颈椎旋转手法所致咔哒声响的临床和基础研究
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摘要
颈椎旋转手法是颈椎疾病常用的非手术治疗方法，旋转手法有多种，其中最常用的是颈椎定点旋转和端提旋转手法两种。如果我们能够了解这两种手法疗效的异同点，以及手法过程中发出咔哒声响的确切关节则可以知道手法作用的确切部位，这样对于提高手法的准确性及疗效非常有益。本论文对颈椎定点旋转手法和端提旋转手法对神经根型颈椎病的疗效进行对比研究。并自行设计出一套声响检测分析系统，对定点旋转手法所致的咔哒声响进行采集、定位及分析，以了解颈椎旋转手法所致咔哒声响的发生部位。论文分三个部分进行论述：
一、两种不同颈椎旋转手法对神经根型颈椎病疗效的对比研究
1、目的：研究颈椎定点旋转复位手法和端提旋转手法对神经根型颈椎病的不同疗效；
2、方法：收集30例神经根型颈椎病人，随机分为治疗组和对照组，分别实施颈椎定点旋转和端提旋转两种手法一个疗程。并根据病人治疗前后的自觉症状、临床检查和日常生活动作设计一个神经根型颈椎病治疗效果评定表，在治疗前后的进行评分，并将所得数据进行统计学分析。
3、结果：治疗组治疗前后症状体征积分相比较，有显著性差异(P＜0.001)；同时，对照组治疗前后症状体征积分比较也有显著性差异(P＜0.001)；但是治疗组的症状体征治疗前后积分差值和对照组的相比较明显要大，二者比较也有显著性差异(P＜0.001)。
4、结论：两种手法对神经根型颈椎病患者的症状体征都有明显改善，但是定点旋转手法的效果比端提旋转手法的效果更明显。
二、脊柱推拿时咔哒声响的测量技术分析与设计
1、目的：为研究脊柱推拿时所发出咔哒声响提供一套可采集、定位和分析的检测仪器；
2、方法：在回顾咔哒声响测量技术现状的基础上，分析研究了实现声响测量的技术路线，设计了由时钟脉冲发生器、发送／接受接口、校准波发生器、复合传感器、计算机、测定分析软件以及输出部件等组成的声响测量系统；
3、结果：经初步试验，在40cm的距离上测到的关节发出的咔哒声响，说明技术上基本可行；
4、小结：本仪器可以作为脊柱推拿所致咔哒声响的采集、定位和分析系统使用；
三、颈椎定点旋转手法所致咔哒声响的定位研究
1、目的：确定颈椎定点旋转手法所致咔哒声响的确切小关节位置；
2、方法：对30名健康成年人施行定位于C_4棘突的颈椎定点旋转手法，左右各一次，同时运用自行设计的声响采集定位系统对手法所致的咔哒声响进行采集，分析其发出声响的确切小关节，并进行统计学分析；
3、结果：颈椎定点旋转手法所致的咔哒声响主要集中在C_(3-7)间小关节，这些小关节发生声响的次数与其它颈椎间小关节发出声响的次数有显著性差异(P＜0.05)。
4、小结：颈椎定点旋转手法只是相对的定点，而不是精确的定点。
最后，对本课题的研究成果进行系统的总结，对本研究的创新点和局限性进行分析，并提出需要进一步的研究：
1、根据患者的症状、体征和日常生活动作三个项目我们设计一个神经根型颈椎病治疗效果表，它能够量化、客观地比较治疗前后的状况。但是其评判治疗效果也存在一定的主观性。
2、为了便于研究推拿力与咔哒声响的量效关系，我们还需要对声响采集系统进一步提高采样频率、改进检测技术和分析方法，还需要与其它测试技术进行融合。
3、本咔哒声响定位试验的研究验仅是对健康人群的结果，对其他颈椎疾病患者的研究还需要进一步的展开。另外，如果我们手法时定位在不同的颈椎棘突上是否就会产生不同的试验结果，发生多处咔哒声响时以同侧的声音最大者为采集对象的方法有无局限性?颈椎定点旋转手法的作用点有没有一定的规律可以探讨?对此我们都需要进一步研究。
Cervical rotatory manipulation is a usual non-surgery method of treatment forcervical disease. There are some kinds of rotatory manipulations, but the mostfrequently used ways are cervical rotatory and local manipulation and cervicalrotatory and local manipulation. If we know the difference of curative effect oncervical disease between the rotarory and local manipulation and lifted and rotatorymanipulation, and the facet joints' location of cracking sounds caused by cervicalrotatory manipulation, then we can know the exact location of manipulation's effecton. It's very good for promoting the accuracy and curative effect of manipulation. Inthis study, we compare the curative effect on cervical spondylotic radiculopathy ofcervical rotatory and local manipulation with that of cervical lifted and rotatorymanipulation. And we design a set of equipment to collect, locate and analyze thecracking sounds during cervical rotatory and local manipulation, so we can locate thecracking sound. The study is divided into 3 parts.
