身高对腰椎斜扳手法“咔哒”声响时推扳力的影响

目的研究身高对腰椎斜扳手法"咔哒"声响时推扳力的影响,为手法提供定量化依据。方法使用压力检测系统,测量并记录对不同身高两组受试者进行斜扳手法出现"咔哒"声响时的推扳力。结果以出现"咔哒"声响作为腰椎斜扳手法成功的标志,此刻对身材较高和较矮的受试者肩部的平均推扳力分别为(12.814±1.264)kg和(12.414±1.387)kg,臀部的推扳力分别为(13.627±1.351)kg和(13.500±1.094)kg。结论斜扳手法操作时所需推扳力的大小与身高无直接关系。     

颈椎定点旋转手法所致咔哒声响与最大推扳力的量效关系研究

目的:研究颈椎定点旋转手法作用时咔哒声响与拇指最大推扳力的量效关系,为推拿手法的量化提供定量化依据。方法:应用压力传感器检测系统,检测并记录旋转手法作用时出现咔哒声响时术者拇指顶推患者颈椎棘突的最大推扳力。结果:以出现咔哒声响作为颈椎旋转手法成功的标志,此刻术者左右手拇指的最大平均推扳力分别为4.727±1.037kg和6.420±1.329kg。结论:推扳力的大小与咔哒声响的发生无直接关系,利手对左右拇指的推扳力有显著的影响。     

胸椎掌按法所致“咔哒”声响与最大按压力的量效关系

目的: 研究胸椎掌按法作用时“咔哒”声响与最大按压力的量效关系,为推拿手法的量化提供定量化依据。方法: 利用压力检测系统,检测并记录胸椎掌按法操作时出现“咔哒”声响时术者手掌按压患者胸椎棘突的最大按压力。结果：以“咔哒”声响作为胸椎掌按压法成功的标志,通过出现声响的最大按压力（247.21±8.02 mmHg）和没有出现“咔哒”声响的最大按压力（251.15±2.87mmHg）的比较,两者之间没有显著差异（P>0.05）。结论：胸椎掌按时按压力大小和“咔哒”声响的发生没有直接关系。     

两种颈椎旋转手法所致咔哒声响的比较

目的:研究两种颈椎旋转手法作用时咔哒声响次数,并进行比较分析。方法:72名健康在校大学生,随机分为两组:实验1组和对照1组,均采用先向左后向右扳动的颈椎旋转手法,其中实验1组施行常规快速颈椎旋转手法,左右各2次;对照1组施行慢速颈椎旋转手法,左右各2次。间隔1周后进行第二轮实验,仍然随机分为两组,实验2组和对照2组,均采用先向右后向左扳动的颈椎旋转手法,其中实验2组仍施行常规快速颈椎旋转手法,左右各2次,对照2组仍施行慢速颈椎旋转手法,左右各2次。运用自行设计的声响采集系统对手法所致的咔哒声响进行采集,分析其发出声响的次数,并进行统计学分析。结果:第一次旋转时,实验1组和对照1组在亚生理区内继续向左旋转出现的咔哒声响次数差异有显著性意义(t=4.077,P=0.009),向右旋转出现的咔哒声响次数差异同样有显著性意义(t=2.017,P=0.047);实验2组和对照2组在亚生理区内继续向左旋转出现的咔哒声响次数差异有显著性意义(t=2.014,P=0.048),向右旋转出现的咔哒声响次数差异同样有显著性意义(t=3.281,P=0.002);实验1组在亚生理区内继续向左旋转出现的咔哒声响次数跟向右旋转相比差异有显著性意义(t=1.87,P=0.007),向左产生的声响次数少于向右者;实验2组在亚生理区内继续向左旋转出现的咔哒声响次数跟向右旋转相比差异也有显著性意义(t=4.077,P=0.009),向右产生的声响次数少于向左者;对照1组在亚生理区内继续向左旋转出现的咔哒声响次数跟向右旋转相比差异无显著性意义(t=0.499,P=0.620),对照2组在亚生理区内继续向左旋转出现的咔哒声响次数跟向右旋转相比差异也无显著性意义(t=1.825,P=0.072)。第2次重复实施颈部旋转手法时产生咔哒声响次数的比较结果发现,四组受试者在全部操作过程中出现了极少的咔哒声响,两两比较组间差异无显著性意义(P>0.05)。结论:在颈椎旋转手法时,在亚生理区采用闪动力能引发较多的咔哒声响;使用闪动力向一侧旋转产生咔哒声响后,会影响到向对侧旋转时咔哒声响的产生。     

推拿手法治疗腰椎间盘突出症的机制

目的应用生物力学的方法研究推拿手法治疗腰椎间盘突出症的机制。方法用5具新鲜尸体腰椎在生物力学材料实验机上,在计算机定量控制下模拟不同手法的作用条件,使用引伸仪测量神经根与临近椎间盘之间的位移。结果3种手法的位移分期为1.283±0.758m,1.411±0.769mm,1.348±0.774mm。结论腰椎间盘突出手法推拿的治疗机制是通过神经根相对位移来减轻或消除髓核突出症对神经根的刺激与压迫,松解突出的间盘与神经根两者之间的炎性粘连,是腰椎间盘突出物的"变位"作用,而非髓核的还纳复位。     

