坐位腰椎旋转手法时腰椎单元内在应力和位移的实时监测

目的:用三维有限元法,分析施行坐位腰椎旋转手法时退变腰椎单元的内在应力及位移分布的特点,以探讨手法的作用机制、安全性及其合理性。方法:使用正常L4,5腰椎CT片,以Mimics软件系统逐层重建,建立L4,5三维有限元模型。根据手法原理,将坐位腰椎旋转手法进行分解,把各项力学参数代入三维有限元模型进行计算分析。观察手法作用时腰椎间盘的位移和内在应力的变化。结果:最大的应力集中点分布于环椎体峡部、椎弓根、上位椎体小关节面的下端。椎间盘的应力集中分布于环前外侧部,右后外侧部应力大于左后外侧部。最大位移出现在上位椎体的上关节。左侧小关节面相对位移较大,左侧椎间孔变大;右侧椎小关节面间移位小,右侧椎间孔变小,椎间盘右后外侧部向后突出。结论:模拟坐位腰椎旋转手法时,向健侧旋转优于向患侧旋转。     

微创截骨手法整复术治疗拇外翻

目的： 探讨微创截骨手法整复术治疗拇外翻的临床疗效。方法： 自2018年1月至2019年5月采用微创截骨手法整复术治疗拇外翻患者31例（42足）,其中男3例,女28例;年龄18~76（50.1±4.9）岁。观察并比较手术前后拇外翻角（hallux valgus angle,HVA）,第1,2跖骨间角（inter metatarsal angle,IMA）,第1,2跖骨长度差变化,术后采用美国矫形骨科学会足踝外科学组（American Orthopaedic Foot and Ankle Society,AOFAS）拇趾-跖趾-趾间关节评分系统进行功能评价。结果： 31例（42足）患者获得随访,时间14~18（15.1±1.2）个月。HVA、IM分别由术前的（38.5±5.4）°、（13.0±1.1）°矫正到术后的（14.3±4.7）°、（9.1±1.5）°（P<0.05）。术前1、2跖骨长度差为2~-4（-0.59±1.80） mm,术后为0~-6（-3.53±1.60） mm,平均第1跖骨短缩2.94 mm,差异有统计学意义（P<0.05）。AOFAS评分由术前的（57.8±9.7）分提高到术后的（92.1±9.3）分,手术前后比较差异有统计学意义（P<0.05）;其中优23足,良16足,可3足。结论： 微创截骨手法整复术手术时间短、切口小、能够有效纠正拇外翻畸形、改善前足功能,获得良好疗效。     

早期手法矫正系列石膏固定治疗先天性马蹄内翻足

目的 评价早期应用手法矫正系列石膏固定(Ponseti方法)治疗先天性马蹄内翻足的效果。方法 从1997年5月-2001年12月保守治疗出生后3个月内的先天性马蹄内翻足22例共30个足。患儿的平均年龄为生后第23d，方法 采用Ponseti的手法矫正和连续长腿石膏固定，每周更换石膏一次。在石膏固定结束后，患儿穿戴矫形支具至少1年。结果 本组平均治疗时间10．5周，平均随访2年4个月。27个足(90％)的畸形获得满意矫正，3个足因支具穿戴欠配合，随访时仍有残余畸形，需广泛软组织松解术矫正。结论 Ponseti的“旋后外展”手法矫正方法和连续长腿石膏固定，可使不同畸形程度的先天性马蹄内翻足在早期获得充分的矫正，石膏固定结束后应佩戴矫形支具至少1年，以防畸形复发。     

手法治疗神经根型颈椎病的X线椎体位移观察及分析

目的：观察手法治疗后神经根型颈椎病的X线椎体位移改变方法：收集140例神经根型颈椎病的病人，对治疗前后X线椎体位移改变进行观察，并与70例正常人群进行比较。结果：两组颈4、5、6椎体位移治疗前比较，有显著性差异（P〈0．05，P〈0．01）；手法治疗后能够改善椎体的水平及角度位移，治疗前比较有显著性差异（P〈0．05．P〈0．01）；治疗后临床控制69．3％，好转22．9％，总有效率92．1％。结论：神经根型颈椎病椎体位移改变可能是其发病原因之一，手法治疗改善颈椎椎体异常位移，提高颈椎的稳定性是手法治疗神经根型颈椎病取得较好疗效的因素之一。     

杠杆定位手法治疗腰椎间盘突出症疗效及对Cobb角影响

目的:观察杠杆定位手法治疗腰椎间盘突出症疗效及对Cobb角的影响。方法:2017年12月至2018年11月纳入67例腰椎间盘突出症患者进行研究,将67例患者用随机数字表法分为治疗组和对照组。治疗组34例,其中男20例,女14例,年龄(36.09±8.26)岁,病程(13.79±15.50)个月,采用杠杆定位手法治疗。对照组33例,其中男18例,女15例,年龄(36.48±7.81)岁,病程(12.82±15.68)个月,采用腰椎斜扳法治疗。两组每周均治疗3次,隔1 d治疗1次,6次为1个疗程,治疗2个疗程后,通过影像学资料比较两组患者治疗前后Cobb角的变化;参照临床评定标准对症状体征进行评分;参照国家中医药管理局颁布的腰椎间盘突出症《中医病证诊断疗效标准》对总体疗效进行评价。结果:两组各有1例脱落患者。治疗组和对照组治疗前症状体征评分分别是18.56±4.81,18.61±3.72,治疗后分别为9.41±5.19,13.55±3.68,治疗后治疗组症状体征评分明显低于对照组(P<0.05),总体疗效有效率治疗组和对照组分别为97.06%、75.76%,治疗组优于对照组(P<0.05),治疗后两组患者的Cobb角均有变小(P<0.05)。治疗组和对照组治疗前Cobb角分别为(17.95±4.45)°,(18.14±3.59)°,治疗后分别为(18.14±3.59)°,(15.49±1.75)°,治疗组Cobb角变化优于对照组(P<0.05)。结论:杠杆定位手法与腰椎斜扳法两种方法对腰椎间盘突出症治疗均有疗效,但杠杆定位手法治疗腰椎间盘突出症患者的疗效更为显著,对Cobb角的影响更为明显,值得推广。     

