[1]丘明旺,孙玫瑶,吴耿佳,等.腰椎立体定位斜扳法与传统腰椎斜扳法对椎间盘及关节突关节软骨影响的有限元分析[J].中医正骨,2024,36(1):14-22.
　QIU Mingwang,SUN Meiyao,WU Gengjia,et al.Effects of lumbar stereotaxic oblique-pulling manipulation versus traditional oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints:a finite element analysis-based biomechanical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(1):14-22.
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腰椎立体定位斜扳法与传统腰椎斜扳法对椎间盘及关节突关节软骨影响的有限元分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年1期
页码:
14-22
栏目:
基础研究
出版日期:
2024-01-20

文章信息/Info

Title:
Effects of lumbar stereotaxic oblique-pulling manipulation versus traditional oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints:a finite element analysis-based biomechanical study
作者:
丘明旺1; 孙玫瑶2; 吴耿佳2; 黄帆3; 刘嘉俊2; 卢曼琪2; 刘岘4; 严兆贤4; 赵思怡5; 田强4; 吴山4; 范志勇4
1.广州中医药大学第二临床医学院,广东 广州 510405; 2.广州中医药大学针灸康复临床医学院,广东 广州 510405; 3.香港理工大学康复科学系,香港 999077; 4.广东省中医院,广东 广州 510120; 5.深圳市龙岗区第五人民医院,广东 深圳 518111
Author(s):
QIU Mingwang1; SUN Meiyao2; WU Gengjia2; HUANG Fan3; LIU Jiajun2; LU Manqi2; LIU Xian4; YAN Zhaoxian4; ZHAO Siyi5; TIAN Qiang4; WU Shan4; FAN Zhiyong4
1.The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China 2.Clinical Medical College of Acupuncture Moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou510405,Guangdong,China 3.Department of Rehabilitation Sciences,The Hong Kong Polytechnic University,Hong Kong 999077,China 4.Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,Guangdong,China 5.The Fifth People's Hospital of Longgang District,Shenzhen 518111,Guangdong,China
关键词:
推拿疗法;  有限元分析;  椎间盘移位;  腰椎;  生物力学
Keywords:
tui na therapy;  finite element analysis;  intervertebral disc displacement;  lumbar vertebrae;  biomechanics
摘要:
目的:分析腰椎立体定位斜扳法与传统腰椎斜扳法对椎间盘及关节突关节软骨的影响。方法:选取1例成年男性L4～5椎间盘突出症患者(椎间盘向左后方突出),采用西门子Light Speed 64排螺旋CT进行腰椎和骨盆扫描,层厚0.5 mm。基于CT扫描数据,应用三维有限元建模软件建立腰椎-骨盆三维有限元模型,通过与文献数据比较验证模型有效性后,分析腰椎立体定位斜扳法与传统腰椎斜扳法作用下腰椎-骨盆整体应力、L4～5椎间盘应力和位移、L4～5关节突关节软骨应力和位移、L4～5上下关节突表面中心点相对空间距离。结果:①腰椎-骨盆三维有限元模型建立及验证结果。建立的腰椎-骨盆三维有限元模型共有 550 215 个节点、344 359个单元,高度模拟了腰椎-骨盆的结构与材料特性。在模拟加载条件下,L4～5节段屈伸、侧屈、轴向旋转活动范围与文献中的既往研究结果基本相同。②模型整体应力。实施传统腰椎斜扳法时,腰椎-骨盆三维有限元模型最大应力为5.31 MPa,主要集中于L1、L2、L4、L5椎体; 实施腰椎立体定位斜扳法时,腰椎-骨盆三维有限元模型最大应力为29.30 MPa,主要集中于L1、L2椎体及L3、L4、L5椎弓根。③L4～5椎间盘应力及位移。实施传统腰椎斜扳法时,L4～5椎间盘纤维环平均等效应力为 1.12 MPa,纤维环整体向左、向前、向下发生位移,平均位移分别为0.36 mm、0.20 mm、0.05 mm; 髓核平均等效应力为0.02 MPa,髓核整体向左、向前、向下发生位移,平均位移分别为0.35 mm、0.24 mm、0.06 mm。实施腰椎立体定位斜扳法时,L4～5椎间盘纤维环平均等效应力为1.14 MPa,纤维环整体向左、向前、向下发生位移,平均位移分别为0.39 mm、1.30 mm、0.05 mm; 髓核平均等效应力为0.02 MPa,髓核整体向左、向前、向下发生位移,平均位移分别为0.38 mm、1.30 mm、0.07 mm。④L4～5关节突关节软骨应力及位移。实施传统腰椎斜扳法时,L4～5左侧和右侧关节突关节软骨平均等效应力分别为2.46 MPa、3.18 MPa,平均位移分别为1.10 mm、0.21 mm; 实施腰椎立体定位斜扳法时,L4～5左侧和右侧关节突关节软骨平均等效应力分别为2.70 MPa、3.22 MPa,平均位移分别为1.46 mm、0.65 mm。⑤L4～5上下关节突表面中心点相对空间距离。实施传统腰椎斜扳法时,L4～5左、右侧上下关节突表面中心点相对空间距离分别为0.75 mm、0.34 mm; 实施腰椎立体定位斜扳法时,L4～5左、右侧上下关节突表面中心点相对空间距离分别为0.81 mm、0.23 mm。结论:腰椎立体定位斜扳法与传统腰椎斜扳法均能使腰椎间盘突出症患者病变节段椎间盘及关节突关节软骨产生一定的应力和位移; 相较于传统腰椎斜扳法,腰椎立体定位斜扳法能使病变节段椎间盘和关节突关节软骨产生更大的应力和位移,这也可能是腰椎立体定位斜扳法比传统腰椎斜扳法治疗腰椎间盘突出症疗效更佳的原因。
Abstract:
Objective:To compare and analyze the effects of lumbar stereotaxic oblique-pulling manipulation versus traditional lumbar oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints.Methods:One male adult with L4-5 intervertebral disc herniation(herniated to left rear)was selected for lumbar spine and pelvis scanning by using a Siemens Light Speed 64-slice spiral CT,with a slice thickness of 0.5 mm.Based on the CT scanning data,a three-dimensional(3D)finite element model of lumbar spine-pelvis was established by using a 3D finite element modeling software.After verifying the validity of the model by comparing with the article data,the overall stress of the lumbar spine-pelvis