| Background:Degenerative lumbar spondylolisthesis (DLS) is one of the common diseases in orthopaedic. Traditional Chinese medicine (TCM) know it for a long time, and which belongs to "bone malposition" and "tendon displacement" in TCM and can be treated by manipulation. Seated lumbar rotation manipulation, which is widely used in the clinical, has features of stable, accurate, light and artful, and the process of treatment for spinal has truly achieving minimally invasive, even noninvasive, above all, it’s effective in treatment. This study will adopt the methods of multicenter randomized control to test the clinical curative effect of DLS, and then discuss part of mechanism of manipulation through imaging data.But, seated lumbar rotation manipulation needs strong skill. There is no objective technical indicator as reference, though we have already regulate the operation steps. In other words, experienced manipulation have not transformed into a series of quantitative standardized indicators yet. Meanwhile, owing to the insufficiency of research on kinematics and mechanics of seated lumbar rotation manipulation and quantitative research on its influencing factors, the reliable evaluation methodology on kinematics and mechanics still not be built up yet.Mechanical quantification, through mathematical extraction and analysis of mechanical characteristics in the process of manipulation, can be put into practice as an objective evaluation methodology. Therefore, in order to apply fundamental research to clinical practice better, the study will select experienced operator from clinical research to make a real-time measurement of the in vivo kinematic and mechanical parameters by using mechanical measuring instrument that made by ourselves and motion capture technology, and study the mechanical characteristics and influencing factors of seated lumbar rotation manipulation so as to provide the basis for quantitative evaluation of kinematics and mechanics in future.Objective:1To study the clinical effects and partial mechanism of action of seated lumbar rotation manipulation in treating DLS, and provide experienced manipulation operator for the following experiment research.2To study the kinematic and mechanical parameters and the correlation during seated lumbar rotation manipulation, summarize the kinematic and mechanical characteristics of seated lumbar rotation manipulation, and discuss the potential influencing factors of seated lumbar rotation manipulation.Method:1Clinical research:Through making a comparative study among60DLS patients by adopting the methods of multicenter randomized control, to test the clinical curative effect of the seated lumbar rotation manipulation in treating DLS and discuss partial mechanism of manipulation through imaging data, and provide experienced manipulation operator for the following experiment research.2Experiment research:To collect the potential influencing factors during manipulation among patients (age, height, weight, body mass index (BMI)), and made a real-time measurement of mechanical parameters (preload force, peak force, rotary thrust force, rotary thrust duration, thumb thrust force) by using the mechanical measuring instrument that made by ourselves and kinematic parameters (peak velocity, peak acceleration, angular variation) by using motion capture technology when chief physician Gao conducted seated lumbar rotation manipulation to31subjects. Then summarized the kinematic and mechanical characteristics of seated lumbar rotation manipulation, and made an analysis of the correlativity of influencing indicators and the kinematic and mechanical parameters, and carried out a discussion of potential influencing factors on seated lumbar rotation manipulation among subjects with different traits.Results:1Clinical research:(1) Compared with prior treatment,2groups had highly significant difference on VAS after3weeks treatment and follow-up period (P<0.01)(2) Compared with control group, the treatment group had highly significant difference on VAS after3weeks treatment and follow-up period (P<0.01)(3) Compared with prior treatment,2groups had highly significant difference on JOA after3weeks treatment and follow-up period (P<0.01)(4) Compared with control group, the treatment group had significant difference on the clinical effect of JOA after3weeks treatment (P<0.05) and highly significant difference in follow-up period (P<0.01)(5) Compared with prior treatment,, the treatment group had a significant difference on angular displacement after3weeks treatment (P<0.05)2Experiment research:(1) The average value of parameters during seated lumbar rotation manipulation were as follows:the preload force is3.60±0.18kg, the peak force is8.17±0.26kg, the rotary thrust force is6.75±0.33kg, the rotary thrust duration is0.53±0.02s, the thumb thrust force is9.22±0.34kg, the peak velocity is500.29±20.78mm/s, the peak acceleration is3193.58±174.87mm/s2, the variation of anteflexion is5.47±1.10°, the variation of lateral curvature is12.09±1.16°, the variation of rotation is10.07±1.04°.(2) No significant difference (P>0.05) showed between the left and the right hand of the kinematic and mechanical parameters during seated lumbar rotation manipulation.(3) By pearson correlation analysis, there was a prominent positive correlation (R>0.8, P<0.01) among the peak force, rotary thrust force, peak velocity, peak acceleration; a positive correlation (R>0.6, P<0.01) among the preload force and rotary thrust force, peak velocity, peak acceleration.(4) By multivariate linear regression, we revealed that the preload force has prominent correlation (R>0.4, P<0.05) with height, weight and BMI; the peak force and rotary thrust force have prominent correlation (R>0.4,P<0.05) with age and height; the rotary thrust duration has prominent correlation (R>0.4, P<0.01) with age; the peak velocity and peak acceleration have prominent correlation (R>0.4, P <0.01) with height. Conclusion:1Clinical research:(1) The seated lumbar rotation manipulation can significantly improve the clinical symptoms of DLS, and relapse rarely.(2) The rotary lumbar can be adjusted by the seated lumbar rotation manipulation.2Experiment research:(1) The average value of parameters for clinical reference during seated lumbar rotation manipulation were as follows:the preload force is3.60±0.18kg, the peak force is8.17±0.26kg, the rotary thrust force is6.75±0.33kg, the rotary thrust duration is0.53±0.02s, the thumb thrust force is9.22±0.34kg, the peak velocity is500.29±20.78mm/s, the peak acceleration is3193.58±174.87mm/s2, the variation of anteflexion is5.47±1.10°, the variation of lateral curvature is12.09±1.16°, the variation of rotation is10.07±1.04°.(2) The kinematic and mechanical parameters (preload force, peak force, rotary thrust force, rotary thrust duration, thumb thrust force, peak velocity, peak acceleration, angular variation) between the left and the right hand during seated lumbar rotation manipulation were approximate.(3) During seated lumbar rotation manipulation, the more powerful preload force is, the greater rotary thrust force and peak acceleration are. The strength of rotary thrust force and peak acceleration partial depends on that of preload force, which is characterized by seated lumbar rotation manipulation.(4) Age, height, weight and BMI are the influencing factors of seated lumbar rotation manipulation.Innovation point:1. To make a real-time measurement of mechanical parameters for the first time during manipulation by using the mechanical measuring instrument that made by ourselves.2. To make a real-time measurement of kinematic parameters for the first time during manipulation by using motion capture technology.3. To make an analysis of the correlativity of influencing indicators and the kinematic and mechanical parameters, and carried out a discussion of potential influencing factors on seated lumbar rotation manipulation among subjects with different traits. It is rarely mentioned in the past articles. |
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