脊柱推拿和侧卧位后腰痛患者的磁共振成像关节突关节间隙变化（间隙增宽）：一项采用盲法的随机对照机制试验
Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding.
作者信息
Cramer Gregory D, Cambron Jerrilyn, Cantu Joe A, Dexheimer Jennifer M, Pocius Judith D, Gregerson Douglas, Fergus Michael, McKinnis Ray, Grieve Thomas J
机构信息
Department of Research, National University of Health Sciences, Lombard, IL 60148, USA.
出版信息
J Manipulative Physiol Ther. 2013 May;36(4):203-17. doi: 10.1016/j.jmpt.2013.04.003. Epub 2013 May 3.
OBJECTIVE
The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP).
METHODS
This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed.
RESULTS
Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001).
CONCLUSIONS
Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT.
目的
本研究旨在量化脊柱手法治疗（SMT）或侧卧位姿势（SPP）后下腰痛（LBP）受试者的腰椎关节突（Z）关节间隙分离（间隙增宽）情况。
方法
这是一项采用随机分组和盲法的对照机制试验。急性下腰痛受试者（N = 112；四个n = 28的磁共振成像[MRI]方案组）进行2次MRI检查（初次入组时和整脊治疗2周后，每次MRI检查时对L4/L5和L5/S1 Z关节进行2次MRI扫描）。在每次检查的第一次MRI扫描后，受试者被随机分组（初次入组检查时）或分配分组（整脊治疗2周后的检查时）到SPP（非手法治疗）、SMT（手法治疗）或对照MRI方案组。在SPP或SMT后，进行第二次MRI检查。测量中央前后关节间隙。干预后与干预前在最痛侧进行的前后测量值之差即为Z关节“间隙增宽差值”。对各方案组之间的间隙增宽差值进行比较（方差分析）。评估疼痛（视觉模拟量表、言语数字疼痛评分量表）和功能（伯恩茅斯问卷）的次要指标。
结果
在第一次（校正后，P = .009；SPP，0.66±0.48 mm；SMT，0.23±0.86；对照，0.18±0.71）和第二次（校正后，P = .0005；SPP，0.65±0.92 mm；SMT，0.89±0.71；对照，0.35±0.32）MRI检查时，间隙增宽差值具有统计学意义。言语数字疼痛评分量表差值在第一次MRI检查时具有统计学意义（P = .04），其中SMT显示出最大改善。所有组在护理2周后视觉模拟量表和伯恩茅斯问卷均有所改善（均P < .0001）。
结论
侧卧位姿势在基线时显示出最大的间隙增宽。2周后，SMT导致最大的间隙增宽。侧卧位姿势似乎对SMT具有附加治疗益处。
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