[1]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):8-12.
 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(03):8-12.
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颈椎定位旋转扳法对不同曲度颈椎内部结构应力的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年03期
页码:
8-12
栏目:
颈椎疾患
出版日期:
2018-03-20

文章信息/Info

Title:
Effect of cervical fixed-position rotary pulling manipulation on internal structure stresses of cervical vertebrae with different curvature
作者:
沈知彼王辉昊王宽邓真陈威烨詹红生
上海中医药大学附属曙光医院,上海市中医药研究院骨伤科研究所,上海 201203
Author(s):
SHEN ZhibiWANG HuihaoWANG KuanDENG ZhenCHEN WeiyeZHAN Hongsheng
Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,The Institute of Traumatology and Orthopedics Affiliated to Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203,China
关键词:
颈椎 手法整骨 扳法 应力物理 有限元分析
Keywords:
Keywords cervical vertebrae manipulationosteopathic pulling manipulation stressmechanical finite element analysis
摘要:
目的:观察颈椎定位旋转扳法对不同曲度颈椎内部结构应力的影响。方法:基于可靠的正常颈椎有限元模型(正常模型),结合1例颈椎曲度变直患者和1例颈椎反弓患者的颈椎CT图像,建立曲度变直颈椎有限元模型(变直模型)和反弓颈椎有限元模型(反弓模型)。模拟右侧颈椎定位旋转扳法,分别加载于正常模型、变直模型和反弓模型,观察3种模型椎间盘、韧带、关节软骨和终板的应力特征。结果:①颈椎椎间盘应力分布。正常模型椎间盘应力主要集中于C6~7和C7T1椎间盘右侧纤维环,变直模型椎间盘应力主要集中于C2~3椎间盘左侧纤维环,反弓模型椎间盘应力主要集中于C2~3、C3~4、C4~5椎间盘右侧纤维环; 3种模型椎间盘最高应力均集中于下段颈椎椎间盘纤维环,其中正常模型最高应力集中于C6~C7右侧钩椎关节处,变直模型和反弓模型最高应力集中区域分别为C7~T1左侧钩椎关节处和C5~C6左侧钩椎关节处; 反弓模型椎间盘最高应力值最大,变直模型次之,正常模型最小。②颈椎主要韧带应力分布。正常模型韧带应力主要集中于C2~C3、C3~C4、C4~C5双侧关节囊韧带及横韧带,最高应力集中于C3~C4右侧关节囊韧带; 变直模型韧带应力主要集中于寰枕后韧带、前纵韧带(寰枕节段)、横韧带,最高应力集中于齿突尖韧带; 反弓模型韧带应力主要集中于下颈段右侧关节囊韧带、上颈段左侧关节囊韧带、横韧带,最高应力集中于寰枕后韧带。③颈椎关节软骨应力分布。3种模型关节软骨应力均主要集中于寰枕关节两侧,最高应力均集中于寰枢关节软骨,正常模型和反弓模型应力主要集中区域、最高应力集中区域位于右侧,变直模型应力主要集中区域、最高应力集中区域位于左侧; 反弓模型关节软骨最高应力值最大,变直模型次之,正常模型最小。④颈椎终板应力分布。正常模型、变直模型、反弓模型终板应力主要集中部位分别为C2下终板、C3下终板和C4上终板; 正常模型终板最高应力集中于C3上终板左前部,变直模型和反弓模型终板最高应力均集中于C3上终板后部。结论:在颈椎定位旋转扳法作用下,不同曲度颈椎内部结构应力集中部位及大小均不同。
Abstract:
ABSTRACT Objective:To observe the effect of cervical fixed-position rotatry pulling manipulation on internal structure stresses of cervical vertebrae with different curvature.Methods:A finite element model of cervical vertebrae with straightened physiological-curvature(straightened model)and a finite element model of cervical vertebrae with reversed physiological-curvature(reversed model)were created by using a reliable finite element model of normal cervical vertebrae(normal model)and the CT images of cervical vertebrae with straightened physiological-curvature and reversed physiological-curvature respectively.The loads,which simulated the cervical fixed-position rotatry pulling manipulation on the right side,were exerted on normal model,straightened model and reversed model.The stress characteristics of intervertebral disc,ligament,articular cartilage and endplate of the 3 kinds of models were observed.Results:The intervertebral disc stresses of normal model,straightened model and reversed model concentrated mainly on the right fibrous rings of C6/C7 and C7/T1 intervertebral discs,the left fibrous ring of C2/C3 intervertebral disc and the right fibrous rings of C2/C3,C3/C4 and C4/C5 intervertebral discs respectively.The highest stress of intervertebral discs of the 3 kinds of models concentrated on fibrous rings of intervertebral discs of lowe cervical vertebrae.The highest stress of intervertebral discs of normal model,straightened model and reversed model concentrated on right C6/C7 uncovertebral joint,left C7/T1 uncovertebral joint and left C5/C6 uncovertebral joint respectively.The intervertebral disc had high-to-low highest stress value in reversed model,straightened model and normal model in turn.The ligament stresses of normal model concentrated mainly on bilateral articular capsule ligaments and transverse ligaments at C2/C3,C3/C4 and C4/C5 segments,and the highest stress concentrated on right articular capsule ligament at C3/C4 segment.The ligament stresses of straightened model concentrated mainly on posterior occipitoatlantal ligament,occipitoatlantal anterior longitudinal ligament and transverse ligament,and the highest stress concentrated on apical dental ligament.The ligament stresses of reversed model concentrated mainly on right articular capsule ligament of lower cervical vertebrae,left articular capsule ligament of upper cervical vertebrae and transverse ligament,and the highest stress concentrated on posterior occipitoatlantal ligament.The articular cartilage stresses of the 3 kinds of models concentrated mainly on both sides of atlanto-occipital joint,and the highest stress concentrated on atlantoaxial articular cartilage.The stress concentration area and the highest stress concentration area of articular cartilage of normal model and reversed model were on the right,and those of straightened model were on the left.The articular cartilages had high-to-low highest stress value in reversed model,straightened model and normal model in turn.The endplate stresses of normal model,straightened model and reversed model concentrated mainly on lower endplates of C2 and C3 and upper endplate of C4 respectively.The highest stress of endplate of normal model concentrated on the left front of upper endplate of C3,and those of straightened model and reversed model concentrated on the back of upper endplate of C3.Conclusion:Both stress concentration position and stress concentration value are different in internal structure of cervical vertebrae with different curvature under the action of cervical fixed-position rotatry pulling manipulation.