1 The comparison of two kinds of cervical spinal rotatory manipulations'effect on cervical spondylotic radiculopathy
(1)Objective To study the differences of curative effects on cervical spondyloticradiculopathy between the cervical rotatory and local manipulation and lifted and rotatory manipulation.
(2)Methods 30 cases of cervical spondylotic radiculopathy patients were dividedinto two groups. The treatment group were performed rotatory and local manipulationfor a course of treatment, and the control group were performed lifted and rotatorymanipulation for a course of treatment too. And we design a assessment scale ofcurative effect on cervical spondylotic radiculopathy according to the patients'subjective symptom, clinical examination and daily living action. We score beforeand after treatment respectively. Then we have the data statistical analysis.
(3)Results There is significant difference between post and prior-treatmentscore of symptom and physical sign in treatment group (P＜0.001), at the same timethere is significant difference between post and prior-treatment score of symptom andphysical sign in control group too (P＜0.001). But the difference of post andprior-treatment score of symptom and physical sign in treatment group is much morethan that in control group significantly, there is significant difference too(P＜0.001).
(4)Conclusion The two kinds of manipulations both make obviousimprovements in symptom and physical sign of patients with spondyloticradiculopathy. But the effect of the cervical rotatory and local manipulation is muchbetter than that of the cervical lifted and rotatory manipulation.
2 Measurement technique for the cracking sounds during spinalmanipulation
(1)Objective To design a set of equipment to collect, locate and analyze thecracking sounds during spinal manipulation.
(2)Methods On the basis of reviewing the current techniques for cracking soundmeasurement, we designed a cracking measurement system consisting of a pulsegenerator, transmission/reception interface calibrating wave generator, compoundsensors, computer, analytical software and output components.
(3)Results Preliminary experiments demonstrated that the cracking sounds couldbe detected at a distance of 40m.
(4)Conclusion This device can be used for collecting, locating and analyzing thecracking sounds during spinal manipulation.
3 Study on the location of cracking sounds by cervical rotatory and localmanipulation
(1)Objective To detect the facet joints' location of cracking sounds caused bycervical rotatory and local manipulation.
(2)Methods 30 healthy adults were performed cervical rotatory and localmanipulation which were located at the spinous process of C_4 each on left and rightside, at the same time, a set of equipment devised by ourselves was applied to collectand locate the cracking sounds, and made statistical analysis.
(3)Results The cracking sounds caused by cervical rotatory and localmanipulation mainly localized at C_(3-7) facet joints, and the times of cracking sounds ofthese facet joints had significant differences with those of the other facet joints.
(4)Conclusion The location of cervical rotatory and local manipulation is notaccurate but inexplicit.
At last, it takes a conclusion to the whole thesis and analyze the innovation andlimitation of the study. There is a suppose on the further research following the thesisand propose to the further study:
At last, it takes a conclusion to the whole thesis and analyze the innovation andlimitation of the study. There is a suppose on the further research following the study:
(1)We design a assessment scale of curative effect on cervical spondyloticradiculopathy according to the patients' subjective symptom, clinical examination anddaily living action, which can compare the patients' condition of prior-treatment withthat of post-treatment condition quantitatively and objectively. But it is subjective when judging the therapeutic efficacy.
(2) In order to study the dose-effect relationship of cracking sounds andmanipulative force easily, we should boost the sample frequency of sound collectingsystem, improve the technique of detection and the analytical method, and we shouldmix other testing techniques together.
(3)The test of cracking sounds location is just on the basis of healthy people, weshould progress more studies on patients with cervical syndrome. Otherwise, is theredifferent testing result if we locate on different cervical spinous process duringmanipulation? is there any limitation if we collect the homolat maximum sound whenthere are many sounds during manipulation? Is there any rule of cervical rotatory andlocal manipulation to detect? We should progress more study on these questions.
