| Low Back Pain has been listed as one of the human major health problems by WHO.Lumbar intervertebral disc herniation(LIDH) is the main reason which causes low back pain.The clinical statistic shows that patients who suffer from LIDH is reported 18%in the total amount of low hack pain patients.This disease is included among the categories of paralyze and low hack pain,the pathological mechanism of low hack pain is related to "tendons out,bone disorder".Manipulation utilize the rule "first soothing tendon,then ajustment bone" "tendon and bone are both important" as the treatment principle.Overall adjustment is the character and advantage of chinese traditional treatment.By using the chinese traditional treatment,it can lubricate joint,release the conglutination etc.Lumbar manipulation is simple,quick,etc.But it is difficult to master techniques in a short time,and the steps lack of standards and operate with a certain degree of risk.So the treatment effect differences exist which affects clinical widespread.To develop more secure,simple,effective and feasible approach to optimize a standard manipulation program,and to evaluate manipulation safety and efficacy by the rigorous clinical trials,have important practical significance.Professor Zhang Jun follow the movement of the spine,the biomechanical principle,refinement steps,extract the lumbar standard manipulation.In order to verify the repeatability and clinical efficacy and safety,the project will carry out mechanical visualization training and clinical trial.Main Research Content1.Experimental Part:Using manipulation training system to measure mechanical values of specialists(include effective strength in the whole process of manipulation operation,effective time,etc.),have the operation of manipulation quantitative,analyses the values in between, and collect the specialty in the mechanism of manipulation.2.Clinical Part:Select 63 cases of LIDH patients in accordance with this research,using the central online random grouping ways to separate the testing group(standard manipulation group) and comparison group (traction therapy group),with 32 cases of standard manipulation group and 31 cases of comparison group.Observe at each first,second,and third week during the therapy sessions on JOA lower-back pain patients treatment assessment,lower-back and leg pain visual simulation score (VAS score),CT 3D reconstructed image of protrude objects morphology value,side-effects,etc.,in order to have full evaluation on safeness and effectiveness of standard manipulation.Results1.Experimental Part1.1 Based on the age,BMI value,waistline and other values on 15 LIDH patients fundamental physical-mechanical tests data analysis on specialty manipulation operation(patient's pathological pain segment threshold on pressure point besides spinous process is between 1.8-2.2kg; 2.8-3.2kg:3.8-4.2kg,within each pain pressure threshold has 5 patients), draw special mechanical wave chart on finger-kneading manipulation, palm-press manipulation,step-by-step oblique-plank experimental standard operation.1.2 Finger-kneading manipulation most effective kneading strength value is about 40%of pain threshold.Palm-pressure manipulation most effective strengthvalueisabout 70%of painthreshold;Elbow-plankaboveshoulder fixed push-and-pull most effective strength value is about 85%of pain threshold,and planking most effective strength is 2.5times of fixed most effective strength value.;Elbow-plank posterior of hip fixed push-and-pull most effective strength is 1.1times of pain threshold,and the plank most effective value is 2times fixed effective value. Elbow-plank above shoulder and posterior of hip most effective value are close,the instantaneous applying force to both elbows are basically the same.Step-by-step fixed-oblique-plank has obvious correlation (P＜0.001).1.3 Trainees follow the manipulation assessment advice to re-train,able to cope with thespecialists' standard wave chart with their own strength mechanical curve(curve fitting degrees greater than 85%).2.Clinical Part2.1 Two Groups treatment comparison Clinical testing group always has 96.86%effectiveness,and clinical comparison group always has 87.10%effectiveness.2.2 Analysis of JOA score from two groups2.2.1 Comparison before and after treatment at each visit each groupJOA score from two groups of patients at each visit after the treatment were significantly increased(P＜0.001),so both groups have good effects on in improving symptoms,signs,life ability.2.2.2 Comparison before and after treatment at each visit between two groupTesting group is obviously better than the control group at 1,2,3 visit (P＜0.05,P＜0.05,P＜0.01).2.3 Analysis of VAS score from two groups 2.3.1 Comparison before and after treatment at each visit each groupVAS score from two groups of patients at each visit after the treatment were significantly decreased(P＜0.001),so both groups have good effects on in relieving pain.2.3.2 Comparison before and after treatment at each visit between two groupTesting group is obviously better than the control group at 1,2,3 visit (P＜0.05,P＜0.01,P＜0.01).2.4 Analysis of morphological indicators of three-dimensional reconstruction image of prominence and the average CT value of pulposus nucleus2.4.1 Comparison before and after treatment from Testing groupAN score after the treatment were significantly increased in unilateral herniation(P＜0.05),so testing group can make prominence deformated.Testing group treatment efficacy in unilateral herniation is not better than central one.2.4.2 Comparison before and after treatment from control groupSagittal index after the treatment were significantly reduced in central herniation(P＜0.05),so testing group can make prominence deformated.Control group treatment efficacy in central herniation is better than unilateral one.2.4.3 Effect comparison for different type of prominence from two groupsTesting group treatment efficacy in unilateral herniation is better than control group.Control group treatment efficacy in central herniation is no better than testing group.Conclusions1.Experimental Part1.1 Lumbar manipulation has its certain standard regularity,the role in efforts is related to the threshold of pain pressure of pressure points beside the spinous process.The greater the pain threshold,the greater the efforts of manipulation.Tendon-smoothing manipulation has less efforts,but it focus deep and steady;the greater the pain threshold, along with prolonged manipulation,it enhanced the stimulation,follow with light and soft-strong flexible principle.During oblique-pulling manipulation operation,the greater the fixed with pre-loaded force,the greater the pulled-force,and so the greater the efforts.The strength of the pulled-force is determined by the fixed with pre-loaded force. This positive correlation shows the impotency the operation of manipulation.1.2 The trainees can basically bring out the special mechanical manipulation of professionals,verifies the repeatability of standard manipulation operation.2.Clinical Part2.1 Lumbar standard manipulation is a safe and effective way of treatment with high-secured operation in LIDH patients,improving their pain,sign and symptoms,living ability and gain notable effects in their treatment.2.2 Lumbar standard manipulation is more fast and effective than pelvis traction therapy in LIDH patients,improving their pain,sign and symptoms, living ability and other aspect.2.3 Both of the treatments can change the prominence patterns. Manipulation can mainly change the unilateral protrude nucleoplasty or eventration objects,and its efficacy is superior to traction,may be related to the release between the protrude objects and neurons,to improve the mutual position;traction can mainly change the central protrude objects or eventration objects,its result is not better than manipulation,but better than the same unilateral group,maybe shorten the distance between the distal protrude objects and trailing edge of intervertebral disc,release the pressure in hard capsule. |
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