不同腰椎扳法对椎间盘内压的影响-《中医正骨》

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Title:: Effect of different lumbar vertebrae pulling method on intradiscal pressure

作者:: 刘强¹; 张军²; 张慧²; 乔杰²; 1.沈阳体育学院,辽宁沈阳 110101;
2.中国中医科学院望京医院,北京 100700

Author(s):: Liu Qiang^*; Zhang Jun; Zhang Hui; Qiao Jie.^*Shenyang; Sport University,Shenyang 110101,Liaoning,China

关键词:: 腰椎椎间盘椎间盘退变性变舒筋整复手法扳法椎间盘内压

Keywords:: Lumbar vertebrae; Intervertebral disk; Intervertebral disc degeneration; Muscle tendon relax reduction; Pulling method; Intradiscal pressure

摘要:: 目的:测试不同扳法对腰椎间盘内压的影响,探讨扳法治疗椎间盘退变性疾病的作用机制。方法:截取12具新鲜湿润尸体的腰骶段,包埋所有标本的L₁、L₂、S₁、S₂椎体,露出L₃～L₅。将微型压力传感器植入L_3～4、L_4～5、L₅S₁椎间盘,并与压力测试数据采集系统相连接,收集不同体位、不同载荷下L_3～4、L_4～5、L₅S₁3个椎间盘的内压。将腰椎标本固定在BOSE动静态材料试验机上,使用WinTest软件控制扭矩和角度,编写运行程序,模拟坐位和卧位2种体位、4种不同载荷扳法。实验前进行2次加载和卸载循环预处理,在第3次加载时进行测试。测试模拟4种不同扳法的L_3～4、L_4～5、L₅S₁椎间盘内压基线值和扳法复位后椎间盘内压值; 模拟4种不同扳法7.5 Nm预加载相和25 Nm扳动相L_3～4、L_4～5、L₅S₁椎间盘内压值; 模拟4种扳法7.5 Nm预加载相和25 Nm扳动相的腰椎旋转角度。结果:①4种载荷扳法椎间盘内压基线值的比较。4种不同载荷扳法椎间盘内压基线值比较,组间差异均有统计学意义[(0.2589±0.1256)MPa,(0.1757±0.0970)MPa,(0.0522±0.0645)MPa,(0.0348±0.0472)MPa,F=17.140,P=0.000;(1.0844±0.2180)MPa,(0.7119±0.2841)MPa,(0.1599±0.1243)MPa,(0.0944±0.0627)MPa,F=72.159,P=0.000;(0.4407±0.1691)MPa,(0.2843±0.1154)MPa,(0.0684±0.0653)MPa,(0.0458±0.0490)MPa,F=34.805,P=0.000)。L_3～4椎间盘内压基线值组间两两比较,-500 N载荷组与-300 N载荷组比较,差异无统计学意义(P=0.386); -500 N载荷组高于0 N、+100 N载荷组(P=0.001,P=0.000); -300 N载荷组高于0 N、+100 N载荷组(P=0.009,P=0.002); 0 N载荷组与+100 N载荷组比较,差异无统计学意义(P=0.968)。L_4～5椎间盘内压基线值组间两两比较,-500 N载荷组高于-300 N、0 N、+100 N载荷组(P=0.010,P=0.000,P=0.000); -300 N载荷组高于0 N、+100 N载荷组(P=0.000,P=0.000); 0 N载荷组与+100 N载荷组比较,差异无统计学意义(P=0.507)。L₅S₁椎间盘内压基线值组间两两比较,-500 N载荷组与-300 N载荷组比较,差异无统计学意义(P=0.087); -500 N载荷组高于0 N、+100 N载荷组(P=0.000,P=0.000); -300 N载荷组高于0 N、+100 N载荷组(P=0.000,P=0.000); 0 N载荷组与+100 N载荷组比较,差异无统计学意义(P=0.909)。-500 N载荷组内两两比较,L_3～4椎间盘内压基线值低于L_4～5、L₅S₁(P=0.000,P=0.021),L_4～5椎间盘内压值高于L₅S₁(P =0.000); 0 N载荷组内两两比较,L_3～4椎间盘内压基线值低于L_4～5、L₅S₁(P =0.000,P=0.048),L_4～5椎间盘内压值高于L₅S₁(P=0.000)。②椎间盘内压基线值和扳法复位后椎间盘内压值的比较。