自体垂直悬吊牵引治疗腰椎间盘突出症的临床及机理研究
|
摘要
腰椎间盘突出症(Lumbar disc herniation, LDH)是在椎间盘退变基础上,因纤维环裂隙、髓核突出刺激或压迫后方的脊髓、神经根或马尾神经所引起的以腰痛和坐骨神经放射痛为主要临床表现的疾病,是椎间盘退行性疾病常见的一种临床类型。腰椎牵引是治疗LDH主要的保守治疗方法之一,但传统的腰椎牵引因适应症的选择、牵引参数设置、牵引时不可抗拒的摩擦力及缓解腰痛机制未明等原因,使其应用受到一定程度限制。自体垂直悬吊牵引是腰椎牵引的一种特殊形式,近年来在临床上广泛应用,取得了一定的临床效果。本研究拟在这些研究的基础上,观察自体垂直悬吊牵引治疗LDH的短期疗效,分析影响疗效的相关预测变量,并采用自体垂直悬吊牵引观察其对退变兔椎间盘的影响,进一步揭示其可能的机制,验证其临床疗效。
目的：
依据自体垂直悬吊牵引治疗腰椎间盘突出症的短期疗效,筛选对疗效反应良好的预测变量并揭示其可能的缓解腰椎间盘退变的病理机制,为临床应用提供可靠依据。
方法：
1.临床研究
选择符合纳入标准的患者150例,治疗前详细记录患者的基本情况、标准的专科查体、影像学评估、并采用疼痛视觉模拟评分(visual analog scale, vas)及下腰痛评分法(Japanese Orthopaedic Association Scores, JOA score)评价腰椎功能情况后,行自体垂直悬吊牵引治疗,计算并记录每次牵引时间、每周牵引频次,以牵引4周后JOA改善大于等于50%为标准,应用logistic回归分析与疗效相关的预测变量,并分别在牵引4周、牵引8周及牵引12周采用VAS和腰椎JOA评分评价其疗效。
2.动物实验
为验证纤维环穿刺法建立椎间盘退变模型的可靠性,我们首先利用16G普通针刺损伤纤维环诱发椎间盘退变,观察手术前后兔椎间盘随时间变化的椎间隙高度变化及大体病理改变。在成功制作纤维环损伤诱导椎间盘退变模型基础上,应用自制自体垂直悬吊牵引装置对退变腰椎椎间盘的兔行持续牵引治疗,牵引参数为每天牵引一次,每次30分钟,持续牵引12周,通过牵引不同时间点腰椎侧位X线检查及病理组织学变化评估兔退变椎间盘退变程度的改善情况。
成果：
1.自体垂直悬吊牵引对腰椎间盘突出症短期疗效的预测因素为：年纪≦37岁,非体力工作和急性发病三个因素；
2.腰椎退变程度较轻的患者相对于退变程度重的患者对牵引的疗效反应较好；
3.自体垂直悬吊牵引可缓解患者腰痛,明显改善患者肢体功能,延长牵引时间和频次能提高临床疗效。
4.纤维环穿刺法损伤兔腰椎间盘纤维环,可缓慢模拟人类损伤后椎间盘退变过程,可成功建立腰椎间盘退变模型而应用于椎间盘退变机制的进一步研究。
5.自体垂直悬吊牵引可改善兔退变椎间盘的高度,通过直接化生软骨细胞、减少死亡细胞数目等方式延缓和抑制椎间盘退变。
6.早期的牵引干预对维持椎间盘的健康和刺激组织修复是非常重要。
结论：
自体垂直悬吊牵引能延缓和抑制早期椎间盘退变,早期的牵引干预对椎间盘的康复有利,短期疗效满意,对年龄小于等于37岁,非体力工作及急性发病的腰椎间盘突出症的疗效最为肯定。
Objective
Lumbar disc herniation(LDH) is a disease of which the main clinical manifestations is low back pain and radiated sciatica caused by the stimulation or compression of the spinal cord, nerve root or cauda equin, due to the annulus f ibrosus tear and herniated nucleus based on disc degeneration, and it is also a common clinical types of degenerative disc disease. Lumbar traction,as one of the major conservative treatment of LDH, is limited by a certain extent due to the choice of indications, traction parameter, irresistible friction and uncertain mechanism to relieve pain. Gravitational traction is widely used in clinic as a special form of lumbar traction in recent years and its efficacy has been proved. This study observes the short-term effects of gravitational traction therapy on LDH, analyzing its curative effect and related prediction variables, futhermore we observe its therapeutic mechanism of intervertebral disc degeneration on rabbit, and thus reveals the possible mechanism to verify its clinical curative effect.
Methods
150patients that met the inclusion criteria were included in the study in the clinical studies. Patient demographic information, standard physical examination, pain evaluation using a visual analogue scale (VAS) and Japanese Orthopaedic Association Scores for Assessment of Cervical Myelopathy (JOA score) were recorded before intervention. The cumulative traction time of each therapy and traction frequency were calculated and recorded during12weeks of continuous traction. The improvement of the JOA score more than50%than pre-treatment was used as a determinant for a responder of gravitational traction. The predictor variables associated with the efficacy were analyzed by logistic regression analysis method. The efficacy was evaluated by VAS scores and lumbar JOA score on week4,8and12.
To verify the reliability of disc degeneration model by the annulus fibrosus puncture,16gauge ordinary needles was first used to damage annulus fibrosus to induce disc degeneration, the intervertebral disc height changes and pathologic changes over time before and after surgery were observed. Then based on the disc degeneration model induced by annulus puncture, the rabbits with disc degeneration received a routine gravitational traction using a device of our own design,30min per day, for12weeks. Radiographic exam and gross pathological changes of the microscope were performed on week2,4,6and8, following the initiation of the gravitational traction to assess the improvement of disc degeneration.
Results
1. A clinical prediction rule with three variables that had positive response to gravitational traction (age below37years old, non-physical work and the acute onset) was indentified.
2. The patient with lesser lumbar degeneration had better response for gravitational traction than that with worse lumbar degeneration.
3. Gravitational traction can relieve lumbago and improve function. The clinical efficacy can be improved by extending traction time and frequency.
4. The annulus puncture injuries model mimics the disc degeneration process in human. The degenerative disc model can be successfully established and applied to the further study of the mechanisms of disc degeneration.
5. Gravitational traction can delay and inhibit intervertebral disc degeneration through direct metaplastic of chondrocytes, reduction of the number of cell death in the substance of the annulus.
6. The early traction intervention is of great importance in order to maintain the intervertebral disc health and stimulating tissue repair.
Conelusion
Gravitational traction can delay and inhibit early disc degeneration. Early traction intervention is favorable for intervertebral disc rehabilitation and its short-term results are satisfactory. Clinical outcome will be most desirable if the patients are less than or equal to37years of age, on-physical work and the acute onset of lumbar disc herniation.
