Evaluating and Characterizing the Scope of Care for Interventions Labeled as Manual Therapy in Low Back Pain Trials: A Scoping Review.

OBJECTIVE: The purpose of this scoping review was to evaluate and characterize the scope of care for low back pain that falls under the specific label of manual therapy. METHODS: PubMed database, Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and SPORTDiscus were searched from journal inception through May 2022 for randomized controlled trials that investigated the treatment of low back pain using manual therapy. Terminology used to define manual therapy was extracted and categorized by using only the words included in the description of the intervention. An expert consultation phase was undertaken to gather feedback. RESULTS: One hundred seventy-six trials met final inclusion criteria, and 169 unique terms labeled as manual therapy for the treatment of low back pain were found. The most frequent terms were mobilization (29.0%), manipulation (16.0%), and thrust (6.4%). Eight percent of trials did not define or specify what type of manual therapy was used in the study. After removing duplicates, 169 unique terms emerged within 18 categories. CONCLUSIONS: Manual therapy intervention labels used in low back pain trials are highly variable. With such variation, the heterogeneity of the intervention in trials is likely large, and the likelihood that different trials are comparing the same interventions is low. Researchers should consider being more judicious with the use of the term manual therapy and provide greater detail in titles, methods, and supplementary appendices in order to improve clarity, clinical applicability, and usefulness of future research. IMPACT: The ability to interpret and apply findings from manual therapy-related research for low back pain is challenging due to the heterogeneity of interventions under this umbrella term. A clear use of terminology and description of interventions by researchers will allow for improved understanding for the role of manual therapy in managing back pain.

Best Practices for Chiropractic Management of Adult Patients With Mechanical Low Back Pain: A Clinical Practice Guideline for Chiropractors in the United States.

OBJECTIVE: The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States. METHODS: Two experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations. RESULTS: The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP. CONCLUSION: This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.

[Closed manipulative reduction and external fixation with cardboard splint for the treatment of Monteggia fracture].

OBJECTIVE: To explore clinical efficicacy of closed manipulative reduction and external fixation with cardboard splint in treating Monteggia fracture. METHODS: Fifty-eight children with Monteggia fracture were underwent closed manipulative reduction and external fixation with cardboard splint from January 2010 to Junuary 2018. Among them, including 37 males and 21 females, aged from 3.5 to 12 years old with an average of (8.48±2.29) years old;the courses of disease ranged from 0.5 hours to 9 days with an average of (4.21±1.46) days. Broberg and Morrey scores before treatment, 1, 3 and 6 months after treatment were used to evaluate clinical effects. RESULTS: All children were followed up from 1 to 6 months with an average of (3.35±2.12) months. Broberg and Morrey score (7.24±2.81) before treatment, (32.06 ±8.33) at 1 month after treatment, (73.18±5.56) at 3 months after treatment and (95.87±6.75) at 6 months after treatment; there were statistical differences at each time points after treatment with before treatment (P<0.05);37 children got excellent results, 19 good and 1 moderate. CONCLUSION: Treatment of Monteggia fractures with closed manipulative reduction and external fixation with cardboard splint could reach integration of motion and quietness, also could remove external fixation at early stage, and get obvious short-term and medium-term therapeutic results.

[Lever positioning manipulation combined with pulsed electric field on the analgesic effect of patients with lumbar disc herniation and its influence on IL-1ß and TNF-α].

