颈椎定点旋转手法"点"的数字化解剖

背景:虽然颈椎定点旋转复位手法效果显著,但其机制一直缺乏深入的研究.临床上对所要实施的推拿力和旋转节段无法做到精确控制,有时会造成手法的医源性损伤.目的:从颈椎定点旋转手法旋转中心点的角度分析旋转手法的作用途径.方法:在64排螺旋CT工作平台扫描标本,层距1 mm.在PHILIPS MEDICAL SYSTEMS图像处理功能模块中提取图片中轮廓线数据,进行上颈椎三维结构重建和图像显示.取枢椎棘突顶点(A点)、齿突垂直轴心(B点)以及两者之间连线的中点(C点)为旋转轴心(模拟中的旋转中心点),分别以各点为原点建立球坐标系.观察枢椎棘突顶点与下颌尖旋转前后的连线夹角,以及齿突垂直轴心与下颌尖旋转前后的连线夹角.结果与结论:做定点手法旋转时其中心并非是施术者利手作用的枢椎棘突顶点,而是枢椎齿突垂直轴心;实际轴心旋转角>术者观察角.提示应建立颈椎定轴旋转的新概念,并掌握颈椎定轴旋转手法的原则,以指导临床正确应用脊柱旋转类手法.

Digital anatomical position of the "point" in cervical vertebra fixed-point rotatory technique

BACKGROUND: Although the fixed-point cervical vertebra rotating reduction has a notable treatment effect, yet it has not been deeply studied in the medical field. Some clinical surgeons feel difficult to make an accurate control on the power and rotatory joint position while operating, even results in iatrogenic injury. OBJECTIVE: To discuss the action mechanism of rotatory technique based on the central rotatory point of cervical vertebra fixed-point rotatory technique. METHODS: Samples were scanned through a 64-row spiral CT working platform at 1-mm layer distance. The picture's profilogram data were extracted from the image processing functional module in PHILIPS MEDICAL SYSTEMS, and then the three-dimensional structure of the upper cervical vertebra was reconstructed and displayed. Taking the axis spinous process peak (point A), odontoid process vertical axes (point B), and the midpoint (point C) of their link as the rotating axes (the rotating central point in simulation), spherical system on each point was set up. The intersection angle of the links between the axis' spinous process peak and the lower jaw, and between the odontoid process vertical axes and the lower jaw before and after rotation were all measured. RESULTS AND CONCLUSION: While applying fixed-point rotation of the cervical spine, the rotatory centre is the vertical axle center of the odontoid process, rather than the handy axis spinous process peak. The rotatory angle of the axle centre is larger than the observation angle. A new concept of fixed-axis rotation should be accepted and its principle should be comprehended in order to appropriately apply the cervical rotatory technique.