定位与非定位颈椎旋转手法对不同程度粥样硬化颈内动脉拉伸力学性能的影响

Effect of positioning and non-positioning cervical rotatory manipulation on tensile mechanical properties of internal carotid artery with different degrees of atherosclerosis

背景:颈椎旋转手法被广泛应用于颈部疾病的治疗且疗效明确,但临床发现其存在一定风险。作者前期研究发现颈椎旋转手法会降低粥样硬化颈动脉的拉伸力学性能,但尚不明确不同颈椎旋转手法(定位/非定位)及不同程度(轻/中/重度)粥样硬化对颈动脉拉伸力学性能的影响。目的:探索不同颈椎旋转手法及不同程度粥样硬化对颈内动脉拉伸力学性能的影响。方法:120只雄性新西兰兔根据不同程度粥样硬化及不同颈椎旋转手法干预随机分为重度粥样硬化+定位/非定位颈椎旋转手法、中度粥样硬化+定位/非定位颈椎旋转手法、轻度粥样硬化+定位/非定位颈椎旋转手法、正常兔+定位/非定位颈椎旋转手法共8个实验组,以及轻/中/重度粥样硬化+无手法干预共3个模型对照组和1个空白对照组。采用两因素方差分析探索不同颈椎旋转手法及不同程度粥样硬化对颈内动脉拉伸力学性能的主效应及交互效应,并用单因素方差分析探索同一程度粥样硬化情况下,不同手法干预对颈内动脉拉伸力学性能的影响。结果与结论:①“不同颈椎旋转手法”与“不同程度粥样硬化”均是影响颈内动脉拉伸力学性能的主效应因素;②对于轻度及重度粥样硬化,定位颈椎旋转手法及非定位颈椎旋转手法均会降低颈内动脉的最大应力(P<0.05),也均会升高颈内动脉的生理性弹性模量(P<0.05);③对于中度粥样硬化,定位颈椎旋转手法及非定位颈椎旋转手法会升高颈内动脉的生理性弹性模量(P<0.05),非定位颈椎旋转手法还会降低颈内动脉的最大应变(P<0.05),其最大应变也小于行定位颈椎旋转手法的颈内动脉(P<0.05);④对于正常颈内动脉,除最大应变外,行定位颈椎旋转手法及非定位颈椎旋转手法均对颈内动脉的其他拉伸力学指标无显著性影响(P>0.05);⑤结果提示,定位颈椎旋转手法及非定位颈椎旋转手法均可能会增加动脉粥样硬化颈内动脉的刚度,使其弹性降低、脆性增加;因此定位颈椎旋转手法及非定位颈椎旋转手法均会增加轻/中/重度颈内动脉粥样硬化家兔出现心血管事件的风险,且粥样硬化程度越重,定位/非定位颈椎旋转手法风险均越大,但定位颈椎旋转手法的风险并未比非定位颈椎旋转手法低。

BACKGROUND:Cervical rotatory manipulation is widely used in the treatment of neck-related diseases with a clear curative effect,but it also has some risks in clinical practice.The previous study of our group found that cervical rotatory manipulation can reduce the tensile mechanical properties of the atherosclerotic carotid artery,but it is not clear about the effects of different cervical rotatory manipulations(positioning/non-positioning)and different degrees(mild/moderate/severe)of atherosclerosis on the tensile mechanical properties of the carotid artery.OBJECTIVE:To explore the effects of different cervical rotatory manipulations and different degrees of atherosclerosis on the tensile mechanical properties of the internal carotid artery.METHODS:The 120 male New Zealand rabbits were randomly divided into eight experimental groups with different degrees of atherosclerosis and different cervical rotatory manipulations:severe atherosclerosis+positioning/non-positioning cervical rotatory manipulation,moderate atherosclerosis+positioning/non-positioning cervical rotatory manipulation,mild atherosclerosis+positioning/non-positioning cervical rotatory manipulation,and normal rabbit+positioning/non-positioning cervical rotatory manipulation,as well as three model control groups:mild/moderate/severe atherosclerosis+non-cervical rotatory manipulation,and the blank control group.Two-factor analysis of variance was used to explore the main effects and interactive effects of different cervical rotatory manipulations and different degrees of atherosclerosis on the tensile mechanical properties of the internal carotid artery.One-way analysis of variance was applied to explore the influence of different cervical rotatory manipulations on the tensile mechanical properties of the internal carotid artery under the same degree of atherosclerosis.RESULTS AND CONCLUSION:(1)Both different cervical rotatory manipulations and different degrees of atherosclerosis were the main effect factors affecting the tensile mechanical properties of the internal carotid artery.(2)For both mild and severe atherosclerosis,both positioning and non-positioning cervical rotatory manipulations reduced the maximum stress of the internal carotid artery(P<0.05)and also increased the physiological elastic modulus of the internal carotid artery(P<0.05).(3)For moderate atherosclerosis,positioning and non-positioning cervical rotatory manipulations also increased the physiological elastic modulus of the internal carotid artery(P<0.05).Non-positioning cervical rotatory manipulation reduced the maximum strain of the internal carotid artery(P<0.05),and its maximum strain was also less than the internal carotid artery of the positioning cervical rotatory manipulations(P<0.05).(4)For the normal internal carotid artery,in addition to the maximum strain,both positioning and non-positioning cervical rotatory manipulations had no statistically significant effects on other tensile mechanical indicators of the internal carotid artery(P>0.05).(5)The results suggest that both positioning and non-positioning cervical rotatory manipulations may increase the stiffness of the atherosclerotic internal carotid artery,reducing its elasticity and brittleness.Therefore,both positioning and non-positioning cervical rotatory manipulations may increase the risk of cardiovascular events in mild/moderate/severe atherosclerotic internal carotid artery,and the more severe the atherosclerosis is,the greater the risk of positioning/non-positioning cervical rotatory manipulation treatment,but the risk of positioning cervical rotatory manipulation is not lower than that of non-positioning cervical rotatory manipulation.