OBJECTIVE: To observe the analgesic effect of lever positioning manipulation combined with pulsed electric field on patients with lumbar disc herniation and the influence on serum IL-1ß and TNF-α. METHODS: From January 2018 to March 2019, 58 patients with lumbar disc herniation were included in the study, which were randomly divided into observation group and control group by digital table method. Observation group of 29 cases, including 16 males and 13 females, aged (38.03±11.29) years old, were treated with lever positioning manipulation combined with pulsed electric field. The 29 cases in control group, including 17 males and 12 females, aged (38.21±9.16) years old, were treated with pulsed electric field. Both groups of patients were treated 3 times a week, once every other day, 3 times as a course of treatment. After 2 courses of treatment, the two groups of patients were scored before and after treatment by the numeric rating scales (NRS);at the same time, the serum levels of IL-1ß and TNF-α were measured before and after treatment. RESULTS: The NRS scores of observation group and control group were 4.21±1.76, 4.66±1.61 before treatment, and 1.28±0.84, 2.10±1.35 after treatment, respectively. The NRS scores of the observation group after treatment was significantly lower than that of the control group (P<0.05). After treatment, the concentrations of IL-1ß and TNF-α in both groups became lower(P<0.05). The levels of IL-1ß in observation group and control group before treatment were (119.01±69.65), (112.23±78.43) pg /ml, and after treatment were (59.78±36.60), (77.51±40.46) pg/ml, respectively. The levels of TNF-α in observation group and control group before treatment were (1.68± 1.13), (1.74±0.70) pg /ml, and after treatment were (1.14±0.56), (1.45±0.58) pg /ml, respectively. The change of IL-1ß and TNF-α in observation group was better than that in control group (P<0.05). CONCLUSION: The lever positioning manipulation combined with pulsed electric field has a good analgesic effect on patients with lumbar disc herniation, and it has a significant impact on the patient's serum IL-1ß and TNF-α concentration, which can be used as a clinical guide. However, the synergistic effect of lever positioning technique combined with pulsed electric field and guidelines for clinical treatment need further research.

Correlates of Manual Therapy and Acupuncture Use Among Rural Patients Seeking Conventional Pain Management: A Cross-sectional Study.

OBJECTIVE: In this cross-sectional study, we examined correlates of manual therapy (spinal manipulation, massage therapy) and/or acupuncture use in a population engaging in conventional pain care in West Virginia. METHODS: Participants were patients (aged 18+ years) from 4 Appalachian pain and rheumatology clinics. Of those eligible (N = 343), 88% completed an anonymous survey including questions regarding health history, pain distress (Short Form Global Pain Scale), prescription medications, and current use of complementary health approaches for pain management. We used age-adjusted logistic regression to assess the relation of sociodemographic, lifestyle, and health-related factors to use of manual therapies and/or acupuncture for pain (complete-case N = 253). RESULTS: The majority of participants were white (92%), female (56%), and middle aged (mean age, 54.8 ± 13.4 years). Nearly all reported current chronic pain (94%), and 56% reported ≥5 comorbidities (mean, 5.6 ± 3.1). Manual therapy and/or acupuncture was used by 26% of participants for pain management (n = 66). Current or prior opioid use was reported by 37% of those using manual therapies. Manual therapy and/or acupuncture use was significantly elevated in those using other complementary health approaches (adjusted odds ratio, 3.0; 95% confidence interval, 1.5-5.8). Overall Short Form Global Pain Scale scores were not significantly associated with use of manual therapies and/or acupuncture after adjustment (adjusted odds ratio per 1-point increase, 1.01; 95% confidence interval, 1.00-1.03). CONCLUSION: We found no evidence for an association of pain-related distress and use of manual therapies and/or acupuncture, but identified a strong association with use of dietary supplements and mind-body therapies. Larger studies are needed to further examine these connections in the context of clinical outcomes and cost-effectiveness in rural adults given their high pain burden and unique challenges in access to care.

Closed manipulative reduction and external fixation with cardboard splint for the treatment of Monteggia fracture / 中国骨伤

OBJECTIVE@#To explore clinical efficicacy of closed manipulative reduction and external fixation with cardboard splint in treating Monteggia fracture.@*METHODS@#Fifty-eight children with Monteggia fracture were underwent closed manipulative reduction and external fixation with cardboard splint from January 2010 to Junuary 2018. Among them, including 37 males and 21 females, aged from 3.5 to 12 years old with an average of (8.48±2.29) years old;the courses of disease ranged from 0.5 hours to 9 days with an average of (4.21±1.46) days. Broberg and Morrey scores before treatment, 1, 3 and 6 months after treatment were used to evaluate clinical effects.@*RESULTS@#All children were followed up from 1 to 6 months with an average of (3.35±2.12) months. Broberg and Morrey score (7.24±2.81) before treatment, (32.06 ±8.33) at 1 month after treatment, (73.18±5.56) at 3 months after treatment and (95.87±6.75) at 6 months after treatment; there were statistical differences at each time points after treatment with before treatment (@*CONCLUSION@#Treatment of Monteggia fractures with closed manipulative reduction and external fixation with cardboard splint could reach integration of motion and quietness, also could remove external fixation at early stage, and get obvious short-term and medium-term therapeutic results.

