腰部斜扳手法在体运动力学测试及治疗腰椎间盘突出症的临床试验研究
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摘要
腰椎间盘突出症(lumbar intervertebral disc herniation, LIDH)所致的腰腿痛是骨科临床常见的慢性痛证,近年来其发病率在逐年升高,并向年轻化、低龄化发展。镇定疼痛、改善功能、降低复发是其治疗与康复的主要目标。脊柱手法是众多国家卫生防治指南中最常建议使用的治疗方法之一,在我国以腰部斜扳手法(Lumbar Oblique-pulling Manipulation, LOM)为代表的中医骨伤手法治疗该病的干预效果确切、应用广泛,深受医生与患者的欢迎。经研究表明手法的治疗效果及操作安全性,与施力的大小、方向角度及时间等因素密切相关。观察腰部斜扳手法操作过程中腰椎的运动力学变化及其生物力学效应等,有助于分析掌握手法技术要点,优化手法规范操作,应是其今后研究的重点方向之一。
为规范与优化腰部斜扳手法技术,分析其操作特点及影响因素,本课题运用力传感测量技术、光学定位捕捉技术,在体实时测量腰部斜扳手法操作的力学、运动学变化过程,总结了腰部斜扳手法操作的运动力学规律,并通过临床对照试验研究,对腰部斜扳手法力学指标变化与操作者、被操作者因素的相关关系等问题进行研究,为腰部斜扳手法操作的标准化、规范化提供参考依据。
研究目的：
1.基于推拿学教材的整理分析,编写腰部斜扳手法操作规范化描述初稿。
2.在体实时动态测量腰部斜扳手法操作,总结其运动力学规律。
3.探讨腰部斜扳手法力学指标变化与操作者、被操作者因素的相关关系。
4.初步建立腰部斜扳手法操作的规范化描述文稿。
研究内容：
1.腰部斜扳手法文献整理分析：充分了解技术标准制定的原则、程序与质量要求,以及标准编写的方法,搜集推拿学教材等材料,参考已出版或待出版的学会专业标准,对手法规范化所涉及的非量化要素与可量化要素进行归纳分类,分析已纳入文献中手法描述的语言特点,在此基础上编写腰部斜扳手法规范化描述初稿。
2.腰部斜扳手法在体运动力学测定：应用肘扳力测量仪实时动态测试腰部斜扳手法的在体操作力学数据；同时应用双目视觉定位仪实时动态捕捉腰部斜扳手法的在体操作运动轨迹,总结分析腰部斜扳手法的运动学与动力学变化规律,从而为腰部斜扳手法的量化研究提供依据。
3.腰部斜扳手法临床对照试验研究：通过LIDH患者手法治疗组与健康青年志愿者正常组进行比较分析,观察腰部斜扳手法治疗的即时疗效与安全性,并探讨咔哒声响或棘突错动感、左肘或右肘、扳肩或扳髋等操作者因素以及疼痛程度、椎旁压痛阈值、前屈痛限范围、体重指数等被操作者因素,与手法作用力大小的相关关系,分析对其的影响因素。
研究结果：
1.拟定腰部斜扳手法规范化描述初稿
患者侧卧位,在上一侧的下肢屈髋屈膝,在下一侧的下肢自然伸直。医者站在其面向侧的床边,以一肘或手抵住其肩前部,另一肘或手抵于臀部。两肘或两手相反方向协调施力,使腰部扭转,至有明显阻力位时,做一突发的、增大幅度的扳动,常可闻及“咔哒”的弹响声。
2.总结腰部斜扳手法操作运动力学规律
2.1在体生物力学测试结果
操作者腰部斜扳手法力学轨迹曲线图具有一定的特点：即重复呈现出一个短、陡、高的波峰,说明操作者扳动时具有“速度快”的特点,符合“随发随收”的操作要求。临床操作应注意在髋部用力要略大于在肩部用力。
2.2在体运动捕捉测试结果
操作者腰部斜扳手法运动轨迹曲线图具有一定的特点：即重复呈现出一个短弧形轨迹,说明者操作者扳动时具有“幅度小”的特点,施力方向以旋转为主同时伴随下压,符合根据被操作者位姿“顺势发力”的操作要求。
受试者在被扳动时运动轨迹曲线图具有一定的特点,即重复呈现出一个短弧形轨迹,与操作者扳动时关节的运动轨迹相似,被操作者是随着操作者关节运动而随之出现相似的运动方式,说明被扳动时被操作者与操作者具有“稳定接触”的特点。
3.腰部斜扳手法临床对照试验结果
3.1即时疗效分析及安全性
试验组临床总有效率为100%,在即时镇痛(腰腿疼痛、椎旁压痛)、改善活动(前屈活动度)等方面效果显著,无不良反应发生。
3.2操作者因素对腰部斜扳手法作用力的影响
3.2.1咔哒声响、错动感与手法作用力
两组病例中只有试验组1例患者未出现咔哒声响,但伴有棘突错动感；其余所有病例均出现咔哒声响伴有棘突错动感。手法作用力的大小与咔哒声响或棘突错动感的发生并无直接的关系(P>0.05)。
3.2.2利肘或非利肘与手法作用力