目的：
依据自体垂直悬吊牵引治疗腰椎间盘突出症的短期疗效,筛选对疗效反应良好的预测变量并揭示其可能的缓解腰椎间盘退变的病理机制,为临床应用提供可靠依据。
方法：
1.临床研究
选择符合纳入标准的患者150例,治疗前详细记录患者的基本情况、标准的专科查体、影像学评估、并采用疼痛视觉模拟评分(visual analog scale, vas)及下腰痛评分法(Japanese Orthopaedic Association Scores, JOA score)评价腰椎功能情况后,行自体垂直悬吊牵引治疗,计算并记录每次牵引时间、每周牵引频次,以牵引4周后JOA改善大于等于50%为标准,应用logistic回归分析与疗效相关的预测变量,并分别在牵引4周、牵引8周及牵引12周采用VAS和腰椎JOA评分评价其疗效。
2.动物实验
为验证纤维环穿刺法建立椎间盘退变模型的可靠性,我们首先利用16G普通针刺损伤纤维环诱发椎间盘退变,观察手术前后兔椎间盘随时间变化的椎间隙高度变化及大体病理改变。在成功制作纤维环损伤诱导椎间盘退变模型基础上,应用自制自体垂直悬吊牵引装置对退变腰椎椎间盘的兔行持续牵引治疗,牵引参数为每天牵引一次,每次30分钟,持续牵引12周,通过牵引不同时间点腰椎侧位X线检查及病理组织学变化评估兔退变椎间盘退变程度的改善情况。
成果：
1.自体垂直悬吊牵引对腰椎间盘突出症短期疗效的预测因素为：年纪≦37岁,非体力工作和急性发病三个因素；
2.腰椎退变程度较轻的患者相对于退变程度重的患者对牵引的疗效反应较好；
3.自体垂直悬吊牵引可缓解患者腰痛,明显改善患者肢体功能,延长牵引时间和频次能提高临床疗效。
4.纤维环穿刺法损伤兔腰椎间盘纤维环,可缓慢模拟人类损伤后椎间盘退变过程,可成功建立腰椎间盘退变模型而应用于椎间盘退变机制的进一步研究。
5.自体垂直悬吊牵引可改善兔退变椎间盘的高度,通过直接化生软骨细胞、减少死亡细胞数目等方式延缓和抑制椎间盘退变。
6.早期的牵引干预对维持椎间盘的健康和刺激组织修复是非常重要。
结论：
自体垂直悬吊牵引能延缓和抑制早期椎间盘退变,早期的牵引干预对椎间盘的康复有利,短期疗效满意,对年龄小于等于37岁,非体力工作及急性发病的腰椎间盘突出症的疗效最为肯定。
Objective
Lumbar disc herniation(LDH) is a disease of which the main clinical manifestations is low back pain and radiated sciatica caused by the stimulation or compression of the spinal cord, nerve root or cauda equin, due to the annulus f ibrosus tear and herniated nucleus based on disc degeneration, and it is also a common clinical types of degenerative disc disease. Lumbar traction,as one of the major conservative treatment of LDH, is limited by a certain extent due to the choice of indications, traction parameter, irresistible friction and uncertain mechanism to relieve pain. Gravitational traction is widely used in clinic as a special form of lumbar traction in recent years and its efficacy has been proved. This study observes the short-term effects of gravitational traction therapy on LDH, analyzing its curative effect and related prediction variables, futhermore we observe its therapeutic mechanism of intervertebral disc degeneration on rabbit, and thus reveals the possible mechanism to verify its clinical curative effect.
Methods
150patients that met the inclusion criteria were included in the study in the clinical studies. Patient demographic information, standard physical examination, pain evaluation using a visual analogue scale (VAS) and Japanese Orthopaedic Association Scores for Assessment of Cervical Myelopathy (JOA score) were recorded before intervention. The cumulative traction time of each therapy and traction frequency were calculated and recorded during12weeks of continuous traction. The improvement of the JOA score more than50%than pre-treatment was used as a determinant for a responder of gravitational traction. The predictor variables associated with the efficacy were analyzed by logistic regression analysis method. The efficacy was evaluated by VAS scores and lumbar JOA score on week4,8and12.
To verify the reliability of disc degeneration model by the annulus fibrosus puncture,16gauge ordinary needles was first used to damage annulus fibrosus to induce disc degeneration, the intervertebral disc height changes and pathologic changes over time before and after surgery were observed. Then based on the disc degeneration model induced by annulus puncture, the rabbits with disc degeneration received a routine gravitational traction using a device of our own design,30min per day, for12weeks. Radiographic exam and gross pathological changes of the microscope were performed on week2,4,6and8, following the initiation of the gravitational traction to assess the improvement of disc degeneration.
Results
1. A clinical prediction rule with three variables that had positive response to gravitational traction (age below37years old, non-physical work and the acute onset) was indentified.
2. The patient with lesser lumbar degeneration had better response for gravitational traction than that with worse lumbar degeneration.
3. Gravitational traction can relieve lumbago and improve function. The clinical efficacy can be improved by extending traction time and frequency.
4. The annulus puncture injuries model mimics the disc degeneration process in human. The degenerative disc model can be successfully established and applied to the further study of the mechanisms of disc degeneration.
5. Gravitational traction can delay and inhibit intervertebral disc degeneration through direct metaplastic of chondrocytes, reduction of the number of cell death in the substance of the annulus.
6. The early traction intervention is of great importance in order to maintain the intervertebral disc health and stimulating tissue repair.
Conelusion
Gravitational traction can delay and inhibit early disc degeneration. Early traction intervention is favorable for intervertebral disc rehabilitation and its short-term results are satisfactory. Clinical outcome will be most desirable if the patients are less than or equal to37years of age, on-physical work and the acute onset of lumbar disc herniation.
引文
[1]陆拯.近代中医珍本集医经分册[M].杭州：浙江科技出版社,1990：138-358.
[2]巢元芳.诸病源侯论[M].北京：人民卫生出版社,1991；150.
[3]朱丹溪.丹溪心法[M].北京：中国书店,1986：298.
[4]王焘.外台秘要[M].北京：华夏出版社,1993：321.
[5]Urban, Maroudas. Measurement of swelling pressure and fluid flow in the interverteral disc with reference to creep[M]. London:Mechanical Engineering Publicatioins, In Engineering Aspects of the Spine,1981.
[6]Wilder,Pope, Frymoyer, et al. The biomechanics of lumbar disc herniatin and the effect of overload and instability[J]. J Spinal Disease.1988,1:16-32.
[7]Zimmerman,Vuono-Hawkings, Parsons, et al. The mechanical properties of the canine lumbar disc and motion segment[J]. Spine,1992,17(2):213-220.
[8]Buckwalter. Aging and degeneration of the human intervertebral disc[J]. Spine Update,1995,20(11):1307-1314.
