Geelhoed Michael A, McGaugh Janna, Brewer Patricia A, Murphy Douglas
Department of Physical Therapy, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 6427, San Antonio, TX 78229, USA.
J Orthop Sports Phys Ther. 2006 Nov;36(11):876-81. doi: 10.2519/jospt.2006.2243.
Nonexperimental, normative research design.
To test a proposed model to locate the level of the transverse processes (TPs) of the thoracic spine through surface palpation.
Palpation of the TPs of the thoracic spine is challenging because of their depth relative to the more superficial structures of the spine. Many clinicians use the more superficial spinous processes (SPs) of the thoracic spine to orient themselves for palpation of the TPs. In 1979, Mitchell described a "rule of threes," which attempted to predict the location of the level of the thoracic TPs relative to their corresponding SPs. We previously conducted a pilot study to investigate the validity of the rule of threes and concluded that it is not an accurate predictor of the level of the location of the TPs of the thoracic spine. Based on that previous work, we hypothesized that a more accurate model for predicting the level of the TPs would be that they are generally at the level of the SP of the adjacent cranial thoracic vertebra throughout the thoracic spine.
We dissected 15 cadavers and measured the vertical distance between the transverse (horizontal) plane of the TPs of 1 vertebra and the SP of the adjacent cranial thoracic vertebra for all levels of the thoracic spine.
Mean vertical distances ranged from 2.0 to 4.0 mm. The means for all thoracic vertebral levels except for T11 and T12 were significantly less than the normal 6-mm threshold of 2-point discrimination of the fingertips (P<.01).
The results of this study indicate that the TPs of each thoracic vertebra are generally at the level of the SP of the vertebra 1 level above, throughout the thoracic spine. It may be more difficult to predict the location of the TPs of the 2 most caudal levels (T11 and T12), given their greater variability of position.
非实验性规范研究设计。
通过体表触诊检验一个用于定位胸椎横突（TPs）水平的模型。
由于胸椎横突相对于脊柱较浅结构的深度，对其进行触诊具有挑战性。许多临床医生利用胸椎较浅的棘突（SPs）来确定触诊横突的位置。1979年，米切尔描述了一种“三分法则”，试图预测胸椎横突水平相对于其相应棘突的位置。我们之前进行了一项初步研究以调查三分法则的有效性，并得出结论，它不是胸椎横突位置水平的准确预测指标。基于之前的工作，我们假设一个更准确的预测横突水平的模型是，在整个胸椎中，它们通常处于相邻上位胸椎棘突的水平。
我们解剖了15具尸体，并测量了胸椎所有节段中一个椎体横突（水平）平面与相邻上位胸椎棘突之间的垂直距离。
平均垂直距离在2.0至4.0毫米之间。除T11和T12外，所有胸椎节段的平均值均显著小于指尖两点辨别觉的正常阈值6毫米（P<0.01）。
本研究结果表明，在整个胸椎中，每个胸椎的横突通常处于其上方1个椎体棘突的水平。鉴于最尾端两个节段（T11和T12）横突位置的变异性较大，可能更难预测它们的位置。