Lever positioning manipulation combined with pulsed electric field on the analgesic effect of patients with lumbar disc herniation and its influence on IL-1β and TNF-α / 中国骨伤

OBJECTIVE@#To observe the analgesic effect of lever positioning manipulation combined with pulsed electric field on patients with lumbar disc herniation and the influence on serum IL-1β and TNF-α.@*METHODS@#From January 2018 to March 2019, 58 patients with lumbar disc herniation were included in the study, which were randomly divided into observation group and control group by digital table method. Observation group of 29 cases, including 16 males and 13 females, aged (38.03±11.29) years old, were treated with lever positioning manipulation combined with pulsed electric field. The 29 cases in control group, including 17 males and 12 females, aged (38.21±9.16) years old, were treated with pulsed electric field. Both groups of patients were treated 3 times a week, once every other day, 3 times as a course of treatment. After 2 courses of treatment, the two groups of patients were scored before and after treatment by the numeric rating scales (NRS);at the same time, the serum levels of IL-1β and TNF-α were measured before and after treatment.@*RESULTS@#The NRS scores of observation group and control group were 4.21±1.76, 4.66±1.61 before treatment, and 1.28±0.84, 2.10±1.35 after treatment, respectively. The NRS scores of the observation group after treatment was significantly lower than that of the control group (@*CONCLUSION@#The lever positioning manipulation combined with pulsed electric field has a good analgesic effect on patients with lumbar disc herniation, and it has a significant impact on the patient's serum IL-1β and TNF-α concentration, which can be used as a clinical guide. However, the synergistic effect of lever positioning technique combined with pulsed electric field and guidelines for clinical treatment need further research.

[Clinical effect of manipulation therapy for the treatment of degenerative lumbar instability based on myofascial chain theory].

OBJECTIVE: To explore clinical effects of manipulation therapy in treating degenerative lumbar instability based on myofascial chain theory. METHODS: Fifty-seven patients with degenerative lumbar spine instability were analyzed retrospectively from January 2018 to December 2019, and treated with massage manipulation therapy. Among them, 29 patients were treated with massage manipulation therapy based on the myofascial chain theory (myofascial chain group), including 14 males and 15 females, aged from 40 to 69 years old with an average of (51.76±5.07) years old, the courses of disease was (3.4±1.6) years. Twenty-eight patients were treated with massage manipulation therapy based on TCM meridian theory (TCM meridian group), including 12 males and 16 females, aged from 42 to 70 years old with an average of(52.48±4.31) years old, the courses of disease was (3.3±1.7) years. Before treatment, after treatment, 1 and 3 months after treatment, visual analogue scale (VAS) was used to evaluate pain degree of lumbar, Japanese Orthopaedic Association (JOA) and modified Oswestry Disability Index (ODI) were used to assess improvement of lumbar function, and changes of lumbar muscle tension were used to evaluate clinical effect. RESULTS: VAS score, JOA score, modified ODI score and lumbar muscle tension after treatment were significantly improved than those of before treatment between two groups (P<0.05) . There were no statistical difference in VAS score, JOA score, modified ODI score and lumbar muscle tension between two groups before treatment and after treatment immediately(P> 0.05). However, VAS score, JOA score, modified ODI score and lumbar muscle tension at one and three months after treatment in myofascial chain group weresignificantly better than that of TCM meridian group (P<0.05). CONCLUSION: Manipulation therapyon in treating degenerative lumbar instability based on myofascial chain theory could effectively relieve low back pain symptom and improve lumbar function. It is worthy of promoting.

[Back arm flexion and extension combined with manipulation for the treatment of patient with adhesive scapulohumeral periarthritis].

