Arnold C, Bourassa R, Langer T, Stoneham G
School of Physical Therapy, University of Saskatchewan, 210-1121 College Drive, Saskatoon, Sask S7N 0W3, Canada.
Man Ther. 2004 Feb;9(1):13-21. doi: 10.1016/s1356-689x(03)00087-0.
General and isolated cervical positional tests are used to screen for potential vertebro-basilar insufficiency (VBI). There is limited research evaluating vertebral artery blood flow in these positions to justify the rationale of progressive mechanical stress occurring to the arteries. The purpose of the study was to determine vertebral artery blood flow in six cervical positions used in clinical practice. A comprehensive cervical assessment was conducted on 22 men and women (mean age 35) with no known vascular pathology. Vertebral artery peak systolic (PS), end diastolic (ED) flow rates and resistive index (RI) were measured using duplex colour Doppler sonography (sampling at C3-C5) in neutral, rotation, extension, combined rotation-extension, combined rotation-extension-traction, deKelyn's position and a C1-C2 pre-manipulative hold. Results showed there was a significant decrease in PS and ED in the contra-lateral artery during the pre-manipulative hold, and a decrease in ED in the contra-lateral artery during rotation. There was no effect of age, gender or mobility restriction on these blood flow changes. The pre-manipulative hold had the greatest response with 34% of the arteries demonstrating a complete cessation of ED flow. In conclusion the pre-manipulative hold and rotation created the greatest mechanical stress to the contra-lateral vertebral artery. These two positions may be useful screening positions to identify individuals at risk for VBI due to inadequate collateral blood flow.
一般和孤立的颈椎定位试验用于筛查潜在的椎基底动脉供血不足（VBI）。评估这些体位下椎动脉血流的研究有限，无法证明动脉所承受的渐进性机械应力的合理性。本研究的目的是确定临床实践中使用的六个颈椎体位下的椎动脉血流情况。对22名无已知血管病变的男性和女性（平均年龄35岁）进行了全面的颈椎评估。使用双功彩色多普勒超声（在C3 - C5水平采样）测量椎动脉的收缩期峰值（PS）、舒张末期（ED）流速和阻力指数（RI），测量体位包括中立位、旋转位、伸展位、旋转伸展联合位、旋转伸展牵引联合位、德凯林位以及C1 - C2手法操作前的固定位。结果显示，在手法操作前的固定位期间，对侧动脉的PS和ED显著降低，在旋转位期间对侧动脉的ED降低。年龄、性别或活动受限对这些血流变化没有影响。手法操作前的固定位反应最大，34%的动脉显示ED血流完全停止。总之，手法操作前的固定位和旋转位对对侧椎动脉产生的机械应力最大。这两个体位可能是有用的筛查体位，用于识别因侧支血流不足而有VBI风险的个体。
