[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(01):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(01):14-22.
点击复制

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()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年01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.

参考文献/References:

[1] MO Z,ZHANG R,CHEN J,et al.Comparison between oblique pulling spinal manipulation and other treatments for lumbar disc herniation:a systematic review and meta-analysis[J].J Manipulative Physiol Ther,2018,41(9):771-779.
[2] 吴山.林应强筋伤学术经验撷英[M].北京:人民卫生出版社,2015:4-6.
[3] 范志勇,蔡敏.吴山诊治筋伤学术思想及临证经验[M].北京:科学出版社,2019:12-13.
[4] KUMARESAN S,YOGANANDAN N,PINTAR F A,et al.Biomechanical study of pediatric human cervical spine:a finite element approach[J].J Biomech Eng,2000,122(1):60-71.
[5] ZHANG Y,AWREJCEWICZ J,BAKER J S,et al.Cartilage stiffness effect on foot biomechanics of Chinese bound foot:a finite element analysis[J].Front Physiol,2018,9:1434.
[6] ZHANG R,MO Z,LI D,et al.Biomechanical comparison of lumbar fixed-point oblique pulling manipulation and traditional oblique pulling manipulation in treating lumbar intervertebral disk protrusion[J].J Manipulative Physiol Ther,2020,43(5):446-456.
[7] DU H G,LIAO S H,JIANG Z,et al.Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint[J].Saudi Pharm J,2016,24(3):305-311.
[8] 田强,钟侨霖,赵家友,等.提拉旋转斜扳法操作时腰椎椎间盘应力及应变的有限元研究[J].中国临床解剖学杂志,2019,37(1):83-86.
[9] 卢钰,向俊宜,尹本敬,等.斜扳手法和拔伸按压斜扳复合手法治疗腰椎间盘突出症的有限元对比分析[J].中国组织工程研究,2023,27(13):2011-2015.
[10] 中华医学会疼痛学分会脊柱源性疼痛学组.腰椎间盘突出症诊疗中国疼痛专家共识[J].中国疼痛医学杂志,2020,26(1):2-6.
[11] ZHONG Z C,WEI S H,WANG J P,et al.Finite element analysis of the lumbar spine with a new cage using a topology optimization method[J].Med Eng Phys,2006,28(1):90-98.
[12] MO Z J,ZHAO Y B,WANG L Z,et al.Biomechanical effects of cervical arthroplasty with U-shaped disc implant on segmental range of motion and loading of surrounding soft tissue[J].Eur Spine J,2014,23(3):613-621.
[13] FAN W,ZHAO D,GUO L X.A finite element model of the human lower thorax to pelvis spinal segment:validation and modal analysis[J].Biomed Mater Eng,2021,32(5):267-279.
[14] SONG M,SUN K,LI Z,et al.Stress distribution of different lumbar posterior pedicle screw insertion techniques:a combination study of finite element analysis and biomechanical test[J].Sci Rep,2021,11(1):12968.
[15] 文鹏飞,李亚宁,路玉峰,等.腰椎-骨盆-髋关节有限元模型建立及生物力学分析[J].中国组织工程研究,2023,27(36):5741-5746.
[16] 郭汝松,林伟锋,田强,等.立体定位斜扳法治疗腰椎间盘突出症的临床研究[J].颈腰痛杂志,2009,30(1):84-85.
[17] 彭思琪,何添艺,曾雯慧,等.腰椎斜扳手法治疗腰椎间盘突出症的研究进展[J].中医正骨,2022,34(4):38-41.
[18] 李俊毅,孔赏,马虎升,等.手法治疗腰椎间盘突出症的作用机制研究进展[J].中医正骨,2019,31(4):40-42.
[19] 吕立江,包家立,范炳华,等.杠杆定位手法作用下正常腰椎间盘的应力-应变特性初探[J].浙江中医药大学学报,2013(10):1156-1159.
[20] 苏少亭,周红海,侯召猛,等.腰椎定点旋转手法操作中拇指推力的有限元分析[J].中国组织工程研究,2024,28(12):1823-1828.
[21] 韩玺铭,牛立盼,刘凤霞,等.基于CT技术的成年人腰椎间盘及终板解剖参数研究[J].中国骨伤,2023,36(1):72-78.
[22] O'LEARY S A,PASCHOS N K,LINK J M,et al.Facet joints of the spine:structure-function relationships,problems and treatments, and the potential for regeneration[J].Annu Rev Biomed Eng,2018,20:145-170.
[23] ZHENG J,DUAN C,MA C.Spinal fixed-point rotating reduction for treatment of facet joint disorders[J].Altern Ther Health Med,2023,29(7):316-321.
[24] 田聪.斜扳、旋转复位法对常用LDH后路手术后腰椎应力影响的有限元分析[D].南宁:广西中医药大学,2018.
[25] CRAMER G D,ROSS K,RAJU P K,et al.Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy[J].J Manipulative Physiol Ther,2012,35(8):614-621.
[26] GHEZELBASH F,SCHMIDT H,SHIRAZI-ADL A,et al.Internal load-sharing in the human passive lumbar spine:review of in vitro and finite element model studies[J].J Biomech, 2020,102:109441.
[27] GRIFFITH J F,WANG Y X,ANTONIO G E,et al.Modified Pfirrmann grading system for lumbar intervertebral disc degeneration[J].Spine(Phila Pa 1976),2007,32(24):E708-E712.
[28] DING H,LIAO L,YAN P,et al.Three-dimensional finite element analysis of L4-5 degenerative lumbar disc traction under different pushing heights[J/OL].J Healthc Eng,2021[2023-09-01].https://pubmed.ncbi.nlm.nih.gov/34336148.

