颈椎整骨手法的运动学与动力学研究
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上海中医药大学附属曙光医院石氏伤科医学中心

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Study on Kinematic and Dynamic Parameters for Chinese Cervical Manual Therapy
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    摘要:

    目的:同步采集和分析两种颈椎整骨手法的运动学与动力学参数,归纳其生物力学特征。方法:由1位高年资医师对10位健康受试者完成颈椎定位定向扳法和颈椎侧屈手法操作,施术者粘贴荧光标志球用于捕捉手法动作,并用压力触感手套和无线表面肌电系统采集并分析动力学参数和表面肌电信号。结果:上臂肌肉是颈椎整骨手法的主发力肌,其中肱二头肌的贡献率最高。颈椎定位定向扳法的运动幅度、速度、扳动作用力和时间都大于颈椎侧屈手法。颈椎定位定向扳法中肘关节的合速度约为67.48±31.21mm/s,三轴最大角速度分别为X轴36.07±11.39°/s,Y轴36.88±14.30°/s,Z轴6.31±3.54°/s;掌心的载荷峰值为9.25±3.91kg,扳动时间为200±86ms;拇指的载荷峰值为2.36±1.05kg,扳动时间为225±103ms;右侧肱二头肌的贡献率最高,为22.82%。颈椎侧屈手法中右肘关节的合速度为10.63±3.51mm/s,三轴最大角速度分别为X轴14.15±7.57°/s,Y轴32.90±11.67°/s,Z轴15.81±7.18°/s;掌心的载荷峰值为1.72±0.60kg,扳动时间为84±69ms;拇指的载荷峰值为1.32±0.69kg,扳动时间为84±56ms;右侧肱二头肌的贡献率最高,为12.83%。颈椎定位定向扳法中施术者各肌肉的iEMG和RMS都大于颈椎侧屈手法。结论:颈椎整骨手法的运动幅度、三维活动角度,扳动瞬间的载荷强度和时间,具备“高速、低幅和力强”的特点,体现出中医学中关于“寸劲”的生物力学特征,可以为进一步规范手法教学、训练以及提升临床安全性提供参考。

    Abstract:

    Objective: To simultaneously collect and analyze the kinematic and dynamic parameters and surface electromyographic (sEMG) signal changes of two techniques of Chinese cervical manual therapy (CCMT), and to quantitatively describe the operation characteristics and biomechanical characteristics of the techniques. Methods: A senior practitioner completed the CCMT, including the cervical spine positioning and directional rotation pulling technique and cervical spine lateral flexion technique on 10 healthy subjects, and the fluorescent marker balls were pasted on the operator to capture the manipulation movements. The dynamic parameters and the sEMG signals of the upper limb muscles were collected by the pressure-sensitive gloves and the wireless sEMG acquisition system, and the data were processed and analyzed. Results: The upper arm muscle was the main force muscle of CCMT, and biceps brachii had the highest contribution rate. The range of motion, speed, pulling force, and time of the cervical spine positioning and directional rotation pulling technique were all greater than the another. In the cervical spine positioning and directional rotation pulling technique, the combined velocity of the elbow joint was 67.48±31.21mm/s, and the maximum angular velocity of the three axes was 36.07±11.39°/s on X-axis, 36.88±14.30°/s on Y-axis, and 6.31±3.54°/s on Z-axis respectively; The peak load was 9.25±3.91kg, and the pulling time was 200±86ms; The peak load was 2.36±1.05kg, and the pulling time was 225±103ms; The contribution rate of right biceps brachii was the highest at 22.82%. In the cervical spine lateral flexion technique, the combined velocity of the elbow joint was 10.63±3.51mm/s, and the maximum angular velocity of the three axes was 14.15±7.57°/s on X-axis, 32.90±11.67°/s on Y-axis, and 15.81±7.18°/s on Z-axis respectively; The peak load was 1.72±0.60kg, and the pulling time was 84±69ms; The peak load was 1.32±0.69kg, and the pulling time was 84±56ms; The contribution rate of right biceps brachii was the highest at 12.83%. The EMG and RMS of each muscle of the operator in the former technique were higher than those in the latter one. Conclusion: The overall movement range, three-dimensional movement angle, load intensity and time at the moment of the CCTM have the characteristics of "high speed, low amplitude, and strong force", reflecting the biomechanical characteristics of "Cunjin" in traditional Chinese medicine, to provide a reference for further standardizing manual teaching and training and improving clinical safety.

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  • 收稿日期:2022-05-03
  • 最后修改日期:2022-08-02
  • 录用日期:2022-08-04
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