一、两种不同颈椎旋转手法对神经根型颈椎病疗效的对比研究
1、目的：研究颈椎定点旋转复位手法和端提旋转手法对神经根型颈椎病的不同疗效；
2、方法：收集30例神经根型颈椎病人，随机分为治疗组和对照组，分别实施颈椎定点旋转和端提旋转两种手法一个疗程。并根据病人治疗前后的自觉症状、临床检查和日常生活动作设计一个神经根型颈椎病治疗效果评定表，在治疗前后的进行评分，并将所得数据进行统计学分析。
3、结果：治疗组治疗前后症状体征积分相比较，有显著性差异(P＜0.001)；同时，对照组治疗前后症状体征积分比较也有显著性差异(P＜0.001)；但是治疗组的症状体征治疗前后积分差值和对照组的相比较明显要大，二者比较也有显著性差异(P＜0.001)。
4、结论：两种手法对神经根型颈椎病患者的症状体征都有明显改善，但是定点旋转手法的效果比端提旋转手法的效果更明显。
二、脊柱推拿时咔哒声响的测量技术分析与设计
1、目的：为研究脊柱推拿时所发出咔哒声响提供一套可采集、定位和分析的检测仪器；
2、方法：在回顾咔哒声响测量技术现状的基础上，分析研究了实现声响测量的技术路线，设计了由时钟脉冲发生器、发送／接受接口、校准波发生器、复合传感器、计算机、测定分析软件以及输出部件等组成的声响测量系统；
3、结果：经初步试验，在40cm的距离上测到的关节发出的咔哒声响，说明技术上基本可行；
4、小结：本仪器可以作为脊柱推拿所致咔哒声响的采集、定位和分析系统使用；
三、颈椎定点旋转手法所致咔哒声响的定位研究
1、目的：确定颈椎定点旋转手法所致咔哒声响的确切小关节位置；
2、方法：对30名健康成年人施行定位于C_4棘突的颈椎定点旋转手法，左右各一次，同时运用自行设计的声响采集定位系统对手法所致的咔哒声响进行采集，分析其发出声响的确切小关节，并进行统计学分析；
3、结果：颈椎定点旋转手法所致的咔哒声响主要集中在C_(3-7)间小关节，这些小关节发生声响的次数与其它颈椎间小关节发出声响的次数有显著性差异(P＜0.05)。
4、小结：颈椎定点旋转手法只是相对的定点，而不是精确的定点。
最后，对本课题的研究成果进行系统的总结，对本研究的创新点和局限性进行分析，并提出需要进一步的研究：
1、根据患者的症状、体征和日常生活动作三个项目我们设计一个神经根型颈椎病治疗效果表，它能够量化、客观地比较治疗前后的状况。但是其评判治疗效果也存在一定的主观性。
2、为了便于研究推拿力与咔哒声响的量效关系，我们还需要对声响采集系统进一步提高采样频率、改进检测技术和分析方法，还需要与其它测试技术进行融合。
3、本咔哒声响定位试验的研究验仅是对健康人群的结果，对其他颈椎疾病患者的研究还需要进一步的展开。另外，如果我们手法时定位在不同的颈椎棘突上是否就会产生不同的试验结果，发生多处咔哒声响时以同侧的声音最大者为采集对象的方法有无局限性?颈椎定点旋转手法的作用点有没有一定的规律可以探讨?对此我们都需要进一步研究。
Cervical rotatory manipulation is a usual non-surgery method of treatment forcervical disease. There are some kinds of rotatory manipulations, but the mostfrequently used ways are cervical rotatory and local manipulation and cervicalrotatory and local manipulation. If we know the difference of curative effect oncervical disease between the rotarory and local manipulation and lifted and rotatorymanipulation, and the facet joints' location of cracking sounds caused by cervicalrotatory manipulation, then we can know the exact location of manipulation's effecton. It's very good for promoting the accuracy and curative effect of manipulation. Inthis study, we compare the curative effect on cervical spondylotic radiculopathy ofcervical rotatory and local manipulation with that of cervical lifted and rotatorymanipulation. And we design a set of equipment to collect, locate and analyze thecracking sounds during cervical rotatory and local manipulation, so we can locate thecracking sound. The study is divided into 3 parts.
1 The comparison of two kinds of cervical spinal rotatory manipulations'effect on cervical spondylotic radiculopathy
(1)Objective To study the differences of curative effects on cervical spondyloticradiculopathy between the cervical rotatory and local manipulation and lifted and rotatory manipulation.
