踩跷力学参数与腰椎曲度及椎间隙变化相关性研究

Correlation of mechanics parameters of stepping lumbus with lumbar vertebral curvature and intervertebral space changes

目的 通过观测踩跷力学参数变化对腰椎曲度及椎间隙变化，探讨踩跷的力学参数与其生物力学效应的量效关系，为踩跷力学参数的优化及进一步为中医推拿学中踩跷法的量化、规范化研究奠定基础。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的加压量程，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，同时以电子计算机断层扫描（CT）采集影像数据，进行CT三维重建，在三维重建模型上测量腰椎曲度及腰椎椎间隙在不同压力时的动态变化。结果压力大小对腰椎曲度变化、L4-5，椎间隙前缘、正中和后缘高度及b～S，正中高度变化比较差异均有显著性意义（P〈0.05），对L5-S1椎间隙前缘和后缘高度变化比较差异无显著性意义（P〉0.05）。结论踩跷能改善腰椎脊柱曲度、下腰椎椎间隙高度，这对于改善脊柱生物力学平衡、促进受压神经根松解、损伤修复有积极作用；可能还有促进突出腰椎间盘回纳的作用；踩跷对腰椎曲度变化、椎间隙高度变化的影响与压力大小有密切相关性。

Objective To investigate the dose-effect relationship between mechanics parameters and biomechanics effect of stepping lumbus （ Caiqiao manipulation ） through exploring the influence of mechanics parameters change on lumbar physical curvature and intervertebral space, and further to establish foundation for optimization of mechanics parameters, as well as quantification and standardization of stepping lumbus. Methods Using self-designed simulating equipment of stepping lumbus, the processus spinosus within intervertebral space of L4-5 was pressurized in 8 healthy subjects. Simultaneously spiral CT scanning was undertaken to implement dynamic three-dimensional reconstruction. In this way, the dynamic changes in intervertebral space and lumbar curvature could be measured under different pressures. Results The changes of lumbar physical curvature, anterior border of intervertebral space of L4-5, the height in the center or posterior edge, and the center height between L5 - Sl under different pressures showed statistically difference（ P 〈 0. 05 ）. However, there was no statistic difference in the changes of anterior or posterior border of intervertebral space of L5 - Sl （ P 〉 0. 05 ）. Conclusion Stepping lumbus can improve spinal curvature and intervertebral space height of lower lumbar vertebra, which will play a positive role in improving biomechanical balance of the spine, relaxing the pressed nerve root and repairing impairment. It may promote the protruded intervertebral disc to return. The pressure of stepping lumbus has significant correlation with the change of lumbar physical curvature and the height of intervertebral space.