颈椎定位旋转扳法对不同曲度颈椎内部结构应力的影响  

Effect of cervical fixed-position rotary pulling manipulation on internal structure stresses of cervical vertebrae with different curvature

作　　者：沈知彼[1] 王辉昊[1] 王宽[1] 邓真[1] 陈威烨[1] 詹红生[1] SHEN Zhibi;WANG Huihao;WANG Kuan;DENG Zhen;CHEN Weiye;ZHAN Hongsheng(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,The Institute of Traumatology and Orthopedics Affiliated to Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海市中医药研究院骨伤科研究所,上海201203

出　　处：《中医正骨》2018年第3期8-12,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81473702,81503596,81202707,81001528);上海市科学技术委员会科研计划项目(14401970402,16401970102,15401934100);上海市卫生和计划生育委员会项目(2017ZZ02024,20170242,ZXYXZ201703,ZYKC201602006,ZY3-LCPT-2-1005);上海市市级医院新兴前沿技术联合攻关项目(SHDC12014121);詹红生上海市名老中医学术经验研究工作室建设项目(SHGZS-2017025,SZYMZYGZS4013)

摘　　要：目的:观察颈椎定位旋转扳法对不同曲度颈椎内部结构应力的影响。方法:基于可靠的正常颈椎有限元模型(正常模型),结合1例颈椎曲度变直患者和1例颈椎反弓患者的颈椎CT图像,建立曲度变直颈椎有限元模型(变直模型)和反弓颈椎有限元模型(反弓模型)。模拟右侧颈椎定位旋转扳法,分别加载于正常模型、变直模型和反弓模型,观察3种模型椎间盘、韧带、关节软骨和终板的应力特征。结果:(1)颈椎椎间盘应力分布。正常模型椎间盘应力主要集中于C_(6~7)和C_7T_1椎间盘右侧纤维环,变直模型椎间盘应力主要集中于C_(2~3)椎间盘左侧纤维环,反弓模型椎间盘应力主要集中于C_(2~3)、C_(3~4)、C_(4~5)椎间盘右侧纤维环;3种模型椎间盘最高应力均集中于下段颈椎椎间盘纤维环,其中正常模型最高应力集中于C_6~C_7右侧钩椎关节处,变直模型和反弓模型最高应力集中区域分别为C_7~T_1左侧钩椎关节处和C_5~C_6左侧钩椎关节处;反弓模型椎间盘最高应力值最大,变直模型次之,正常模型最小。(2)颈椎主要韧带应力分布。正常模型韧带应力主要集中于C_2~C_3、C_3~C_4、C_4~C_5双侧关节囊韧带及横韧带,最高应力集中于C_3~C_4右侧关节囊韧带;变直模型韧带应力主要集中于寰枕后韧带、前纵韧带(寰枕节段)、横韧带,最高应力集中于齿突尖韧带;反弓模型韧带应力主要集中于下颈段右侧关节囊韧带、上颈段左侧关节囊韧带、横韧带,最高应力集中于寰枕后韧带。(3)颈椎关节软骨应力分布。3种模型关节软骨应力均主要集中于寰枕关节两侧,最高应力均集中于寰枢关节软骨,正常模型和反弓模型应力主要集中区域、最高应力集中区域位于右侧,变直模型应力主要集中区域、最高应力集中区域位于左侧;反弓模型关节软骨最高应力值最大,变直模型次之,正常模型最小。(4)颈椎终板应力分布。正常模型To observe the effect of cervical fixed-position rotatry pulling manipulation on internal structure stresses of cervical vertebrae with different curvature.Methods:A finite element model of cervical vertebrae with straightened physiological-curvature(straightened model)and a finite element model of cervical vertebrae with reversed physiological-curvature(reversed model)were created by using a reliable finite element model of normal cervical vertebrae(normal model)and the CT images of cervical vertebrae with straightened physiological-curvature and reversed physiological-curvature respectively.The loads,which simulated the cervical fixed-position rotatry pulling manipulation on the right side,were exerted on normal model,straightened model and reversed model.The stress characteristics of intervertebral disc,ligament,articular cartilage and endplate of the 3 kinds of models were observed.Results:The intervertebral disc stresses of normal model,straightened model and reversed model concentrated mainly on the right fibrous rings of C6/C7 and C1/rYl intervertebral discs,the left fibrous ring of C2/C3 intervertebral disc and the right fibrous rings of C2/C3,C3/C4 and C4/C5 intervertebral discs respectively.The highest stress of intervertebral discs of the 3 kinds of models concentrated on fibrous rings of intervertebral discs of lowercervical vertebrae.The highest stress of intervertebral discs of normal m odel,straightened model and reversed model concentrated on right C6/C7 uncovertebral joint,left C1/rYl uncovertebral joint and left C5/C6 uncovertebral joint respectively.The intervertebral disc had high-tolow highest stress value in reversed m odel,straightened model and normal model in turn.The ligament stresses of normal model concentrated mainly on bilateral articular capsule ligaments and transverse ligaments at C2/C3,C3/C4 and C4/C5 segm ents,and the highest stress concentrated on right articular capsule ligament at C3/C4 segment.The ligament stresses of straightened model concentrated mainly on posterior occip

关 键 词：颈椎 手法 整骨 扳法 应力 物理 有限元分析 

分 类 号：R244.1[医药卫生—针灸推拿学]