(2)Methods 30 cases of cervical spondylotic radiculopathy patients were dividedinto two groups. The treatment group were performed rotatory and local manipulationfor a course of treatment, and the control group were performed lifted and rotatorymanipulation for a course of treatment too. And we design a assessment scale ofcurative effect on cervical spondylotic radiculopathy according to the patients'subjective symptom, clinical examination and daily living action. We score beforeand after treatment respectively. Then we have the data statistical analysis.
(3)Results There is significant difference between post and prior-treatmentscore of symptom and physical sign in treatment group (P＜0.001), at the same timethere is significant difference between post and prior-treatment score of symptom andphysical sign in control group too (P＜0.001). But the difference of post andprior-treatment score of symptom and physical sign in treatment group is much morethan that in control group significantly, there is significant difference too(P＜0.001).
(4)Conclusion The two kinds of manipulations both make obviousimprovements in symptom and physical sign of patients with spondyloticradiculopathy. But the effect of the cervical rotatory and local manipulation is muchbetter than that of the cervical lifted and rotatory manipulation.
2 Measurement technique for the cracking sounds during spinalmanipulation
(1)Objective To design a set of equipment to collect, locate and analyze thecracking sounds during spinal manipulation.
(2)Methods On the basis of reviewing the current techniques for cracking soundmeasurement, we designed a cracking measurement system consisting of a pulsegenerator, transmission/reception interface calibrating wave generator, compoundsensors, computer, analytical software and output components.
(3)Results Preliminary experiments demonstrated that the cracking sounds couldbe detected at a distance of 40m.
(4)Conclusion This device can be used for collecting, locating and analyzing thecracking sounds during spinal manipulation.
3 Study on the location of cracking sounds by cervical rotatory and localmanipulation
(1)Objective To detect the facet joints' location of cracking sounds caused bycervical rotatory and local manipulation.
(2)Methods 30 healthy adults were performed cervical rotatory and localmanipulation which were located at the spinous process of C_4 each on left and rightside, at the same time, a set of equipment devised by ourselves was applied to collectand locate the cracking sounds, and made statistical analysis.
(3)Results The cracking sounds caused by cervical rotatory and localmanipulation mainly localized at C_(3-7) facet joints, and the times of cracking sounds ofthese facet joints had significant differences with those of the other facet joints.
(4)Conclusion The location of cervical rotatory and local manipulation is notaccurate but inexplicit.
At last, it takes a conclusion to the whole thesis and analyze the innovation andlimitation of the study. There is a suppose on the further research following the thesisand propose to the further study:
At last, it takes a conclusion to the whole thesis and analyze the innovation andlimitation of the study. There is a suppose on the further research following the study:
(1)We design a assessment scale of curative effect on cervical spondyloticradiculopathy according to the patients' subjective symptom, clinical examination anddaily living action, which can compare the patients' condition of prior-treatment withthat of post-treatment condition quantitatively and objectively. But it is subjective when judging the therapeutic efficacy.
(2) In order to study the dose-effect relationship of cracking sounds andmanipulative force easily, we should boost the sample frequency of sound collectingsystem, improve the technique of detection and the analytical method, and we shouldmix other testing techniques together.
(3)The test of cracking sounds location is just on the basis of healthy people, weshould progress more studies on patients with cervical syndrome. Otherwise, is theredifferent testing result if we locate on different cervical spinous process duringmanipulation? is there any limitation if we collect the homolat maximum sound whenthere are many sounds during manipulation? Is there any rule of cervical rotatory andlocal manipulation to detect? We should progress more study on these questions.
引文
1．冯天有．中西医结合治疗软组织损伤[M]．北京：人民卫生出版社，1977．8-11．
2．杨克勤．颈椎病[M]．北京：人民卫生出版社．1982．122-4．
3．李义凯，赵卫东，钟世镇．两种旋转手法咔哒声的比较研究[J]．中医正骨，1998， 10(6)：10．
4．严叔泉．颈部按摩推拿手法引起猝倒及高位截瘫一例报告[J]．中华骨科杂志， 1992，2：148．
5．梅跃忠．颈部扳法引起晕厥一例[J]．按摩与导引，1992，1：43．
6．李义凯，钟世镇．颈部推拿过程中小关节咔哒声的分析[J]．中国中医骨伤杂志， 1997，5(2)：57-8．
7. John W, Reggars,D.C and Henry P.Analysis of Zygapophyseal Joint Cracking During Chiropractic Manipulation[J].JMPT, 1995,18(2):65-71.