两组中右肘的手法作用力均大于左肘的手法作用力,但差别无显著意义(P>0.05),两组之间亦无明显差异(P>0.05)。提示利肘操作时用力不会明显大于非利肘操作用力。
3.2.3扳肩或扳髋与手法作用力
两组中扳髋的手法作用力均大于扳肩的手法作用力,但差别无显著意义(P>0.05),但试验组在扳髋的手法作用力比正常组更大些,差异有统计学意义(P<0.05)。提示对患者操作时扳髋用力要比正常人更大些。
3.3被操作者因素对腰部斜扳手法作用力的影响
3.3.1个体病情情况与斜扳手法作用力
采用视觉模拟评分(VAS)、腰部阳性反应点压痛闽值(PPT)、腰屈曲活动范围(LFR)等指标反映不同个体的病情情况,结果显示扳髋的手法作用力与VAS评分、PPT力值、LFR距离之间均无明显相关关系(P值均>0.05),提示扳髋手法作用力不会随着疼痛感觉、椎旁压痛、前屈不利等病情指标的轻重而变化。
3.3.2个体体重指数与斜扳手法作用力
体重指数与扳髋手法作用力之间有明显相关关系(P<0.05),说明扳髋手法作用力会随着不同体重指数的人群而变化。即体重指数越大,实施作用力也越大。
4结论
4.1腰部斜扳手法操作具有“速度快”、“幅度小”的特点,要求“医患稳定接触”、“顺势发力”、“随发随收”,并具有一定的运动力学规律性,力学特征即预加载力越大,扳动力就越大,最大作用力亦越大；运动特征即高速扳动的运动是腰椎小幅度扭转的轨迹。
4.2对于病程短、非急性期的青年发病人群,左肘或右肘、扳肩或扳髋、疼痛程度或痛限范围不同等不会对手法操作作用力产生明显影响；在施用手法操作时对患者的扳髋之力应稍大于对正常健康者的。不同体型(体重指数)是影响手法操作作用力大小的个体因素之一,临床手法运用时对于超重或肥胖的患者要适当增大手法作用力。咔哒声响是手法成功的重要标志,但不是唯一标志。
4.3腰部斜扳手法操作规范化描述文稿：患者侧卧位,在上一侧的下肢屈髋屈膝,在下一侧的下肢自然伸直。医者站在其面向侧的床边,以一肘或手抵住其肩前部,另一肘或手抵于臀部。两肘或两手以相反方向协调施力,使腰部扭转,至有明显阻力位时,在医患稳定接触下,顺势做一突发的、增大幅度的扳动,做到“随发随收”,常可闻及“咔哒”的弹响声。
Lumbar intervertebral disc herniation due to low back pain is a common chronic pain syndrome in orthopedics, and its incidence in recent years increased year by year, and developed in a younger age. Calm pain and improve function and reduce the recurrence is the main objective of the treatment and rehabilitation. Spinal manipulation is one of the most commonly recommended treatment in the health prevention and treatment guidelines in many countries. In China Lumbar Oblique-pulling Manipulation (LOM) treatment of the disease intervention had exact effect of Orthopedics practice, and widely used and welcomed by doctors and patients. The study shows that treatment and operational safety practices are closely related to the size of the force, direction angle and time factors. The observation of LOM method is the process of lumbar spine movement mechanics change and its biomechanical effects, contributing to the analysize, master, and optimize standard operation technique. It should be one of the focus of future research directions.
