| Background:Cervical spondylosis (CS) is a common and frequently occurring vertebral disease.The prevention and treatment of Traditional Chinese Medicine (TCM) in CS is a project of advantages of disease.CS belongs to " arthromyodynia " and " neck rigor" in TCM.Rotation-traction manipulation, which can adjust bone malposition and tendon displacement through its acting force, is one leading therapeutic tool of CS.In modern medicine, it is acknowledged that the rotation-lifting manipulation produces the following five primary effects:relieving muscle convulsion; correcting joint dislocation; releasing adhesion; unfixing synovialinterposing; regulating viscoelasticity and stress distribution of intervertebral discs.A variety of problems about rotation manipulation of cervical vertebrae remains to be solved:too many different types of manipulation, lack of operation criteria, difficulties in mastery of manipulation skills, certain operation risks, and most important of all, lack of objective mechanical evaluation criteria.In other words, experienced manipulation had not yet transformed into a series of quantitative standarized indicators.Meanwhile, owing to the insufficiency of researches on mechanical characteristics of rotation manipulation of cervical vertebrae and quantitative research on its influencing factors, a reliable mechanical evaluation system remains to be built up.Mechanical quantification, through mathematical extraction and analysis of mechanical characteristics in the process of manipulation and its influencing factors, can be put into practice as an objective evaluation system.Rotation-traction manipulation features in its core operation, which can be divided into two parts:rotational positioning of patients and tractive repositioning of manipulators.As for the clinical research, large sample, multi-centered, randomized controlled observation, supported by the key Technologies R&D Programme in 10th national five-year plan subject, had established clinical standardized operation norms and therapeutic effect evaluation system of rotation-traction manipulation.As far as the experimental study is concerned, small-sampled quantitative research of rotation-traction manipulation, supported by National Natural Science Foundation of China in 2006, initially summarized mechanical parameters of rotation-traction manipulation and showed that rotation-traction manipulation might have a certain regularity.In order to apply fundarmental research to clinical practice better, this experiment, based on the previous research results that key Technologies R&D Programme in 10th national five-year plan subject and National Natural Science Foundation of China in 2006 had provided, carries out a study on the opertional characteristics and influencing factors of rotation-traction manipulation through biomechanical measurement in vivo, serving as quantitative supportive evidences for mechanical evaluation.Objective:1,To summarize the mechanical characteristics of rotation-traction manipulation;2,To discuss the potential influencing factors of rotation-traction manipulation;3,To compare the similarities and differences of mechanical characteristics in the process of rotation-traction manipulation among different manipulators;4,To preliminarily explore the establishment of mechanical evaluation system of rotation-traction manipulation.Content:1,Operational characteristics and influencing factors of the same manipulator's rotation-traction manipulation:to collect the potential influencing factors during manipulation among patients (neck circumference, height, weight, body mass index(BMI)), and make a real-time measurement of mechanical parameters(preload force, peak force, thrust force, thrust duration, peak acceleration) when chief physician Zhu conducted rotation-traction manipulation to 45 patients of cervical spondylotic radiculopathy.Then made an analysis of the correlativity of influencing indicators and mechanical parameters, and carried out a discussion of potential influencing factors on rotation-traction manipulation among patients with different traits.2,The comparison of mechanical parameters among different manipulators' rotation-traction manipulation:to select three master manipulators of rotation-traction manipulation, then make them conduct manipulation respectively to ten healthy subjects who participated in the study at different time points.Each manipulator operated both the left and the right side of patients, and in real time the mechanical parameters(preload force, peak force, thrust force, thrust duration, peak accerlation) were measured by mechanical measuring instrument of rotation manipulation.We compared the mechanical parameters among three manipulators and analysed mechanical characteristics among different manipulators' rotation-traction manipulation.3,The comparison of mechanical parameters during the same manipulator's rotation-traction manipulation to patients with different BMI levels:to choose three groups of patients with cervical spondylotic radiculopathy, and the BMI of each group ranged differently from the other.We measured the mechanical parameters(preload force, peak force, thrust force) when chief physician Zhu treated 12 patients of each