OBJECTIVE: To observe clinical efficacy of back arm flexion and extension combined with manipulation in treating adhesive scapulohumeral periarthritis. METHODS: From March 2016 to April 2018, 53 patients with adhesive scapulohumeral periarthritis were treated with back arm flexion and extension combined with manipulation, the main symptoms were shoulder pain and limited activity. There were 22 males and 31 females aged from 45 to 71 years old with an average of (51.63±5.79) years;the courses of disease ranged from 3 to 24 months with an average of (8.62±3.73) months. Manipulation treatment was carried out once a week, and back arm flexion and extension were performed for 3 times a day with15 movements each time, totally 4 weeks for a single course. Visual analogue scale (VAS) and Constant-Murley shoulder function score were observed and compared before treatment and one week, one and three months after treatment. RESULTS: All patients were followed up from 3 to 12 months, with an average of (5.91±3.55) months. VAS score before treatment was 4.02±1.46, and was improved to 3.15±1.54, 1.98±1.37, 1.12±0.86 respectively at one week, one and three months after treatment. Constant-Murley score before treatment was 42.70 ±5.72, and improved to 54.25 ±6.34, 67.45 ±6.84, 82.40 ±6.63 at one week, one and three months after treatment respectively;19 patients got excellent result, 22 good, 9 fair and 3 poor. CONCLUSION: Back arm flexion combined with manipulation for the treatment of adhesive scapulohumeral periarthritis could effectively relieve pain, improve shoulder function, which is a simple effective treatment strategy.

[Evaluation of therapeutic effects of the ultramicro needle knife combined with cervical spine fine adjusting on youth cervical curvature abnormality case].

OBJECTIVE: To study the therapeutic effects of the ultramicro needle-knife combine with cervical spine fine adjusting on youth cervical curvature abnormality case. METHODS: From November 2016 to October 2018, 88 young patients with abnormal curvature of cervical spine were treated. Due to loss of follow up, 86 cases were actually completely including 37 males and 49 females, ranging in age from 20 to 40 years old, with an average of (30.55±5.21) years old, and the course of disease ranged from 1 to 42 months, with a mean of (14.21±7.38) months. All the patients were divided into two groups:treatment group (44 cases) and control group (42 cases). The patients in the treatment group were treated with ultramicro needle-knife and cervical spine fine adjusting, and the patients in the control group were treated with conventional acupuncture and manipulation. The treatments were done 1 time per week in the treatment group while 3 times per week in control group every week, with a duration of 3 weeks for both groups. Before treatment, 3 weeks after treatment, and at the end of 1 month follow-up, the score of neck pain questionnaire(NPQ), range of the motion(ROM) in the cervical region and the D values of cervical physiological curvature were recorded. The efficacy at the end of treatment and in the follow up was evaluated. During the treatment, the patients were also required to correct the bad posture in daily life, to sleep in a low pillow position, and put a moderately columnar pillow behind the neck for 0.5 hours every morning and evening. RESULTS: Two patients in the control group were dropped out after 3 weeks treatment. No adverse reactions were found in the 2 groups during the treatment period. Compared with those before treatment, all scores at all the observation time points were significantly improved between two groups after treatment(all P<0.05). The NPQ scores of cervical symptoms were different significantly between two groups(all P<0.05). The changing range of the the NPQ score of cervical symptoms and cervical spine alignment curve of the treatment group were better than those of the control group (P<0.05).There was statistical difference in NPQ scores between different time points, in the other words, there was time effect(F=203.63, P=0.000). There was interaction between time factor and group factor(F=4.964, P=0.012). There was no statistical difference in the changing range of the ROM score between two groups (all P>0.05). There was statistical difference in ROM scores between different time points, there was time effect (F=240.32), P=0.000). There was no interaction between time factor and group factor (F=0.311, P=0.734). The effective rate of the treatment group and control group were 90.91%(40 / 44) and 80.95%(34 / 42) respectively, the treatment group was more effective than the control group (P<0.05). During the follow-up period, the effective rate of the treatment group and the control group were 84.09%(37 / 44) and 76.19%(32 / 42) respectively. Obviously, the difference of total effective rate between two groups had no statistical signification(P>0.05) in the follow-up duration. CONCLUSION: The method of needle knife combined with cervical spine fine adjusting has a better therapeutic efficiency than conventional acupuncturecombined with manipulation in treating youth cervical curvature abnormality patients. Because this novel method can recover the cervical curvature, relieve the neck pain, and improve cervical mobility.

