| BackgroundCervical spondylosis is the common orthopedics and traumatology disease,which the prevalence in China amounted to about3.8%～17.5%and is increasing rapidly recently. Cervical spondylotic radiculopathy account for above60%of the total. Rotation-traction manipulation(RTM), which has been proven its efficacy and safety by the researches of the clinical research of "eleven-five" support project of the ministry of science and technology of the People’s Republic of China and the National Natural Science Foundation issue, is the first choice of traditional Chinese medicine to treat for Cervical spondylotic radiculopathy, and has been the project of State Administration of Traditional Chinese Medicine to promote its use all around the country. However, the basic research cannot satisfy the clinical wants and needs.In preliminary clinical study, we found that there are some differences of x-ray signs between cervical spondylotic radiculopathy and other types of cervical spondylosis. By retrospect literature, we found that there are many summative analysis of imaging findings on cervical spondylotic radiculopathy, but little contrast studies between cervical spondylotic radiculopathy and other types of cervical spondylosis.In preliminary basic research, the mechanical parameters of rotation-traction manipulation have been preliminarily summary through a small sample mechanical research and a certain regularity during operation of RTM have been found. And the effect of reducing pressure in the cervical nucleus pulposus have been proved through the biomechanical simulation studies about the RTM in vitro.Objective1. To analysis the differences and similarities of X-ray signs between cervical spondylotic radiculopathy (CSR) and vertebral artery type of cervical spondylosis(VCS).2. To analysis the influence of different rotation-traction manipulation (RTM) on three dimensional displacement of lower cervical vertebral body, the pressures of the cervical nucleus pulposus and the structure changes of cervical intervertebral foramen so as to explore the biomechanical mechanism of rotation-traction manipulation. Method1. Comparative analysis of x-ray signs of CSR and VCS.A blinded design research. The X-ray signs both60cases of VCS and60cases of NCS in the cervical lateral、flexion and extension films, including cervical curvature, atlanto-occipital joint angle, atlanto-axial joint angle, C2/C3angle, the rear distances of atlanto-occipital joint, the rear distances of atlanto-axial joint, flexion activities of Joint angles, extension activities of Joint angles and lower cervical instability segment, were measured and recorded. The data were analyzed and compared between the two groups after unblended.2. The in vitro biomechanical study of RTM on cervical vertebral body three dimensional displacement and cervical nucleus pulposus pressures.To use Material Test System on fresh cervical specimens to simulate different RTM, while motion capture system was adopted to dynamically measure the three dimensional displacement of lower cervical vertebrae and micro pressure sensors were used to measure the cervical(C2/3,C3/4,5C4/5,C5/6,C6/7) nucleus pulposus pressures during force loading. To explore the biomechanics mechanism of RTM by analyzing and comparison the mechanical influence of the three dimensional displacement of cervical vertebral body and cervical nucleus pulposus pressures during different simulated RTM.3. The Biomechanical study on the effect of RTM to cervical intervertebral foramen by interactive virtual reality technology.To measure three dimensional movement of lower cervical vertebrae during rotation-traction manipulation with motion capture technique, then apply thin layer spiral CT to scan Cervical spine specimens, then use Mimics software to reconstruct three dimensional entity cervical spine. To realize the virtual reality simulation with multi mode three-dimensional medical image registration by Autodesk Maya software. Finally to measure the dynamic changes of cervical intervertebral foramen of longitudinal diameter and the area during RTM by using Adobe Photoshop software and ImageJ software and to find out the mechanical effects about the RTM. Conclusion1.Clinical research:(1) The flexion and extension limitation of occipitalia and neck, cervical spine curvature straight and lower cervical instability was the X-ray signs of CSR and VCS.(2) The atlanto-occipital joint extension movement disorder are always happened in CSR, and the atlanto-axial joint flexion movement disorder are mainly presented in VCS.This difference is closely related to its pathological mechanism.2.Experiment research:(1) During neutral traction, the force decrease from the bottom of the lower cervical vertebra. The7th cervical spine stress less.(2) During rotated locating sate, the stress was concentrated in the cervical vertebra between the ipsilateral C4/5.(3) Rotation-traction manipulation can adjust the cervical stress concentration.(4) Different methods of cervical spine position status will affect the force effect of Rotation-traction manipulation on the lower cervical spine.(5) In the clinical operation,150N thrust force for most patients is more appropriate, which can effectively adjust the lower cervical vertebral displacement, and reduced the cervical nucleus pulposus pressure.(6) Interactive virtual reality technology enables dynamic analysis the structure of the cervical intervertebral foramen.(7) Rotation-traction manipulation have a certain influence to cervical intervertebral foramen area, especially to the contralateral vertebral foramen. After that, the nerve root may help to loosen adhesions, thus alleviating the symptoms. |
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