腰椎关节松动手法及冲击手法下力在关节突关节内的传导特征

Conduction characteristics of human lumbar facet joint pressures during simulated spinal manipulation versus spinal mobilization

背景:腰椎关节松动手法和腰椎关节冲击手法的目的都是纠正椎间关节的半脱位状态,但两种手法下力在关节突关节内如何传导尚不十分清楚。目的:测量腰椎关节松动手法和冲击手法过程中关节突关节压力的变化,探讨两种手法对关节压力作用的异同。方法:12具成年男性新鲜尸体腰椎标本(T12-S2)随机分为2组。一组模拟松动手法(n=6):预加载15°,速度3(°)/s,最大加载角度20°,速度1(°)/s,L5棘突水平推力9 N;另一组模拟冲击手法(n=6):预加载15°,速度3(°)/s,最大加载角度20°,冲击速度33(°)/s,L5棘突水平推力22 N。采用Tekscan压力分布测量系统测量手法过程中双侧L4-5和L5-S1关节突关节的压力。结果与结论:1两种手法过程中(向右侧旋转再回到中立位),右侧关节压力先逐渐减小再逐渐增大,左侧关节压力先逐渐增大再逐渐减小;2两种手法下右侧关节压力差异无显著性意义(P>0.05),冲击手法左侧关节最大压力大于松动手法(P<0.05);3冲击手法右侧关节压力下降速度大于松动手法(P<0.01),上升速度差异无显著性意义(P>0.05),冲击手法左侧关节压力上升速度和下降速度均大于松动手法(P<0.01);4两种手法下旋转同侧关节压力先减小后增大,旋转对侧关节压力先增大后减小,手法结束后关节压力均恢复到手法前状态;5冲击手法下关节压力变化速度和幅度高于松动手法。冲击手法比松动手法造成关节突关节损伤的可能性大,使用冲击手法时注意把握冲击速度和力度。

BACKGROUND：The aim of spinal mobilization and spinal manipulation is to correct vertebral subluxation.However,facet joint pressures are not clear during these two therapies.OBJECTIVE：To compare human lumbar facet joint pressures during simulated high-velocity,low-amplitude spinal manipulation versus low-velocity,low-amplitude spinal mobilization.METHODS：Totally 12 adult fresh lumbar spinal specimens（T12-S2） were divided into two groups randomly.Parameters of simulated spinal mobilization（n=6）：preload angle 15°（speed 3°/s）,maximum angle 20°（speed 1°/s）,with 9 N horizontal force to L5 spinous process.Parameters of simulated spinal manipulation（n=6）：preload angle 15°（speed 3°/s）,impulse angle 20°（impulse speed 33°/s）,with 22 N horizontal force to L5 spinous process.Pressures of bilateral L4-5/L5-S1 facet joints were measured with Tekscan system.RESULTS AND CONCLUSION：（1） During two spinal manipulative therapies（rotation to the right and then back to the neutral position）,pressures of right facet joints decreased first and then increased gradually,while pressures of left facet joints changed oppositely.（2） Pressures of right facet joints were similar regardless of manipulation type（P〉0.05）.The maximum pressure of left facet joints was larger during manipulation than that during mobilization（P〈0.05）.（3） Descending speed of pressures of right joint was larger during manipulation than that during mobilization（P〈0.01）,and no significant difference in ascending speed of pressure of right facet joints was detected（P〉0.05）.Both ascending and descending speeds of the left facet joints were larger during manipulation than that during mobilization（P〈0.01）.（4） During two spinal manipulative therapies,pressures of ipsilateral facet joints decreased first and then increased,while pressures of contralateral facet joints increased first and then decreased.Joint pressure after treatment restored to that before treatment.（5） Impulse speed and magnitude of pressures of facet joints during manipulation were larger than that during mobilization.Facet joints are more possible to be injured during manipulation than that during mobilization.During manipulation,we should pay attention to the speed and intensity of the impact.