Evaluation of therapeutic effects of the ultramicro needle knife combined with cervical spine fine adjusting on youth cervical curvature abnormality case / 中国骨伤

OBJECTIVE@#To study the therapeutic effects of the ultramicro needle-knife combine with cervical spine fine adjusting on youth cervical curvature abnormality case.@*METHODS@#From November 2016 to October 2018, 88 young patients with abnormal curvature of cervical spine were treated. Due to loss of follow up, 86 cases were actually completely including 37 males and 49 females, ranging in age from 20 to 40 years old, with an average of (30.55±5.21) years old, and the course of disease ranged from 1 to 42 months, with a mean of (14.21±7.38) months. All the patients were divided into two groups:treatment group (44 cases) and control group (42 cases). The patients in the treatment group were treated with ultramicro needle-knife and cervical spine fine adjusting, and the patients in the control group were treated with conventional acupuncture and manipulation. The treatments were done 1 time per week in the treatment group while 3 times per week in control group every week, with a duration of 3 weeks for both groups. Before treatment, 3 weeks after treatment, and at the end of 1 month follow-up, the score of neck pain questionnaire(NPQ), range of the motion(ROM) in the cervical region and the D values of cervical physiological curvature were recorded. The efficacy at the end of treatment and in the follow up was evaluated. During the treatment, the patients were also required to correct the bad posture in daily life, to sleep in a low pillow position, and put a moderately columnar pillow behind the neck for 0.5 hours every morning and evening.@*RESULTS@#Two patients in the control group were dropped out after 3 weeks treatment. No adverse reactions were found in the 2 groups during the treatment period. Compared with those before treatment, all scores at all the observation time points were significantly improved between two groups after treatment(all 0.05). There was statistical difference in ROM scores between different time points, there was time effect (=240.32), =0.000). There was no interaction between time factor and group factor (=0.311, =0.734). The effective rate of the treatment group and control group were 90.91%(40 / 44) and 80.95%(34 / 42) respectively, the treatment group was more effective than the control group (0.05) in the follow-up duration.@*CONCLUSION@#The method of needle knife combined with cervical spine fine adjusting has a better therapeutic efficiency than conventional acupuncturecombined with manipulation in treating youth cervical curvature abnormality patients. Because this novel method can recover the cervical curvature, relieve the neck pain, and improve cervical mobility.

Back arm flexion and extension combined with manipulation for the treatment of patient with adhesive scapulohumeral periarthritis / 中国骨伤

OBJECTIVE@#To observe clinical efficacy of back arm flexion and extension combined with manipulation in treating adhesive scapulohumeral periarthritis.@*METHODS@#From March 2016 to April 2018, 53 patients with adhesive scapulohumeral periarthritis were treated with back arm flexion and extension combined with manipulation, the main symptoms were shoulder pain and limited activity. There were 22 males and 31 females aged from 45 to 71 years old with an average of (51.63±5.79) years;the courses of disease ranged from 3 to 24 months with an average of (8.62±3.73) months. Manipulation treatment was carried out once a week, and back arm flexion and extension were performed for 3 times a day with15 movements each time, totally 4 weeks for a single course. Visual analogue scale (VAS) and Constant-Murley shoulder function score were observed and compared before treatment and one week, one and three months after treatment.@*RESULTS@#All patients were followed up from 3 to 12 months, with an average of (5.91±3.55) months. VAS score before treatment was 4.02±1.46, and was improved to 3.15±1.54, 1.98±1.37, 1.12±0.86 respectively at one week, one and three months after treatment. Constant-Murley score before treatment was 42.70 ±5.72, and improved to 54.25 ±6.34, 67.45 ±6.84, 82.40 ±6.63 at one week, one and three months after treatment respectively;19 patients got excellent result, 22 good, 9 fair and 3 poor.@*CONCLUSION@#Back arm flexion combined with manipulation for the treatment of adhesive scapulohumeral periarthritis could effectively relieve pain, improve shoulder function, which is a simple effective treatment strategy.

Clinical effect of manipulation therapy for the treatment of degenerative lumbar instability based on myofascial chain theory / 中国骨伤