group.Then we compared the variation of mechanical parameters among different BMI levels.Result:1 Operational characteristics and influencing factors of the same manipulator's rotation-traction manipulation:(1) No significant deviation (P>0.05) showed between the mechanical parameters of the left and the right hand during rotation-traction manipulation;(2) Prominent positive correlation (P<0.01) showed among preload force, peak force and thrust force by Pearson correlation analysis;(3) We revealed that preload force, peak force and thrust force has prominent correlation (P<0.01) with BMI by Multivariate Linear Regression.2 The comparison of mechanical parameters among different manipulators' rotation-traction manipulation: (1) No significant deviation (P>0.05) showed between the mechanical parameters (including preload force, peak force, thrust force, thrust duration and peak accerlation) of the left and the right hand during each manipulators'rotation-traction manipulation;(2) Except for thrust duration, no significant deviation (P>0.05) showed among all mechanical parameters of rotation-traction manipulation;(3) We set chief physician Zhu's mechanical parameters as reference standard and compared them with the other two physicians'.No significant deviation (P>0.05) showed among preload force, peak force, thrust force amd peak accerlation, and significant deviation (P<0.01) showed among thrust duration.3 The comparison of mechanical parameters during the same manipulator's rotation-traction manipulation to patients with different BMI levels:(1) Under different BMI levels, no significant deviation (P>0.05) showed between the mechanical parameters of the left and the right hand during rotation-traction manipulation;(2) Highly significant deviation (P<0.001) showed among the preload force, peak force, thrust force by Variance analysis;(3) Between the normal group and the overweight group, significant deviation(P< 0.01) showed in preload force, peak force and thrust force displayed no significant deviation (P>0.05); the mechanical parameters were of significant deviation (P< 0.01) between the overweight group and the obesity group? the mechanical parameters were of highly significant deviation (P< 0.001) between the normal group and the obesity group.Conclusion:1 Operational characteristics and influencing factors of the same manipulator's rotation-traction manipulation:(1) The mechanical parameters (preload force, peak force, thrust force, thrust duration, peak accerlation) between the left and the right hand during rotation-traction manipulation approximates; (2) During rotation-traction manipulation, the greater preload force is, the more powerful thrust force is.The strength of thrust force depends on that of preload force, which is characterized by rotation-traction manipulation;(3) BMI is one of the influencing factors of rotation-traction manipulation.2 The comparison of mechanical parameters among different manipulators' rotation-traction manipulation:(1) Rotation-traction manipulation between the left and the right hand among three manipulators was stable;(2) The mechanical parameters among three manipulators were not all identical.The preload force, peak force, thrust force, peak accerlation approximated, whereas thrust duration differed.But all the parameters were in the range of safety and effectiveness;(3) Process of force initiation and thrust duration were vital indicators of the evaluation of rotation-traction manipulation.3 The comparison of mechanical parameters during the same manipulator's rotation-traction manipulation to patients with different BMI levels:(1) The reference value of mechanical parameters during rotation-traction manipulation among patients with different BMI levels were as follows:BMI19-23:preload force 15.31±4.62kg, peak force 25.38±5.40kg, thrust force 11.72±3.86kg;BMI23-25:preload force 18.52±4.18kg, peak force 28.56±5.60kg, thrust force 12.32±3.39kg;BMI>25:preload force 23.03±4.88kg, peak force 36.21±7.44kg, thrust force 17.35±5.15kg;(2) We should adjust force initiation of rotation-traction manipulation according to patients'somatotype in clinical practice;(3) Patients'somatotype should be taken into consideration while establishing the mechanical evaluation criteria of rotation-traction manipulation. With respect to the training and inheritance of manipulation as well as the summary of expertise, quantitative research on manipulation is of great significance, the key point of which is the operational characteristics and influencing factors of experts'manipulation.Normative rotation-traction manipulation is of certain regularity:no differences lies between the specific manipulation of the left and the right hand; the strength of the thrust force regulates according to the that of the preload force; a wide diversity of patients'somatotype is of certain influence on the process of force initiation in rotation-traction manipulation.While establishing the mechanical evaluation criteria of rotation-traction manipulation, we should take the following three factors into special account:somatotype of patients, the process of force initiation of manipulators and the thrust duration. |
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