[9]Urban JP, Maroudas A. Measurement of fixed charge density and partition coefficients in the intervertebral disc[J]. Biochim Biophys Acta,1979,586:166-178.
[10]Urban JP, Maroudas A. Swelling of the intervertebral disc in vitro[J]. Connect Tissue Res,1981,9:1-10.
[11]Marchand,Ahmed. Investigation of the laminate structure of lumbar disc anulus fibrosus[J]. Spine,1990,15:402-410.
[12]Iatridis, Mente, Stokes IA, et al. Compression-induced changes in intervertebral disc properties in a rat tail model[J]. Spine,1999;24:996-1002.
[13]Perie, Iatridis JC, Demers CN, et al. Assessment of compressive modulus, hydraulic permeability and matrix content of trypsin-treated nucleus pulposus using quantitative MRI[J].J Biomech,2006,39:1392-1400.
[14]Botsford DJ, Esses SI, Ogilvie-Harris DJ. In vivo diurnal variation in intervertebral disc volume and morphology[J]. Spine,1994,19:935-940.
[l5]Koeller W, Muehlhaus S, Meier W,et al. Biomechanical properties of human intervertebral discs subjected to axial dynamic compression-influence of age and degeneration [J]. Biomechanics,1986,19(10):807-816.
[16]Genant H, Block J, Steiger,et al. Quantitative computed tomography in assessment of osteoporosis[J].Semin Nucl Medicine,1987,17:316-333.
[17]Block J, Smith R, Gluer, et al. Models of spinal trabecular bone loss as determined by quantitative computed tomography[J]. J Bone Jt Surg,1989,4(2):249-257.
[18]Urban J, McMullin. Swelling pressure on the lumbar intervertebral discs:influence of age, spinal level, composition, and degeneration[J]. Spine,1988,13:179-187.
[19]Rajasekaran S,Babu JN, Arun R, et al. ISSIS prize winner:a study of diffusion in human lumbar discs:a erial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs[J]. Spine,2004,29:2654-2667.
[20]Horner HA, Urban JP. Effect of nutrient supply on the viability of cells from the nucleus pulposus of the intervertebral disc.2001 Volvo Award Winner in basis science studied.Spine,2001,26:2543-2549.
[21]Ferguson SJ, Ito K, Nolte LP,et al. Fluid flow and convective transport of solutes within the intervertebral disc[J].J Biomechanics,2004,37:213-221.
[22]Huang CY, Gu WY. Effects of mechanical compression on metabolism and distribution of oxygen and lactate in intervertebral disc[J].J Biomechanics,2008,41:1184-1196.
[23]Urban JPG, Smith SR, Fairbank JCT. Nutrition of the intervertebral di sc[J]. Spine,2004,29:2700-2709.
[24]Maroudas A, Stockwell RA, Nachemson A et al. Factors involved in the nutrition of the human lumbar intervertebral disc:Cellularity and diffusion of glucose in vitro [J]. J Anat 1975,120:113-130.
[25]Bartels EM, Fairbank JCT, Winlove CP et al. Oxygen and lactate concentrations measured in vivo in the intervertebral discs of patients with scoliosis and back pain[J]. Spine 1998,23:1-8.
[26]Mirza SK, White AA. Anatomy of intervertebral disc and pathophysiology of herniated disc disease[J].J Clin Laser Med Surg,1995:13131-142.
[27]Biyani A,Andersson GB. Low back pain:pathophysiology and management[J]. J Am Acad Orthop Surg,2004,12:106-115.
[28]Buckwalter JA. Aging and degeneration of the human intervertebral disc[J]. Spine 1995,20:1307-1314.
[29]Ishihara H, Urban JPG, Hall, et al. A 20s application of physiological levels of hydrostatic pressure can simulate matrix synthesis on some regions of the bovine intervertebral disc in vitro[J].J Physilo(London),1993:467:213.
[30]0hshima H, Urban JPG, Bergel DH. Effect of static load on matrix synthesis rates in the intervertebral disc measured in vitro by a new perfusion technique[J]. J Orthopedics Rehabilitation,1995,13:22-29.
[31]Ohshima H, Uran JPG. The effect of lactate and PH on proteoglycan and protein synthesis rates in the intervertebral disc[J]. Spine,1992,17:1079-1082.
[32]Krocber MW.Unglaub F, Wang H, et al. New in vivo animal model to create intervertebral disc degeneration and to investigate effects of therapeutic strategies to stimulate disc regeneration[J]. Spine,2002,27:2684-2690.
[33]StollTM, Dubois G,Schwarzenbach 0, et al. The dynamic neutralization system for the spine:a multi-center study of a novel non-fusion system[J]. European Spine J,2002,11 (suppl2):170-178.
[34]Cavanaugh JM, Ozaktay AC, Yamashita T, Avramov A, Getchell TV, King AL. Mechamisms of low back pain:A neurophysiologic and neuroanatomic study[J]. Clin Orthop,1997,335:166-180.
[35]Mendel T,Wink CS,Zimny ML, et al. Neural elements in human cervical intervertebral discs[J]. Spine,1992,17:132-135.
[36]Palmgren T, Gronblad M, Virri J, et al. An immunohistochemical study of nerve structures in the annulus fibrosus of human normal lumbar intervertebral discs[J]. Spine 1999,24:2075-2079
[37]Ashton IK, Roberts S, Jaffray DC, Polak JM.Eisensein SM. Neuropeptides in the human intervertebral disc[J].J Orthop Res,1994,12:186-192.
[38]Coppes MH, Marani E, Thomeer PT, Groen GJ. Innervation of "painful" lumbar discs[J]. Spine,1997,22:2342-2350.
[39]Fagan A, Moore R, Vernon Roberts B, et al. The innervation of the intervertebral disc:A quantitative analysis[J]. Spine,2003,28:2570-2576.
[40]Beattie PF. Current understanding of lumbar intervertebral disc degeneration:review with emphasis upon etiology, pathophysiology,and lumbar magnetic resonance imaging findings[J]. J Orhopedics Sports Physical Therapy,2008,38:329-340.
[41]Healey EL, Burden AM, McEwan IM,et al. The impact of increasing paraspinal muscle activity on stature recovery in asymptomatic people [J]. Arch Phys Med Rehabil,2008,89:749-753.
[42]Healey EL, Fowler NE, Burden AM, et al. Raised paraspinal muscle activity reduces rate of stature recovery after loaded exercise in individuals with chronic low back pain[J]. Arch Phys Med Rehabil,2005,86:710-715.
[43]Callaghan JP, McGill SM. Low back joint loading and kinematics during standing and unsupported sitting[J]. Ergonomicsm2001,44:280-294.
[44]Marras WS. The case for cumulative trauma in low back disorders[J]. Spine J,2003,3:177-179.
[45]Armstrong.Lumbar disc lesions. Baltimore, Williams&Wilkins,1965.
