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[1]丘明旺,孫玫瑤,吳耿佳,等.腰椎立體定位斜扳法與傳統(tǒng)腰椎斜扳法對椎間盤及關(guān)節(jié)突關(guān)節(jié)軟骨影響的有限元分析[J].中醫(yī)正骨,2024,36(01):14-22.
　QIU Mingwang,SUN Meiyao,WU Gengjia,et al.Effects of lumbar stereotaxic oblique-pulling manipulation versus traditional oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints:a finite element analysis-based biomechanical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(01):14-22.
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腰椎立體定位斜扳法與傳統(tǒng)腰椎斜扳法對椎間盤及關(guān)節(jié)突關(guān)節(jié)軟骨影響的有限元分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年01期
頁碼:
14-22
欄目:
基礎(chǔ)研究
出版日期:
2024-01-20

文章信息/Info

Title:
Effects of lumbar stereotaxic oblique-pulling manipulation versus traditional oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints:a finite element analysis-based biomechanical study
作者:
丘明旺1; 孫玫瑤2; 吳耿佳2; 黃帆3; 劉嘉俊2; 盧曼琪2; 劉峴4; 嚴兆賢4; 趙思怡5; 田強4; 吳山4; 范志勇4
1.廣州中醫(yī)藥大學第二臨床醫(yī)學院,廣東 廣州 510405; 2.廣州中醫(yī)藥大學針灸康復臨床醫(yī)學院,廣東 廣州 510405; 3.香港理工大學康復科學系,香港 999077; 4.廣東省中醫(yī)院,廣東 廣州 510120; 5.深圳市龍崗區(qū)第五人民醫(yī)院,廣東 深圳 518111
Author(s):
QIU Mingwang1; SUN Meiyao2; WU Gengjia2; HUANG Fan3; LIU Jiajun2; LU Manqi2; LIU Xian4; YAN Zhaoxian4; ZHAO Siyi5; TIAN Qiang4; WU Shan4; FAN Zhiyong4
1.The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China 2.Clinical Medical College of Acupuncture Moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou510405,Guangdong,China 3.Department of Rehabilitation Sciences,The Hong Kong Polytechnic University,Hong Kong 999077,China 4.Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,Guangdong,China 5.The Fifth People's Hospital of Longgang District,Shenzhen 518111,Guangdong,China
關(guān)鍵詞:
推拿療法;  有限元分析;  椎間盤移位;  腰椎;  生物力學
Keywords:
tui na therapy;  finite element analysis;  intervertebral disc displacement;  lumbar vertebrae;  biomechanics
摘要:
目的:分析腰椎立體定位斜扳法與傳統(tǒng)腰椎斜扳法對椎間盤及關(guān)節(jié)突關(guān)節(jié)軟骨的影響。方法:選取1例成年男性L4～5椎間盤突出癥患者(椎間盤向左后方突出),采用西門子Light Speed 64排螺旋CT進行腰椎和骨盆掃描,層厚0.5 mm。基于CT掃描數(shù)據(jù),應用三維有限元建模軟件建立腰椎-骨盆三維有限元模型,通過與文獻數(shù)據(jù)比較驗證模型有效性后,分析腰椎立體定位斜扳法與傳統(tǒng)腰椎斜扳法作用下腰椎-骨盆整體應力、L4～5椎間盤應力和位移、L4～5關(guān)節(jié)突關(guān)節(jié)軟骨應力和位移、L4～5上下關(guān)節(jié)突表面中心點相對空間距離。結(jié)果:①腰椎-骨盆三維有限元模型建立及驗證結(jié)果。建立的腰椎-骨盆三維有限元模型共有 550 215 個節(jié)點、344 359個單元,高度模擬了腰椎-骨盆的結(jié)構(gòu)與材料特性。在模擬加載條件下,L4～5節(jié)段屈伸、側(cè)屈、軸向旋轉(zhuǎn)活動范圍與文獻中的既往研究結(jié)果基本相同。②模型整體應力。實施傳統(tǒng)腰椎斜扳法時,腰椎-骨盆三維有限元模型最大應力為5.31 MPa,主要集中于L1、L2、L4、L5椎體; 實施腰椎立體定位斜扳法時,腰椎-骨盆三維有限元模型最大應力為29.30 MPa,主要集中于L1、L2椎體及L3、L4、L5椎弓根。③L4～5椎間盤應力及位移。實施傳統(tǒng)腰椎斜扳法時,L4～5椎間盤纖維環(huán)平均等效應力為 1.12 MPa,纖維環(huán)整體向左、向前、向下發(fā)生位移,平均位移分別為0.36 mm、0.20 mm、0.05 mm; 髓核平均等效應力為0.02 MPa,髓核整體向左、向前、向下發(fā)生位移,平均位移分別為0.35 mm、0.24 mm、0.06 mm。實施腰椎立體定位斜扳法時,L4～5椎間盤纖維環(huán)平均等效應力為1.14 MPa,纖維環(huán)整體向左、向前、向下發(fā)生位移,平均位移分別為0.39 mm、1.30 mm、0.05 mm; 髓核平均等效應力為0.02 MPa,髓核整體向左、向前、向下發(fā)生位移,平均位移分別為0.38 mm、1.30 mm、0.07 mm。④L4～5關(guān)節(jié)突關(guān)節(jié)軟骨應力及位移。實施傳統(tǒng)腰椎斜扳法時,L4～5左側(cè)和右側(cè)關(guān)節(jié)突關(guān)節(jié)軟骨平均等效應力分別為2.46 MPa、3.18 MPa,平均位移分別為1.10 mm、0.21 mm; 實施腰椎立體定位斜扳法時,L4～5左側(cè)和右側(cè)關(guān)節(jié)突關(guān)節(jié)軟骨平均等效應力分別為2.70 MPa、3.22 MPa,平均位移分別為1.46 mm、0.65 mm。⑤L4～5上下關(guān)節(jié)突表面中心點相對空間距離。實施傳統(tǒng)腰椎斜扳法時,L4～5左、右側(cè)上下關(guān)節(jié)突表面中心點相對空間距離分別為0.75 mm、0.34 mm; 實施腰椎立體定位斜扳法時,L4～5左、右側(cè)上下關(guān)節(jié)突表面中心點相對空間距離分別為0.81 mm、0.23 mm。結(jié)論:腰椎立體定位斜扳法與傳統(tǒng)腰椎斜扳法均能使腰椎間盤突出癥患者病變節(jié)段椎間盤及關(guān)節(jié)突關(guān)節(jié)軟骨產(chǎn)生一定的應力和位移; 相較于傳統(tǒng)腰椎斜扳法,腰椎立體定位斜扳法能使病變節(jié)段椎間盤和關(guān)節(jié)突關(guān)節(jié)軟骨產(chǎn)生更大的應力和位移,這也可能是腰椎立體定位斜扳法比傳統(tǒng)腰椎斜扳法治療腰椎間盤突出癥療效更佳的原因。
Abstract:
