Stemper Brian D, Hallman Jason J, Peterson Boyd M
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
J Manipulative Physiol Ther. 2011 Jun;34(5):290-6. doi: 10.1016/j.jmpt.2011.04.001. Epub 2011 May 14.
Chiropractic manipulation of the thoracic spine may induce chest deformations in the anterior-posterior direction. Yet, few studies have examined the biomechanical response of the chest associated with these manipulations. Consequently, an experimental analysis was undertaken to quantify chest compressions resulting from chiropractic thoracic spine manipulations and to estimate amount of risk for injury.
A 2-part study approach was used with a Hybrid III anthropomorphic test dummy. In part 1, the dummy was positioned prone on a chiropractic table and subjected to thoracic spine manipulation by 2 experienced doctors of chiropractic. Chest compressions were quantified in the anterior-posterior direction. Manipulation forces were self-selected, with "typical" and "maximum" efforts examined. In part 2, the dummy was positioned beneath a force-instrumented mechanical piston device. Using the piston, chest compressions were induced with magnitudes identical to those recorded during chiropractic manipulation as well as magnitudes sufficient to induce injury. In all trials, force measurements were recorded.
Thoracic manipulations incorporating the typical and maximum efforts by the chiropractors resulted in maximum chest compressions attaining 1.8% and 4.5% of total chest depth, respectively. According to previously developed correlations between chest compression and injury severity defined using the Abbreviated Injury Scale (AIS), maximum chest compression measured during this study was only 22.7% of the compression required for greater than 10% risk of an AIS 1 injury. Abbreviated Injury Scale 1 level injuries are graded as minor severity and correspond to sternum contusion or fracture of a single rib.
Results from this preliminary study showed that maximum chest compression during thoracic spine manipulation corresponded to minimal risk of AIS 1 level injuries.
对胸椎进行整脊推拿可能会导致胸部在前后方向上发生变形。然而，很少有研究探讨与这些推拿相关的胸部生物力学反应。因此，进行了一项实验分析，以量化整脊胸椎推拿引起的胸部压缩，并估计受伤风险程度。
采用两部分研究方法，使用混合III型人体模型试验假人。在第一部分中，将假人俯卧放置在整脊治疗台上，由两名经验丰富的整脊医生对其胸椎进行推拿。对胸部在前后方向上的压缩进行量化。推拿力量由医生自行选择，检查了“典型”和“最大”用力情况。在第二部分中，将假人放置在一个装有测力装置的机械活塞装置下方。使用该活塞，施加与整脊推拿过程中记录的大小相同以及足以导致受伤的大小的胸部压缩。在所有试验中，记录力的测量值。
整脊医生采用典型和最大用力进行的胸椎推拿分别导致胸部最大压缩达到胸部总深度的1.8%和4.5%。根据先前建立的使用简明损伤分级（AIS）定义的胸部压缩与损伤严重程度之间的相关性，本研究中测量的最大胸部压缩仅为AIS 1级损伤风险大于10%所需压缩量的22.7%。AIS 1级损伤被评为轻度严重程度，相当于胸骨挫伤或单根肋骨骨折。
这项初步研究的结果表明，胸椎推拿过程中的最大胸部压缩对应于AIS 1级损伤的最小风险。