[46]宋献文。中医手法推拿治疗腰椎间盘突出症的疗效分析和治疗机制的研究[J].天津医药杂志(骨科副刊),1962,1：484.
[47]周秉文等。腰椎间盘突出症的分型及术称商榷[J].中华骨科杂志,1989,9：197.
[48]Cox JM, Feller J, Cox-Cid J. Distraction chiropractic adjusting:clinical application and outcomes of 1,000 cases[J]. Topics Clin Chiropractic,1996,3:45-59.
[49]Pellecchia GL. Lumbar traction:a review of the literature[J]. J Orthop Sports Phys Ther,1994,20:262-267.
[50]Gupta RC, Ramarao SV. Epidurography in reduction of lumbar disc prolapsed by traction[J].Arch Phys Med Rehabil,1978,59:322-327.
[51]Karacan I. Computed tomographic investigation of the effect of traction on lumbar disc herniation[J]. Cerrahpasa Tip Fakultesi, Istanbul,1995.
[52]Ibrahim Tekeogulu, Burhan Adak, Mehmet Bozkurt. Distraction of lumbar vertebrae in gravitational tracton[J]. Spine,1998,23:1061-1064.
[53]Twomey LT. Sustained lumbar traction. An experimental study of long spine segments [J]. Spine,1985,10:146-149.
[54]Colachis SC, Strohm BR. Effect of intermittent traction on separation of lumbar vertebrae[J]. Arch Phys Med Rehabil,1969,50:251-258.
[55]Gudavalli MR.Biomechanics research on flexion-distraction procedure. In:Cox JM, editor. Low back pain:mechanisms, diagnosis and treatment.6th ed. Philadelphia(pa): Lippincot Williams& Wilkins,1999:263-268.
[56]Lee RYW, Evans J. The biomechanics of spinal traction therapy. Annual Meeting of the International Society for the Study of the Lumbar Spine, Marseilles 1993;118.
[57]Bridger RS, Ossey S, Fourie G. Effect of lumbar traction on stature[J]. Spine 1990,156:522-524.
[58]Onel D, Tuzlaci M, Sari H,Demir K. Computed tomographic investigation of the effect of traction on lumbar disc herniations[J]. Spine,1989,14:82-90.
[59]Bulent Ozturk, Osman Hakan Gunduz, Kursat Ozoran, et al. Effect of continuous lumbar traction on the size of herniation disc material in lumbar disc herniation[J]. Rheumatol Int 2006,26:622-626.
[60]. Beattie PF, Brooks WM, Rothstein JM, et al. Effect of lordosis on the position of the nucleus pulposus in supine subjects:a study using magnetic resonance imaging. Spine,1994,19:2096-2102.
[61]Fennell AJ, Jones AP, Hukins DW. Migration of the nucleus pulposus within the intervertebral disc during flexion and extension of the spine[J]. Spine,1996,21:2753-7.
[62]Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure[J]. J Neurosurg,1994,81:350-353.
[63]Gudavalli MR, Cox JM, Baker JA et al. Intervertebral disc pressure changes during the flexion-distraction procedure for low back pain. Proceedings of the International Society for the Study of the Lumbar Spine(abstract). Singapore,1997:165.
[64]Andersson GB, Schultz AB, Nachemson AL. Intervebral disc pressures during traction[J]. Scand J Rehabil Meb Suppl,1983,9:88-91.
[65]Sheng B, Yi Kai L, Wei dong. Effect of simulating lumbar manipulations on lumbar nucleus pulposus pressure[J]. J Manipulative Physiol Ther,2002,25:333-336.
[66]Schlegel JD, Champine J, Taylor MS, et al. The role of distraction in improving the space available in the lumbar stenotic canal and foramen[J]. Spine,1994,19:2041-7.
[67]Beira R, Peers A. A study of the effects of chiropractic therapy on the diameter of the spinal canal in patients with low back pain and radiculopathy[J]. J Neuromusculoskel Syst,1998,6:114-26.
[68]Schneider MJ. The traction methods of Cox and Leandre:the neglected role of the multifidus muscle in low back pain[J]. Chiropr Tech,1991,3:109-115.
[69]Bulbulian R, Burke J, Dishman JD. Spinal reflex excitability changes after lumbar spine passive flextion mobilization[J]. J Manipulative Physiol Ther,2002,25:526-532.
[70]Gronblad M, Lukinmaa A, Jolkkonen J, et al. Straight leg raising test and lumbar cerebrospinal fluid levels of vasoactive intestinal peptide and somatostatin in patients with low back pain. Spine,1994,19:1462-1466.
[71]Cooper RG, Freemont AJ, et al. Herniated intervetebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration[J]. Spine,1995,20:591-598.
[72]Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equine nerve roots[J]. Spine, 1993,18:1424-1432.
[73]Cameron BM, Vanderputten DM, Merril CR. Preliminary study of an increase of a plasma apolipoprotein E variant associated with peripheral nerve damage[J]. Spine, 1995,20:581-590.
[74]Beira R, Peers A. A study of the effects of chiropractic therapy on the diameter of the spinal canal in patients with low back pain and radiculopathy[J]. J Neuromusculoskel Syst,1998,6:114-126.
[75]Cox JM, Fromelt KA, Shreiner S. Chiropractic statistical survey of 100 consecutive low back pain patients[J]. J Manipulative Physiol Ther,1983,6:117-28.
[76]Cox JM, Trier K. Chiropractic adjustment results correlated with spondylolisthesis instability[J]. J Man Med,1991,6:67-72.
[77]Browning JE. Chiropractic distractive decompression in treating pelvic pain and multiple system pelvic organic dysfunction[J]. J Manipulative Physiol Ther,1989,12:265-2 74.
[78]Hawk C, Long C, Azad A. Chiropractic care for women with chronic pelvic pain:a prospective single-group intervention study[J]. J Manipulative Physiol Ther, 1997,20:73-79.
[79]Pellecchia GL.Lumbar traction:a review of the literature[J]. J Orthop Sports Phys Ther,1994,20:262-267.
[80]Brault JS, Kappler RE, Grogg BE. Manipulation, traction and massage. In:Braddom RL, editor. Physical medicine & rehabilitation. Philadelphia, PA:Elsevier,2007:437-57.
[81]Aaron W, Janke, Kerkow,et al.The biomechanics of gravity-dependent traction of the lumbar spine[J]. Spine,1997,22(3):253-260.
[82]Bulent Ozturk, Osman Hakan Gunduz,Kursat Ozoran, et al. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation.Rheumatol International[J].2006,26:622-626.
[83]Macario A,Richmond C, Auster M, et al.Treatment of 94 outpatients with chronic discogecnic low back pain with the DRX9000:a retrospective chart review[J]. Pain practice,2008,8(1):11-17.
[84]Kamanli A,Karaca-Acet G, Kaya A, et al.Conventional physical therapy with lumbar traction;clinical evaluation and magnetic resonance for lumbar disc herniation[J].Bratisl Lek Listy,2010,111(10):541-544.