参考文献/References:

[1] 何剑波,苏国义,林定坤.未成年人颈痛与颈椎曲度相关性的回顾分析[J].中华中医药杂志,2017,32(8):3812-3815.
[2] 张玉婷,王翔,詹红生.颈椎曲度的测量方法及其临床意义[J].中国骨伤,2014,27(12):1062-1064.
[3] 陈忻,朱立国,于杰,等.中医综合疗法对神经根型颈椎病颈椎曲度变化的影响[J].北京中医药,2014,33(4):280-282.
[4] VARATHARAJAN S,FERGUSON B,CHROBAK K,et al.Are non-invasive interventions effective for the management of headaches associated with neck pain?An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management(OPTIMa)Collaboration[J].Eur Spine J,2016,25(7):1971-1999.
[5] CASSIDY JD,BRONFORT G,HARTVIGSEN J.Should we abandon cervical spine manipulation for mechanical neck pain? No[J].BMJ,2012,344:3680.
[6] KAWCHUK GN,JHANGRI GS,HURWITZ EL,et al.The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation[J].J Neurol,2008,255(3):371-377.
[7] 王辉昊,詹红生,张明才,等.手法治疗颈椎病意外事件分析与预防策略思考[J].中国骨伤,2012,25(9):730-736.
[8] 詹红生,石印玉,张明才,等.基于“骨错缝、筋出槽”病机认识的椎间盘病症诊治新观点[J].上海中医药杂志,2007,41(9):4-6.
[9] 魏戌,朱立国,高景华,等.旋提手法对椎动脉型颈椎病患者经颅多普勒相关指标的影响[J].中医杂志,2017,58(18):1573-1576.
[10] 王立童,詹红生.以“骨错缝,筋出槽”理论探讨颈椎病的手法治疗[J].中国运动医学杂志,2009,28(6):703-705.
[11] 李义凯,李军朋.与颈部手法治疗相关的解剖学研究[J].中国临床康复,2004,8(17):3348-3350.
[12] 姜宏,施杞.颈椎手法的生物力学研究与探索[J].中国中医骨伤科杂志,1999,7(2):52.
[13] 纪双泉,麦丽玲,陈建平,等.整脊手法结合神经松动术治疗神经根型颈椎病疗效观察[J].中国康复医学杂志,2017,32(5):582-584.
[14] 王辉昊,陈博,詹红生.有限元分析技术在颈椎推拿手法生物力学研究中的应用[J].生物医学工程学杂志,2013,30(5):1123-1126.
[15] 王辉昊,沈知彼,邓真,等.人体全颈椎及椎动脉流固耦合模型的构建[J].浙江大学学报(医学版),2015,44(2):131-137.
[16] WANG K,WANG H,DENG Z,et al.Cervical traction therapy with and without neck support:A finite element analysis[J].Musculoskelet Sci Pract,2017,28:1-9.
[17] KRISTJANSSON E,JONSSON H.Is the sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome?A comparative computer-assisted radiographic assessment[J].J Manipulative Physiol Ther,2002,25(9):550-555.
[18] DENG Z,WANG K,WANG H,et al.A finite element study of traditional Chinese cervical manipulation[J].Eur Spine J,2017,26(7):1-10.
[19] YOGANANDAN N,KUMARESAN S,VOO L,et al.Finite element applications in human cervical spine modeling[J].Spine(Phila Pa 1976),1996,21(15):1824-1834.
[20] DEAN CL,GABRIEL JP,CASSINELLI EH,et al.Degenerative spondylolisthesis of the cervical spine:analysis of 58 patients treated with anterior cervical decompression and fusion[J].Spine J,2009,9(6):439-446.
[21] TEN HAVE HA,EULDERINK F.Degenerative changes in the cervical spine and their relationship to its mobility[J].J Pathol,1980,132(2):133-159.
[22] 魏威,叶杨,王以进.颈椎生理曲度变直的生物力学研究及临床意义[J].浙江中西医结合杂志,2011,21(9):610-613.
[23] 曾岩,党耕町,马庆军.颈椎前路术后融合节段曲度变化与轴性症状和神经功能的相关性研究[J].中国脊柱脊髓杂志,2004,14(9):520-523.
[24] 贾连顺,李家顺.颈椎外科手术学[M].上海:上海远东出版社,2001:139-141.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81473702,81503596,81202707,81001528); 上海市科学技术委员会科研计划项目(14401970402,16401970102,15401934100); 上海市卫生和计划生育委员会项目(2017ZZ02024,20170242,ZXYXZ201703,ZYKC201602006,ZY3-LCPT-2-1005); 上海市市级医院新兴前沿技术联合攻关项目(SHDC12014121); 詹红生上海市名老中医学术经验研究工作室建设项目(SHGZS-2017025,SZYMZYGZS4013) 通讯作者:王辉昊 E-mail:huihaowang@126.com
更新日期/Last Update: 2018-08-02