In order to standardize and optimize LOM technique, and to analyze the operating characteristics and influencing factors, this subject will use force sensing measurement technique, optical positioning capturing technique in vivo, and observe mechanics and kinematics change process, summarize mechanical movement laws, and through clinical controlled trial study, observe mechanical index change and the operator, the operator factors correlation issue, to provide a reference for standardization of LOM operation.
Objective
1. Finish a manipulation standardized description draft.
2. Summarize mechanical movement laws.
3. Investigate mechanical index change and the operator, the operator factors correlation issue.
4. Establish initially a standardized description of the presentation. Research
1. LOM literature analysis:On basis of full understanding of the principles, procedures and quality requirements, technical standards and standard written methods, to collect the massage school textbooks and other materials, and refer professional standards published or awaiting publication of the Institute, make non-quantifiable elements and quantifiable elements categorized, analysize literature incorporated language features, and finish a manipulation standardized description draft.
2. LOM kinematical and mechanical testing:apply a elbow manipulative force measuring instrument dynamic testing operating mechanics data in vivo, apply a binocular visual locator dynamic capturing operating motion locus in vivo, summarize mechanical movement laws, and provide a reference for standardization.
3. LOM controlled clinical trial:compare LIDH treatment group and normal control group of healthy young volunteers to observe the immediate efficacy and safety of the treatment, analysize cracking sounds or spinous process, left elbow or right eblow, shoulder pulling or hip pulling operator dynamic factors, as well as the degree of pain, paravertebral tenderness threshold, limits of flexion pain, body mass index operating dynamic factors, and practices force size, analysis its influencing factors.
Results
1. A draft of manipulation standardized description:Patients with lateral position, hip flexion on the side of the lower limb flexion, the next side of the lower limb is naturally straight. Doctors who stood facing the side of the bed with an elbow or hand against the front of the shoulder, another elbow or hand arrived against the back of the hip. Both elbows or hands in the opposite direction to coordination of force, until reversing the obvious resistance, a sudden increasing significantly flip, and often the "click" sound could be heard.
2. Summarize mechanical movement laws:
2.1Biomechanical testing results in vivo:Operator LOM mechanics curve diagram has certain characteristics:repeatedly showing of a short, steep, high peak, indicating that the operator pulled "fast", conforming "performing force and closing force immediately" operational requirements. Clinical operations should be noted that the force should be slightly larger than the shoulder force in the hip.
2.2Motion capturing testing results in vivo:Operator LOM curve has certain characteristics:the repeat showing of a short curved track locus, state the operator pulled the "small-amplitude", with the force direction to the rotation accompanied pressure, conforming "homeopathy forcing according with operating position and orientation "operation requirement. Subjects has certain characteristics:repeatedly showing a short curved track locus, similarly to operator curved track locus, state operator's movement along with operating's followed a similar exercise, prompting the operator and the operating has the characteristics of "stable contact"
3. LOM controlled clinical trial results
3.1Immediate efficacy and safety
The experimental group total effective rate was100%, a significant effect in the immediate analgesia (leg pain, paravertebral tenderness), improvement activities (flexion activity), and no adverse reactions occur.
3.2The operator factors and the practice force
3.2.1Cracking sounds or spinous process and the forces
In the test group only1patient was were no cracking sounds but with the spinous process; in the two groups the remaining cases were associated with cracking sounds with spinous process. Practices force and cracking sounds or the spinous has no direct relationship (P>0.05).