[85]Anna J Beurskens, Henrica C, Albere J koke, et al. Effect of traction for non-specific low back pain:a randomized clinical trial[J]. The Lancet,1995,346:1596-1600.
[86]Annette A Harte,George D Baxter, Jacueline H Gracey. The effectiveness of motorized lumbar traction in the management of LBP with lumbar sacral nerve root involvement:a feasibility study[J]. BMC Musculoskeletal Disorders,2007,8(18):1-12.
[87]Judy Clarke, Maurits van Tulder, Stefan Blomberg et al. Traction for low back pain with or without sciatica:An updated systematic review within the framework of the Cochrane collaboration[J]. Spine,2006,31:1591-1599.
[88]Alex Macario, Joseph V. Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain[J].Pain Practice,2006,6(3):171-178.
[89]Van Tulder MW, Koes B, Malivaara A. Outcome of non-invasive treatment modalities on back pain:an evidence-based review[J]. European Spine J,2006,15S1:S64-81.
[90]Beurskens AJ, de Vet HC, Koke AJ, Regtop W, et al. Efficacy of traction for nonspecific low back pian.12-week and 6-monthe results of a randomized clinical trial[J]. Spine,1997,22:2756-2762.
[91]Werners R, Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care stting[J]. Spine,1999,24:1579-1584.
[92]Delitto A, Erhard RE, Blowing RW. A treatment-based classification approach to low back syndrome:identifling and staging patients for conservative treatment[J]. Phy Ther,1995,75:470-485.
[93]Beurskens AJ.de Vet HC, Koke AJ, Regtop W, et al. Efficacy of traction for nonspecific low back pian:a randomized clinical trial[J]. Lancet,1995,346:1596-1600.
[94]Congcong Cai.Yong Hao Pua, Kian Chong Lim. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction[J].Eur Spine J,2009,18:554-561.
[95]Beneke R. Zur Lehre von der Spondylitis deformans. Versammlung Deutscher Naturforscher und_rzte.1897:69. In:Heine J. U ber die Arthritis deformans. Virch Arch Pathol Anat.1926,260:642.
[96]Coventry MB, Ghormley RK, Kernohan JW. The intervertebral disc:its microscopic anatomy and pathology:Ⅱ. Changes in the intervertebral disc concomitant with age[J]. J Bone Joint Surg Am,1945,27:233-247.
[97]Miller JA, Schmatz C, Schultz AB. Lumbar disc degeneration:correlation with age, sex, and spine level in 600 autopsy specimens[J]. Spine,1988,13:173-178.
[98]Videman T, Nurminen M. The occurrence of annular tears and their relation to lifetime back pain history:a cadaveric study using BaS04 di scography[J]. Spine,2004,29(23):2668-2676.
[99]Ralph E. Gay, Brice IIharreborde, Kristin D. Stress in lumbar interverteral discs during distraction:a cadaveric study [J]. Spine J,2008,8 (6):982-990.
[100]Markus Kroeber, Frank Unglaud, Thorsten Guegring. Effects of controlled dynamic disc distraction on degenerated intervertebral discs[J]. Spine,2005,30(2):181-187.
[101]Lawrence JS. Rheumatism in miners:III. Occupational factors. Br J Industr Med[J].1955,12:249-261.
[102]Di Fabio R. Efficacy of manual therapy[M]. Physical Therapy,1992,72:853-864.
[103]Unlu Z,Tasci S.Tarhan S, et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging[J]. J Manipulative Physiol Therapy.2008,31 (3):191-198.
[104]Sari H, Akarirmak U, Karacan I, et al. Computed tomographic evaluation of lumbar spinal structures during traction[J]. Physiother Theory Practice,2005,21(1):3-11.
[105]Healey EL, Fowler NE, Burden AM, McEwan IM. Raised paraspinal muscle activity reduces rate of stature recovery after loaded exercise in individuals with chronic low back pain[J]. Arch Phys Med Rehabil,2005,86:710-715.
[106]Van Deursen LL, van Deursen DL, Sni jders CJ, Wilke HJ. Relationship between everyday activities and spinal shrinkage[J]. Clin Biomech (Bristol, Avon),2005,20:547-550.
[107]Judovich B, Nobel G. Traction therapy:a study of resistence forces. American Journal of surgery [J],1957,93:108-114.
[108]Zhao Xin gang, Shi Jian, Hou Tie sheng. Retroperitoneal exposure of lumbar intervertebral disc in New Zealand white rabbits [J]. Journal of Clinical rehabilitative tissue engineering research,2007,11(41):8418-8420.
[109]Howard S, Kenji Takegami, Hiroshi Kamada, et al. Intradiscal administration of osteogenic protein-1 increases intervertebral disc height and proteoglycan content in the nucleus pulposus in normal adolescent rabbits [J]. Spine,2004,30:25-32.
[110]Vresilovic EJ, Johannessen W, Elliott DM. Disc mechanics with trans-endplate partial nucleotomy are not fully restored following cyclic compressive loading and unloaded recovery[J]. J.Biomech, Eng 2006,128:823-829.
[111]Podichetty VK. The aging spine:the role of inflammatory mediators in intervertebral disc degeneration. Cell Mol[J]. Biol[J],2007,53:4-18.
[112]Boos N, Weissbach S, Rohrbach H,Weiler C,Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs:2002 Volvo Award in basic science [J]. Spine,2002,27:2631-2644.
[113]Lotz JC, Hsieh AH, Walsh AL, Palmer El, Chin JR. Mechanobiology of the intervertebral disc[J].Biochem Soc Trans 2002,30(Pt 6):853-858.
[114]Singh K, Masuda K, An HS. Animal models for human disc degeneration[J]. Spine J, 2005,5:S267S-S2679.
[115]Masuda K, Aota Y, Muehleman C, et al. A novel rabbit model ofmild, reproducible disc degeneration by an annulus needle puncture correlation between the degree of disc injury and radiological and histological appearances of disc degeneration[J]. Spine,2005,30:5-14.
[116]Rattanatharn R,Sanjaroensuttikul N, Anadirekkul P et al. Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome[J].J Medicine Association Thailand,2004,87:S272-277.
[117]Colachis SC Jr, Strohm BR. Effects of intermittent traction on separation of lumbar vertebrae [J]. Arch Phys Med Rehabil,1969,50(5):251-258.
[2]巢元芳.诸病源侯论[M].北京：人民卫生出版社,1991；150.
[3]朱丹溪.丹溪心法[M].北京：中国书店,1986：298.
[4]王焘.外台秘要[M].北京：华夏出版社,1993：321.
[5]Urban, Maroudas. Measurement of swelling pressure and fluid flow in the interverteral disc with reference to creep[M]. London:Mechanical Engineering Publicatioins, In Engineering Aspects of the Spine,1981.