脊柱微调手法对退行性腰椎滑脱症腰椎稳定性的影响

目的：探讨脊柱微调手法对退行性腰椎滑脱症腰椎稳定性的影响。方法：将99例患者随机分为2组，试验组采用软组织推拿和脊柱微调手法治疗．对照组采用软组织推拿和屈膝屈髋垫枕整复法治疗。治疗前后进行腰痛程度、神经损伤及生活障碍评估，以X线测量法观察微调手法对滑脱椎体前后向位移、腰椎前凸角、腰骶角、骶骨水平角等影响。结果：试验组疗效优良率60％。对照组疗效优良率36．7％，两组间疗效差异显著（P〈0．05）；试验组滑脱椎体前后向位移治疗前后无显著性差异（P〉0.05）。增大和减小的腰椎前凸角、腰骶角、骶骨水平角等治疗前后均有显著性差异（P〈0．01）。结论：脊柱微调手法疗效优于屈膝屈髋垫枕整复手法；脊柱微调手法可动态调整退行性腰椎滑脱患者的异常脊柱曲度和序列，改善脊柱承重力线．增强脊柱稳定性。     

A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain

Design:

Randomized clinical trial.

Objectives:

To determine the effectiveness of seated thoracic manipulation versus targeted supine thoracic manipulation on cervical spine pain and flexion range of motion (ROM). There is evidence that thoracic spine manipulation is an effective treatment for patients with cervical spine pain. This evidence includes a variety of techniques to manipulate the thoracic spine. Although each of them is effective, no research has compared techniques to determine which produces the best outcomes.

Methods:

A total of 39 patients with cervical spine pain were randomly assigned to either a seated thoracic manipulation or targeted supine thoracic manipulation group. Pain and flexion ROM measures were taken before and after the intervention.

Results:

Pain reduction (post-treatment–pre-treatment) was significantly greater in those patients receiving the targeted supine thoracic manipulation compared to the seated thoracic manipulation (P<0·05). Although not significant, we did observe greater improvement in flexion ROM in the targeted supine thoracic manipulation group. The results of this study indicate that a targeted supine thoracic manipulation may be more effective in reducing cervical spine pain and improving cervical flexion ROM than a seated thoracic manipulation. Future studies should include a variety of patients and physical therapists (PTs) to validate our findings.     

The influence of flexion distraction spinal manipulation on patients with lumbar spinal stenosis: A prospective,open-label,single-arm,pilot study

ObjectiveEvaluate chiropractic care including flexion distraction spinal manipulation for improving function, symptoms and performance-based mobility in patients with lumbar spinal stenosis (LSS) using a pretest-posttest design.MethodsData were collected at baseline, midpoint and final visits prior to care on each visit. Objective data included Timed Up and Go, Five Times Sit to Stand, and balance (force plate). An additional balance assessment was also conducted after care on the baseline visit. Subjective data included: Activities-Specific Balance Confidence Scale, Zurich Claudication Questionnaire, and pain ratings. Balance data were securely transferred via iDrive; the others were collected via REDCap.ResultsTwelve patients (mean age = 83.5 years ± 5.71) completed the average midpoint visit at 9 visits and the final visit at 13.7 visits. Timed Up and Go and Five Times Sit to Stand Test decreased by 5.2 and 6.7 s at midpoint and 5.4 and 5.7 s at the final visit, respectively compared to the baseline visit (p < 0.05). Baseline visit pre-post reductions were found in anterior-posterior sample entropy and mean frequency of postural sway (p < 0.05). No balance change was found between baseline and mid or final visits. All subjective measures had statistically and clinically meaningful improvement.ConclusionSignificant improvement in objective and subjective outcomes were found after a pragmatic course of care including spinal manipulation in LSS patients.     

坐位旋转手法对正常腰椎间盘内在应力和位移的实时监测的实验研究

目的:了解坐位旋转手法对正常腰椎间盘的内在应力及位移分布的特点.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.即时显示手法作用时腰椎间盘的位移和内在应力的变化.结果:纤维环旋转侧的前部所受压力和旋转对侧的后部受到张力都逐渐增加;旋转侧的前部出现明显垂直压缩,并向前、向外侧膨出移位;纤维环旋转对侧的后部出现拉伸变形,并向前、向内侧回缩移位.结论:模拟坐位腰椎旋转手法时,椎间盘在旋转侧的前部为压力主要集中区,同时在旋转对侧的后部为张力集中区.椎间盘的最大位移在旋转侧的前部上缘;旋转对侧的后部受到张力也相应出现拉伸.髓核内的应力和位移变化相对较小.     

护理专业操作技能训练方法的研究与应用

[目的]有计划对护理专业的学生进行操作技能训练，提高学生的技能操作能力及创新能力。[方法]采用比较、调查和实验等方法在两届学生中各随机抽取2个班为实验组，2个班为对照组进行研究。[结果]实验组与对照组综合实验技能成绩比较，P〈0．05，带教护士对实习生护理技能掌握情况评价比较，P〈0．01。[结论]采取规范方法进行技能操作训练，可培养学生的创新意识和解决问题的综合能力，提高护理人才质量。     

护理专业操作技能训练方法的研究与应用

[目的]有计划对护理专业的学生进行操作技能训练,提高学生的技能操作能力及创新能力。[方法]采用比较、调查和实验等方法在两届学生中各随机抽取2个班为实验组,2个班为对照组进行研究。[结果]实验组与对照组综合实验技能成绩比较,P<0.05,带教护士对实习生护理技能掌握情况评价比较,P<0.01。[结论]采取规范方法进行技能操作训练,可培养学生的创新意识和解决问题的综合能力,提高护理人才质量。