3.2.2Left elbow or right eblow and the practice force
The force of the right elbow in both two groups were greater than the force of the left elbow of the practices, but the difference was significant (P>0.05), there is no significant difference between the two groups (P>0.05). Prompt profit elbow operation force is not significantly greater than the force of the non-profit elbow operation.
3.2.3Shoulder pulling or hip pulling and the practice force
Hip Pulling force forces are greater than the pulling shoulder in both two groups, but the difference was significant (P>0.05), but the test group the hip pulling force is greater than the normal group, the difference was statistically significance (P<0.05). Prompted operating on patients the hip pulling force than normal more.
3.3Operating factors and the practice force
3.3.1Individual prevalence condition and the practice force
Using a visual analog score (VAS), positive point pressure threshold (PPT), lumbar flexion range (LFR) indicators reflect the individual's prevalence condition, and results show that the hip pulling force has no significant correlation (P>0.05) between VAS score, PPT score, LFR distance. There was no suggesting that the hip pulling force does not adjust according to pain feeling, paraspinal tenderness, flexion adverse severity of the disease indicators.
3.3.2Individual body mass index and the practice force
The hip pulling forces were significantly related with individual body mass index (P <0.05), the hip pulling force adjust with populations of different body mass index. That is the individual body mass index is greater, and the force implementing is greater.
4Conclusion
4.1LOM operation is "fast","small-amplitude", conforming "doctor-patient stable contact","homeopathic force" requirement. It have some regularity of movement mechanics. Mechanics features include pre-load force increases, the greater the pulling power. Motion characteristics of the movement include minor lumbar reverse with high-speed flip.
4.2For short duration young population of non-acute phase, the left elbow or right elbow, shoulder pulling or hip pulling, the pain degree or the pain limitation scope don't impact the operating forces; in the application of LOM operation the patient's hip pulling should be slightly larger than normal healthy. Different size (body mass index) is an individual one of the factors affecting the operating force, clinical practices using should increas practice force adjusting with overweight or obese patients. Cracking sounds is the important indicator of success, but not the only sign.
4.3LOM standardized description:Patients with lateral position, hip flexion on the side of the lower limb flexion, the next side of the lower limb is naturally straight. Doctors who stood facing the side of the bed with an elbow or hand against the front of the shoulder, another elbow or hand arrived against the back of the hip. Both elbows or hands in the opposite direction to coordination of force, until reversing the obvious resistance, in the doctor-patient stable contact, a sudden increasing significantly flip,"performing force and closing force immediately", and often the "click" sound could be heard.
