伤科手法治疗腰椎间盘突出症的运动学研究

为探索中医手法治疗腰椎间盘突出症的运动学规律和机制,选取上海交通大学附属瑞金医院魏氏伤科手法中的经典“悬足压膝”和“腰部提拉”手法动作作为研究对象。对10名健康青年男性施加手法动作,并通过三维运动捕捉系统采集手法作用时受试者的5次运动学数据,定义人体相对关节坐标系,并通过Visual3D软件建立人体三维运动模型。计算下肢髋关节、膝关节和踝关节的相对运动角度,并分解对应得到各关节的屈曲/伸展、外展/内收、轴向旋转运动,处理计算得到关节的平均运动角度和轨迹规律。统计各运动数据,分析运动的左右侧差异。结果表明,右侧髋关节的平均被动屈曲角度可达137.33°,被动伸展角度可达30.86°,这与解剖学上髋关节的被动最大角度以及其与膝关节位置相关的理论相一致,也验证了髋关节的极限屈曲/伸展角度与膝关节的位置有关,从而说明魏氏手法的运动学作用机理在于促进髋关节被动运动达到可达最大程度。同时发现,部分关节运动角度针对下肢惯用侧存在统计学上的左右侧差异(P<0.05)。该研究为手法的研究和定量评估提供新的研究方法。

Kinematic Analysis of Traumatology Manipulation for Treatment of Lumbar Disc Herniation

To explore kinematic mechanism of Chinese traumatology manipulation for the treatment of lumbar disc herniation (LDH), two classic motions of Wei′s manipulation, “foot hanging and knee bending”(FHKB) and “waist pulling-over”(WPO), were selected as study subjects. Based on 3D motion capture system, kinematic data of 5 trials of 10 healthy men while receiving manipulation was collected. A local coordinate system was defined and 3D kinematic models were established using Visual3D. The means of the 3D angles of the hip, knee, and ankle joints were calculated and were decomposed to represent flexion/extension, abduction/adduction, and internal/external rotation of the joints. Statistical analysis was conducted and the bilateral difference was compared. At the right hip joint, the range of motion (ROM) of the flexion was 137.33°, the abduction reached 30.86°. This was consistent with the maximum passive ROM of hip joint which was related with the position of knee joint, suggesting the kinematic mechanism of manipulation was promoting the passive joint angle to the maximum extent. Differences of some joint motion were observed between the right and left side according to idiomatic side (P<0.05). The research was expected valuable in establishing new analysis method and quantitative evaluation of Chinese manipulation.