OBJECTIVE@#To explore clinical effects of manipulation therapy in treating degenerative lumbar instability based on myofascial chain theory.@*METHODS@#Fifty-seven patients with degenerative lumbar spine instability were analyzed retrospectively from January 2018 to December 2019, and treated with massage manipulation therapy. Among them, 29 patients were treated with massage manipulation therapy based on the myofascial chain theory (myofascial chain group), including 14 males and 15 females, aged from 40 to 69 years old with an average of (51.76±5.07) years old, the courses of disease was (3.4±1.6) years. Twenty-eight patients were treated with massage manipulation therapy based on TCM meridian theory (TCM meridian group), including 12 males and 16 females, aged from 42 to 70 years old with an average of(52.48±4.31) years old, the courses of disease was (3.3±1.7) years. Before treatment, after treatment, 1 and 3 months after treatment, visual analogue scale (VAS) was used to evaluate pain degree of lumbar, Japanese Orthopaedic Association (JOA) and modified Oswestry Disability Index (ODI) were used to assess improvement of lumbar function, and changes of lumbar muscle tension were used to evaluate clinical effect.@*RESULTS@#VAS score, JOA score, modified ODI score and lumbar muscle tension after treatment were significantly improved than those of before treatment between two groups (@*CONCLUSION@#Manipulation therapyon in treating degenerative lumbar instability based on myofascial chain theory could effectively relieve low back pain symptom and improve lumbar function. It is worthy of promoting.

[Treatment of anterior glenohumeral dislocations with manual reduction of WU medical school].

OBJECTIVE: To investigate the technique, mechanism and clinical efficacy of manual reduction of WU medical school in the treatment of anterior glenohumeral dislocations. METHODS: From January 2016 to December 2017, 181 patients with anterior glenohumeral dislocations were treated with our manual reduction, including 71 males and 110 females, ranging in age from 19 to 94 years old, with a mean age of(61.1±16.3) years old; 68 cases of subglenoid type, 93 cases of subcoracoid type and 20 cases of subclavian type. Constant score was used to evaluate limb function while the external fixation was removed. RESULTS: One hundred and fifty-seven patients achieved reduction at the first attempt and 23 patients achieved at the second time. There was no vascular damage, nerve damage or iatrogenic fracture accmpanied. The Constant score ranged from 75 to 100, with a mean score of 92.1±4.3. One hundred and sixty-eight patients were followed up, and the duration ranged from 12 to 24 months, with an average of (16.1±3.2) months, no recurrent dislocation occurred during the follow up period. CONCLUSIONS: The manual reduction of WU medical school in the treatment of anterior glenohumeral dislocations has high success rate and low complication rate, which is scientific, safe, standardized, easy to learn and worth promoting.

[Finite element analysis of bending and standing manipulation in the treatment of lumbosacral joint disorder].

OBJECTIVE: To analyze the displacement, stress and mechanism of lumbosacral joint disorder patients after bending and standing manipulation in the finite element model. METHODS: A three-dimensional finite element model of a patient with lumbosacral joint disorder was established. The finite element analysis method was used to observe and analyze the three loading conditions of the model:axial, 34 degree inclined upward and vertical upward. RESULTS: In the lumbosacral joint disorder model, the L5 vertebral body was concentrated in the middle of the lower endplate, the intervertebral disc was concentrated in the center of the intervertebral disc, and the stress of S1 and related structures were concentrated in the anterior and posterior edges of the vertebral body. After simulated manipulation, stress mainly concentrated in the anterior, posterior and central circular areas of L5 vertebral upper endplate. The posterior structures of vertebral body concentrated in the ventral part of pedicle, isthmus and dorsal part of lamina. The stress of intervertebral disc dispersed in the posterior edge of vertebral body. Displacement results:In the lumbosacral joint disorder model, the left transverse process, the upper and lower articular process and the left part of spinous process were significantly displaced to the left, and the intervertebral disc was protruded forward. After simulated manipulation, the lower notch of L5 vertebral body moved forward and upward; the area of intervertebral foramen increased; the inferior articular process of L5 vertebral body moved forward; the superior articular process of sacrum moved forward and downward; the distance of articular process joints increased; and the displacement of sacrum concentrated on the posterior edge of vertebral body and the median sacral crest. CONCLUSIONS: Successful lumbosacral joint modeling can be carried out by finite element analysis, and the mechanism of bending and erecting manipulation is clear, which is effective and safe for the treatment of lumbosacral joint disorders.