L_3～4、L_4～5、L₅S₁在-500 N、-300 N、0 N、+100N载荷下,椎间盘内压基线值与扳法复位后椎间盘内压值比较,差异均无统计学意义[(0.2589±0.1256)MPa,(0.2659±0.1238)MPa,t=-0.223,P=0.828;(1.0844±0.2180)MPa,(1.0444±0.2807)MPa,t=0.409,P=0.690;(0.4407±0.1691)MPa,(0.5155±0.3420)MPa,t=-0.633,P=0.539;(0.1757±0.0970)MPa,(0.1747±0.0966)MPa,t=0.207,P=0.839;(0.7119±0.2841)MPa,(0.7128±0.2647)MPa,t=-0.010,P=0.992;(0.2843±0.1154)MPa,(0.3469±0.2551)MPa,t=-0.880,P=0.398;(0.0522±0.0645)MPa,(0.0495±0.0623)MPa,t=0.367,P=0.720;(0.1599±0.1243)MPa,(0.1404±0.1249)MPa,t=0.500,P=0.627;(0.0684±0.0653)MPa,(0.0603±0.0651)MPa,t=0.609,P=0.555;(0.0348±0.0472)MPa,(0.0346±0.0484)MPa,t=0.042,P=0.967;(0.0944±0.0627)MPa,(0.1003±0.0731)MPa,t=-0.314,P=0.760;(0.0458±0.0490)MPa,(0.0575±0.0443)MPa,t=0.204,P=0.842]。③7.5 Nm预加载相和25 Nm扳动相腰椎旋转角度及椎间盘内压值的比较。25 Nm扳动相腰椎旋转角度大于7.5 Nm预加载相腰椎旋转角度[(19.5692°±0.6969°),(14.6475°±0.6471°),t=-40.694,P=0.000]。在0 N和+100 N载荷下,25 Nm扳动相L_3～4椎间盘内压值高于7.5 Nm预加载相[(0.1168±0.1153)MPa,(0.1020±0.1091)MPa,t=3.902,P=0.002;(0.0879±0.1107)MPa,(0.0746±0.0962)MPa,t=2.678,P=0.022]; 在-500 N、-300 N载荷下25 Nm扳动相L_3～4椎间盘内压值与7.5 Nm预加载相L_3～4椎间盘内压值比较,差异无统计学意义[(0.3718±0.2774)MPa,(0.3228±0.1929)MPa,t=1.704,P=0.116;(0.2916±0.2333)MPa,(0.2379±0.1649)MPa,t=1.982,P=0.073]。在-500 N、-300 N和0 N载荷下,25 Nm扳动相L_4～5椎间盘内压值高于7.5 Nm预加载相[(1.1551±0.3425)MPa,(1.0779±0.3203)MPa,t=2.211,P=0.049;(0.8840±0.3533)MPa,(0.7839±0.3563)MPa,t=2.844,P=0.016;(0.3992±0.2088)MPa,(0.3305±0.2081)MPa,t=7.088,P=0.000]; 在+100 N载荷下,25 Nm扳动相L_4～5椎间盘内压值与7.5 Nm预加载相L_4～5椎间盘内压值比较,差异无统计学意义[(0.2765±0.2116)MPa,(0.2639±0.2197)MPa,t=0.207,P=0.840]。在-500 N、-300 N、0 N、+100 N载荷下,25 Nm扳动相L₅S₁椎间盘内压值高于7.5 Nm预加载相[(0.6980±0.4896)MPa,(0.6245±0.4450)MPa,t=3.585,P=0.004;(0.5212±0.4434)MPa,(0.4599±0.4033)MPa,t=3.023,P=0.012;(0.3186±0.2749)MPa,(0.2650±0.2534)MPa,t=3.975,P=0.002;(0.2252±0.2396)MPa,(0.1786±0.1945)MPa,t=3.158,P=0.009]。7.5 Nm预加载相和25 Nm扳动相的椎间盘内压差与腰椎旋转角度差呈正相关(r=0.919,P=0.000)。结论:无论是坐位还是卧位,椎间盘内压值由高到低均依次为L_4～5、L₅S₁、L_3～4。不同扳法在扳动瞬间均会使椎间盘内压发生显著变化,体位不同、载荷不同对L_3～4、L_4～5、L₅S₁扳动瞬间的椎间盘内压影响不同,临床可以根据退变椎间盘的不同节段采用不同方式的扳法操作。腰椎扳法虽然在瞬间增加了椎间盘内压,但增加了腰椎活动度,这可能是腰椎扳法治疗椎间盘退变性疾病的作用机制。