Objective:To compare and analyze the effects of lumbar stereotaxic oblique-pulling manipulation versus traditional lumbar oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints.Methods:One male adult with L4-5 intervertebral disc herniation(herniated to left rear)was selected for lumbar spine and pelvis scanning by using a Siemens Light Speed 64-slice spiral CT,with a slice thickness of 0.5 mm.Based on the CT scanning data,a three-dimensional(3D)finite element model of lumbar spine-pelvis was established by using a 3D finite element modeling software.After verifying the validity of the model by comparing with the article data,the overall stress of the lumbar spine-pelvis model,the stresses and displacements of the L4-5 intervertebral disc and articular cartilage of L4-5 zygapophysial joint,and the relative spatial distance between the central points of upper and lower articular process surfaces at L4～5 segment under the action of stereotaxic oblique-pulling manipulation and traditional oblique-pulling manipulation were recorded and analyzed.Results:①The established lumbar spine-pelvis 3D finite element model consisted of 550 215 nodes and 344 359 elements,which highly simulated the structure and material properties of the lumbar spine-pelvis.Under the simulated loading conditions,the range of motion(ROM),including flexion-extension,lateroflexion,and axial rotation,of the L4-5 segment were basically the same as the results previously reported.②When the traditional oblique-pulling manipulation was performed on the lumbar spine-pelvis 3D finite element model,the maximum stress of the model was 5.31 MPa,and mainly concentrated on the L1,L2,L4,and L5 vertebrae; while when the stereotaxic oblique-pulling manipulation was implemented,the maximum stress of the model was 29.30 MPa,and mainly on L1 and L2 vertebrae as well as the L3,L4,and L5 vertebral pedicles.③Under the action of traditional lumbar oblique-pulling manipulation,the annulus fibrosus of L4-5 intervertebral disc showed the average equivalent stress as 1.12 MPa,and the whole annulus fibrosus displaced leftward,forward,and downward,with an average displacement of 0.36,0.20,and 0.05 mm,respectively; the nucleus pulposus showed the average equivalent stress as 0.02 MPa,and the whole nucleus pulposus displaced leftward,forward,and downward,with an average displacement of 0.35,0.24,and 0.06 mm,respectively.While,under the stereotaxic oblique-pulling manipulation,the annulus fibrosus of L4-5 intervertebral disc exhibited the average equivalent stress as 1.14 MPa,and the whole annulus fibrosus displaced leftward,forward,and downward,with an average displacement of 0.39,1.30,and 0.05 mm,respectively; the nucleus pulposus exhibited the average equivalent stress as 0.02 MPa,and the whole nucleus pulposus displaced leftward,forward,and downward,with an average displacement of 0.38,1.30,and 0.07 mm,respectively.④In the case of the traditional oblique-pulling manipulation,the articular cartilage of zygapophysial joint at L4-5 showed the average equivalent stresses as 2.46 and 3.18 MPa and the average displacements as 1.10 and 0.21 mm on the left side and right side,respectively.While,in the case of the stereotaxic oblique-pulling manipulation,the average equivalent stresses were 2.70 and 3.22 MPa and the average displacements were 1.46 and 0.65 mm on the left side and right side,respectively.⑤The relative spatial distances between the central points of the upper and lower articular process surfaces on the left side and right side at L4-5 were 0.75 and 0.34 mm in the case of traditional oblique-pulling manipulation,and 0.81 and 0.23 mm in the case of stereotaxic oblique-pulling manipulation.Conclusion:Both lumbar stereotaxic oblique-pulling manipulation and traditional lumbar oblique-pulling manipulation can cause stress and displacement in intervertebral discs and articular cartilage of zygapophysial joints of the affected segment in patients with lumbar disc herniation.Compared with the latter,the former can cause greater stress and displacement,which may be the reason why the former behaves better than the latter in the outcome in treating lumbar disc herniation.

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備注/Memo

備注/Memo:
基金項目:廣東省中醫(yī)藥局科研項目(20212093); 廣東省中醫(yī)院林氏正骨推拿流派傳承工作室建設(shè)項目
通訊作者:范志勇 E-mail:[email protected]
更新日期/Last Update: 1900-01-01