Cramer Gregory D, Ross J Kim, Raju P K, Cambron Jerrilyn A, Dexheimer Jennifer M, Bora Preetam, McKinnis Ray, Selby Scott, Habeck Adam R
Dean of Research, Department of Research, National University of Health Sciences, Lombard, IL, USA.
J Manipulative Physiol Ther. 2011 Nov;34(9):572-83. doi: 10.1016/j.jmpt.2011.05.015. Epub 2011 Jul 18.
This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT).
This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (7 on spinous processes/sacral tubercles of L1-S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (groups 1 and 2) and SMT (group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using χ(2) or McNemar test were made between number of joints cavitating from group 1 vs group 2, upside (contact side for SMT) vs downside, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs outside the target area (L1/L2, L2/L3, sacroiliac).
Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than group 2 joints (P < .0001), upside joints cavitated more than downside joints (P < .0001), and joints inside the target area cavitated more than those outside the target area (P < .01).
Most cavitations (93.5%) occurred on the upside of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than did subjects with side-posture positioning only (96.7% vs 30%). Multiple cavitations from the same Z joints had not been previously reported.
本项目确定了接受脊柱手法治疗（SMT）的腰椎关节突（Z）关节中产生空洞（产生振动和可听声音）的位置和分布。
本随机对照临床研究评估了40名年龄在18至30岁之间的健康受试者（20名男性，20名女性），他们被整群随机分为SMT组（第1组，n = 30）或仅侧卧位组（第2组；对照组，n = 10）。在每位患者身上放置九个加速度计（七个在L1 - S2的棘突/骶结节上，两个放置在L4/L5棘突间隙左右3厘米处）。在侧卧位（第1组和第2组）和SMT（仅第1组）过程中进行加速度计记录。SMT由一位有19年实践经验的脊椎按摩师实施，包括连续快速进行的两次高速、低振幅推力。使用χ(2)或McNemar检验对第1组与第2组、上方（SMT的接触侧）与下方、目标区域内的Z关节（L3/L4、L4/L5、L5/S1）与目标区域外的Z关节（L1/L2、L2/L3、骶髂关节）的关节空洞数量进行比较。
从40名受试者的46个关节中记录到56次空洞。8个关节出现多次空洞。第1组关节的空洞比第2组关节多（P <.0001），上方关节的空洞比下方关节多（P <.0001），目标区域内的关节空洞比目标区域外的关节多（P <.01）。
大多数空洞（93.5%）发生在SMT受试者目标区域内节段的上方（71.7%）。正如预期的那样，SMT受试者的空洞比仅采用侧卧位的受试者更频繁（96.7%对30%）。同一Z关节的多次空洞此前未见报道。