8．李义凯，陈建华，邱桂春．脊柱推拿时咔哒声响的测量技术分析和设计[J]．第一军医大学学报，2005，25(4)：419-22．
9． 李义凯，赵卫东，钟世镇．两种颈部旋转手法“咔哒声”的比较研究[J]．中医正骨， 1998，10(6)：9-10．
10．陈孝平．外科学[M]．北京：人民卫生出版社，2005．1059．
11．孙宇，陈琪福．第二届颈椎病专题座谈会纪要[J]．中华外科杂志，1993，31(6)： 472-6．
12．朱立国，于杰，高景华．旋转手法治疗神经根型颈椎病研究概述[J]．中医正骨， 2005，17(8)：69-73．
13．章煜铭．牵旋手法治疗颈椎间盘突出症[J]．中国中医骨伤科杂志，1994．429．
14．郑良义．卧位旋转复位法治疗根型颈椎病[J]．中医骨伤，1999，12(4)：61．
15．管政．牵引下旋转手法为主治疗颈椎病42例[J]．山东中医杂志，1992，4：29．
16．奚胜．定点旋转手法配合枕颌牵引治疗颈椎间盘突出症[J]．现代康复，2001， 5(5)：88．
17．梅继文，梁文杰，韦贵康．颈椎病手法意外21例临床分析[J]．中国中医骨伤科杂志，2003，11(5)：53．
18．李义凯，张云昆，钟世镇．颈椎旋转手法对椎动脉流速影响的研究[J]．中国中医骨伤科杂志，1995，5(5)：7．
19．李义凯，叶淦湖．中国脊柱推拿手法全书[M]．北京：军事医学科学出版社，2005． 438．
20．王晓红，何成奇，丁明甫，等．颈椎病治疗成绩评分表[J]．华西医学，2005，12(2)： 232-3．
21．张军，尚秀兰，孙树椿，等．神经根型颈椎病根性疼痛的解剖学基础和发病机理的研究[J]．中国中医骨伤科杂志，1999，7(1)：49．
22. Paul G, Shekelle.Spine update spinal manipulation[J].Spine, 1994,19(8):858.
23．张军武，王道福，林琦，等．颈椎病手法治疗的作用机制[J]．现代康复，2000，4(7)： 1052．
24．姜宏，施杞，王以进．旋转手法对颈椎间盘粘弹性影响的实验研究[J]．中国中医骨伤科杂志，1999，7(1)：4-6．
25．骆竞洪．中华推拿医学志-手法源流[M]．重庆：科学技术文献出版社重庆分社， 1987．284-6．
26．孙明太．航空反潜概论[M]．北京：国防工业出版社，2001．4-8．
27. Sandoz R.The significance of the manipulative crack and other articular noise[J]. Ann Swiss Chiropract Assoc,1969,4:47-49.
28. Herzog W, Zhang Y, Conway P, et al.Cavitation sounds during spinal manipulative treatment[J].Manipulative Physical, 1993,16:523.
29. Conway PJ,Herzog W, Zhang Y, et al.Force required to cause cavitation during spinal manipulation of the thoracic spine[J].Clin Biomech, 1993,8:210-2.