Finite element analysis of bending and standing manipulation in the treatment of lumbosacral joint disorder / 中国骨伤

OBJECTIVE@#To analyze the displacement, stress and mechanism of lumbosacral joint disorder patients after bending and standing manipulation in the finite element model.@*METHODS@#A three-dimensional finite element model of a patient with lumbosacral joint disorder was established. The finite element analysis method was used to observe and analyze the three loading conditions of the model:axial, 34 degree inclined upward and vertical upward.@*RESULTS@#In the lumbosacral joint disorder model, the L₅ vertebral body was concentrated in the middle of the lower endplate, the intervertebral disc was concentrated in the center of the intervertebral disc, and the stress of S₁ and related structures were concentrated in the anterior and posterior edges of the vertebral body. After simulated manipulation, stress mainly concentrated in the anterior, posterior and central circular areas of L₅ vertebral upper endplate. The posterior structures of vertebral body concentrated in the ventral part of pedicle, isthmus and dorsal part of lamina. The stress of intervertebral disc dispersed in the posterior edge of vertebral body. Displacement results:In the lumbosacral joint disorder model, the left transverse process, the upper and lower articular process and the left part of spinous process were significantly displaced to the left, and the intervertebral disc was protruded forward. After simulated manipulation, the lower notch of L₅ vertebral body moved forward and upward; the area of intervertebral foramen increased; the inferior articular process of L₅ vertebral body moved forward; the superior articular process of sacrum moved forward and downward; the distance of articular process joints increased; and the displacement of sacrum concentrated on the posterior edge of vertebral body and the median sacral crest.@*CONCLUSIONS@#Successful lumbosacral joint modeling can be carried out by finite element analysis, and the mechanism of bending and erecting manipulation is clear, which is effective and safe for the treatment of lumbosacral joint disorders.

Comparison of the effect of operation and manipulation reduction on ankle fracture / 中国基层医药

Objective@#To compare the clinical effect of operation and manual reduction in the treatment of ankle fracture and provide guidance for clinical practice.@*Methods@#From March 2015 to March 2018, 88 cases of ankle fracture who admitted and treated in the People's Hospital of Xianju County were selected as the observation objects.Forty-eight patients in the operation group were treated with surgery.Forty cases in the manipulation group were treated by manipulation reduction.The two groups were followed up for half a year, and the rate of excellent and good reduction, hospitalization time, hospitalization cost, fracture healing time, excellent and good recovery rate of ankle joint function, ankle joint function score and incidence of complications were compared between the two groups.@*Results@#The positive and negative rate of reduction in the operation group was 93.75%(45/48), which was higher than 75.00%(30/40) in the manipulation group(χ2=6.092, P<0.05). The length and cost of hospitalization in the operation group were (17.56±3.12)d, (14 265.56±1 543.78)CNY, respectively, which in the manipulation group were (6.42±2.25)d, (2 565.56±487.69)CNY, respectively.There were statistically significant differences between the two groups(t=18.856, 46.019, all P<0.05). The healing time of fracture in the operation group was (9.12±1.25)weeks, which was shorter than that in the manipulation group[(11.56±2.36)weeks](t=6.200, P<0.05). There was no statistically significant difference in ankle function score between the two groups(P>0.05). The excellent and good rate of ankle function recovery in the operation group was 95.83%(46/48), which in the manipulation group was 92.50%(37/40), there was no statistically significant difference(P>0.05). The incidence rate of complications in the operation group was 14.58%(7/48), which was higher than that in the manipulation group [2.50%(1/40)](χ2=3.855, P<0.05).@*Conclusion@#The treatment of ankle fracture by operation and manual reduction has good results, both of which have advantages and disadvantages.The treatment cost of manual reduction is less than surgery, and the length of hospitalization is shorter than surgery.However, the fracture healing time is long, and a reasonable treatment plan can be developed in combination with the patients' condition and family economy.

Comparison of the effect of operation and manipulation reduction on ankle fracture / 中国基层医药