Impact of Spinal Manipulation on Lower Extremity Motor Control in Lumbar Spinal Stenosis Patients: A Small-Scale Assessor-Blind Randomized Clinical Trial

ObjectiveThe purpose of this study was to quantify the impact of a single lumbar spinal manipulation (SM) intervention on the leg movement performance of degenerative lumbar spinal stenosis (LSS) patients in a small-scale registered randomized clinical trial.MethodsParticipants with LSS (n = 14) were tested at baseline for pain, lumbar range of motion, and behavioral or kinematic motor performance (using an established Fitts’ Law foot-pointing task), then underwent covariate adaptive randomization to receive SM or no intervention. Postintervention all dependent measures were repeated. Experimenters were blinded to patient group allocation. University ethics board approval was attained.ResultsFor the primary outcome movement time, there was no significant difference between groups. As predicted by Fitts’ Law, all participants had longer movement times as task difficulty increased. Secondary kinematic outcomes yielded no significant between-group differences. Consistent with Fitts’ Law, kinematic measures changed significantly with task difficulty. Pairwise comparisons revealed the kinematic variables were more adversely affected by greater movement amplitudes than target size changes. No exploratory differences in pain or lumbar range of motion were observed.ConclusionChanges in motor performance were not observed in this chronic pain population after a single SM intervention compared with a control group. Given the sample size, the study may have been underpowered to detect meaningful differences. Fitts’ Law was observed for the lower extremity–pointing task for an LSS population and may provide an objective measure of motor performance.     

Use of muscle energy technique amongst a nationally representative sample of Australian osteopaths

IntroductionMuscle energy technique (MET) is a therapeutic technique involving active muscle contraction by the patient. The selection of particular techniques by osteopaths is underexplored. The aim of the study was to explore the practice profile of those Australian osteopaths who use MET often in their practice compared to those who do not use the technique often.MethodsA secondary analysis of data collected from 922 participants by a practice-based research network (PBRN) for the Australian osteopathy profession was performed. Frequency of use of MET on a 4 point scale: never, rarely, sometimes, and often were binary coded as less often and often. Inferential statistics were used to explore the associations between individual practice characteristics and the frequency of MET use. Adjusted odds ratios (OR) with 95% confidence intervals (CI) and p-values were calculated from regression modelling.ResultsDichotomising participant responses resulted in less often (203, 20.5%) and often (788, 79.4%). There was a significantly greater proportion of male practitioners using MET compared to those practitioners who did not often use the technique (OR = 0.46; CI = 0.33, 0.63; p < 0.01). Australian osteopaths who often used MET were younger (36.3 vs 44.6 years old) and had fewer years in practice (9.9 vs 17.3 years) compared to osteopaths who used the technique less often.ConclusionOsteopaths who reported that they often used MET were more likely to be male, often use counterstrain and more likely to use orthopaedic testing in patient examination. The study provides an insight into how Australian osteopaths practice, particularly their use of MET.Implications for practice

• •When the responses of 922 Australian osteopaths who participated in a practice-based research network were dichotomized according to usage of MET, the majority reported they use MET frequently.
• •MET and counterstrain appear to be used in combination for musculoskeletal patient care by Australian osteopaths.
• •Australian osteopaths who reported often using MET were more likely to see patients for low back pain, perform orthopaedic testing, use neurological cranial nerve testing, and refer for diagnostic imaging.
• •The practice characteristics of osteopaths who use MET often compared to those who do not reveal insight into different practice styles within the osteopathic profession.

     

Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial

ObjectiveWe evaluated the efficacy of spinal manipulation for the management of nonacute lumbar radiculopathy.MethodsIn a university hospital we performed a randomized controlled trial with 2 parallel arms. Patients (n = 44) with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups. The primary outcome was the intensity of the low back pain on a visual analog scale. The secondary outcome was the Oswestry Disability Questionnaire score. We also measured spinal ranges of motion. The assessments were carried out at the baseline, immediately after intervention, and at 3 months’ follow-up. All patients underwent physiotherapy. The manipulation group received three sessions of manipulation therapy 1 week apart. For manipulation, we used Robert Maigne's technique.ResultsBoth groups experienced a decrease in back and leg pain significantly (all P ≤ 0.003). However, only the manipulation group showed significantly favorable results in the Oswestry scores (P < 0.001), and the straight leg raise test (P = 0.001). All ranges of motion increased significantly with manipulation (all P < 0.001), but the control group showed favorable results only in right and left rotations and in extension (all P < 0.001). Between-group analyses showed significantly better outcomes for manipulation in all measurements (all P ≤ 0.009) with large effect sizes.ConclusionSpinal manipulation improves the results of physiotherapy over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.