为规范与优化腰部斜扳手法技术,分析其操作特点及影响因素,本课题运用力传感测量技术、光学定位捕捉技术,在体实时测量腰部斜扳手法操作的力学、运动学变化过程,总结了腰部斜扳手法操作的运动力学规律,并通过临床对照试验研究,对腰部斜扳手法力学指标变化与操作者、被操作者因素的相关关系等问题进行研究,为腰部斜扳手法操作的标准化、规范化提供参考依据。
研究目的：
1.基于推拿学教材的整理分析,编写腰部斜扳手法操作规范化描述初稿。
2.在体实时动态测量腰部斜扳手法操作,总结其运动力学规律。
3.探讨腰部斜扳手法力学指标变化与操作者、被操作者因素的相关关系。
4.初步建立腰部斜扳手法操作的规范化描述文稿。
研究内容：
1.腰部斜扳手法文献整理分析：充分了解技术标准制定的原则、程序与质量要求,以及标准编写的方法,搜集推拿学教材等材料,参考已出版或待出版的学会专业标准,对手法规范化所涉及的非量化要素与可量化要素进行归纳分类,分析已纳入文献中手法描述的语言特点,在此基础上编写腰部斜扳手法规范化描述初稿。
2.腰部斜扳手法在体运动力学测定：应用肘扳力测量仪实时动态测试腰部斜扳手法的在体操作力学数据；同时应用双目视觉定位仪实时动态捕捉腰部斜扳手法的在体操作运动轨迹,总结分析腰部斜扳手法的运动学与动力学变化规律,从而为腰部斜扳手法的量化研究提供依据。
3.腰部斜扳手法临床对照试验研究：通过LIDH患者手法治疗组与健康青年志愿者正常组进行比较分析,观察腰部斜扳手法治疗的即时疗效与安全性,并探讨咔哒声响或棘突错动感、左肘或右肘、扳肩或扳髋等操作者因素以及疼痛程度、椎旁压痛阈值、前屈痛限范围、体重指数等被操作者因素,与手法作用力大小的相关关系,分析对其的影响因素。
研究结果：
1.拟定腰部斜扳手法规范化描述初稿
患者侧卧位,在上一侧的下肢屈髋屈膝,在下一侧的下肢自然伸直。医者站在其面向侧的床边,以一肘或手抵住其肩前部,另一肘或手抵于臀部。两肘或两手相反方向协调施力,使腰部扭转,至有明显阻力位时,做一突发的、增大幅度的扳动,常可闻及“咔哒”的弹响声。
2.总结腰部斜扳手法操作运动力学规律
2.1在体生物力学测试结果
操作者腰部斜扳手法力学轨迹曲线图具有一定的特点：即重复呈现出一个短、陡、高的波峰,说明操作者扳动时具有“速度快”的特点,符合“随发随收”的操作要求。临床操作应注意在髋部用力要略大于在肩部用力。
2.2在体运动捕捉测试结果
操作者腰部斜扳手法运动轨迹曲线图具有一定的特点：即重复呈现出一个短弧形轨迹,说明者操作者扳动时具有“幅度小”的特点,施力方向以旋转为主同时伴随下压,符合根据被操作者位姿“顺势发力”的操作要求。
受试者在被扳动时运动轨迹曲线图具有一定的特点,即重复呈现出一个短弧形轨迹,与操作者扳动时关节的运动轨迹相似,被操作者是随着操作者关节运动而随之出现相似的运动方式,说明被扳动时被操作者与操作者具有“稳定接触”的特点。
3.腰部斜扳手法临床对照试验结果
3.1即时疗效分析及安全性
试验组临床总有效率为100%,在即时镇痛(腰腿疼痛、椎旁压痛)、改善活动(前屈活动度)等方面效果显著,无不良反应发生。
3.2操作者因素对腰部斜扳手法作用力的影响
3.2.1咔哒声响、错动感与手法作用力
两组病例中只有试验组1例患者未出现咔哒声响,但伴有棘突错动感；其余所有病例均出现咔哒声响伴有棘突错动感。手法作用力的大小与咔哒声响或棘突错动感的发生并无直接的关系(P>0.05)。
3.2.2利肘或非利肘与手法作用力
两组中右肘的手法作用力均大于左肘的手法作用力,但差别无显著意义(P>0.05),两组之间亦无明显差异(P>0.05)。提示利肘操作时用力不会明显大于非利肘操作用力。
3.2.3扳肩或扳髋与手法作用力
两组中扳髋的手法作用力均大于扳肩的手法作用力,但差别无显著意义(P>0.05),但试验组在扳髋的手法作用力比正常组更大些,差异有统计学意义(P<0.05)。提示对患者操作时扳髋用力要比正常人更大些。
3.3被操作者因素对腰部斜扳手法作用力的影响
3.3.1个体病情情况与斜扳手法作用力
采用视觉模拟评分(VAS)、腰部阳性反应点压痛闽值(PPT)、腰屈曲活动范围(LFR)等指标反映不同个体的病情情况,结果显示扳髋的手法作用力与VAS评分、PPT力值、LFR距离之间均无明显相关关系(P值均>0.05),提示扳髋手法作用力不会随着疼痛感觉、椎旁压痛、前屈不利等病情指标的轻重而变化。
3.3.2个体体重指数与斜扳手法作用力
体重指数与扳髋手法作用力之间有明显相关关系(P<0.05),说明扳髋手法作用力会随着不同体重指数的人群而变化。即体重指数越大,实施作用力也越大。
4结论
4.1腰部斜扳手法操作具有“速度快”、“幅度小”的特点,要求“医患稳定接触”、“顺势发力”、“随发随收”,并具有一定的运动力学规律性,力学特征即预加载力越大,扳动力就越大,最大作用力亦越大；运动特征即高速扳动的运动是腰椎小幅度扭转的轨迹。
4.2对于病程短、非急性期的青年发病人群,左肘或右肘、扳肩或扳髋、疼痛程度或痛限范围不同等不会对手法操作作用力产生明显影响；在施用手法操作时对患者的扳髋之力应稍大于对正常健康者的。不同体型(体重指数)是影响手法操作作用力大小的个体因素之一,临床手法运用时对于超重或肥胖的患者要适当增大手法作用力。咔哒声响是手法成功的重要标志,但不是唯一标志。
4.3腰部斜扳手法操作规范化描述文稿：患者侧卧位,在上一侧的下肢屈髋屈膝,在下一侧的下肢自然伸直。医者站在其面向侧的床边,以一肘或手抵住其肩前部,另一肘或手抵于臀部。两肘或两手以相反方向协调施力,使腰部扭转,至有明显阻力位时,在医患稳定接触下,顺势做一突发的、增大幅度的扳动,做到“随发随收”,常可闻及“咔哒”的弹响声。
Lumbar intervertebral disc herniation due to low back pain is a common chronic pain syndrome in orthopedics, and its incidence in recent years increased year by year, and developed in a younger age. Calm pain and improve function and reduce the recurrence is the main objective of the treatment and rehabilitation. Spinal manipulation is one of the most commonly recommended treatment in the health prevention and treatment guidelines in many countries. In China Lumbar Oblique-pulling Manipulation (LOM) treatment of the disease intervention had exact effect of Orthopedics practice, and widely used and welcomed by doctors and patients. The study shows that treatment and operational safety practices are closely related to the size of the force, direction angle and time factors. The observation of LOM method is the process of lumbar spine movement mechanics change and its biomechanical effects, contributing to the analysize, master, and optimize standard operation technique. It should be one of the focus of future research directions.