30．陈建华．舰艇作战模拟理论与实践[M]．北京：国防工业出版社，2002．5-7．
31. Brodeur R.The audible release associated with joint manipulation[J].J Manipulative Physical Ther, 1995,18:155.
32. Brodeur R.The audible release associated with joint manipulation[J]. JMPT, 1995,18:155-7.
33．赵振彰．生理性关节弹想的实质和临床意义[J]．按摩与导引，1997，5：4-5．
34．李义凯，彭玉出，蔡乐农．推拿所致咔哒声响的研究[J]．颈腰痛杂志，2004，25(1)： 59-60．
35．吴惠明．两种手法治疗神经根型颈椎病疗效比较[J]．中国骨伤，2005，4(18)： 233-4．
36．北京按摩医院．中国按摩全书[M]．北京：华夏出版社，1993，10：112．
37．李义凯，叶淦湖，刘晓华，等．颈椎棘突的形态学特征及在颈部推拿中的临床意义[J]．中国临床解剖学杂志，2003，23(1)：25-6．
38．韦贵康．腰椎间盘突出症手法意外11例分析[J]．中国骨伤，1999，12(4)：37-38．
39．李义凯，董晓晖，粟志辉等．颈部推拿与非激素类抗炎制剂的危险性评价[J]．按摩与导引，1998，10：7-8．
40．李义凯，李军朋．与颈部手法治疗相关的解剖学研究[J]．中国临床康复，2004，8(17)：3348-50．
41．王亦璁．骨与关节损伤[M]．北京：人民卫生出版社，1990．490．
42．李义凯，王国林，徐海涛，等．颈椎定点旋转手法所致咔哒声与拇指最大推扳力的量效关系研究[J]．中国康复医学杂志，2004．19(9)：644-646．
43．史继祥，王志泉，王以进．颈椎斜扳手法的生物力学研究[J]．医用生物力学． 1994，13(2)：110-3．
44．李义凯．脊柱推拿的基础与临床[M]．北京：军事医学科学出版社，2001．222．
1 Dvir Zeevi. Clinical Biomechanics[M]. Churchill Livingstone Philadelphia, 2000.299.
2 张雪军，府强．中外独特按摩技法大全[M]．北京：北京科学技术出版社，1993．41．
3 包来发．百家推拿经验集[M]．上海：上海科学技术出版社，1995．94．
4 吴惠明．两种手法治疗神经根型颈椎病疗效比较[J]．中国骨伤，2005，4(18)：233-4．
5 钟世镇，李义凯．计算机三维图像和声响检测技术在脊柱推拿手法研究中的应用[J]．科学中国人，2005，9：20-2．
6 沈国权，严隽涛．二十一世纪推拿学科建设的若干学术问题[c]．全国推拿流派与文献交流会论文集，2001．3-5．
7 李义凯，钟世镇．旋转手法对椎管内结构和容积影响的研究[J]．中国中医骨伤杂志，1997，5(6)：4-7．
8 John W.Reggars, D.C and HenryP.Analysis of Zygapophyseal Joint Cracking During Chiropractic Manipulation[J]. JMPT, 1995. 18(2): 65-71.
9 赵振彰．生理性关节弹想的实质和临床意义[J]．按摩与导引，1997，5：4-5．
10 李义凯，彭玉，蔡乐农．推拿所致咔哒声响的研究[J]．颈腰痛杂志，2004，25(1)：59-60．
11 李义凯，陈建华，邱桂春．脊柱推拿时咔哒声响的测量技术分析和设计[J]．第一军医大学学报，2005，25(4)：419-422．
12 朱立国，于杰，高景华．旋转手法治疗神经根型颈椎病研究概述[J]．中医正骨，2005，17(8)：69-73．
13 李义凯，赵卫东，钟世镇．两种旋转手法咔哒声的比较研究[J]．中医正骨，1998，10(6)：10．
14 Sandoz R. The significance of the manipulative crack and other articular noise [J]. Ann Swiss Chiropract Assoc, 1969, 4: 47-9.
15 Meal GM, Scott RA. Analysis of the joint crack by simultaneous recording of sound and tension[J]. JMPT, 1986, 9: 189-191.
16 李义凯，钟世镇．颈部推拿过程中小关节咔哒声的分析[J]．中国中医骨伤杂志，1997，5(2)：57-8．
17 Conway PJ, Herzog W, Zhang Y, et al. Force required to cause cavitation during spinal manipulation of the thoracic spine[J]. Clin Biomech, 1993, 8: 210-2.
18 李义凯，王国林，徐海涛，等．腰椎旋转手法所致咔哒声与拇指最大推扳力的量效关系研究[J]．中国临床解剖学杂志，2004，22(6)：658-60．
19 李义凯，王国林，徐海涛等．颈椎定点旋转手法所致咔哒声与拇指最大推扳力的量效关系研究[J]．中国康复医学杂志，2004，19(9)：644-6．
20 李义凯，叶淦湖．中国脊柱推拿手法全书[M]．北京：军事医学科学出版社，2005．25．
21 韦贵康．腰椎间盘突出症手法意外11例分析[J]．中国骨伤，1999，12(4)：37-38．
22 李义凯，董晓晖，粟志辉，等．颈部推拿与非激素类抗炎制剂的危险性评价[J]．按摩与导引，1998，10：7．
2．杨克勤．颈椎病[M]．北京：人民卫生出版社．1982．122-4．
3．李义凯，赵卫东，钟世镇．两种旋转手法咔哒声的比较研究[J]．中医正骨，1998， 10(6)：10．
4．严叔泉．颈部按摩推拿手法引起猝倒及高位截瘫一例报告[J]．中华骨科杂志， 1992，2：148．
5．梅跃忠．颈部扳法引起晕厥一例[J]．按摩与导引，1992，1：43．
6．李义凯，钟世镇．颈部推拿过程中小关节咔哒声的分析[J]．中国中医骨伤杂志， 1997，5(2)：57-8．
7. John W, Reggars,D.C and Henry P.Analysis of Zygapophyseal Joint Cracking During Chiropractic Manipulation[J].JMPT, 1995,18(2):65-71.
