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[1]吳周統(tǒng),周紅海,蘇少亭,等.腰椎定點(diǎn)旋轉(zhuǎn)手法治療L4～S1雙節(jié)段腰椎間盤突出癥力學(xué)效應(yīng)的三維有限元分析[J].中醫(yī)正骨,2024,36(10):1-9,38.
　WU Zhoutong,ZHOU Honghai,SU Shaoting,et al.Biomechanical effects of lumbar fixed-point rotation manipulation in treatment of lumbar disc herniation at L4-S1 segments:a three-dimensional finite element analysis-based biomechanical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(10):1-9,38.
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腰椎定點(diǎn)旋轉(zhuǎn)手法治療L4～S1雙節(jié)段腰椎間盤突出癥力學(xué)效應(yīng)的三維有限元分析()
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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10期
頁碼:
1-9,38
欄目:
基礎(chǔ)研究
出版日期:
2024-10-20

文章信息/Info

Title:
Biomechanical effects of lumbar fixed-point rotation manipulation in treatment of lumbar disc herniation at L4-S1 segments:a three-dimensional finite element analysis-based biomechanical study
作者:
吳周統(tǒng); 周紅海; 蘇少亭; 陸延; 劉糧酺
廣西中醫(yī)藥大學(xué)骨傷學(xué)院,廣西 南寧 530001
Author(s):
WU Zhoutong; ZHOU Honghai; SU Shaoting; LU Yan; LIU Liangpu
College of Orthopaedics and Traumatology of Guangxi University of Chinese Medicine,Nanning 530001,Guangxi,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  限定因素分析;  正骨推拿療法;  生物力學(xué)現(xiàn)象
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  finite element analysis;  bone setting tui na therapy;  biomechanical phenomena
摘要:
目的:分析腰椎定點(diǎn)旋轉(zhuǎn)手法治療L4～S1雙節(jié)段腰椎間盤突出癥(lumbar disc herniation,LDH)的力學(xué)效應(yīng)。方法:提取1名健康成年男性志愿者脊柱L4～S1段的CT薄層掃描數(shù)據(jù),建立正常脊柱L4～S1節(jié)段三維有限元模型,并進(jìn)行有效性驗(yàn)證。基于建立的正常脊柱L4～S1節(jié)段三維有限元模型,通過調(diào)整椎間盤高度和髓核體積及修改髓核和纖維環(huán)的材料屬性模擬椎間盤退變,建立L4～S1雙節(jié)段LDH(左旁中央型)三維有限元模型。在建立的L4～S1雙節(jié)段LDH三維有限元模型上,模擬腰椎定點(diǎn)旋轉(zhuǎn)手法操作,并以拇指推頂位置為條件,建立2種操作模式(拇指推頂于L4棘突上為M1,拇指推頂于L5棘突上為M2)。分析腰椎定點(diǎn)旋轉(zhuǎn)手法2種操作模式下,L4～S1雙節(jié)段LDH三維有限元模型整體應(yīng)力變化情況,L4～5和L5S1椎間盤纖維環(huán)與髓核的應(yīng)力和位移情況,以及L4～5和L5S1關(guān)節(jié)突關(guān)節(jié)軟骨接觸力與應(yīng)變情況。結(jié)果:①正常脊柱L4～S1節(jié)段三維有限元模型的建立與驗(yàn)證結(jié)果。建立的正常脊柱L4～S1節(jié)段三維有限元模型共有508 705個(gè)節(jié)點(diǎn)、318 640個(gè)單元,經(jīng)驗(yàn)證可用于進(jìn)一步研究。②L4～S1雙節(jié)段LDH三維有限元模型整體應(yīng)力測定結(jié)果。M1操作模式下,模型整體應(yīng)力最大為16.85 MPa,主要集中于L4～5、L5S1的上下軟骨終板和L5椎體,以及L4～5、L5S1關(guān)節(jié)突關(guān)節(jié); M2操作模式下,模型整體應(yīng)力最大為15.02 MPa,主要集中于L4～5、L5S1關(guān)節(jié)突關(guān)節(jié)和L4椎弓根,以及L5雙側(cè)椎板。③椎間盤纖維環(huán)應(yīng)力與位移測定結(jié)果。M1操作模式下,L4～5和L5S1纖維環(huán)的最大等效應(yīng)力分別為4.3 MPa、3.8 MPa,L4～5纖維環(huán)向左、向前、向上的最大位移分別為0.31 mm、0.24 mm、1.20 mm,L5S1纖維環(huán)向左、向前、向上的最大位移分別為0.20 mm、0.23 mm、1.10 mm; M2操作模式下,L4～5和L5S1纖維環(huán)的最大等效應(yīng)力分別為4.2 MPa、3.7 MPa,L4～5纖維環(huán)向左、向前、向上的最大位移分別為0.35 mm、0.24 mm、1.10 mm,L5S1纖維環(huán)向左、向前、向上的最大位移分別為0.32 mm、0.22 mm、1.00 mm。④椎間盤髓核應(yīng)力與位移測定結(jié)果。