中文摘要：

目的通过观察推拿手法对腰突症患者腰椎三维空间位移的影响，探讨推拿手法治疗腰突症“骨错缝”的干预机制。方法选取10名腰突症患者，分为理筋手法组（5例，简称理筋组）和理筋手法加调整手法组（5例，简称理渊组）进行治疗；正常志愿者5例为理筋手法（简称正常组）。应用ITK重建软件重建腰椎椎体并进行有限元分析，比较3组手法干预前后腰椎椎体三维位移变化情况。结果3组腰突症患者推拿手法治疗后Ll～5各椎体的空间位置发生了一定改变。理调组L3在x轴角位移为（1．77±0．46）°；M存x、y轴角传移分别为（1．78±0．53）°、（1．89±0．75）°，显著大于理筋组和正常组（P〈0．05）；理调组Ll～5在x轴三维角位移分别为（1．50±0．47）°、（1．55±0．57）°、（1．77±0．46）°、（1．784±0．53）°、（1．61±0．39）°，均显著大于正常组（P〈0．05）；理调组L3在y轴三维位移为（2．87±O．74）mm，IA在x轴三维位移为（1．68±0．64）lnnl，显著大于理筋组和正常组（P〈0．05）；理调组IJl、14、L5在x轴三维位移分别为（1．284±0．21）、（1．68±O．64）、（1．304-0．51）mm，L1～3在y轴三维位移分别为（1．92±O．42）、（2．25±O．61）、（2．87±0．74）mm，均显著大于正常组（P〈0．05）。理筋手法组Ll～5各节段三维角位移和位移与正常组相比，均呈现大于正常组的趋势。结论理调手法比理筋手法更能调整失稳或退变节段的空间位置，使腰椎椎体产生水平及旋转移位，而非上下移位，对纠正腰椎“骨错缝”产生重要作用。理筋手法对腰突症患者腰椎结构有一定的影响，但不显著。

英文摘要：

Objective To study the mechanisms of vertebrae semi-dislocation of Tuina manipulation for treating patients with lumbar intervertebral disc protrusion （LIDP） by observing the three-dimensional （3 D） displacement of lumbar before and after Tuina manipulation. Methods Ten LIDP patients were selected and evenly divided in-to two groups： Group 1 as tendon-smoothing manipulation group （ relaxing group）, Group 2 as tendon-smoothing plus adjusting manipulation group （adjusting group）. Besides, Group 3 as control group was established by 5 healthy volunteers treated with tendon-smoothing manipulation. Before and after manipulation intervention, all subjects were scanned from L! to L5 segment by using Philips 64 spiral CT under equal conditions for accessing the volume data. ITK reconstruction software was used to reconstruct each lumbar skeleton for finite element a- nalysis. The 3D displacements and angular displacements among three groups were compared. Results 3D dis- placement from L! to L5 segment all changed in three groups. For adjusting group, the angular displacements at X-axis in 1.3 segment was （ ]. 77 ± 0.46） °, and that in L4 segment at X-axis and Y-axis was （ 1.78 ± 0.53 ） ° and （ ]. 89 ± 0.75） °, respectively, which was significantly larger than relaxing group and control group （ P 〈 0.05 ） ; the angular displacements at X-axis from L1 to L5 segment were （I.50 ±0.47）°, （1.55 ±0.57） °, （1.77 ±O. 46） °, （ l. 78 ±0.53 ）° （ 1. 6± O. 39）°, respectively, which were significantly larger than control group （ P 〈 O. 05） ; displacement at Y-axis in 1_3 segment was （2.87 ± O. 74） mm, and that at X-axis in L4 segment was （1.68 ±0.64） mm, which were significantly larger than relaxing group and control group （P 〈 O. 05 ） ; displace- ment at X-axis in L1, L4 and 1_5 segment was （ 1. 28 ± 0.21 ）, （ 1. 68 ± 0.64）, （ 1.30 ± 0.51 ） mm, and that at Y- axis in L1 to I..3 segment was （ 1. 92 ± 0.42）, （2.25 ± 0.61