颈椎定点旋转手法运动学及相关个体影响因素研究

Study on the Kinematics of Cervical Spindle Rotation Manipulation and Related Individual Influencing Factors

目的:研究颈椎定点旋转手法操作的在体运动学参数并进行初步分析验证,并在患者颈椎正侧位+开口位X线片上测量相关个体参数指标,分析其对颈椎定点旋转手法的影响,从而增加手法操作的科学性与规范性。方法:手法操作前在患者X线片测量相关个体参数(寰椎前后弓长度、枢椎前后长度、寰椎前弓宽度、枢椎宽度、寰椎倾斜角、枢椎倾斜角、寰椎椎弓根高度、枢椎椎弓根高度、齿状突横经、寰枢关节最大纵径);采用运动捕捉系统获取30例诊断为寰枢关节紊乱的患者在接受颈椎定点旋转手法治疗过程中相关运动学参数(前屈角度、侧屈角度、旋转角度、再扳旋角度差),再分析不同患者个体骨性结构参数的差异对定点旋转手法的影响。结果:1)初步获得颈椎定点旋转手法相关参考数值:前屈角度35.69°±4.09°,侧屈角度34.94°±3.47°,旋转角度31.12°±2.76°,再扳旋角度差4.50°±1.05°,操作者左、右手施展颈椎定点旋转手法过程中的运动学参数差异均无统计学意义(P>0.05)。2)多元线性回归分析结果:枢椎倾斜角是前屈角度的重要影响因素;寰椎前后弓长度、枢椎椎弓根高度是侧屈角度的重要影响因素;寰枢关节纵径、枢椎倾斜角、枢椎前后长度是旋转角度的重要影响因素;寰椎前后弓长度是再旋转角度的重要影响因素。结论:颈椎定点旋转手法是集合前屈、侧屈、旋转为一体的复合动作,同一施术者左右手操作无差异,不同患者的个体参数会影响该手法操作。

Objective : To study the in vivo kinematics parameters of cervical fixed - point rotation manipulation , and measurethe related bone structure parameters on the X - rays of the patients to analyze the influence of the fixed - point rotation ma -nipulation on the cervical spine , so as to increase the scientific and normative nature of the manipulation.Methods : Thebone structure parameters ( anterior and posterior length of atlas , anterior and posterior length of axis , width of anteriorarch of atlas , width of axis , angle of inclination of atlas , angle of inclination of axis , height of pedicle of atlas ) weremeasured before manipulation.Axial pedicle height , odontoid transverse meridian , maximum longitudinal diameter of at -lantoaxial joint , kinematics parameters ( flexion angle ) of 30patients diagnosed as atlantoaxial joint disorder were obtainedbymotion capture system.The influence of different individual bone structure parameters on fixed point rotation manipu -lations was analyzed.Results : 1 ) The reference values of cervical spine rotation manipulation were obtained : flexion angle( 35.69°±4.09° ), lateral flexion angle ( 34.94°±3.47° ), rotation angle ( 31.12°±2.76° ), rotation angle difference( 4.50°±1.05° ) .There was no significant difference in thekinematic parameters between the left and right hand in theprocess of cervical vertebra fixed - point rotation ( P >0.05 ) .2 ) The results of multiple linear regression analysis showedthat : the angle of inclination of axis was an important factoraffecting the angle of anterior flexion; the length of the ante -rior and posterior arch of atlas and height of pedicle of axisare important factors influencing lateral flexion angle ; the longitudinal diameter of atlantoaxial joint, the angle of inclina -tion of axis and the length of anterior and posterior axis are the important factors influencing rotation angle , and thelength of anterior and posterior arch of atlas is the important factor of rerotation angle.Conclusion : The fixed - point rota -tion manipulation of cervical vertebrae is a combination of flexion , lateral flexion and rotation.There is no significantdifference between the left and right hand operation of the same operator , and the individual parameters of different pa -tients will affect the manipulation.