不同角度肘按法对正常人腰椎椎体及后部结构的应力和位移分析  

Stress and displacement of normal lumbar vertebra and posterior structure with different elbow pressing methods

作　　者：吕倩忆 陈芯仪 郑慧娥 何灏龙 李棋龙 陈楚淘[1] 田浩梅[1] LüQianyi;Chen Xinyi;Zheng Huie;He Haolong;Li Qilong;Chen Chutao;Tian Haomei(Hunan University of Chinese Medicine,Changsha 410208,Hunan Province,China)

机构地区：[1]湖南中医药大学,湖南省长沙市410208

出　　处：《中国组织工程研究》2022年第9期1346-1350,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(81874508),项目负责人:田浩梅;湖南省教育厅科学研究项目(19K068),项目负责人:陈楚淘;2015年度推拿学国家中医药管理局重点学科开放基金(2015-003),项目负责人:陈楚淘。

摘　　要：背景:肘按法是推拿治疗腰椎间盘突出症的常用手法,在使用肘按法时,不同的角度对腰椎的作用不同,且手法操作不当可能会加重病情,目前相关研究有待进一步完善。目的:基于有限元分析方法,观察不同角度肘按法对腰椎L4-L5椎体及后部结构的应力分布、位移分布及方向,探讨肘按法最安全及适宜角度,为临床提供参考。方法:取1名25岁健康男性志愿者的CT图像,利用Mimics、Geomagic Studio、Solidworks、Hypermesh、ABAQUS软件建立正常腰椎有限元模型,并改变髓核和纤维环的弹性模量、泊松比建立向左后突出的腰椎间盘有限元模型。以突出物的体表投影为按压点,按压力度为400 N,从左往右每隔15°模拟按压1次至165°。分析不同角度肘按法对正常及腰椎间盘突出腰椎有限元模型椎体及后部结构的应力分布、位移分布及方向。该研究方案的实施符合湖南中医药大学第一附属医院的相关伦理要求,受试者对测试过程及用途完全知情同意。结果与结论:①与正常腰椎模型相比,腰椎间盘突出模型后部结构中小关节、椎弓根、模拟按压部位等处应力集中范围较大,且L4右侧椎板下部及L5椎体下部后面与侧面等多处出现应力集中;②当肘按角度为15°-45°时,相较正常模型,腰椎间盘突出模型的应力主要集中在右侧;③当按压角度为30°-60°时,位移分布最大为L4双侧上关节突,且椎体及其后部结构及会产生向前、向右的位移;④比较不同角度肘按法,当按压角度为30°-45°时,对患侧椎体的负荷较小,安全性较高,且可调节L4-L5腰椎关节突关节的位置,恢复脊柱的正常生物力学状态,推荐临床参考。BACKGROUND:Elbow pressing method is the common manipulation of massage.The forces on the lumbar vertebra are different with different angle elbow pressing methods and improper manipulation may aggravate the disease.Currently,the relevant research needs to be further improved.OBJECTIVE:Using the method of finite element analysis,to observe the distribution of stress,the distribution and direction of displacement at L4-L5 vertebra and posterior structure of lumbar model with different angle elbow pressing methods,and to investigate the safest and most suitable angle of elbow pressing method so as to provide reference for clinical practice.METHODS:CT images of a 25-year-old healthy male volunteer were obtained.A normal lumbar finite element model was established using Mimics,Geomagic Studio,Solidworks,Hypermesh,and ABAQUS softwares.The elastic modulus and Poisson’s ratio of nucleus pulposus and annulus fibrosus were changed to establish the left and back protrusion of lumbar intervertebral disc.The pressing position was the projection of the protrusion’s body surface.The pressing force was 400 N,and the pressing was simulated once every 15°until 165°from left to right.The distribution of stress,the distribution and direction of displacement in the vertebral body and posterior structure of finite element models with normal and lumbar disc herniated lumbar spine were observed under the different angle elbow pressing methods.The implementation of the research protocol complied with the relevant ethical requirements of the First Affiliated Hospital of Hunan University of Chinese Medicine,and the subjects signed informed consent to the test process and use.RESULTS AND CONCLUSION:(1)Compared with the normal lumbar spine model,the range of stress concentration in the posterior structure of the lumbar disc herniation model was larger,such as articular joints,pedicles,and simulated compression parts.Many stress concentrations occurred,such as back and side of the lower part of the right lamina of L4 and the lower part

关 键 词：有限元分析 腰椎 腰椎间盘突出 肘按法 推拿 

分 类 号：R459.9[医药卫生—治疗学] R496[医药卫生—临床医学]