定位定向扳法对上颈椎复合体作用的生物力学机制研究

Though there are many categories of the cervical manipulation, the efficiency and safety of them remain controversial. For the special anatomical structure and complex function of the upper cervical complex, it is necessary to determine a more target-oriented technique with a better curative effect and higher safety. Preliminary studies have showed definite clinical effect of the positioning and orientation pulling technique, was also more simplified and controllable than other traditional rotary pulling techniques. Nevertheless, the mechanism of action for this and biomechanical characteristics of this technique remain unclear. Therefore, a hypothesis was proposed as that the positioning and orientation pulling technique should be safer and more accurate for the chronic muscle and bone lesions of the upper cervical complex. The mechanism of the technique was that regarding the stability of the lower limb joint, the therapist treated the side upper limb joint with an appropriate application of loading, acceleration combined with the action points according to the actual pathology of the upper cervical complex. Then it brings about the slight slip of the target joints. Then the negative pressure of facet joint capsules would be redistributed. Meanwhile, the position of the vertebra structure would be adjusted thanks to the viscoelastic property of soft tissues. After that, the abnormal state among the tissues would be reformed or even eliminated. This project aims to study the kinematics and kinetics of the positioning and orientation pulling technique with the application of the motion capture and the 3D finite element modeling. We would load on the upper cervical complex models with various combinations of multi-point loading to simulate the pulling techniques. The findings of this study are supposed to verify the hypothesis proposed above and be helpful for clinical practice.

颈椎手法种类繁多，优效性和安全性存在争议。上颈椎复合体的解剖结构特殊、功能特征复杂，明确一种疗效肯定、安全性更高、针对性更好手法具有重要临床意义。前期研究显示，定向定位扳法的临床疗效明确，且比传统旋转扳法更简化和可控。然而，该手法的运动生物力学特征以及作用机制尚未明确。据此, 课题组提出假说：定位定向扳法治疗上颈椎复合体慢性筋骨病损安全性和精准性更高。以下肢关节的稳定为前提，上肢关节根据实际病理状态，采用适当的载荷、加速度和作用点组合加载，致目标关节产生轻微滑动，使囊内负压重新分配，并借助软组织粘弹属性调整骨结构空间位置，改善或消除组织间异常应力和应激状态。本项目拟采用红外线动作捕捉系统结合三维有限元模型，模拟不同手法组合加载于上颈椎复合体正常与病理模型，从运动学和动力学角度归纳定位定向扳法的生物力学优势特征，验证本项目提出的假说，指导临床实践。

颈椎手法种类繁多，而优效性和安全性存在争议。由于上颈椎复合体的解剖结构及功能特征复杂，明确一直安全、简洁和高效的手法具有重要临床意义。本项目在前期临床研究基础上，围绕定位定向扳法，开展生物力学研究。本项目首先优化并验证了全颈椎三维有限元模型，并创建颈椎“筋出槽骨错缝”模型；其次在体测量并记录30例接受定位定向扳法受试者的力学参数；最后将数据加载于仿真模型，进行计算分析定位定向扳法和传统旋转扳法对颈椎内部结构的力学作用。研究结果显示，两种手法在扳动瞬间均可减轻颈椎内部高应力状态，而定位定向扳法更加安全。此外，颈椎内部结构的应力变化受被施术者个人基本情况和颈椎生理曲度的不同而略有差异。