Abstract:: Objective:To test the effect of different pulling methods on intradiscal pressure and explore the mechanisms of action of pulling method in the treatment of intervertebral disc degeneration disease.Methods:Lumbosacral spine were cut out from 12 fresh moist cadavers,and the vertebral body of L₁,L₂,S₁ and S₂ were embeded and the vertebral body of L₃-L₅ were exposed.Micro pressure sensors were implanted into the intervertebral discs of L_3-4,L_4-5 and L₅S₁,and were connected to the pressure test data acquisition system.The intradiscal pressures of L_3-4,L_4-5 and L₅S₁ in different body posture and different load.Then the lumbar vertebrae specimens were fixed to BOSE dynamic/static materials testing machine,and torque and angle were regulated through WinTest software.After that the programs were written and four different loading pulling methods were simulated.Circulation pretreatment of loading and unloading were performed for 2 times before the formal test was carried on.The baseline values of intradiscal pressure of L_3-4,L_4-5 and L₅S₁ were measured and the intradiscal pressure values were measured after restoration by pulling method.The intradiscal pressure and rotation angles of L_3-4,L_4-5 and L₅S₁ were measured in preload phase(7.5Nm)and pulling phase(25Nm).Results:There was statistical difference in the baseline values of intradiscal pressure between 4 different load pulling methods(0.2589+/-0.1256,0.1757+/-0.0970,0.0522+/-0.0645,0.0348+/-0.0472 MPa,F=17.140,P=0.000; 1.0844+/-0.2180,0.7119+/-0.2841,0.1599+/-0.1243,0.0944+/-0.0627 MPa,F=72.159,P=0.000; 0.4407+/-0.1691,0.2843+/-0.1154,0.0684+/-0.0653,0.0458+/-0.0490 MPa,F=34.805,P=0.000).Further pairwise comparison in baseline values of L_3-4 intradiscal pressure showed that(1)there was no statistical difference between -500 N load group and -300 N load group(P=0.386);(2)-500 N load group surpassed 0 N load group and +100 N load group(P=0.001,P=0.000);(3)-300 N load group surpassed 0 N load group and +100 N load group(P=0.009,P=0.002);(4)there was no statistical difference between 0 N load group and +100 N load group(P=0.968).Further pairwise comparison in baseline values of L_4-5 intradiscal pressure showed that(1)-500 N load group surpassed -300 N,0 N and +100 N load groups(P=0.010,P=0.000,P=0.000);(2)-300 N load group surpassed 0 N load group and +100 N load group(P=0.000,P=0.000);(3)there was no statistical difference between 0 N load group and +100 N load group(P=0.507).Further pairwise comparison in baseline values of L₅S₁ intradiscal pressure showed that(1)there was no statistical difference between -500 N load group and -300 N load group(P=0.087);(2)-500 N load group surpassed 0 N load group and +100 N load group(P=0.000,P=0.000);(3)-300 N load group surpassed 0 N load group and +100 N load group(P=0.000,P=0.000);(4)there was no statistical difference between 0 N load group and +100 N load group(P=0.909).Further pairwise comparison in baseline values of intradiscal pressure within -500 N load group showed that(1)L_3-4 disc was inferior to L_4-5 disc and L₅S₁ disc(P=0.000,P=0.021);(2)L_4-5 disc surpassed L₅S₁ disc(P=0.000).Further pairwise comparison in baseline values of intradiscal pressure within 0 N load group showed that(1)L_3-4 disc was inferior to L_4-5 disc and L₅S₁ disc(P=0.000,P=0.048);(2)L_4-5 disc surpassed L₅S₁ disc(P=0.000).There was no statistical difference between the