值與7.5 Nm預(yù)加載相L_3～4椎間盤內(nèi)壓值比較,差異無統(tǒng)計(jì)學(xué)意義[(0.3718±0.2774)MPa,(0.3228±0.1929)MPa,t=1.704,P=0.116;(0.2916±0.2333)MPa,(0.2379±0.1649)MPa,t=1.982,P=0.073]。在-500 N、-300 N和0 N載荷下,25 Nm扳動(dòng)相L_4～5椎間盤內(nèi)壓值高于7.5 Nm預(yù)加載相[(1.1551±0.3425)MPa,(1.0779±0.3203)MPa,t=2.211,P=0.049;(0.8840±0.3533)MPa,(0.7839±0.3563)MPa,t=2.844,P=0.016;(0.3992±0.2088)MPa,(0.3305±0.2081)MPa,t=7.088,P=0.000]; 在+100 N載荷下,25 Nm扳動(dòng)相L_4～5椎間盤內(nèi)壓值與7.5 Nm預(yù)加載相L_4～5椎間盤內(nèi)壓值比較,差異無統(tǒng)計(jì)學(xué)意義[(0.2765±0.2116)MPa,(0.2639±0.2197)MPa,t=0.207,P=0.840]。在-500 N、-300 N、0 N、+100 N載荷下,25 Nm扳動(dòng)相L₅S₁椎間盤內(nèi)壓值高于7.5 Nm預(yù)加載相[(0.6980±0.4896)MPa,(0.6245±0.4450)MPa,t=3.585,P=0.004;(0.5212±0.4434)MPa,(0.4599±0.4033)MPa,t=3.023,P=0.012;(0.3186±0.2749)MPa,(0.2650±0.2534)MPa,t=3.975,P=0.002;(0.2252±0.2396)MPa,(0.1786±0.1945)MPa,t=3.158,P=0.009]。7.5 Nm預(yù)加載相和25 Nm扳動(dòng)相的椎間盤內(nèi)壓差與腰椎旋轉(zhuǎn)角度差呈正相關(guān)(r=0.919,P=0.000)。結(jié)論:無論是坐位還是臥位,椎間盤內(nèi)壓值由高到低均依次為L(zhǎng)_4～5、L₅S₁、L_3～4。不同扳法在扳動(dòng)瞬間均會(huì)使椎間盤內(nèi)壓發(fā)生顯著變化,體位不同、載荷不同對(duì)L_3～4、L_4～5、L₅S₁扳動(dòng)瞬間的椎間盤內(nèi)壓影響不同,臨床可以根據(jù)退變椎間盤的不同節(jié)段采用不同方式的扳法操作。腰椎扳法雖然在瞬間增加了椎間盤內(nèi)壓,但增加了腰椎活動(dòng)度,這可能是腰椎扳法治療椎間盤退變性疾病的作用機(jī)制。

Abstract:

