旋提手法的力学分析、机械模拟及风险评估研究

Rotation-traction manipulation, the first choice of traditional Chinese medicine to treat for Cervical spondylotic radiculopathy, has already been the promotion project of State Administration of Traditional Chinese Medicine. Meanwhile, Rotation-traction manipulation is a technically complicated medical technology skills which need to be mastered through standardized training. The key of promotion popularization and application is to avoid the operational risk from non-standard rotation-traction manipulation and to improve the quality of practices operation. Therefore, the scientific issues need to be resolved is to understand the non-standard operations of rotation-traction manipulation and its risk potential to the human body. In preliminary studies, we had carried out the mechanics quantitative research about standardized rotation-traction manipulation and established the mechanics evaluation criteria and quantitative assessment instrument. On this basis, the research intends to adopt rotation-traction manipulation quantitative assessment instrument to implement mechanics evaluation and analyze the reasons for non-standard operation and the mechanical parameters features. Then we use robot technology to dynamically simulate the whole non-standard rotation-traction manipulation in human cervical specimens by three-dimensional motion automation control and high precision and high frequency response of mechanical loading device. Meanwhile, the motion capture technology and vertebral artery blood circulation simulation system are adopted to measure the change of three-dimensional displacement of the cervical vertebrae and vertebral arteries liquid velocity during simulation process so as to assess the operational risk. The purpose of this research is to provide a scientific basis for security applications of rotation-traction manipulation and to promote its clinical application.

旋提手法是中医治疗神经根型颈椎病的重要手段，已被国家中医药管理局立项向全国推广应用。同时该手法是一项技巧性强的医疗技术，需要经过规范培训方可掌握。规避不规范旋提手法的操作风险、提高手法操作质量是促进其推广应用的关键。因此，了解不规范的旋提手法操作及其对人体的潜在风险是急需解决的科学问题。在前期研究中，已对规范化旋提手法进行了力学量化研究，并建立了力学评价标准及量化考核仪器。在此基础上，本课题拟采用旋提手法模拟操作考核系统对初学者的旋提手法操作进行力学量化评价，分析不规范操作的原因及其力学参数特征；然后采用机器人技术，通过三维运动自动化控制及高精度高频响的机械加载装置，在人体颈椎标本上动态模拟不规范的旋提手法操作全程；同时采用运动捕捉技术及椎动脉血液循环模拟系统，实时测量模拟手法过程中颈椎椎体的三维位移及椎动脉液体流速的变化，评估操作风险，为安全应用旋提手法提供科学依据，促进其临床推广应用。

旋提手法是中医治疗神经根型颈椎病的重要手段，已被国家中医药管理局立项向全国推广应用。同时该手法是一项技巧性强的医疗技术，需要经过规范培训方可掌握。规避不规范旋提手法的操作风险、提高手法操作质量是促进其推广应用的关键。因此，了解不规范的旋提手法操作及其对人体的潜在风险是急需解决的科学问题。在前期研究中，已对规范化旋提手法进行了力学量化研究，并建立了力学评价标准及量化考核仪器。针对上述问题，本课题延续前期研究成果，进行了以下研究工作：1、针对旋提手法教学机器人系统进行了稳定性研究，结果证实了该系统作为考核工具能稳定有效地评价术者施行旋提手法操作的优劣。2、采用旋提手法模拟操作考核系统对初学者的旋提手法操作进行力学量化评价，明确了旋提手法不规范操作的原因及其力学特征，分别为发力不当、旋转幅度过大、提扳方向不垂直以及提扳时间过长；其中，初学者操作旋提手法时最难以掌握的技巧是如何合理地进行发力操作。3、采用串并联机器人技术，研制了脊柱三维运动自动化控制的加载装置，初步实现了模拟颈椎生理运动及复杂运动的自动化加载。4、构建了新鲜颈椎标本椎动脉流量测定实验模型，通过实验证实该模型可满足复杂体位下椎动脉流量的动态测定，并分析了旋转相关体位对椎动脉流量的影响及潜在风险。通过本项目研究为安全应用旋提手法提供了科学依据，为旋提手法教学培训提供了客观依据及素材，积极推进了中医骨伤事业的科学化进程。