[6]Wilder,Pope, Frymoyer, et al. The biomechanics of lumbar disc herniatin and the effect of overload and instability[J]. J Spinal Disease.1988,1:16-32.
[7]Zimmerman,Vuono-Hawkings, Parsons, et al. The mechanical properties of the canine lumbar disc and motion segment[J]. Spine,1992,17(2):213-220.
[8]Buckwalter. Aging and degeneration of the human intervertebral disc[J]. Spine Update,1995,20(11):1307-1314.
[9]Urban JP, Maroudas A. Measurement of fixed charge density and partition coefficients in the intervertebral disc[J]. Biochim Biophys Acta,1979,586:166-178.
[10]Urban JP, Maroudas A. Swelling of the intervertebral disc in vitro[J]. Connect Tissue Res,1981,9:1-10.
[11]Marchand,Ahmed. Investigation of the laminate structure of lumbar disc anulus fibrosus[J]. Spine,1990,15:402-410.
[12]Iatridis, Mente, Stokes IA, et al. Compression-induced changes in intervertebral disc properties in a rat tail model[J]. Spine,1999;24:996-1002.
[13]Perie, Iatridis JC, Demers CN, et al. Assessment of compressive modulus, hydraulic permeability and matrix content of trypsin-treated nucleus pulposus using quantitative MRI[J].J Biomech,2006,39:1392-1400.
[14]Botsford DJ, Esses SI, Ogilvie-Harris DJ. In vivo diurnal variation in intervertebral disc volume and morphology[J]. Spine,1994,19:935-940.
[l5]Koeller W, Muehlhaus S, Meier W,et al. Biomechanical properties of human intervertebral discs subjected to axial dynamic compression-influence of age and degeneration [J]. Biomechanics,1986,19(10):807-816.
[16]Genant H, Block J, Steiger,et al. Quantitative computed tomography in assessment of osteoporosis[J].Semin Nucl Medicine,1987,17:316-333.
[17]Block J, Smith R, Gluer, et al. Models of spinal trabecular bone loss as determined by quantitative computed tomography[J]. J Bone Jt Surg,1989,4(2):249-257.
[18]Urban J, McMullin. Swelling pressure on the lumbar intervertebral discs:influence of age, spinal level, composition, and degeneration[J]. Spine,1988,13:179-187.
[19]Rajasekaran S,Babu JN, Arun R, et al. ISSIS prize winner:a study of diffusion in human lumbar discs:a erial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs[J]. Spine,2004,29:2654-2667.
[20]Horner HA, Urban JP. Effect of nutrient supply on the viability of cells from the nucleus pulposus of the intervertebral disc.2001 Volvo Award Winner in basis science studied.Spine,2001,26:2543-2549.
[21]Ferguson SJ, Ito K, Nolte LP,et al. Fluid flow and convective transport of solutes within the intervertebral disc[J].J Biomechanics,2004,37:213-221.
[22]Huang CY, Gu WY. Effects of mechanical compression on metabolism and distribution of oxygen and lactate in intervertebral disc[J].J Biomechanics,2008,41:1184-1196.
[23]Urban JPG, Smith SR, Fairbank JCT. Nutrition of the intervertebral di sc[J]. Spine,2004,29:2700-2709.
[24]Maroudas A, Stockwell RA, Nachemson A et al. Factors involved in the nutrition of the human lumbar intervertebral disc:Cellularity and diffusion of glucose in vitro [J]. J Anat 1975,120:113-130.
[25]Bartels EM, Fairbank JCT, Winlove CP et al. Oxygen and lactate concentrations measured in vivo in the intervertebral discs of patients with scoliosis and back pain[J]. Spine 1998,23:1-8.
[26]Mirza SK, White AA. Anatomy of intervertebral disc and pathophysiology of herniated disc disease[J].J Clin Laser Med Surg,1995:13131-142.
[27]Biyani A,Andersson GB. Low back pain:pathophysiology and management[J]. J Am Acad Orthop Surg,2004,12:106-115.
[28]Buckwalter JA. Aging and degeneration of the human intervertebral disc[J]. Spine 1995,20:1307-1314.
[29]Ishihara H, Urban JPG, Hall, et al. A 20s application of physiological levels of hydrostatic pressure can simulate matrix synthesis on some regions of the bovine intervertebral disc in vitro[J].J Physilo(London),1993:467:213.
[30]0hshima H, Urban JPG, Bergel DH. Effect of static load on matrix synthesis rates in the intervertebral disc measured in vitro by a new perfusion technique[J]. J Orthopedics Rehabilitation,1995,13:22-29.
[31]Ohshima H, Uran JPG. The effect of lactate and PH on proteoglycan and protein synthesis rates in the intervertebral disc[J]. Spine,1992,17:1079-1082.
[32]Krocber MW.Unglaub F, Wang H, et al. New in vivo animal model to create intervertebral disc degeneration and to investigate effects of therapeutic strategies to stimulate disc regeneration[J]. Spine,2002,27:2684-2690.
[33]StollTM, Dubois G,Schwarzenbach 0, et al. The dynamic neutralization system for the spine:a multi-center study of a novel non-fusion system[J]. European Spine J,2002,11 (suppl2):170-178.
[34]Cavanaugh JM, Ozaktay AC, Yamashita T, Avramov A, Getchell TV, King AL. Mechamisms of low back pain:A neurophysiologic and neuroanatomic study[J]. Clin Orthop,1997,335:166-180.
[35]Mendel T,Wink CS,Zimny ML, et al. Neural elements in human cervical intervertebral discs[J]. Spine,1992,17:132-135.
[36]Palmgren T, Gronblad M, Virri J, et al. An immunohistochemical study of nerve structures in the annulus fibrosus of human normal lumbar intervertebral discs[J]. Spine 1999,24:2075-2079
[37]Ashton IK, Roberts S, Jaffray DC, Polak JM.Eisensein SM. Neuropeptides in the human intervertebral disc[J].J Orthop Res,1994,12:186-192.
[38]Coppes MH, Marani E, Thomeer PT, Groen GJ. Innervation of "painful" lumbar discs[J]. Spine,1997,22:2342-2350.
[39]Fagan A, Moore R, Vernon Roberts B, et al. The innervation of the intervertebral disc:A quantitative analysis[J]. Spine,2003,28:2570-2576.
[40]Beattie PF. Current understanding of lumbar intervertebral disc degeneration:review with emphasis upon etiology, pathophysiology,and lumbar magnetic resonance imaging findings[J]. J Orhopedics Sports Physical Therapy,2008,38:329-340.
[41]Healey EL, Burden AM, McEwan IM,et al. The impact of increasing paraspinal muscle activity on stature recovery in asymptomatic people [J]. Arch Phys Med Rehabil,2008,89:749-753.
[42]Healey EL, Fowler NE, Burden AM, et al. Raised paraspinal muscle activity reduces rate of stature recovery after loaded exercise in individuals with chronic low back pain[J]. Arch Phys Med Rehabil,2005,86:710-715.