intradiscal pressure baseline values and intradiscal pressure values measured after restoration by pulling method in the load of -500 N,-300 N,0 N and +100 N for L_3-4,L_4-5 and L₅S₁ disc(0.2589+/-0.1256 vs 0.2659+/-0.1238 MPa,t=-0.223,P=0.828; 1.0844+/-0.2180 vs 1.0444+/-0.2807 MPa,t=0.409,P=0.690; 0.4407+/-0.1691 vs 0.5155+/-0.3420 MPa,t=-0.633,P=0.539; 0.1757+/-0.0970 vs 0.1747+/-0.0966 MPa,t=0.207,P=0.839; 0.7119+/-0.2841 vs 0.7128+/-0.2647 MPa,t=-0.010,P=0.992; 0.2843+/-0.1154 vs 0.3469+/-0.2551 MPa,t=-0.880,P=0.398; 0.0522+/-0.0645 vs 0.0495+/-0.0623 MPa,t=0.367,P=0.720; 0.1599+/-0.1243 vs 0.1404+/-0.1249 MPa,t=0.500,P=0.627; 0.0684+/-0.0653 vs 0.0603+/-0.0651 MPa,t=0.609,P=0.555; 0.0348+/-0.0472 vs 0.0346+/-0.0484 MPa,t=0.042,P=0.967; 0.0944+/-0.0627 vs 0.1003+/-0.0731 MPa,t=-0.314,P=0.760; 0.0458+/-0.0490 vs 0.0575+/-0.0443 MPa,t=0.204,P=0.842).The lumbar vertebras rotation angles of pull phase(25 Nm)were greater than that of preload phase(7.5 Nm)(19.5692+/-0.6969 vs 14.6475+/-0.6471 degrees,t=-40.694,P=0.000).Intradiscal pressure values of L_3-4 of pull phase(25 Nm)were higher than that of preload phase(7.5 Nm)in the load of 0 N and +100 N(0.1168+/-0.1153 vs 0.1020+/-0.1091 MPa,t=3.902,P=0.002; 0.0879+/-0.1107 vs 0.0746+/-0.0962 MPa,t=2.678,P=0.022).There was no statistical difference in the intradiscal pressure values between pull phase(25 Nm)and preload phase(7.5 Nm)for L_3-4 disc in the load of -500 N and -300 N(0.3718+/-0.2774 vs 0.3228+/-0.1929 MPa,t=1.704,P=0.116; 0.2916+/-0.2333 vs 0.2379+/-0.1649 MPa,t=1.982,P=0.073).Intradiscal pressure values of L_4-5 of pull phase(25 Nm)were higher than that of preload phase(7.5 Nm)in the load of -500,-300 and 0 N(1.1551+/-0.3425 vs 1.0779+/-0.3203 MPa,t=2.211,P=0.049; 0.8840+/-0.3533 vs 0.7839+/-0.3563 MPa,t=2.844,P=0.016; 0.3992+/-0.2088 vs 0.3305+/-0.2081 MPa,t=7.088,P=0.000)There was no statistical difference in the intradiscal pressure values between pull phase(25 Nm)and preload phase(7.5 Nm)for L_4-5 disc in the load of +100 N(0.2765+/-0.2116 vs 0.2639+/-0.2197 MPa,t=0.207,P=0.840).Intradiscal pressure values of L₅S₁ disc of pull phase(25 Nm)were higher than that of preload phase(7.5 Nm)in the load of -500,-300,0 and +100 N(0.6980+/-0.4896 vs 0.6245+/-0.4450 MPa,t=3.585,P=0.004; 0.5212+/-0.4434 vs 0.4599+/-0.4033 MPa,t=3.023,P=0.012; 0.3186+/-0.2749 vs 0.2650+/-0.2534 MPa,t=3.975,P=0.002; 0.2252+/-0.2396 vs 0.1786+/-0.1945 MPa,t=3.158,P=0.009).The intradiscal pressure difference was positively correlated to the difference of lumbar vertebras rotation angles between preload phase and pull phase(r=0.919,P=0.000).Conclusion:People have high-to-low intradiscal pressures in L_4-5,L₅S₁ and L_3-4 in turn whether at the sitting position or at the supine position.The intradiscal pressure changes significantly at the moment of pulling,and it is influenced by body position and loads.Therefore,the degenerative intervertebral discs can be treated by different pulling methods in clinic according to the segments of lumbar vertebrae.Although the intradiscal pressure increases at the moment of lumbar vertebrae pulling,the range of motion of lumbar vertebrae increases at the same time,and it may be the mechanism of action of lumbar vertebrae pulling method in the treatment of intervertebral disc degeneration disease.

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

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