基于仿真技术比较脉冲激励手法和振荡激励手法治疗腰椎疾患的有效性和安全性  

A comparison of clinical efficacy and safety of pulse excitation manipulation and oscillation excitation manipulation for treatment of lumbar vertebral diseases based on simulation technology

作　　者：张延海 吕杰 杨戈尔 徐军 张培茗 吕强[3] 周楠[3] 郭婧 饶兰 张存亮 ZHANG Yanhai;LYU Jie;YANG Geer;XU Jun;ZHANG Peiming;LYU Qiang;ZHOU Nan;GUO Jing;RAO Lan;ZHANG Cunliang(School of Medical Instrument and Food Engineering of University of Shanghai for Science and Technology,Shanghai 200093,China;School of Medical Instruments of Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海理工大学医疗器械与食品学院,上海200093 [2]上海健康医学院医疗器械学院,上海201318 [3]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中医正骨》2020年第6期1-6,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81574096)。

摘　　要：目的:比较脉冲激励手法与振荡激励手法治疗腰椎疾患的有效性与安全性。方法:选择1名无腰椎疾患的健康志愿者。由2位推拿医生分别对志愿者实施腰椎调整手法,其中一位采用作用力为脉冲力的脉冲激励手法,另一位采用作用力为振荡力的振荡激励手法。通过T4500高敏度触觉压力测量系统采集手法实施过程中的作用力,并进行归一化处理,使2种手法作用力的最大值保持一致。假设腰椎椎体为刚体,椎间盘、韧带等周围软组织作为连接刚体的弹簧和阻尼器,建立五自由度振动系统腰椎生物力学模型,归一化的作用力作为模型的输入载荷。运用Matlab/Simulink仿真技术,模拟得到腰椎各节段在2种手法作用下的轴向位移和轴向加速度随时间变化的情况,并进行比较。结果:脉冲激励手法作用时,L1~L5节段轴向最大位移的绝对值分别为0.1541m、0.1233m、0.0925m、0.0617m、0.0309m,轴向最大加速度的绝对值分别为3.7212m·s^-2、2.9403m·s^-2、2.2067m·s^-2、1.4444m·s^-2、0.7310m·s^-2;振荡激励手法作用时,L1~L5节段轴向最大位移的绝对值分别为0.1600m、0.1281m、0.0961m、0.0641m、0.0320m,轴向最大加速度的绝对值分别为2.7883m·s^-2、2.2431m·s^-2、1.6349m·s^-2、1.1251m·s^-2、0.5361m·s^-2。在2种手法作用时,L1~L5节段的轴向最大位移绝对值相当;在脉冲激励手法作用时,L1~L5节段的轴向最大加速度绝对值均明显高于振荡激励手法。结论:采用手法治疗腰椎疾患时,在最大作用力保持一致的情况下,脉冲激励手法和振荡激励手法的有效性几乎一致,但振荡激励手法更加安全。Objective:To compare the clinical efficacy and safety of pulse excitation manipulation versus oscillation excitation manipulation in treatment of lumbar vertebral diseases.Methods:A healthy volunteer without lumbar vertebral diseases was selected.The lumbar vertebrae adjustment was performed on the volunteer by two massagists using pulse excitation manipulation and oscillation excitation manipulation respectively.The acting forces were measured by using T4500 high-sensitivity tactile pressure measuring system during the implementation of the manipulation,and were normalized to make the maximum acting force of the two manipulations in consistency with each other.A five-degree-freedom vibration biomechanical model of lumbar vertebrae was built by assuming lumbar vertebral body as rigid-body and assuming surrounding soft tissues including intervertebral discs and ligaments as spring and damper which served as connection of rigid bodies.The normalized acting forces served as the input load of the model.The time-dependent changes of axial displacements and axial acceleration of each segment of lumbar vertebrae under the action of pulse excitation manipulation and oscillation excitation manipulation were measured by using Matlab/Simulink simulation technology,and were compared between the 2 kinds of manipulations.Results:The absolute values of the maximum axial displacement of lumbar vertebrae from L 1 to L 5 were 0.1541,0.1233,0.0925,0.0617 and 0.0309 metres respectively,and the absolute values of the maximum axial acceleration were 3.7212,2.9403,2.2067,1.4444 and 0.7310 m/s(2)respectively under the action of pulse excitation manipulation.The absolute values of the maximum axial displacement of lumbar vertebrae from L 1 to L 5 were 0.1600,0.1281,0.0961,0.0641 and 0.0320 metres respectively,and the absolute values of the maximum axial acceleration were 2.7883,2.2431,1.6349,1.1251 and 0.5361 m/s(2)respectively under the action of oscillation excitation manipulation.The two kinds of manipulations were similar to each oth

关 键 词：手法 捏脊 脉冲 振荡 生物力学 仿真 

分 类 号：R681.57[医药卫生—骨科学]