In order to standardize and optimize LOM technique, and to analyze the operating characteristics and influencing factors, this subject will use force sensing measurement technique, optical positioning capturing technique in vivo, and observe mechanics and kinematics change process, summarize mechanical movement laws, and through clinical controlled trial study, observe mechanical index change and the operator, the operator factors correlation issue, to provide a reference for standardization of LOM operation.
Objective
1. Finish a manipulation standardized description draft.
2. Summarize mechanical movement laws.
3. Investigate mechanical index change and the operator, the operator factors correlation issue.
4. Establish initially a standardized description of the presentation. Research
1. LOM literature analysis:On basis of full understanding of the principles, procedures and quality requirements, technical standards and standard written methods, to collect the massage school textbooks and other materials, and refer professional standards published or awaiting publication of the Institute, make non-quantifiable elements and quantifiable elements categorized, analysize literature incorporated language features, and finish a manipulation standardized description draft.
2. LOM kinematical and mechanical testing:apply a elbow manipulative force measuring instrument dynamic testing operating mechanics data in vivo, apply a binocular visual locator dynamic capturing operating motion locus in vivo, summarize mechanical movement laws, and provide a reference for standardization.
3. LOM controlled clinical trial:compare LIDH treatment group and normal control group of healthy young volunteers to observe the immediate efficacy and safety of the treatment, analysize cracking sounds or spinous process, left elbow or right eblow, shoulder pulling or hip pulling operator dynamic factors, as well as the degree of pain, paravertebral tenderness threshold, limits of flexion pain, body mass index operating dynamic factors, and practices force size, analysis its influencing factors.
Results
1. A draft of manipulation standardized description:Patients with lateral position, hip flexion on the side of the lower limb flexion, the next side of the lower limb is naturally straight. Doctors who stood facing the side of the bed with an elbow or hand against the front of the shoulder, another elbow or hand arrived against the back of the hip. Both elbows or hands in the opposite direction to coordination of force, until reversing the obvious resistance, a sudden increasing significantly flip, and often the "click" sound could be heard.
