腰椎定点旋转手法治疗L_(4)~S_(1)双节段腰椎间盘突出症力学效应的三维有限元分析  

Biomechanical effects of lumbar fixed-point rotation manipulation in treatment of lumbar disc herniation at L_(4)-S_(1) segments:a three-dimensional finite element analysis-based biomechanical study

作　　者：吴周统 周红海[1] 苏少亭 陆延[1] 刘粮酺 WU Zhoutong;ZHOU Honghai;SU Shaoting;LU Yan;LIU Liangpu(College of Orthopaedics and Traumatology of Guangxi University of Chinese Medicine,Nanning 530001,Guangxi,China)

机构地区：[1]广西中医药大学骨伤学院,广西南宁530001

出　　处：《中医正骨》2024年第10期1-9,38,共10页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81660800);广西高校中青年学科带头人项目(RC20061005009);广西中医药大学国医大师韦贵康学术思想与临床诊疗传承发展研究中心建设项目(2022V001)。

摘　　要：目的:分析腰椎定点旋转手法治疗L_(4)~S_(1)双节段腰椎间盘突出症(lumbar disc herniation,LDH)的力学效应。方法:提取1名健康成年男性志愿者脊柱L_(4)~S_(1)段的CT薄层扫描数据,建立正常脊柱L_(4)~S_(1)节段三维有限元模型,并进行有效性验证。基于建立的正常脊柱L_(4)~S_(1)节段三维有限元模型,通过调整椎间盘高度和髓核体积及修改髓核和纤维环的材料属性模拟椎间盘退变,建立L_(4)~S_(1)双节段LDH(左旁中央型)三维有限元模型。在建立的L_(4)~S_(1)双节段LDH三维有限元模型上,模拟腰椎定点旋转手法操作,并以拇指推顶位置为条件,建立2种操作模式(拇指推顶于L_(4)棘突上为M1,拇指推顶于L_(5)棘突上为M2)。分析腰椎定点旋转手法2种操作模式下,L_(4)~S_(1)双节段LDH三维有限元模型整体应力变化情况,L_(4~5)和L_(5)S_(1)椎间盘纤维环与髓核的应力和位移情况,以及L_(4~5)和L_(5)S_(1)关节突关节软骨接触力与应变情况。结果:(1)正常脊柱L_(4)~S_(1)节段三维有限元模型的建立与验证结果。建立的正常脊柱L_(4)~S_(1)节段三维有限元模型共有508705个节点、318640个单元,经验证可用于进一步研究。(2)L_(4)~S_(1)双节段LDH三维有限元模型整体应力测定结果。M1操作模式下,模型整体应力最大为16.85 MPa,主要集中于L_(4~5)、L_(5)S_(1)的上下软骨终板和L_(5)椎体,以及L_(4~5)、L_(5)S_(1)关节突关节;M2操作模式下,模型整体应力最大为15.02 MPa,主要集中于L_(4~5)、L_(5)S_(1)关节突关节和L_(4)椎弓根,以及L_(5)双侧椎板。(3)椎间盘纤维环应力与位移测定结果。M1操作模式下,L_(4~5)和L_(5)S_(1)纤维环的最大等效应力分别为4.3 MPa、3.8 MPa,L_(4~5)纤维环向左、向前、向上的最大位移分别为0.31 mm、0.24 mm、1.20 mm,L_(5)S_(1)纤维环向左、向前、向上的最大位移分别为0.20 mm、0.23 mm、1.10 mm;M2操作模式下,L_(4~5)和L_(5)S_(1)纤维环的最大等效应�Objective:To analyze the biomechanical effects of lumbar fixed-point rotation manipulation in treating lumbar disc herni-ation(LDH)at L_(4)-S_(1) segments.Methods:The CT thin-slice scan data of the L_(4)-S_(1) segments of the spine in a healthy adult male volunteer was extracted.Based on the CT scanning data,a three-dimensional(3D)finite element model of the L_(4)-S_(1) segments of normal spine was established,and the validity of the model was verified.Based on the established 3D finite element model of the L_(4)-S_(1) segment of normal spine,a 3D finite element model of LDH at L_(4)-S_(1) segments(left paracentral type)was established by adjusting the height of the intervertebral disc and the volume of the nucleus pulposus,as well as modifying the material properties of the nucleus pulposus and annulus fibrosus to simulate intervertebral disc degeneration,then the lumbar fixed-point rotation manipulation was simulated on the established 3D finite element model of LDH at L_(4)-S_(1) segments in two modes that built based on the thumb tip-pushing position(M1:the thumb tip-pushing on the L_(4) spinous process;M2:the thumb tip-pushing on the L5spinous process).Furthermore,the biomechanical changes,including the overall stress changes of the 3D finite element model of LDH at L_(4)-S_(1) segments,the stress and displacement of the annulus fibrosus and nucleus pulposus of L_(4-5)and L_(5)S_(1) intervertebral discs,as well as the contact force and strain of the articular cartilages of L_(4-5)and L_(5)S_(1) zygapophyses,under the two modes of lumbar fixed-point rotation manipulation were analyzed.Results:(1)The establishment and verification of the 3D finite element model of the L_(4)-S_(1) segments of the normal spine.The established 3D finite element model of the L_(4)-S_(1) segments of the normal spine consisted of 508705 nodes and 318640 elements,and could be used for further research.(2)The overall stress of the 3D finite element model of LDH at L_(4)-S_(1) segments.In the M1 mode,the maximum overall stress of the m

关 键 词：椎间盘移位 腰椎 限定因素分析 正骨推拿疗法 生物力学现象 

分 类 号：R274[医药卫生—中医骨伤科学]