Wu Li-Ping, Huang Yuan-Qiao, Zhou Wei-Hua, Manas Das, Zhao Wei-Dong, Chen Juan-Zhi, Yin Qin-Shui, Wang Li-Heng
Department of Orthopedics, Jiangmen Central Hospital, Sun Yat-sen University, Jiangmen, Guangdong, People's Republic of China.
J Manipulative Physiol Ther. 2012 Jul;35(6):428-36. doi: 10.1016/j.jmpt.2012.06.005. Epub 2012 Aug 22.
The purpose of this study was to determine influences of cervical spine positions, turning times, and cervical segments on cadaver intradiscal pressure (IDP) during cervical spinal manipulative therapy (SMT).
We simulated cervical SMT with stretching and rotation on 7 fresh adult cadaver specimens in the material test system machine. The changes in IDP for cervical intervertebral disks (C3/4, C4/5, and C5/6) during 4 different stages of cervical SMT (physiologic state, end of the traction stage, turning stage, and finish time) were monitored. Five different cervical positions (extension 20°, extension 10°, neutral position, flexion 10°, flexion 20°) and 3 different turning times (0.06, 0.11, 0.16 second) of IDP were monitored, using micropressure sensors.
The variable tendency of cervical IDP presents a "V"-shaped curve during SMT. The 4 stages of SMT had significantly different IDP (F=5498.956; P<.001). There were also significant differences in IDP between 5 cervical positions ([F=1371.216; P<.001], [flexion 20°>flexion 10°>neutral position>extension 10°>extension 20°]), 3 turning times ([F=419.530; P<.001], [0.06>0.11>0.16 seconds]), and 3 cervical segments ([F=84.282; P<.001], [C3/4<C4/5<C5/6]). Intradiscal pressure was lowest at 20° extension combined with a turning time of 0.16 second.
Different cervical positions, turning times, and cervical segments largely influence IDP during the process of SMT. Further research using human subjects should determine if these findings contribute to greater patient comfort, safety, and clinical efficacy with SMT.
本研究旨在确定颈椎位置、旋转时间和颈椎节段对颈椎手法治疗（SMT）过程中尸体椎间盘内压力（IDP）的影响。
我们在材料测试系统机器上对7个新鲜成人尸体标本进行拉伸和旋转模拟颈椎SMT。监测颈椎SMT的4个不同阶段（生理状态、牵引阶段结束、旋转阶段和结束时）颈椎间盘（C3/4、C4/5和C5/6）的IDP变化。使用微压力传感器监测5种不同颈椎位置（伸展20°、伸展10°、中立位、屈曲10°、屈曲20°）和3种不同旋转时间（0.06、0.11、0.16秒）的IDP。
颈椎SMT过程中颈椎IDP的变化趋势呈“V”形曲线。SMT的4个阶段IDP有显著差异（F = 5498.956；P <.001）。5种颈椎位置（[F = 1371.216；P <.001]，[屈曲20°>屈曲10°>中立位>伸展10°>伸展20°]）、3种旋转时间（[F = 419.530；P <.001]，[0.06>0.11>0.16秒]）和3个颈椎节段（[F = 84.282；P <.001]，[C3/4<C4/5<C5/6]）之间的IDP也有显著差异。椎间盘内压力在伸展20°并结合旋转时间0.16秒时最低。
不同的颈椎位置、旋转时间和颈椎节段在SMT过程中对IDP有很大影响。使用人体受试者的进一步研究应确定这些发现是否有助于提高SMT的患者舒适度、安全性和临床疗效。