M1操作模式下,L4～5和L5S1髓核的最大等效應(yīng)力分別為0.35 MPa、0.32 MPa,L4～5髓核向左、向前、向上的最大位移分別為0.10 mm、0.46 mm、0.41 mm,L5S1髓核向左、向前、向上的最大位移分別為0.08 mm、0.40 mm、0.40 mm; M2操作模式下,L4～5和L5S1髓核的最大等效應(yīng)力分別為0.34 MPa、0.31 MPa,L4～5髓核向左、向前、向上的最大位移分別為0.23 mm、0.46 mm、0.41 mm,L5S1髓核向左、向前、向上的最大位移分別為0.09 mm、0.45 mm、0.40 mm。⑤關(guān)節(jié)突關(guān)節(jié)軟骨接觸力與應(yīng)變測定結(jié)果。M1操作模式下,L4～5左右側(cè)關(guān)節(jié)突關(guān)節(jié)軟骨最大接觸力分別為17.0 MPa、15.8 MPa,最大應(yīng)變值分別為0.34%、0.32%; L5S1左右側(cè)關(guān)節(jié)突關(guān)節(jié)軟骨最大接觸力分別為9.7 MPa、9.4 MPa,最大應(yīng)變值分別為0.33%、0.27%。M2操作模式下,L4～5左右側(cè)關(guān)節(jié)突關(guān)節(jié)軟骨最大接觸力分別為15.0 MPa、13.0 MPa,最大應(yīng)變值分別為0.31%、0.27%; L5S1左右側(cè)關(guān)節(jié)突關(guān)節(jié)軟骨最大接觸力分別為10.0 MPa、8.4 MPa,最大應(yīng)變值分別為0.29%、0.24%。結(jié)論:腰椎定點(diǎn)旋轉(zhuǎn)手法治療L4～S1雙節(jié)段LDH,可使L4～5和L5S1椎間盤產(chǎn)生一定的應(yīng)力變化和位移,促進(jìn)關(guān)節(jié)突關(guān)節(jié)滑動(dòng); 且手法操作時(shí)拇指推頂于L4棘突,力學(xué)效應(yīng)更明顯。
Abstract:
Objective:To analyze the biomechanical effects of lumbar fixed-point rotation manipulation in treating lumbar disc herni-ation(LDH)at L4-S1 segments.Methods:The CT thin-slice scan data of the L4-S1 segments of the spine in a healthy adult male volunteer was extracted.Based on the CT scanning data,a three-dimensional(3D)finite element model of the L4-S1 segments of normal spine was established,and the validity of the model was verified.Based on the established 3D finite element model of the L4-S1 segment of normal spine,a 3D finite element model of LDH at L4-S1 segments(left paracentral type)was established by adjusting the height of the intervertebral disc and the volume of the nucleus pulposus,as well as modifying the material properties of the nucleus pulposus and annulus fibrosus to simulate intervertebral disc degeneration,then the lumbar fixed-point rotation manipulation was simulated on the established 3D finite element model of LDH at L4-S1 segments in two modes that built based on the thumb tip-pushing position(M1:the thumb tip-pushing on the L4 spinous process; M2:the thumb tip-pushing on the L5 spinous process).Furthermore,the biomechanical changes,including the overall stress changes of the 3D finite element model of LDH at L4-S1 segments,the stress and displacement of the annulus fibrosus and nucleus pulposus of L4-5 and L5S1 intervertebral discs,as well as the contact force and strain of the articular cartilages of L4-5 and L5S1 zygapophyses,under the two modes of lumbar fixed-point rotation manipulation were analyzed.Results:①The establishment and verification of the 3D finite element model of the L4-S1 segments of the normal spine.The established 3D finite element model of the L4-S1 segments of the normal spine consisted of 508 705 nodes and 318 640 elements,and could be used for further research.