[43]Callaghan JP, McGill SM. Low back joint loading and kinematics during standing and unsupported sitting[J]. Ergonomicsm2001,44:280-294.
[44]Marras WS. The case for cumulative trauma in low back disorders[J]. Spine J,2003,3:177-179.
[45]Armstrong.Lumbar disc lesions. Baltimore, Williams&Wilkins,1965.
[46]宋献文。中医手法推拿治疗腰椎间盘突出症的疗效分析和治疗机制的研究[J].天津医药杂志(骨科副刊),1962,1：484.
[47]周秉文等。腰椎间盘突出症的分型及术称商榷[J].中华骨科杂志,1989,9：197.
[48]Cox JM, Feller J, Cox-Cid J. Distraction chiropractic adjusting:clinical application and outcomes of 1,000 cases[J]. Topics Clin Chiropractic,1996,3:45-59.
[49]Pellecchia GL. Lumbar traction:a review of the literature[J]. J Orthop Sports Phys Ther,1994,20:262-267.
[50]Gupta RC, Ramarao SV. Epidurography in reduction of lumbar disc prolapsed by traction[J].Arch Phys Med Rehabil,1978,59:322-327.
[51]Karacan I. Computed tomographic investigation of the effect of traction on lumbar disc herniation[J]. Cerrahpasa Tip Fakultesi, Istanbul,1995.
[52]Ibrahim Tekeogulu, Burhan Adak, Mehmet Bozkurt. Distraction of lumbar vertebrae in gravitational tracton[J]. Spine,1998,23:1061-1064.
[53]Twomey LT. Sustained lumbar traction. An experimental study of long spine segments [J]. Spine,1985,10:146-149.
[54]Colachis SC, Strohm BR. Effect of intermittent traction on separation of lumbar vertebrae[J]. Arch Phys Med Rehabil,1969,50:251-258.
[55]Gudavalli MR.Biomechanics research on flexion-distraction procedure. In:Cox JM, editor. Low back pain:mechanisms, diagnosis and treatment.6th ed. Philadelphia(pa): Lippincot Williams& Wilkins,1999:263-268.
[56]Lee RYW, Evans J. The biomechanics of spinal traction therapy. Annual Meeting of the International Society for the Study of the Lumbar Spine, Marseilles 1993;118.
[57]Bridger RS, Ossey S, Fourie G. Effect of lumbar traction on stature[J]. Spine 1990,156:522-524.
[58]Onel D, Tuzlaci M, Sari H,Demir K. Computed tomographic investigation of the effect of traction on lumbar disc herniations[J]. Spine,1989,14:82-90.
[59]Bulent Ozturk, Osman Hakan Gunduz, Kursat Ozoran, et al. Effect of continuous lumbar traction on the size of herniation disc material in lumbar disc herniation[J]. Rheumatol Int 2006,26:622-626.
[60]. Beattie PF, Brooks WM, Rothstein JM, et al. Effect of lordosis on the position of the nucleus pulposus in supine subjects:a study using magnetic resonance imaging. Spine,1994,19:2096-2102.
[61]Fennell AJ, Jones AP, Hukins DW. Migration of the nucleus pulposus within the intervertebral disc during flexion and extension of the spine[J]. Spine,1996,21:2753-7.
[62]Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure[J]. J Neurosurg,1994,81:350-353.
[63]Gudavalli MR, Cox JM, Baker JA et al. Intervertebral disc pressure changes during the flexion-distraction procedure for low back pain. Proceedings of the International Society for the Study of the Lumbar Spine(abstract). Singapore,1997:165.
[64]Andersson GB, Schultz AB, Nachemson AL. Intervebral disc pressures during traction[J]. Scand J Rehabil Meb Suppl,1983,9:88-91.
[65]Sheng B, Yi Kai L, Wei dong. Effect of simulating lumbar manipulations on lumbar nucleus pulposus pressure[J]. J Manipulative Physiol Ther,2002,25:333-336.
[66]Schlegel JD, Champine J, Taylor MS, et al. The role of distraction in improving the space available in the lumbar stenotic canal and foramen[J]. Spine,1994,19:2041-7.
[67]Beira R, Peers A. A study of the effects of chiropractic therapy on the diameter of the spinal canal in patients with low back pain and radiculopathy[J]. J Neuromusculoskel Syst,1998,6:114-26.
[68]Schneider MJ. The traction methods of Cox and Leandre:the neglected role of the multifidus muscle in low back pain[J]. Chiropr Tech,1991,3:109-115.
[69]Bulbulian R, Burke J, Dishman JD. Spinal reflex excitability changes after lumbar spine passive flextion mobilization[J]. J Manipulative Physiol Ther,2002,25:526-532.
[70]Gronblad M, Lukinmaa A, Jolkkonen J, et al. Straight leg raising test and lumbar cerebrospinal fluid levels of vasoactive intestinal peptide and somatostatin in patients with low back pain. Spine,1994,19:1462-1466.
[71]Cooper RG, Freemont AJ, et al. Herniated intervetebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration[J]. Spine,1995,20:591-598.
[72]Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equine nerve roots[J]. Spine, 1993,18:1424-1432.
[73]Cameron BM, Vanderputten DM, Merril CR. Preliminary study of an increase of a plasma apolipoprotein E variant associated with peripheral nerve damage[J]. Spine, 1995,20:581-590.
[74]Beira R, Peers A. A study of the effects of chiropractic therapy on the diameter of the spinal canal in patients with low back pain and radiculopathy[J]. J Neuromusculoskel Syst,1998,6:114-126.
[75]Cox JM, Fromelt KA, Shreiner S. Chiropractic statistical survey of 100 consecutive low back pain patients[J]. J Manipulative Physiol Ther,1983,6:117-28.
[76]Cox JM, Trier K. Chiropractic adjustment results correlated with spondylolisthesis instability[J]. J Man Med,1991,6:67-72.
[77]Browning JE. Chiropractic distractive decompression in treating pelvic pain and multiple system pelvic organic dysfunction[J]. J Manipulative Physiol Ther,1989,12:265-2 74.
[78]Hawk C, Long C, Azad A. Chiropractic care for women with chronic pelvic pain:a prospective single-group intervention study[J]. J Manipulative Physiol Ther, 1997,20:73-79.
[79]Pellecchia GL.Lumbar traction:a review of the literature[J]. J Orthop Sports Phys Ther,1994,20:262-267.
[80]Brault JS, Kappler RE, Grogg BE. Manipulation, traction and massage. In:Braddom RL, editor. Physical medicine & rehabilitation. Philadelphia, PA:Elsevier,2007:437-57.
[81]Aaron W, Janke, Kerkow,et al.The biomechanics of gravity-dependent traction of the lumbar spine[J]. Spine,1997,22(3):253-260.