model,the stresses and displacements of the L4-5 intervertebral disc and articular cartilage of L4-5 zygapophysial joint,and the relative spatial distance between the central points of upper and lower articular process surfaces at L4～5 segment under the action of stereotaxic oblique-pulling manipulation and traditional oblique-pulling manipulation were recorded and analyzed.Results:①The established lumbar spine-pelvis 3D finite element model consisted of 550 215 nodes and 344 359 elements,which highly simulated the structure and material properties of the lumbar spine-pelvis.Under the simulated loading conditions,the range of motion(ROM),including flexion-extension,lateroflexion,and axial rotation,of the L4-5 segment were basically the same as the results previously reported.②When the traditional oblique-pulling manipulation was performed on the lumbar spine-pelvis 3D finite element model,the maximum stress of the model was 5.31 MPa,and mainly concentrated on the L1,L2,L4,and L5 vertebrae; while when the stereotaxic oblique-pulling manipulation was implemented,the maximum stress of the model was 29.30 MPa,and mainly on L1 and L2 vertebrae as well as the L3,L4,and L5 vertebral pedicles.③Under the action of traditional lumbar oblique-pulling manipulation,the annulus fibrosus of L4-5 intervertebral disc showed the average equivalent stress as 1.12 MPa,and the whole annulus fibrosus displaced leftward,forward,and downward,with an average displacement of 0.36,0.20,and 0.05 mm,respectively; the nucleus pulposus showed the average equivalent stress as 0.02 MPa,and the whole nucleus pulposus displaced leftward,forward,and downward,with an average displacement of 0.35,0.24,and 0.06 mm,respectively.While,under the stereotaxic oblique-pulling manipulation,the annulus fibrosus of L4-5 intervertebral disc exhibited the average equivalent stress as 1.14 MPa,and the whole annulus fibrosus displaced leftward,forward,and downward,with an average displacement of 0.39,1.30,and 0.05 mm,respectively; the nucleus pulposus exhibited the average equivalent stress as 0.02 MPa,and the whole nucleus pulposus displaced leftward,forward,and downward,with an average displacement of 0.38,1.30,and 0.07 mm,respectively.④In the case of the traditional oblique-pulling manipulation,the articular cartilage of zygapophysial joint at L4-5 showed the average equivalent stresses as 2.46 and 3.18 MPa and the average displacements as 1.10 and 0.21 mm on the left side and right side,respectively.While,in the case of the stereotaxic oblique-pulling manipulation,the average equivalent stresses were 2.70 and 3.22 MPa and the average displacements were 1.46 and 0.65 mm on the left side and right side,respectively.⑤The relative spatial distances between the central points of the upper and lower articular process surfaces on the left side and right side at L4-5 were 0.75 and 0.34 mm in the case of traditional oblique-pulling manipulation,and 0.81 and 0.23 mm in the case of stereotaxic oblique-pulling manipulation.Conclusion:Both lumbar stereotaxic oblique-pulling manipulation and traditional lumbar oblique-pulling manipulation can cause stress and displacement in intervertebral discs and articular cartilage of zygapophysial joints of the affected segment in patients with lumbar disc herniation.Compared with the latter,the former can cause greater stress and displacement,which may be the reason why the former behaves better than the latter in the outcome in treating lumbar disc herniation.

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备注/Memo

备注/Memo:
基金项目:广东省中医药局科研项目(20212093); 广东省中医院林氏正骨推拿流派传承工作室建设项目
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更新日期/Last Update: 1900-01-01