不同体位下按压手法治疗腰椎间盘突出症的三维有限元分析  

Three-dimensional finite element analysis of lumbar disc herniation under different body positions

作　　者：尹本敬 卢钰 吉富涛 邱荣能 谢元洋 陈葛 徐天利 保超宇 李具宝 YIN Ben-jing;LU Yu;JI Fu-tao;QIU Rong-neng;XIE Yuan-yang;CHEN Ge;XU Tian-li;BAO Chao-yu;LI Ju-bao(Yunnan University of Traditional Chinese Medicine,Kunming 650500,Yunnan,China;The Fourth Department of Orthopaedics,the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine,Yunnan Provincial Hospital of Traditional Chinese Medicine,Kunming 650100,Yunnan,China)

机构地区：[1]云南中医药大学,云南昆明650500 [2]云南中医药大学第一附属医院云南省中医医院骨四科,云南昆明650100

出　　处：《中国骨伤》2024年第6期599-604,共6页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金(编号:81860862);青年岐黄学者[编号:国中医药人教函(2022)256号];云南省高层次中医药人才学科带头人[编号:云卫中医发展发(2021)1号]~。

摘　　要：目的:通过有限元分析法比较不同体位下按压手法治疗腰椎间盘突出症(lumbar disc herniation,LDH)三维模型的生物力学作用。方法:收集1例48岁LDH女性患者(身高163 cm,体重53 kg)的腰椎CT图像,使用Mimics20.0、Geomagic Studio、Solidwords等软件建立L4,5节段LDH患者的三维有限元模型。分别模拟水平位置、前屈30°、后伸10°体位下的按压手法,在施加按压力之后,观察不同体位下按压手法对椎间盘、神经根各个组织的应力、应变、位移的影响。结果:成功建立L4,5节段的有限元模型,并验证模型有效,分别在水平位置、前屈30°、后伸10°体位下进行按压手法时,纤维环应力大小分别为0.732、5.929、1.286 MPa,髓核应力大小分别为0.190、1.527、0.295 MPa,纤维环应变大小分别为0.097、0.922、0.424,髓核应变大小分别为0.153、1.222、0.282;椎间盘在Y方向上的整体位移距离分别为-3.707、-18.990、-4.171 mm,神经根在Y方向上的位移距离分别为+7.836、+5.341、+3.859 mm;神经根和椎间盘在Y方向上的相对位移距离分别为11.543、24.331、8.030 mm。结论:按压手法能使突出的椎间盘产生收缩和回纳趋势,通过增加突出椎间盘和神经根之间的距离,达到减轻神经压迫症状,达到对LDH的治疗目的,其中在前屈30°时按压手法作用效果更佳。Objective To campare biomechanical effects of different postural compression techniques on three-dimensional model of lumbar disc herniation(LDH)by finite element analysis.Methods Lumbar CT image of a 48-year-old female patient with LDH(heighted 163 cm,weighted 53 kg)was collected.Mimics 20.0,Geomagic Studio,Solidwords and other software were used to establish three-dimensional finite element model of LDH on L4,5 segments.Compression techniques under horizontal position,30°forward bending and 10°backward extension were simulated respectively.After applying the pressure,the effects of compression techniques under different positions on stress,strain and displacement of various tissues of intervertebral disc and nerve root were observed.Results L4,5 segment finite element model was successfully established,and the model was validated.When compression manipulation was performed on the horizontal position,30°flexion and 10°extension,the annular stress were 0.732,5.929,1.286 MPa,the nucleus pulposus stress were 0.190,1.527,0.295 MPa,and the annular strain were 0.097,0.922 and 0.424,the strain sizes of nucleus pulposus were 0.153,1.222 and 0.282,respectively.The overall displacement distance of intervertebral disc on Y direction were-3.707,-18.990,-4.171 mm,and displacement distance of nerve root on Y direction were+7.836,+5.341,+3.859 mm,respectively.The relative displacement distances of nerve root and intervertebral disc on Y direction were 11.543,24.331 and 8.030 mm,respectively.Conclusion Compression manipulation could make herniated intervertebral disc produce contraction and retraction trend,by increasing the distance between herniated interverte bral disc and nerve root,to reduce symptoms of nerve compression,to achieve purpose of treatment for patients with LDH,in which the compression manipulation is more effective when the forward flexion is 30°.

关 键 词：腰椎间盘突出症 三维有限元 按压手法 不同体位 

分 类 号：R274.9[医药卫生—中西医结合]