Objective:To test the effect of different pulling methods on intradiscal pressure and explore the mechanisms of action of pulling method in the treatment of intervertebral disc degeneration disease.Methods:Lumbosacral spine were cut out from 12 fresh moist cadavers,and the vertebral body of L₁,L₂,S₁ and S₂ were embeded and the vertebral body of L₃-L₅ were exposed.Micro pressure sensors were implanted into the intervertebral discs of L_3-4,L_4-5 and L₅S₁,and were connected to the pressure test data acquisition system.The intradiscal pressures of L_3-4,L_4-5 and L₅S₁ in different body posture and different load.Then the lumbar vertebrae specimens were fixed to BOSE dynamic/static materials testing machine,and torque and angle were regulated through WinTest software.After that the programs were written and four different loading pulling methods were simulated.Circulation pretreatment of loading and unloading were performed for 2 times before the formal test was carried on.The baseline values of intradiscal pressure of L_3-4,L_4-5 and L₅S₁ were measured and the intradiscal pressure values were measured after restoration by pulling method.The intradiscal pressure and rotation angles of L_3-4,L_4-5 and L₅S₁ were measured in preload phase(7.5Nm)and pulling phase(25Nm).Results:There was statistical difference in the baseline values of intradiscal pressure between 4 different load pulling methods(0.2589+/-0.1256,0.1757+/-0.0970,0.0522+/-0.0645,0.0348+/-0.0472 MPa,F=17.140,P=0.000; 1.0844+/-0.2180,0.7119+/-0.2841,0.1599+/-0.1243,0.0944+/-0.0627 MPa,F=72.159,P=0.000; 0.4407+/-0.1691,0.2843+/-0.1154,0.0684+/-0.0653,0.0458+/-0.0490 MPa,F=34.805,P=0.000).Further pairwise comparison in baseline values of L_3-4 intradiscal pressure showed that(1)there was no statistical difference between -500 N load group and -300 N load group(P=0.386);(2)-500 N load group surpassed 0 N load group and +100 N load group(P=0.001,P=0.000);(3)-300 N load group surpassed 0 N load group and +100 N load group(P=0.009,P=0.002);(4)there was no statistical difference between 0 N load group and +100 N load group(P=0.968).Further pairwise comparison in baseline values of L_4-5 intradiscal pressure showed that(1)-500 N load group surpassed -300 N,0 N and +100 N load groups(P=0.010,P=0.000,P=0.000);(2)-300 N load group surpassed 0 N load group and +100 N load group(P=0.000,P=0.000);(3)there was no statistical difference between 0 N load group and +100 N load group(P=0.507).Further pairwise comparison in baseline values of L₅S₁ intradiscal pressure showed that(1)there was no statistical difference between -500 N load group and -300 N load group(P=0.087);(2)-500 N load group surpassed 0 N load group and +100 N load group(P=0.000,P=0.000);(3)-300 N load group surpassed 0 N load group and +100 N load group(P=0.000,P=0.000);(4)there was no statistical difference between 0 N load group and +100 N load group(P=0.909).Further pairwise comparison in baseline values of intradiscal pressure within -500 N load group showed that(1)L_3-4 disc was inferior to L_4-5 disc and L₅S₁ disc(P=0.000,P=0.021);(2)L_4-5 disc surpassed L₅S₁ disc(P=0.000).Further pairwise comparison in baseline values of intradiscal pressure within 0 N load group showed that(1)L_3-4 disc was inferior to L_4-5 disc and L₅S₁ disc(P=0.000,P=0.048);(2)L_4-5 disc surpassed L₅S₁ disc(P=0.000).There was no statistical difference between the intradiscal pressure baseline values and intradiscal pressure values measured after restoration by pulling method in the load of -500 N,-300 N,0 N and +100 N for L_3-4,L_4-5 and L₅S₁ disc(0.2589+/-0.1256 vs 0.2659+/-0.1238 MPa,t=-0.223,P=0.828; 1.0844+/-0.2180 vs 1.0444+/-0.2807 MPa,t=0.409,P=0.690; 0.4407+/-0.1691 vs 0.5155+/-0.3420 MPa,t=-0.633,P=0.539; 0.1757+/-0.0970 vs 0.1747+/-0.0966 MPa,t=0.207,P=0.839; 0.7119+/-0.2841 vs 0.7128+/-0.2647 MPa,t=-0.010,P=0.992; 0.2843+/-0.1154 vs 0.3469+/-0.2551 MPa,t=-0.880,P=0.398; 0.0522+/-0.0645 vs 0.0495+/-0.0623 MPa,t=0.367,P=0.720; 0.1599+/-0.1243 vs 0.1404+/-0.1249 MPa,t=0.500,P=0.627; 0.0684+/-0.0653 vs 0.0603+/-0.0651 MPa,t=0.609,P=0.555; 0.0348+/-0.0472 vs 0.0346+/-0.0484 MPa,t=0.042,P=0.967; 0.0944+/-0.0627 vs 0.1003+/-0.0731 MPa,t=-0.314,P=0.760; 0.0458+/-0.0490 vs 0.0575+/-0.0443 MPa,t=0.204,P=0.842).The lumbar vertebras rotation angles of pull phase(25 Nm)were greater than that of preload phase(7.5 Nm)(19.5692+/-0.6969 vs 14.6475+/-0.6471 degrees,t=-40.694,P=0.000).Intradiscal pressure values of L_3-4 of pull phase(25 Nm)were higher than that of preload phase(7.5 Nm)in the load of 0 N and +100 N(0.1168+/-0.1153 vs 0.1020+/-0.1091 MPa,t=3.902,P=0.002; 0.0879+/-0.1107 vs 0.0746+/-0.0962 MPa,t=2.678,P=0.022).There was no statistical difference in the intradiscal pressure values between pull phase(25 Nm)and preload phase(7.5 Nm)for L_3-4 disc in the load of -500 N and -300 N(0.3718+/-0.2774 vs 0.3228+/-0.1929 MPa,t=1.704,P=0.116; 0.2916+/-0.2333 vs 0.2379+/-0.1649 MPa,t=1.982,P=0.073).Intradiscal pressure values of L_4-5 of pull phase(25 Nm)were higher than that of preload phase(7.5 Nm)in the load of -500,-300 and 0 N(1.1551+/-0.3425 vs 1.0779+/-0.3203 MPa,t=2.211,P=0.049; 0.8840+/-0.3533 vs 0.7839+/-0.3563 MPa,t=2.844,P=0.016; 0.3992+/-0.2088 vs 0.3305+/-0.2081 MPa,t=7.088,P=0.000)There was no statistical difference in the intradiscal pressure values between pull phase(25 Nm)and preload phase(7.5 Nm)for L_4-5 disc in the load of +100 N(0.2765+/-0.2116 vs 0.2639+/-0.2197 MPa,t=0.207,P=0.840).Intradiscal pressure values of L₅S₁ disc of pull phase(25 Nm)were higher than that of preload phase(7.5 Nm)in the load of -500,-300,0 and +100 N(0.6980+/-0.4896 vs 0.6245+/-0.4450 MPa,t=3.585,P=0.004; 0.5212+/-0.4434 vs 0.4599+/-0.4033 MPa,t=3.023,P=0.012; 0.3186+/-0.2749 vs 0.2650+/-0.2534 MPa,t=3.975,P=0.002; 0.2252+/-0.2396 vs 0.1786+/-0.1945 MPa,t=3.158,P=0.009).The intradiscal pressure difference was positively correlated to the difference of lumbar vertebras rotation angles between preload phase and pull phase(r=0.919,P=0.000).Conclusion:People have high-to-low intradiscal pressures in L_4-5,L₅S₁ and L_3-4 in turn whether at the sitting position or at the supine position.The intradiscal pressure changes significantly at the moment of pulling,and it is influenced by body position and loads.Therefore,the degenerative intervertebral discs can be treated by different pulling methods in clinic according to the segments of lumbar vertebrae.Although the intradiscal pressure increases at the moment of lumbar vertebrae pulling,the range of motion of lumbar vertebrae increases at the same time,and it may be the mechanism of action of lumbar vertebrae pulling method in the treatment of intervertebral disc degeneration disease.

備注/Memo

備注/Memo:

基金項(xiàng)目:2011年國(guó)家自然科學(xué)基金面上項(xiàng)目(81072824),2011年北京自然基金資助項(xiàng)目(7112147)
通訊作者:張軍 E-mail:[email protected]

常用功能

更新日期/Last Update: 2014-01-20