2. Summarize mechanical movement laws:
2.1Biomechanical testing results in vivo:Operator LOM mechanics curve diagram has certain characteristics:repeatedly showing of a short, steep, high peak, indicating that the operator pulled "fast", conforming "performing force and closing force immediately" operational requirements. Clinical operations should be noted that the force should be slightly larger than the shoulder force in the hip.
2.2Motion capturing testing results in vivo:Operator LOM curve has certain characteristics:the repeat showing of a short curved track locus, state the operator pulled the "small-amplitude", with the force direction to the rotation accompanied pressure, conforming "homeopathy forcing according with operating position and orientation "operation requirement. Subjects has certain characteristics:repeatedly showing a short curved track locus, similarly to operator curved track locus, state operator's movement along with operating's followed a similar exercise, prompting the operator and the operating has the characteristics of "stable contact"
3. LOM controlled clinical trial results
3.1Immediate efficacy and safety
The experimental group total effective rate was100%, a significant effect in the immediate analgesia (leg pain, paravertebral tenderness), improvement activities (flexion activity), and no adverse reactions occur.
3.2The operator factors and the practice force
3.2.1Cracking sounds or spinous process and the forces
In the test group only1patient was were no cracking sounds but with the spinous process; in the two groups the remaining cases were associated with cracking sounds with spinous process. Practices force and cracking sounds or the spinous has no direct relationship (P>0.05).
3.2.2Left elbow or right eblow and the practice force
The force of the right elbow in both two groups were greater than the force of the left elbow of the practices, but the difference was significant (P>0.05), there is no significant difference between the two groups (P>0.05). Prompt profit elbow operation force is not significantly greater than the force of the non-profit elbow operation.
3.2.3Shoulder pulling or hip pulling and the practice force
Hip Pulling force forces are greater than the pulling shoulder in both two groups, but the difference was significant (P>0.05), but the test group the hip pulling force is greater than the normal group, the difference was statistically significance (P<0.05). Prompted operating on patients the hip pulling force than normal more.
3.3Operating factors and the practice force
3.3.1Individual prevalence condition and the practice force
Using a visual analog score (VAS), positive point pressure threshold (PPT), lumbar flexion range (LFR) indicators reflect the individual's prevalence condition, and results show that the hip pulling force has no significant correlation (P>0.05) between VAS score, PPT score, LFR distance. There was no suggesting that the hip pulling force does not adjust according to pain feeling, paraspinal tenderness, flexion adverse severity of the disease indicators.
3.3.2Individual body mass index and the practice force
The hip pulling forces were significantly related with individual body mass index (P <0.05), the hip pulling force adjust with populations of different body mass index. That is the individual body mass index is greater, and the force implementing is greater.
4Conclusion
4.1LOM operation is "fast","small-amplitude", conforming "doctor-patient stable contact","homeopathic force" requirement. It have some regularity of movement mechanics. Mechanics features include pre-load force increases, the greater the pulling power. Motion characteristics of the movement include minor lumbar reverse with high-speed flip.
4.2For short duration young population of non-acute phase, the left elbow or right elbow, shoulder pulling or hip pulling, the pain degree or the pain limitation scope don't impact the operating forces; in the application of LOM operation the patient's hip pulling should be slightly larger than normal healthy. Different size (body mass index) is an individual one of the factors affecting the operating force, clinical practices using should increas practice force adjusting with overweight or obese patients. Cracking sounds is the important indicator of success, but not the only sign.
4.3LOM standardized description:Patients with lateral position, hip flexion on the side of the lower limb flexion, the next side of the lower limb is naturally straight. Doctors who stood facing the side of the bed with an elbow or hand against the front of the shoulder, another elbow or hand arrived against the back of the hip. Both elbows or hands in the opposite direction to coordination of force, until reversing the obvious resistance, in the doctor-patient stable contact, a sudden increasing significantly flip,"performing force and closing force immediately", and often the "click" sound could be heard.
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