[82]Bulent Ozturk, Osman Hakan Gunduz,Kursat Ozoran, et al. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation.Rheumatol International[J].2006,26:622-626.
[83]Macario A,Richmond C, Auster M, et al.Treatment of 94 outpatients with chronic discogecnic low back pain with the DRX9000:a retrospective chart review[J]. Pain practice,2008,8(1):11-17.
[84]Kamanli A,Karaca-Acet G, Kaya A, et al.Conventional physical therapy with lumbar traction;clinical evaluation and magnetic resonance for lumbar disc herniation[J].Bratisl Lek Listy,2010,111(10):541-544.
[85]Anna J Beurskens, Henrica C, Albere J koke, et al. Effect of traction for non-specific low back pain:a randomized clinical trial[J]. The Lancet,1995,346:1596-1600.
[86]Annette A Harte,George D Baxter, Jacueline H Gracey. The effectiveness of motorized lumbar traction in the management of LBP with lumbar sacral nerve root involvement:a feasibility study[J]. BMC Musculoskeletal Disorders,2007,8(18):1-12.
[87]Judy Clarke, Maurits van Tulder, Stefan Blomberg et al. Traction for low back pain with or without sciatica:An updated systematic review within the framework of the Cochrane collaboration[J]. Spine,2006,31:1591-1599.
[88]Alex Macario, Joseph V. Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain[J].Pain Practice,2006,6(3):171-178.
[89]Van Tulder MW, Koes B, Malivaara A. Outcome of non-invasive treatment modalities on back pain:an evidence-based review[J]. European Spine J,2006,15S1:S64-81.
[90]Beurskens AJ, de Vet HC, Koke AJ, Regtop W, et al. Efficacy of traction for nonspecific low back pian.12-week and 6-monthe results of a randomized clinical trial[J]. Spine,1997,22:2756-2762.
[91]Werners R, Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care stting[J]. Spine,1999,24:1579-1584.
[92]Delitto A, Erhard RE, Blowing RW. A treatment-based classification approach to low back syndrome:identifling and staging patients for conservative treatment[J]. Phy Ther,1995,75:470-485.
[93]Beurskens AJ.de Vet HC, Koke AJ, Regtop W, et al. Efficacy of traction for nonspecific low back pian:a randomized clinical trial[J]. Lancet,1995,346:1596-1600.
[94]Congcong Cai.Yong Hao Pua, Kian Chong Lim. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction[J].Eur Spine J,2009,18:554-561.
[95]Beneke R. Zur Lehre von der Spondylitis deformans. Versammlung Deutscher Naturforscher und_rzte.1897:69. In:Heine J. U ber die Arthritis deformans. Virch Arch Pathol Anat.1926,260:642.
[96]Coventry MB, Ghormley RK, Kernohan JW. The intervertebral disc:its microscopic anatomy and pathology:Ⅱ. Changes in the intervertebral disc concomitant with age[J]. J Bone Joint Surg Am,1945,27:233-247.
[97]Miller JA, Schmatz C, Schultz AB. Lumbar disc degeneration:correlation with age, sex, and spine level in 600 autopsy specimens[J]. Spine,1988,13:173-178.
[98]Videman T, Nurminen M. The occurrence of annular tears and their relation to lifetime back pain history:a cadaveric study using BaS04 di scography[J]. Spine,2004,29(23):2668-2676.
[99]Ralph E. Gay, Brice IIharreborde, Kristin D. Stress in lumbar interverteral discs during distraction:a cadaveric study [J]. Spine J,2008,8 (6):982-990.
[100]Markus Kroeber, Frank Unglaud, Thorsten Guegring. Effects of controlled dynamic disc distraction on degenerated intervertebral discs[J]. Spine,2005,30(2):181-187.
[101]Lawrence JS. Rheumatism in miners:III. Occupational factors. Br J Industr Med[J].1955,12:249-261.
[102]Di Fabio R. Efficacy of manual therapy[M]. Physical Therapy,1992,72:853-864.
[103]Unlu Z,Tasci S.Tarhan S, et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging[J]. J Manipulative Physiol Therapy.2008,31 (3):191-198.
[104]Sari H, Akarirmak U, Karacan I, et al. Computed tomographic evaluation of lumbar spinal structures during traction[J]. Physiother Theory Practice,2005,21(1):3-11.
[105]Healey EL, Fowler NE, Burden AM, McEwan IM. Raised paraspinal muscle activity reduces rate of stature recovery after loaded exercise in individuals with chronic low back pain[J]. Arch Phys Med Rehabil,2005,86:710-715.
[106]Van Deursen LL, van Deursen DL, Sni jders CJ, Wilke HJ. Relationship between everyday activities and spinal shrinkage[J]. Clin Biomech (Bristol, Avon),2005,20:547-550.
[107]Judovich B, Nobel G. Traction therapy:a study of resistence forces. American Journal of surgery [J],1957,93:108-114.
[108]Zhao Xin gang, Shi Jian, Hou Tie sheng. Retroperitoneal exposure of lumbar intervertebral disc in New Zealand white rabbits [J]. Journal of Clinical rehabilitative tissue engineering research,2007,11(41):8418-8420.
[109]Howard S, Kenji Takegami, Hiroshi Kamada, et al. Intradiscal administration of osteogenic protein-1 increases intervertebral disc height and proteoglycan content in the nucleus pulposus in normal adolescent rabbits [J]. Spine,2004,30:25-32.
[110]Vresilovic EJ, Johannessen W, Elliott DM. Disc mechanics with trans-endplate partial nucleotomy are not fully restored following cyclic compressive loading and unloaded recovery[J]. J.Biomech, Eng 2006,128:823-829.
[111]Podichetty VK. The aging spine:the role of inflammatory mediators in intervertebral disc degeneration. Cell Mol[J]. Biol[J],2007,53:4-18.
[112]Boos N, Weissbach S, Rohrbach H,Weiler C,Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs:2002 Volvo Award in basic science [J]. Spine,2002,27:2631-2644.
[113]Lotz JC, Hsieh AH, Walsh AL, Palmer El, Chin JR. Mechanobiology of the intervertebral disc[J].Biochem Soc Trans 2002,30(Pt 6):853-858.
[114]Singh K, Masuda K, An HS. Animal models for human disc degeneration[J]. Spine J, 2005,5:S267S-S2679.
[115]Masuda K, Aota Y, Muehleman C, et al. A novel rabbit model ofmild, reproducible disc degeneration by an annulus needle puncture correlation between the degree of disc injury and radiological and histological appearances of disc degeneration[J]. Spine,2005,30:5-14.
[116]Rattanatharn R,Sanjaroensuttikul N, Anadirekkul P et al. Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome[J].J Medicine Association Thailand,2004,87:S272-277.
[117]Colachis SC Jr, Strohm BR. Effects of intermittent traction on separation of lumbar vertebrae [J]. Arch Phys Med Rehabil,1969,50(5):251-258.