相似文献/References:

[1]邓真,王辉昊,王宽,等.C2～T1三维有限元模型的建立和验证[J].中医正骨,2016,28(10):1.
　DENG Zhen,WANG Huihao,WANG Kuan,et al.Establishment and verification of three-dimensional finite element model of C2-T1 vertebrae[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):1.
[2]叶宜颖,高景华,高春雨.有限元分析法在脊柱推拿手法生物力学研究中的应用[J].中医正骨,2016,28(10):29.
[3]杨鹏,魏秋实,陈镇秋,等.基于多模态图像配准技术构建半骨盆全髋关节有限元模型[J].中医正骨,2017,29(05):1.
　YANG Peng,WEI Qiushi,CHEN Zhenqiu,et al.Construction of finite element models of hemipelvis and total hip joint using multi-modality image registration technique[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(01):1.
[4]沈知彼,王辉昊,王宽,等.颈椎定位旋转扳法对不同曲度颈椎内部结构应力的影响[J].中医正骨,2018,30(03):8.
　SHEN Zhibi,WANG Huihao,WANG Kuan,et al.Effect of cervical fixed-position rotary pulling manipulation on internal structure stresses of cervical vertebrae with different curvature[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(01):8.
[5]彭小东,张晓刚,赵文韬,等.有限元分析在过伸复位治疗骨质疏松性椎体压缩性骨折生物力学研究中的应用进展[J].中医正骨,2018,30(07):25.
[6]张明才,陈博,石印玉,等.颈椎单节椎体平移错缝对颈椎主要结构应力影响的有限元分析[J].中医正骨,2020,32(04):1.
　ZHANG Mingcai,CHEN Bo,SHI Yinyu,et al.Influence of translational dislocation of single-segment cervical vertebral body on the stresses of main structures of cervical vertebra:a finite element analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(01):1.
[7]林福,付坤飞,全仁夫.有限元法在颈椎生物力学研究中的应用进展[J].中医正骨,2021,33(06):60.
[8]黄帆,郑贝思,吴存书,等.推拿的质量控制与规范化[J].中医正骨,2022,34(02):54.
[9]范升,刘巨尧,龙抗胜,等.推拿手法结合运动疗法的治疗理念和理论依据[J].中医正骨,2023,35(05):52.

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
通讯作者:范志勇 E-mail:fzystrong@126.com
更新日期/Last Update: 1900-01-01