基于三维有限元技术解析颈椎斜扳手法作用机制  

Mechanism of Cervical Vertebra Oblique Manipulation Analyzed Based on Three-Dimensional Finite Element Technique

作　　者：姜雪佳 赵虹飞 张文霞[2] 王义善 颜纯淳 王从安 JIANG Xuejia;ZHAO Hongfei;ZHANG Wenxia;WANG Yishan;YAN Chunchun;WANG Congan(Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 250117,China;Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Hospital for Pain in Neck,Shoulder,Waist and Leg,Shandong First Medical University,Jinan 250062,China)

机构地区：[1]山东第一医科大学(山东省医学科学院),山东济南250117 [2]山东中医药大学,山东济南250355 [3]山东第一医科大学附属颈肩腰腿痛医院,山东济南250062

出　　处：《山东中医杂志》2024年第11期1249-1254,共6页Shandong Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:82004495);山东省自然科学基金青年基金项目(编号:ZR2020QH318);中国博士后基金项目(编号:2021M691985);济南市科技局临床医学科技创新计划项目(编号:202225002);泰山学者青年专家项目(编号:tsqn202211349);山东省中医药科技计划项目(编号:2021Q087)。

摘　　要：目的:通过三维有限元分析,探讨颈椎斜扳手法对神经根型颈椎病患者的生物力学作用特点,阐明颈椎斜扳手法的即时效应及安全性。方法:选取1名神经根型颈椎病志愿者的颈部影像学资料,以DICOM格式保存,应用MIMICS软件和ANYSY软件构建椎体、椎间盘、椎管等C_(3)~C_(7)颈椎有限元模型,模拟斜扳手法,观察椎间盘应力应变、椎管有效横截面积变化,探讨斜扳手法治疗神经根型颈椎病的生物力学效应。结果:给予C_(4)~C_(5)椎体向左侧斜扳力时,C_(4)~C_(5)椎间盘应力最大,为5.95×10^(-4)MPa至1.03×10^(2)MPa;C_(3-4)位移变化最明显,最大形变在椎间盘纤维环的左侧偏后位置,为2.43×10^(-1)mm,最小形变在椎间盘纤维环的前侧,为2.08×10^(-3)mm;C_(4)~C_(5)椎管有效横截面积变化最大,增加59.00 mm^(2)。随着模拟手法力学信息的加载,颈椎神经根右侧最大应变逐渐后移,左侧最小应变前移,呈顺时针方向改变。结论:颈椎斜扳手法向健侧的推力对椎间盘的影响最大;斜扳手法可增加椎管有效横截面积,减轻神经根周围组织的张力,缓解受压状况,从而改善神经根型颈椎病的临床症状。Objective:To study the biomechanical effects of cervical oblique manipulation on cervical radiculopathy and the immediate effects and safety of cervical oblique manipulation through finite element analysis.Method:Cervical image data of a volunteer with radiculotic cervical spondylosis were collected and stored in DICOM format.MIMICS software and ANYSY software were applied to construct the finite element model of C_(3)~C_(7)cervical vertebra such as vertebra,intervertebral disc and spinal canal,and the oblique manipulation was simulated to observe the changes in the stress and strain of intervertebral disc and the effective cross-sectional area of spinal canal.To investigate the biomechanical effect of oblique manipulation in the treatment of cervical radiculopathy.Results:The stress of the C_(4)~C_(5)intervertebral disc was the highest when the C_(4)~C_(5)vertebral body was subjected to the left oblique pull force,ranging from 5.95×10^(-4)MPa to 1.03×10^(2)MPa.The maximum strain was 2.43×10^(-1)mm on the left side of the annulus,and the minimum strain was 2.08×10^(-3)mm on the anterior side of the annulus.The effective cross-sectional area of the spinal canal varies the most between C_(4)~C_(5),increased by 59.00 mm^(2).With the loading of the mechanical information of the simulation manipulation,the maximum strain on the right side of the cervical nerve root gradually shifted backward,and the minimum strain on the left side shifted forward,in a clockwise direction.Conclusions:The driving force of cervical oblique manipulation to the healthy side has the greatest effect on the intervertebral disc.Oblique manipulation can increase the effective cross-sectional area of the spinal canal,reduce the tension of the tissue around the nerve root,relieve the compression,and thus improve the clinical symptoms of cervical spondylotic radiculopathy.

关 键 词：神经根型颈椎病 颈椎斜扳手法 三维有限元分析 生物力学 动作捕捉 

分 类 号：R244.1[医药卫生—针灸推拿学]