| Lumbar intervertebral disc herniation due to low back pain is a common chronic pain syndrome in orthopedics, and its incidence in recent years increased year by year, and developed in a younger age. Calm pain and improve function and reduce the recurrence is the main objective of the treatment and rehabilitation. Spinal manipulation is one of the most commonly recommended treatment in the health prevention and treatment guidelines in many countries. In China Lumbar Oblique-pulling Manipulation (LOM) treatment of the disease intervention had exact effect of Orthopedics practice, and widely used and welcomed by doctors and patients. The study shows that treatment and operational safety practices are closely related to the size of the force, direction angle and time factors. The observation of LOM method is the process of lumbar spine movement mechanics change and its biomechanical effects, contributing to the analysize, master, and optimize standard operation technique. It should be one of the focus of future research directions.In order to standardize and optimize LOM technique, and to analyze the operating characteristics and influencing factors, this subject will use force sensing measurement technique, optical positioning capturing technique in vivo, and observe mechanics and kinematics change process, summarize mechanical movement laws, and through clinical controlled trial study, observe mechanical index change and the operator, the operator factors correlation issue, to provide a reference for standardization of LOM operation.Objective1. Finish a manipulation standardized description draft.2. Summarize mechanical movement laws.3. Investigate mechanical index change and the operator, the operator factors correlation issue.4. Establish initially a standardized description of the presentation. Research1. LOM literature analysis:On basis of full understanding of the principles, procedures and quality requirements, technical standards and standard written methods, to collect the massage school textbooks and other materials, and refer professional standards published or awaiting publication of the Institute, make non-quantifiable elements and quantifiable elements categorized, analysize literature incorporated language features, and finish a manipulation standardized description draft.2. LOM kinematical and mechanical testing:apply a elbow manipulative force measuring instrument dynamic testing operating mechanics data in vivo, apply a binocular visual locator dynamic capturing operating motion locus in vivo, summarize mechanical movement laws, and provide a reference for standardization.3. LOM controlled clinical trial:compare LIDH treatment group and normal control group of healthy young volunteers to observe the immediate efficacy and safety of the treatment, analysize cracking sounds or spinous process, left elbow or right eblow, shoulder pulling or hip pulling operator dynamic factors, as well as the degree of pain, paravertebral tenderness threshold, limits of flexion pain, body mass index operating dynamic factors, and practices force size, analysis its influencing factors.Results1. A draft of manipulation standardized description:Patients with lateral position, hip flexion on the side of the lower limb flexion, the next side of the lower limb is naturally straight. Doctors who stood facing the side of the bed with an elbow or hand against the front of the shoulder, another elbow or hand arrived against the back of the hip. Both elbows or hands in the opposite direction to coordination of force, until reversing the obvious resistance, a sudden increasing significantly flip, and often the "click" sound could be heard.2. Summarize mechanical movement laws:2.1Biomechanical testing results in vivo:Operator LOM mechanics curve diagram has certain characteristics:repeatedly showing of a short, steep, high peak, indicating that the operator pulled "fast", conforming "performing force and closing force immediately" operational requirements. Clinical operations should be noted that the force should be slightly larger than the shoulder force in the hip.2.2Motion capturing testing results in vivo:Operator LOM curve has certain characteristics:the repeat showing of a short curved track locus, state the operator pulled the "small-amplitude", with the force direction to the rotation accompanied pressure, conforming "homeopathy forcing according with operating position and orientation "operation requirement. Subjects has certain characteristics:repeatedly showing a short curved track locus, similarly to operator curved track locus, state operator’s movement along with operating’s followed a similar exercise, prompting the operator and the operating has the characteristics of "stable contact"3. LOM controlled clinical trial results 3.1Immediate efficacy and safetyThe experimental group total effective rate was100%, a significant effect in the immediate analgesia (leg pain, paravertebral tenderness), improvement activities (flexion activity), and no adverse reactions occur.3.2The operator factors and the practice force3.2.1Cracking sounds or spinous process and the forcesIn the test group only1patient was were no cracking sounds but with the spinous process; in the two groups the remaining cases were associated with cracking sounds with spinous process. Practices force and cracking sounds or the spinous has no direct relationship (P>0.05).3.2.2Left elbow or right eblow and the practice forceThe force of the right elbow in both two groups were greater than the force of the left elbow of the practices, but the difference was significant (P>0.05), there is no significant difference between the two groups (P>0.05). Prompt profit elbow operation force is not significantly greater than the force of the non-profit elbow operation.3.2.3Shoulder pulling or hip pulling and the practice forceHip Pulling force forces are greater than the pulling shoulder in both two groups, but the difference was significant (P>0.05), but the test group the hip pulling force is greater than the normal group, the difference was statistically significance (P<0.05). Prompted operating on patients the hip pulling force than normal more.3.3Operating factors and the practice force3.3.1Individual prevalence condition and the practice forceUsing a visual analog score (VAS), positive point pressure threshold (PPT), lumbar flexion range (LFR) indicators reflect the individual’s prevalence condition, and results show that the hip pulling force has no significant correlation (P>0.05) between VAS score, PPT score, LFR distance. There was no suggesting that the hip pulling force does not adjust according to pain feeling, paraspinal tenderness, flexion adverse severity of the disease indicators.3.3.2Individual body mass index and the practice forceThe hip pulling forces were significantly related with individual body mass index (P <0.05), the hip pulling force adjust with populations of different body mass index. That is the individual body mass index is greater, and the force implementing is greater.4Conclusion4.1LOM operation is "fast","small-amplitude", conforming "doctor-patient stable contact","homeopathic force" requirement. It have some regularity of movement mechanics. Mechanics features include pre-load force increases, the greater the pulling power. Motion characteristics of the movement include minor lumbar reverse with high-speed flip.4.2For short duration young population of non-acute phase, the left elbow or right elbow, shoulder pulling or hip pulling, the pain degree or the pain limitation scope don’t impact the operating forces; in the application of LOM operation the patient’s hip pulling should be slightly larger than normal healthy. Different size (body mass index) is an individual one of the factors affecting the operating force, clinical practices using should increas practice force adjusting with overweight or obese patients. Cracking sounds is the important indicator of success, but not the only sign.4.3LOM standardized description:Patients with lateral position, hip flexion on the side of the lower limb flexion, the next side of the lower limb is naturally straight. Doctors who stood facing the side of the bed with an elbow or hand against the front of the shoulder, another elbow or hand arrived against the back of the hip. Both elbows or hands in the opposite direction to coordination of force, until reversing the obvious resistance, in the doctor-patient stable contact, a sudden increasing significantly flip,"performing force and closing force immediately", and often the "click" sound could be heard. |
PDF Full Text Request