To compare the clinical effect of operation and manual reduction in the treatment of ankle fracture and provide guidance for clinical practice.Methods From March 2015 to March 2018,88 cases of ankle fracture who admitted and treated in the People＇s Hospital of Xianju County were selected as the observation objects.Forty-eight patients in the operation group were treated with surgery.Forty cases in the manipulation group were treated by manipulation reduction.The two groups were followed up for half a year ,and the rate of excellent and good reduction,hospitalization time, hospitalization cost , fracture healing time, excellent and good recovery rate of ankle joint function,ankle joint function score and incidence of complications were compared between the two groups . Results The positive and negative rate of reduction in the operation group was 93.75%(45／48),which was higher than 75.00%(30／40) in the manipulation group(χ2 ＝6.092,P＜0.05).The length and cost of hospitalization in the operation group were (17.56 ±3.12)d,(14 265.56 ±1 543.78)CNY,respectively,which in the manipulation group were (6.42 ±2.25) d, ( 2 565.56 ±487.69) CNY, respectively.There were statistically significant differences between the two groups(t＝18.856,46.019,all P＜0.05).The healing time of fracture in the operation group was (9.12 ±1.25)weeks,which was shorter than that in the manipulation group [(11.56 ±2.36)weeks](t＝6.200,P＜0.05).There was no statistically significant difference in ankle function score between the two groups (P＞0.05).The excellent and good rate of ankle function recovery in the operation group was 95.83%(46／48),which in the manipu-lation group was 92.50%(37／40),there was no statistically significant difference (P＞0.05).The incidence rate of complications in the operation group was 14.58%(7／48), which was higher than that in the manipulation group [2.50%(1／40)] (χ2 ＝3.855,P＜0.05).Conclusion The treatment of ankle fracture by operation and manual reduction has good results,both of which have advantages and disadvantages.The treatment cost of manual reduction is less than surgery,and the length of hospitalization is shorter than surgery.However,the fracture healing time is long, and a reasonable treatment plan can be developed in combination with the patients ＇condition and family economy.

Treatment of anterior glenohumeral dislocations with manual reduction of WU medical school / 中国骨伤

OBJECTIVE@#To investigate the technique, mechanism and clinical efficacy of manual reduction of WU medical school in the treatment of anterior glenohumeral dislocations.@*METHODS@#From January 2016 to December 2017, 181 patients with anterior glenohumeral dislocations were treated with our manual reduction, including 71 males and 110 females, ranging in age from 19 to 94 years old, with a mean age of(61.1±16.3) years old; 68 cases of subglenoid type, 93 cases of subcoracoid type and 20 cases of subclavian type. Constant score was used to evaluate limb function while the external fixation was removed.@*RESULTS@#One hundred and fifty-seven patients achieved reduction at the first attempt and 23 patients achieved at the second time. There was no vascular damage, nerve damage or iatrogenic fracture accmpanied. The Constant score ranged from 75 to 100, with a mean score of 92.1±4.3. One hundred and sixty-eight patients were followed up, and the duration ranged from 12 to 24 months, with an average of (16.1±3.2) months, no recurrent dislocation occurred during the follow up period.@*CONCLUSIONS@#The manual reduction of WU medical school in the treatment of anterior glenohumeral dislocations has high success rate and low complication rate, which is scientific, safe, standardized, easy to learn and worth promoting.

[Case-control study on the treatment of heel spur syndrome with modified stretching manipulation combined with needle Dao loosing].

OBJECTIVE: To study the clinical effects of modified plantar fascia stretching manipulation combined with needle Dao loosing in the treatment of heel spur syndrome. METHODS: From September 2010 to September 2015, 115 patients diagnosed as heel spur syndrome were divided into two groups: treatment group and control group. There were 58 patients in the treatment group, including 21 males and 37 females, ranging in age from 26 to 73 years old, with the course of disease from 6 to 51 months. The patients in the treatment group were treated with modified plantar fascia stretching manipulation combined with needle Dao loosing. There were 57 patients in the control group, including 22 males and 35 females, ranging in age from 31 to 75 years old, with the course of disease from 7 to 58 months. The patients in the control group were treated with traditonal stretching manipulation combined with needle Dao loosing. The NRS scores of heel pain were evaluated at the 1st week, 1 and 3 months after treatment; and the clinical effects of the two groups were evaluated with the Foot and Ankle Ability Measure(FAAM) scale evaluation system. RESULTS: The numerical rating scale(NRS) scores were 3.89±0.96 and 2.46±0.95 in the treatment group 1 month and 3 months after treatment, which were superior to 4.52±1.21 and 4.73±1.11 in the control group; and the FAAM rates in the treatment group were (3.89±0.96)% and(2.46±0.95)% separately 1 month and 3 months after treatment, which were better than (4.52±1.21)% and (4.73±1.11)% in the control group. The total curative effects of the treatment group were better than that of the control group. CONCLUSIONS: The modified plantar fascia stretching manipulation combined with needle Dao loosing can locate the traction point, which has a significant effect on the patients with heel spur syndrome. Compared with traditonal stretching manipulation combined with needle Dao loosing, this modified mainpulation combined with needle knife loosing has better medium to-long term effects.