②The overall stress of the 3D finite element model of LDH at L4-S1 segments.In the M1 mode,the maximum overall stress of the model was 16.85 MPa,and mainly concentrated on the upper and lower cartilage endplates of L4-5 and L5S1,the vertebral body of L5,and the zygapophyseal joints of L4-5 and L5S1.In the M2 mode,the maximum overall stress of the model was 15.02 MPa,and mainly concentrated on the zygapophyseal joints of L4-5 and L5S1,the pedicle of L4,and the bilateral laminae of L5.③Stress and displacement of intervertebral disc annulus fibrosus.In the M1 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc annulus fibrosus was 4.3 and 3.8 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc annulus fibrosus was 0.31,0.24,and 1.20 mm,respectively,and that of the L5S1 was 0.20,0.23,and 1.10 mm,respectively.In the M2 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc annulus fibrosus was 4.2 and 3.7 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc annulus fibrosus was 0.35,0.24,and 1.10 mm,respectively,and that of the L5S1 was 0.32,0.22,and 1.00 mm,respectively.④Stress and displacement of intervertebral disc nucleus pulposus.In the M1 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc nucleus pulposus was 0.35 and 0.32 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc nucleus pulposus was 0.10,0.46,and 0.41 mm,respectively,and that of the L5S1 was 0.08,0.40,and 0.40 mm,respectively.In the M2 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc nucleus pulposus was 0.34 and 0.31 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc nucleus pulposus was 0.23,0.46,and 0.41 mm,respectively,and that of the L5S1 was 0.09,0.45,and 0.40 mm,respectively.⑤Contact force and strain of the zygapophysial articular cartilages.In the M1 mode,the articular cartilages of the left and right zygapophyses at L4-5 segment showed the maximum contact force of 17.0 and 15.8 MPa,and the maximum strain values of 0.34% and 0.32%,respectively,and that of L5S1 showed the maximum contact force of 9.7 and 9.4 MPa,and the maximum strain values of 0.33% and 0.27%,respectively.In the M2 mode,the articular cartilages of the left and right zygapophyses at L4-5 segment showed the maximum contact force of 15.0 and 13.0 MPa,and the maximum strain value of 0.31% and 0.27%,respectively,and that of L5S1 showed the maximum contact force of 10.0 and 8.4 MPa,and the maximum strain value of 0.29% and 0.24%,respectively.Conclusion:The lumbar fixed-point rotation manipulation in treating LDH at L4-S1 segments can induce certain stress changes and displacement in the L4-5 and L5S1 intervertebral discs,which promot the sliding of zygapophyseal joints.The biomechanical effects are stronger if the thumb pushes on the L4 spinous process in the process of manipulation.

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備注/Memo

備注/Memo:
基金項(xiàng)目:國家自然科學(xué)基金項(xiàng)目(81660800); 廣西高校中青年學(xué)科帶頭人項(xiàng)目(RC20061005009); 廣西中醫(yī)藥大學(xué)國醫(yī)大師韋貴康學(xué)術(shù)思想與臨床診療傳承發(fā)展研究中心建設(shè)項(xiàng)目(2022V001)
通訊作者:周紅海 E-mail:[email protected]
更新日期/Last Update: 1900-01-01