腰椎间盘突出症患者手法治疗前后腰椎节段运动改变特点——附电荷藕合器件腰椎运动测定系统临床观察

Changes of Segmental Motion after Spinal Manipulation in Patients with Lumbar Intervertebral Disc Protrusion

目的 :通过自行研制的腰椎功能电荷藕合器件 (chargecoupledevice,CCD)测量系统对腰椎间盘突出症患者手法治疗前后腰椎各节段运动变化的测量 ,探讨手法治疗对腰椎功能的影响及腰椎功能CCD测量系统的临床意义。方法 :分别对 30例患者在手法及其他保守治疗前后做了动力学X线摄片和CCD系统的测定 ,经过对腰椎各节段的屈伸、左右侧弯运动角度的分析比较 ,探讨了CCD系统测量和X线测量的相关性及治疗前后腰椎各节段运动的恢复特点。结果 :经直线相关检验发现X线测量和CCD系统测量的腰椎节段运动有一定的相关性 (r =0 4 2 2～ 0 72 4 ,P <0 0 5～ 0 0 1) ;配对t检验发现治疗后下腰椎节段屈伸运动恢复十分显著 (t=2 2 6～ 2 61,P <0 0 5～ 0 0 1) ,但其他节段的恢复并不显著。结论 :CCD系统对节段性腰椎功能的评价具有十分重要的临床意义 ;下腰椎屈伸运动状态是评价腰椎间盘突出症手法治疗疗效的重要指征。

Objective: To explore the effect of manipulation on segmental motion of lumbar vertebra and the clinical significance before and after treatment, and evaluation with charge couple device (CCD) measurement system. Methods: CCD and dynamic radiography were conducted in 30 patients before and after treated by manipulation or other conservative therapy, analysis and comparisons in segmental motion ranges of flexion extension and lateral bending, correlation between data of CCD system and radiography as well as characteristics of lumbar vertebral function recovery after manipulation were performed. Results: Certain correlation between data of CCD and radiography was shown by linear correlation test (r=0 42～0 72,P<0 05～0 01). Paired t test showed that the lower lumbar segmental flexion extension function was significantly recovered (t=2 26～2 61,P<0 05～0 01) after manipulation, but the recovery on other segments was insignificant. Conclusion: The special designed CCD system is of important clinical significance in assessing segmental lumbar vertebral function. Lower lumbar vertebral flexion extention functional state is a crucial criterium for evaluation of manipulative therapy in lumbar intervertebral disc protrusion.