不同体位下斜扳手法治疗腰椎间盘突出的三维有限元分析  

Three-dimensional finite element analysis of the oblique-pulling manipulation on lumbar disc herniation in different body positions

作　　者：卢钰 郑太才 王琪 张荆 程强 吉富涛 尹本敬 保超宇[1,2] 贾涛 李骥征 李具宝[1,2] Lu Yu;Zheng Taicai;Wang Qi;Zhang Jing;Cheng Qiang;Ji Futao;Yin Benjing;Bao Chaoyu;Jia Tao;Li Jizheng;Li Jubao(Yunnan University of Chinese Medicine,Kunming 650500,Yunnan Province,China;Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650021,Yunnan Province,China;Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming 650051,Yunnan Province,China)

机构地区：[1]云南中医药大学,云南省昆明市650500 [2]云南省中医医院,云南省昆明市650021 [3]昆明市中医医院,云南省昆明市650051

出　　处：《中国组织工程研究》2021年第36期5872-5877,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81860862,81460736),项目负责人:李具宝;云南省应用基础研究计划面上项目(2011FB146),项目负责人:李具宝;云南省中青年学术和技术带头人后备人才(云科人发[2019]7号),项目负责人:李具宝;云南省高层次中医药人才学科带头人及云南省卫生科技计划项目(2017NS161),项目负责人:李具宝。

摘　　要：背景:斜扳手法治疗腰椎间盘突出症疗效可靠,已被临床广泛应用,但是不同体位下斜扳手法的生物力学作用机制、疗效有何不同目前尚不明确。目的:利用三维有限元方法分析不同体位下斜扳手法治疗腰椎间盘突出症的生物力学机制及其作用效果,从而优化手法治疗的操作方案,指导提高临床疗效。方法:采集腰椎间盘突出症患者腰椎CT数据,利用Mimics和Ansys软件建立脊柱L4-5运动单元的三维有限元模型。分别模拟斜扳手法作用于前屈30°、水平0°和后伸10°3种不同体位状态,分析不同体位下斜扳手法对椎间盘包括髓核和纤维环应力的影响,以及椎间盘与神经根之间位移的变化情况。结果与结论:(1)在前屈30°、水平0°和后伸10°3种不同体位斜扳手法作用下,腰椎间盘髓核内应力均明显减小,且后伸10°时减小最为明显;(2)在前屈30°、水平0°和后伸10°3种不同体位斜扳手法作用下,纤维环应力均增大,且在后伸10°时纤维环应力增加最大;(3)前屈30°体位时,在斜扳手法力矩作用下,椎间盘后外侧与神经根之间位移增大,可能更有利于缓解神经根压迫产生的症状;但在后伸10°体位下,椎间盘与神经根之间位移减小,可能不利于缓解神经根压迫产生的症状。BACKGROUND:Oblique-pulling manipulation showed great effectiveness in treating patients with lumbar disc herniation,and had been extensively used in clinic;however,the biomechanics and efficacy of the oblique-pulling manipulation in different positions are still undefined.OBJECTIVE:To analyze the biomechanical effect of the oblique-pulling manipulation in different body positions of lumbar disc herniation using threedimensional finite element,so as to guide its treatment and associated clinical work.METHODS:A three-dimensional finite element model of L4-5 was developed from the CT scan images of a volunteer.The oblique-pulling manipulation was simulated to study the influence in different positions(anteflexion 30°,neutral position 0°and extension 10°)on the stress on the intervertebral disc,including the nucleus pulposus and annulus fibrosus,and the changes in the displacement between the intervertebral disc and the nerve root under the oblique-pulling manipulation.RESULTS AND CONCLUSION:(1)Under the oblique-pulling manipulation in different body positions:anteflexion 30°,neutral position 0°,and extension 10°,the stress in the intervertebral disc nucleus pulposus was significantly reduced;the most obvious reduction occurred when the extension was 10°.(2)Under the oblique-pulling manipulation in different body positions:anteflexion 30°,neutral position 0°,and extension 10°,the stress on the annulus was increased;the most obvious increase occurred when the extension was 10°.(3)When anteflexion was 30°,the disc was far away from the nerve root under oblique-pulling manipulation,which helps to relieve the symptoms of nerve compression.However,in the extension of 10°,the opposite is true.

关 键 词：腰椎 运动节段 三维有限元 斜扳手法 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]