8．李义凯，陈建华，邱桂春．脊柱推拿时咔哒声响的测量技术分析和设计[J]．第一军医大学学报，2005，25(4)：419-22．
9． 李义凯，赵卫东，钟世镇．两种颈部旋转手法“咔哒声”的比较研究[J]．中医正骨， 1998，10(6)：9-10．
10．陈孝平．外科学[M]．北京：人民卫生出版社，2005．1059．
11．孙宇，陈琪福．第二届颈椎病专题座谈会纪要[J]．中华外科杂志，1993，31(6)： 472-6．
12．朱立国，于杰，高景华．旋转手法治疗神经根型颈椎病研究概述[J]．中医正骨， 2005，17(8)：69-73．
13．章煜铭．牵旋手法治疗颈椎间盘突出症[J]．中国中医骨伤科杂志，1994．429．
14．郑良义．卧位旋转复位法治疗根型颈椎病[J]．中医骨伤，1999，12(4)：61．
15．管政．牵引下旋转手法为主治疗颈椎病42例[J]．山东中医杂志，1992，4：29．
16．奚胜．定点旋转手法配合枕颌牵引治疗颈椎间盘突出症[J]．现代康复，2001， 5(5)：88．
17．梅继文，梁文杰，韦贵康．颈椎病手法意外21例临床分析[J]．中国中医骨伤科杂志，2003，11(5)：53．
18．李义凯，张云昆，钟世镇．颈椎旋转手法对椎动脉流速影响的研究[J]．中国中医骨伤科杂志，1995，5(5)：7．
19．李义凯，叶淦湖．中国脊柱推拿手法全书[M]．北京：军事医学科学出版社，2005． 438．
20．王晓红，何成奇，丁明甫，等．颈椎病治疗成绩评分表[J]．华西医学，2005，12(2)： 232-3．
21．张军，尚秀兰，孙树椿，等．神经根型颈椎病根性疼痛的解剖学基础和发病机理的研究[J]．中国中医骨伤科杂志，1999，7(1)：49．
22. Paul G, Shekelle.Spine update spinal manipulation[J].Spine, 1994,19(8):858.
23．张军武，王道福，林琦，等．颈椎病手法治疗的作用机制[J]．现代康复，2000，4(7)： 1052．
24．姜宏，施杞，王以进．旋转手法对颈椎间盘粘弹性影响的实验研究[J]．中国中医骨伤科杂志，1999，7(1)：4-6．
25．骆竞洪．中华推拿医学志-手法源流[M]．重庆：科学技术文献出版社重庆分社， 1987．284-6．
26．孙明太．航空反潜概论[M]．北京：国防工业出版社，2001．4-8．
27. Sandoz R.The significance of the manipulative crack and other articular noise[J]. Ann Swiss Chiropract Assoc,1969,4:47-49.
28. Herzog W, Zhang Y, Conway P, et al.Cavitation sounds during spinal manipulative treatment[J].Manipulative Physical, 1993,16:523.
29. Conway PJ,Herzog W, Zhang Y, et al.Force required to cause cavitation during spinal manipulation of the thoracic spine[J].Clin Biomech, 1993,8:210-2.
