| ObjectiveFirstly,the study aimed to analyze the morphology of posterior superior iliac spine(PSIS)and its clinical implication during the palpation of sacroiliac joint(SIJ)subluxation,as well as to analyze the characteristics of SIJ space under CT scan examination,to provide a better reference of imaging technology to diagnose SIJ subluxation in oral clinical practice.Sencondly,the studty aimed to explore the biomechanical effects of oblique-pulling manipulation on the SIJIn addition,the study aimed to explore the potential and adverse effects of cervical thrusting-wrenching manipulations(CTM)on the common carotid artery and plque with severe carotid atherosclerosis(CAS),especially in vulnerability and mechanical properties.Methods1.A total of 280 intact and dry hip bones of adult were observed and measured.After classification by morphology of PSIS,the size,and related location were measured and compared among different classifications.2.A total of 75 cases of SIJ computed temography(CT)images including the region of SIJ were enrolled.The morphology,area and ratio between two parts of SIJ space was measured in the horizontal level of the first,second,and third sacral vertebra(S1,S2,and S3).3.Six pieces of human pelvic specimen were prepared for biomechanical test.Compression,tensile and oblique-pulling tests were performed in order.All of the test procdures were not only performed in the normal SIJ,but also in the SIJ with disruped pubis symphysis,anterior ligaments and even posterior ligaments,respectively.During each test,the displacement and angular displacement around SIJ were measured,at both process of force loading and unloading.4.Rabbits were randomly divided into four groups,including the manipultion group ?,the manipulation group ?,CAS group and control group.Severe CAS model of common carotid artery was developed in the manipultion group ?,the manipulation group II,and CAS group.Then,CTM or manipulaitons of pushing on Qiaogong(MPQ)was performed in manipultion group ?,and the manipulation group ?,respectively.In the end,determination of serum level of high sensitivity C-reaction protein(hs-CRP),calculation of blood flow shearing force,histological analysis of plaque content under HE,oil red O and Masson trichromic staining,as well as immunohistochemical analysis with CD34 and CD68 antibody were completed in order.5.Finally,uniaxial tensile test was performed on rabbit common carotid artery acquired from the former experiment,in order to identify the difference in biomechanical properties among four groups.Results1.Generally,four different morphologies of PSIS could be found.The U shaped was the most,accouting for 43.2%.On the contrast,the V shaped,W shaped and osteoproliferation type,accouting for 38.2%,11.1%,and 7.5%respectively.No significant difference was found in gender distribution of the morphology of PSIS(P>0.05)2.At the level of S1,both SIJ synovial space of the male and the female appeared to be a line.At both levels of S2 and S3,synovial space of the male appeared to be an arc,however the female appeared to be "S" shaped.Also,at both levels of S1 and S2,the ratio of synovial space on overall space in the male was higher than the female,significantly(P<0.05).3.Firstly,for the normal SIJ,angular displacement under oblique-pulling test was less than that under compression and tensile tests(P<0.05).The displacemet in upper SIJ under oblique-pulling test was less than compression test(P<0.05);however,no signicant diffeferce was found in the displacement in lower SIJ(P>0.05).Secondly,the displacement between ilium and lumbar vertebrae was significantly more than the displacement occurred in SIJ(P<0.05),during the oblique-pulling test.Thirdly,when the pubis symphysis,the anterior and posterior ligaments were disrupted step by step,angular displacement and dislapcement in SIJ showed an increasing tendency approximately.The tendency was similar in all three types of biomechanical tests.Besides,relative angular displacements under oblique-pulling test were no more than that under compression test(P>0.05).Forthly,during the unloading process,angular displacements and displacements of joints in all tests were no more than 0.02° and 0.05mm respectively,in comparison with the origin status.4.Firstly,both manipultion group ?,and the manipulation group ? had the increased serum level of hs-CRP and blood flow shearing force of common carotid artery,in comparison with the CAS group and control group.Secondly,the CAS plaque in both manipultion group ? and the manipulation group ? showed a series of characteristics in comparison with the CAS group,as the increased lipid content and IOD of CD38,and the decreased collagen fiber(P<0.05).Morover,plaque in both manipultion group ? showed more micro-vessel density,compared to other two groups(P<0.05)5.The result of tensile test showed that the elasticity modulus of rabbit common carotid artery in manipultion group ? was higer than that in other groups(P<0.05).ConclusionFirst of all,differences in.the morphology of PSIS and area distribution of SIJ space under CT scans may influence the accuracy of palpation and radiological diagnosis,in clinical practice of SIJ subluxation.Moverover,in biomechanics,oblique-pulling manipulation may develop tiny displacement and rotation of SIJ.Once the ligaments was severe disrupted,the effects of manipulation would increase gradually.However,the effects caused by oblique-pulling manipulation seem to be no more than the the effects of physiological loading approximately.Once the force was no longer existed with the the finished manipulation,the recovery mobility of SIJ up to the former status may appear at the same time.Thus,the mechanism of the manipulations remains to be explored.In addition,cervical TM techniques may increase the carotid blood shear force,and accelerate the disruption of the unstable plaque,and it even has the effects in decrese the tensile elasticity of the common carotid arety with severe atherosclerosis,In brief,all of these should be pay more attention in clinical practice. |
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