| BackgroundCervical Spondylotic Radiculopathy(CR)is the main classification of Cervical Spondylosis(CS).The main manifestations of this disease are neck pain accompanied by numbness and radioactive pain in one or both upper limbs.Besides,decreased muscle strength,grip strength and skin sensation in upper limbs are also can be found.It has a great impact on patients’ work and life due to repeated and refractory.Meanwhile,with the change of lifestyle and the popularity of electronic devices,CR shows an obvious trend of younger and larger,so as to become one of the urgent clinical problems in orthopedics.As an important part of conservative treatment for CS,the manipulations of traditional chinese medicine(TCM)can correct joint disorder and dislocation,restore local mechanics balance,regulate "out of the groove,bone break" pathological state,its effectiveness and safety in many clinical research and evidence-based evaluation has been confirmed,but its effect mechanism is not clear and needs further validation.The core of spinal diseases are the biomechanics balance of the spine.The most representative theory spinal diseases of is the ’muscles and bones theory’ in Traditional Chinese medicine and the ’three pillars theory’ in modern medicine.The muscles and bones theory believes that the abnormal changes of muscles and bones are the basis of cervical spondylosis,they influence each other.’three pillars theory’divided the spine into three mechanical unit:anterior column,spinal column,posterior column and spinal stability can be divided into endogenous and exogenous stability.Internal stability is provided by bone structure and exogenous stability provided by the peripheral of muscle tissue and other soft tissue.Repairing the balance of spinal biomechanical is the main target of the treatment of cervical spondylosis.Based on the Traditional Chines cervical rotation manipulation,Cervical Rotation Traction Manipulation(CRTM)was inherited and innovated by li-guo zhu chief physician from China Academy of Chinese Medical Sciences wangjing hospital,the technique specifications have been established already.The main characteristic of this manipulation is decomposing the core operating into two part:patient rotation positioning and operator rotation reduction,which can protect patients due to cervical spine won’t exceed the physiological limits of patients,with considerable curative effect and good safety.Relevant research achievements have won many awards including the second prize of National Science and Technology Progress Award.However,the mechanism of its curative effect has not been fully elucidated.Therefore,based on soft tissue tension analysis system and finite element analysis technology,this study attempts to clarify the therapeutic mechanism of CRTM in the treatment of CR from the two directions of clinical application basic research and biomechanical research.ObjectivesBased on the modern medical technique included soft tissue tension analysis system and finite element analysis technology,this study will explore the curative effect mechanism of CRTM on CR patients from "Jingu" theory of TCM,further clarify the therapeutic effect of CRTM in the treatment of CR and provide a new theoretical basis for the promotion and application of this manipulation.Content1.The soft tissue tension analysis system was used to record the differences of cervical soft tissue tension on 30 patients with CR before and after CRTM treatment,so as to analyze the effect of CRTM on the soft tissue of these patients.2.Construct a cervical rotation finite element model,apply the mechanical parameters of the CRTM to the model,analyze the mechanical characteristics and structure of to clarify the influence of the this manipulation on the area of the intervertebral foramen.MethodsAccording to the corresponding criteria,30 CR patients with definite diagnosis were selected from the Wangjing Hospital and Institute of Orthopedics of China Academy of Chinese Medical Sciences.After the informed consent was signed and the patient’s medical history was recorded,CRTM as the intervention method,the patient’s neck soft tissue tension was analyzed twice 5 minutes before the manipulation and 5 minutes after the it.After obtaining the data,the probe displacement value of soft tissue tension analysis system under 500g compression pressure was selected.The soft tissue tension changes before and after manipulation were analyzed by SPSS 22.0 software,and the coordinate system was constructed with the spinal process of the first thoracic segment as the origin.The soft tissue tension cloud map was drawn by Matlab software to intuitively evaluate the therapeutic effect of manipulation.Meanwhile,a volunteer with no obvious neck symptoms recently and no abnormal cervical lesions indicated by imaging was included.After signing informed consent,cervical CT were taken in rotating neck position and finite element models of cervical vertebra from third cervical to frist thoracic were completed by finite element software like Mimics.The mechanical parameters of the CRTM were applied to determine the mechanical effect of this manipulation on cervical tissue results and the influence of the intervertebral foramen.Results1.The effect analysis of CRTM on CR patients soft tissue tensionA total of 30 patients were included in this part of the study,with an average age of(49.79±11.54)years old,the oldest 64 years old,the youngest 25 years old,including 11 males and 19 females,with a median course of 4.5 weeks,the longest course of 18 weeks,the shortest course of 2 weeks,8 patients on the left side and 22 patients on the right side.There were 11 patients with upper limb pain and 19 patients with upper limb numbness.The soft tissue tension cloud map results showed that after CRTM,the soft tissue tension of patients from the 3rd cervical segment to the 7th cervical segment,from the 4th to the 1st thoracic segment,from the right thoracic segment to the 3rd thoracic segment,from th e 7th to the 3rd thoracic segment was significantly lower than that before manipulation.Data analysis results showed that there was statistically significant difference between the two groups before and after manipulation(P<0.001),and there was statistically significant difference between the affected side and the healthy side of the 5th to 7th cervical segment before manipulation(P<0.001),while there was no statistically significant difference between the two groups after manipulation(P=0.231).2.The mechanical mechanism of CRTM based on finite element modelOne volunteer was included in this part of the study,male,26 years old,186cm in height and 86Kg in weight,with no recent symptoms of neck discomfort.According to the study of stress and displacement cloud of cervical vertebra,the stress of bone structure was significantly higher than that of intervertebral disc when the CRTM was implemented.The stress at the top of each cervical vertebra is high,the stress at the bottom is low,and the stress at the facet joint and transverse process is low.The stress at the top of the intervertebral disc was lower and the stress at the bottom was higher,but the highest point of intervertebral disc stress was at the top and outside.After pulling force loading,the area of intervertebral foramen increased compared with that before loading,especially in cervical 6/7.Conclusion1.Patients with CR have the characteristics of uneven distribution of neck soft tissue tension;CRTM not only has the effect of reducing soft tissue tension,but also can balance the uneven distribution of neck soft tissue tension in such patients;2.CRTM exerted on both sides of the lateral facet joint,the upper surface of the vertebral body and the upper surface of the intervertebral disc was the most obvious.Meanwhile,CRTM can increase the area of the intervertebral foramen on the opposite side of the CR patient and the increasing of cervical 6/7 segment is the most obvious.3.CRTM can treat soft tissue and bone tissue together,achieve the state of"balance between muscles and bones" and relieve the symptoms of CR.Innovation1.The multipoint and area soft tissue tension analyzing method is adopted for wide area measurement,replacing the traditional single point muscle force measurement to evaluate the soft tissue state more comprehensively and intuitively;2.Based on the modern medical technology,objective evaluation was used to explain the therapeutic mechanism of CRTM in the treatment of CR with,which established a modern medical interpretation of "Jingu" theory. |
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