30．陈建华．舰艇作战模拟理论与实践[M]．北京：国防工业出版社，2002．5-7．
31. Brodeur R.The audible release associated with joint manipulation[J].J Manipulative Physical Ther, 1995,18:155.
32. Brodeur R.The audible release associated with joint manipulation[J]. JMPT, 1995,18:155-7.
33．赵振彰．生理性关节弹想的实质和临床意义[J]．按摩与导引，1997，5：4-5．
34．李义凯，彭玉出，蔡乐农．推拿所致咔哒声响的研究[J]．颈腰痛杂志，2004，25(1)： 59-60．
35．吴惠明．两种手法治疗神经根型颈椎病疗效比较[J]．中国骨伤，2005，4(18)： 233-4．
36．北京按摩医院．中国按摩全书[M]．北京：华夏出版社，1993，10：112．
37．李义凯，叶淦湖，刘晓华，等．颈椎棘突的形态学特征及在颈部推拿中的临床意义[J]．中国临床解剖学杂志，2003，23(1)：25-6．
38．韦贵康．腰椎间盘突出症手法意外11例分析[J]．中国骨伤，1999，12(4)：37-38．
39．李义凯，董晓晖，粟志辉等．颈部推拿与非激素类抗炎制剂的危险性评价[J]．按摩与导引，1998，10：7-8．
40．李义凯，李军朋．与颈部手法治疗相关的解剖学研究[J]．中国临床康复，2004，8(17)：3348-50．
41．王亦璁．骨与关节损伤[M]．北京：人民卫生出版社，1990．490．
42．李义凯，王国林，徐海涛，等．颈椎定点旋转手法所致咔哒声与拇指最大推扳力的量效关系研究[J]．中国康复医学杂志，2004．19(9)：644-646．
43．史继祥，王志泉，王以进．颈椎斜扳手法的生物力学研究[J]．医用生物力学． 1994，13(2)：110-3．
44．李义凯．脊柱推拿的基础与临床[M]．北京：军事医学科学出版社，2001．222．
1 Dvir Zeevi. Clinical Biomechanics[M]. Churchill Livingstone Philadelphia, 2000.299.
2 张雪军，府强．中外独特按摩技法大全[M]．北京：北京科学技术出版社，1993．41．
3 包来发．百家推拿经验集[M]．上海：上海科学技术出版社，1995．94．
4 吴惠明．两种手法治疗神经根型颈椎病疗效比较[J]．中国骨伤，2005，4(18)：233-4．
5 钟世镇，李义凯．计算机三维图像和声响检测技术在脊柱推拿手法研究中的应用[J]．科学中国人，2005，9：20-2．
6 沈国权，严隽涛．二十一世纪推拿学科建设的若干学术问题[c]．全国推拿流派与文献交流会论文集，2001．3-5．
7 李义凯，钟世镇．旋转手法对椎管内结构和容积影响的研究[J]．中国中医骨伤杂志，1997，5(6)：4-7．
8 John W.Reggars, D.C and HenryP.Analysis of Zygapophyseal Joint Cracking During Chiropractic Manipulation[J]. JMPT, 1995. 18(2): 65-71.
9 赵振彰．生理性关节弹想的实质和临床意义[J]．按摩与导引，1997，5：4-5．
10 李义凯，彭玉，蔡乐农．推拿所致咔哒声响的研究[J]．颈腰痛杂志，2004，25(1)：59-60．
11 李义凯，陈建华，邱桂春．脊柱推拿时咔哒声响的测量技术分析和设计[J]．第一军医大学学报，2005，25(4)：419-422．
12 朱立国，于杰，高景华．旋转手法治疗神经根型颈椎病研究概述[J]．中医正骨，2005，17(8)：69-73．
13 李义凯，赵卫东，钟世镇．两种旋转手法咔哒声的比较研究[J]．中医正骨，1998，10(6)：10．
14 Sandoz R. The significance of the manipulative crack and other articular noise [J]. Ann Swiss Chiropract Assoc, 1969, 4: 47-9.
15 Meal GM, Scott RA. Analysis of the joint crack by simultaneous recording of sound and tension[J]. JMPT, 1986, 9: 189-191.
16 李义凯，钟世镇．颈部推拿过程中小关节咔哒声的分析[J]．中国中医骨伤杂志，1997，5(2)：57-8．
17 Conway PJ, Herzog W, Zhang Y, et al. Force required to cause cavitation during spinal manipulation of the thoracic spine[J]. Clin Biomech, 1993, 8: 210-2.
18 李义凯，王国林，徐海涛，等．腰椎旋转手法所致咔哒声与拇指最大推扳力的量效关系研究[J]．中国临床解剖学杂志，2004，22(6)：658-60．
19 李义凯，王国林，徐海涛等．颈椎定点旋转手法所致咔哒声与拇指最大推扳力的量效关系研究[J]．中国康复医学杂志，2004，19(9)：644-6．
20 李义凯，叶淦湖．中国脊柱推拿手法全书[M]．北京：军事医学科学出版社，2005．25．
21 韦贵康．腰椎间盘突出症手法意外11例分析[J]．中国骨伤，1999，12(4)：37-38．
22 李义凯，董晓晖，粟志辉，等．颈部推拿与非激素类抗炎制剂的危险性评价[J]．按摩与导引，1998，10：7．