基于有限元分析探讨针刀“解结法”棘上及棘间韧带松解对纤维环生物力学的影响  

Biomechanical effect of ligament release by acupotomy‘tubercle release method'on annulus fibrosus:A finite element analysis

作　　者：鄢来军 葛海雅 周斌[1] 张燕 李楠[2,3] 王和鸣 YAN Laijun;GE Hai-ya;ZHOU Bin;ZHANG Yan;LI Nan;WANG He-ming(Nantong Hospital of Traditional Chinese Medicine,Nantong 226000,China;College of Traditional Chinese Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China;Key Laboratory of Orthopedics&Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education,Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China)

机构地区：[1]南通市中医院,南通226000 [2]福建中医药大学中医学院,福州350122 [3]福建中医药大学中医骨伤及运动康复教育部重点实验室,福州350122

出　　处：《中华中医药杂志》2022年第12期7342-7346,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.81973880);中医骨伤及运动康复教育部重点实验室开放课题(No.ZD2020-1-1)。

摘　　要：目的:通过建立正常与退变的腰椎三维有限元模型,评估针刀松解棘上韧带、棘间韧带对椎间盘的应力分布变化的影响。方法:建立正常人体L4-5节段正常模型、椎间盘退变模型及针刀韧带松解模型。通过模拟施加腰椎不同运动载荷,计算正常模型、腰椎退变模型与针刀韧带松解模型下L4-5椎间盘应力差异。结果:构建了L4-5椎正常模型、L4-5退变模型及棘上、棘间韧带针刀松解模型。在前屈运动载荷下,正常模型韧带松解后,纤维环前部应力较干预前增加;在后伸运动载荷下,正常模型韧带松解后纤维环后部应力较干预前减少。在后伸运动与前屈运动载荷下,退变椎间盘的纤维环后部应力增加,应力分布改变以纤维环后部最为明显。结论:对于无明显腰椎间盘退变的患者,针刀松解棘上、棘间韧带能降低纤维环后部应力,临床应用安全有效;但是在中重度腰椎退变患者的治疗中应当谨慎使用。Objective:A three-dimensional finite element model of normal and degenerative lumbar spine was established to evaluate the biomechanical effect of releasing the supraspinous and interspinous ligaments by needle-knife on the stress distribution of the intervertebral disc under different motion loads.Methods:The normal human model of L4-5 segment,intervertebral disc degeneration model and needle-knife ligament release model were established.By applying physiological load under various settings,the stress differences of the L4-5 intervertebral disc in normal model,lumbar degeneration model and needle-knife ligament releasing models were estimated.Results:The supraspinous and interspinous ligament releasing model via needle-knife,the L4-5 segment normal model,and the L4-5 segment degenerational model were all built.The stress of normal intervertebral disc annulus fibrosus increased under the load of flexion after posterior column ligament releasing;the stress of normal intervertebral disc annulus fibrosus decreased under the load of extension;the stress in the annulus fibrosus of degenerative intervertebral disc increased under the load of extension and flexion,and the change in stress distribution was most obvious in the posterior part of annulus fibrosus.Conclusion:For patients without obvious lumbar intervertebral disc degeneration,needle-knife release of supraspinous and interspinous ligaments can reduce the stress in the posterior part of fibrous annulus,and its clinical application is safe and effective,but it should be used cautiously in the treatment of moderate and severe lumbar degeneration.

关 键 词：椎间盘 脊柱 针刀 有限元 生物力学 解结法 

分 类 号：R246.9[医药卫生—针灸推拿学]