旋提手法预置体位中颈椎耦合运动研究  

Study of Rotary Lifting Manipulation on the Treatment of Cervical Spondylotic Radiculopathy in Preset Position

作　　者：符碧峰 苏瑾[1,2,3] 张超 姜星羽[1,2,3] 杨征辉 杨光 冯敏山 王平[1,2,3] FU Bifeng;SU Jin;ZHANG Chao;JIANG Xinyu;YANG Zhenghui;YANG Guang;FENG Minshan;WANG Ping(The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China;National Clinical Research Center of Traditional Chinese Acupuncture and Moxibustion,Tianjin 300381,China;Regional Orthopedic Diagnosis and Treatment Center of Traditional Chinese Medicine,National Administration of Traditional Chinese Medicine,Tianjin 300381,China;Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102)

机构地区：[1]天津中医药大学第一附属医院,天津300381 [2]国家中医针灸临床医学研究中心 [3]国家中医药管理局区域中医骨伤科诊疗中心 [4]中国中医科学院望京医院

出　　处：《中国中医骨伤科杂志》2023年第4期20-24,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：中医药循证能力建设项目(2019XZZX-GK006);天津中医药大学第一附属医院“拓新工程”项目(201908);王平劳模创新工作室项目;天津市名中医传承工作室建设项目(881022);中医骨伤重点专科建设项目。

摘　　要：目的:分析旋提手法操作中不同预置体位下的颈椎节段角度的变化,为旋提手法治疗颈椎疾患的生物力学作用机制建立良好的工作平台。方法:选取一名27岁健康女性志愿者进行旋提手法预置体位(中立位0°→向左旋转30°→屈曲30°→再向左旋转30°→达到关节固定状态)中不同角度的颈椎薄层CT扫描,并将CT原始数据以DICOM格式保存,用Mimics 20.0、Geomagic Studio 2017、Solidworks 2017进行模型的组装以及不同体位下颈椎各节段重心与第七颈椎重心之间三个维度的角度测量,观察预置体位下的颈椎骨性形态学的变化。结果:颈椎在旋转30°过程中,上颈椎有同侧的侧弯耦合和后伸耦合,而下颈椎有向对侧侧弯耦合和后伸耦合;在旋转至60°时,上颈椎依旧是同侧的侧弯耦合和后伸耦合,而下颈椎则由对侧耦合转为向同侧侧弯耦合和后伸耦合;颈椎在屈曲30°时,颈椎的旋转和侧屈幅度很少,屈曲的运动可以看作是单一方向的运动。结论:颈椎的旋转活动是多方向、多椎体耦合代偿而产生;上颈椎活动度比下颈椎活动度大;在小幅度活动时(<30°),颈椎的活动主要集中在上颈椎;而在大幅度活动时(>30°),颈椎的耦合代偿相对较明显。Objective:To analyze the changes of cervical segmental angles in different preset positions during the operation of the rotation manipulation,so as to establish a good working platform for the biomechanical mechanism on the treatment of cervical diseases by the rotation manipulation.Methods:A 27-year-old healthy female volunteer was selected to perform thin-slice CT scanning of cervical vertebrae at different angles in the preset position(neutral position 0°→left rotation 30°→flexion 30°→left rotation 30°again→joint fixation)in the rotation maneuver,and the original CT data were saved in DICOM format.Mimics 20.0,Geomagic Studio 2017 and Solidworks 2017 were used to construct the model and measure the angle of three dimensions between the center of gravity of each segment of the cervical spine and the center of gravity of the seventh cervical spine in different body positions.The changes of cervical spine skeletal morphology in the preconfigured body position was observed.Results:In the process of 30°rotation of cervical spine,the upper cervical spine had ipsilateral lateral bending coupling and posterior extension coupling,while the lower cervical spine had contralateral lateral bending coupling and posterior extension coupling.When the rotation reached 60°,the upper cervical spine was still ipsilateral lateral bending coupling and posterior extension coupling,while the lower cervical spine was transformed from contralateral lateral bending coupling to ipsilateral lateral bending coupling and posterior extension coupling.At 30°flexion of the cervical spine,the range of rotation and lateral flexion of the cervical spine was very small,and the movement of flexion can be regarded as the movement of a single direction.Conclusion:The rotation of cervical vertebrae is caused by the coupling of multiple directions and multiple vertebrae.The range of motion of the upper cervical spine was greater than that of the lower cervical spine.In the small range of movement(<30°),the cervical spine activity mainly

关 键 词：旋提手法 预置体位 颈椎活动度 耦合机制 

分 类 号：R681.5[医药卫生—骨科学]