[1]吴周统,周红海,苏少亭,等.腰椎定点旋转手法治疗L4～S1双节段腰椎间盘突出症力学效应的三维有限元分析[J].中医正骨,2024,36(10):1-9,38.
　WU Zhoutong,ZHOU Honghai,SU Shaoting,et al.Biomechanical effects of lumbar fixed-point rotation manipulation in treatment of lumbar disc herniation at L4-S1 segments:a three-dimensional finite element analysis-based biomechanical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(10):1-9,38.
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腰椎定点旋转手法治疗L4～S1双节段腰椎间盘突出症力学效应的三维有限元分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年10期
页码:
1-9,38
栏目:
基础研究
出版日期:
2024-10-20

文章信息/Info

Title:
Biomechanical effects of lumbar fixed-point rotation manipulation in treatment of lumbar disc herniation at L4-S1 segments:a three-dimensional finite element analysis-based biomechanical study
作者:
吴周统; 周红海; 苏少亭; 陆延; 刘粮酺
广西中医药大学骨伤学院,广西 南宁 530001
Author(s):
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
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
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  finite element analysis;  bone setting tui na therapy;  biomechanical phenomena
摘要:
目的:分析腰椎定点旋转手法治疗L4～S1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L4～S1段的CT薄层扫描数据,建立正常脊柱L4～S1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L4～S1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L4～S1双节段LDH(左旁中央型)三维有限元模型。在建立的L4～S1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L4棘突上为M1,拇指推顶于L5棘突上为M2)。分析腰椎定点旋转手法2种操作模式下,L4～S1双节段LDH三维有限元模型整体应力变化情况,L4～5和L5S1椎间盘纤维环与髓核的应力和位移情况,以及L4～5和L5S1关节突关节软骨接触力与应变情况。结果:①正常脊柱L4～S1节段三维有限元模型的建立与验证结果。建立的正常脊柱L4～S1节段三维有限元模型共有508 705个节点、318 640个单元,经验证可用于进一步研究。②L4～S1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L4～5、L5S1的上下软骨终板和L5椎体,以及L4～5、L5S1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L4～5、L5S1关节突关节和L4椎弓根,以及L5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,L4～5和L5S1纤维环的最大等效应力分别为4.3 MPa、3.8 MPa,L4～5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,L5S1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,L4～5和L5S1纤维环的最大等效应力分别为4.2 MPa、3.7 MPa,L4～5纤维环向左、向前、向上的最大位移分别为0.35 mm、0.24 mm、1.10 mm,L5S1纤维环向左、向前、向上的最大位移分别为0.32 mm、0.22 mm、1.00 mm。④椎间盘髓核应力与位移测定结果。M1操作模式下,L4～5和L5S1髓核的最大等效应力分别为0.35 MPa、0.32 MPa,L4～5髓核向左、向前、向上的最大位移分别为0.10 mm、0.46 mm、0.41 mm,L5S1髓核向左、向前、向上的最大位移分别为0.08 mm、0.40 mm、0.40 mm; M2操作模式下,L4～5和L5S1髓核的最大等效应力分别为0.34 MPa、0.31 MPa,L4～5髓核向左、向前、向上的最大位移分别为0.23 mm、0.46 mm、0.41 mm,L5S1髓核向左、向前、向上的最大位移分别为0.09 mm、0.45 mm、0.40 mm。⑤关节突关节软骨接触力与应变测定结果。M1操作模式下,L4～5左右侧关节突关节软骨最大接触力分别为17.0 MPa、15.8 MPa,最大应变值分别为0.34%、0.32%; L5S1左右侧关节突关节软骨最大接触力分别为9.7 MPa、9.4 MPa,最大应变值分别为0.33%、0.27%。M2操作模式下,L4～5左右侧关节突关节软骨最大接触力分别为15.0 MPa、13.0 MPa,最大应变值分别为0.31%、0.27%; L5S1左右侧关节突关节软骨最大接触力分别为10.0 MPa、8.4 MPa,最大应变值分别为0.29%、0.24%。结论:腰椎定点旋转手法治疗L4～S1双节段LDH,可使L4～5和L5S1椎间盘产生一定的应力变化和位移,促进关节突关节滑动; 且手法操作时拇指推顶于L4棘突,力学效应更明显。
Abstract:
Objective:To analyze the biomechanical effects of lumbar fixed-point rotation manipulation in treating lumbar disc herni-ation(LDH)at L4-S1 segments.Methods:The CT thin-slice scan data of the L4-S1 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 L4-S1 segments of normal spine was established,and the validity of the model was verified.Based on the established 3D finite element model of the L4-S1 segment of normal spine,a 3D finite element model of LDH at L4-S1 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 L4-S1 segments in two modes that built based on the thumb tip-pushing position(M1:the thumb tip-pushing on the L4 spinous process; M2:the thumb tip-pushing on the L5 spinous process).Furthermore,the biomechanical changes,including the overall stress changes of the 3D finite element model of LDH at L4-S1 segments,the stress and displacement of the annulus fibrosus and nucleus pulposus of L4-5 and L5S1 intervertebral discs,as well as the contact force and strain of the articular cartilages of L4-5 and L5S1 zygapophyses,under the two modes of lumbar fixed-point rotation manipulation were analyzed.Results:①The establishment and verification of the 3D finite element model of the L4-S1 segments of the normal spine.The established 3D finite element model of the L4-S1 segments of the normal spine consisted of 508 705 nodes and 318 640 elements,and could be used for further research.②The overall stress of the 3D finite element model of LDH at L4-S1 segments.In the M1 mode,the maximum overall stress of the model was 16.85 MPa,and mainly concentrated on the upper and lower cartilage endplates of L4-5 and L5S1,the vertebral body of L5,and the zygapophyseal joints of L4-5 and L5S1.In the M2 mode,the maximum overall stress of the model was 15.02 MPa,and mainly concentrated on the zygapophyseal joints of L4-5 and L5S1,the pedicle of L4,and the bilateral laminae of L5.③Stress and displacement of intervertebral disc annulus fibrosus.In the M1 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc annulus fibrosus was 4.3 and 3.8 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc annulus fibrosus was 0.31,0.24,and 1.20 mm,respectively,and that of the L5S1 was 0.20,0.23,and 1.10 mm,respectively.In the M2 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc annulus fibrosus was 4.2 and 3.7 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc annulus fibrosus was 0.35,0.24,and 1.10 mm,respectively,and that of the L5S1 was 0.32,0.22,and 1.00 mm,respectively.④Stress and displacement of intervertebral disc nucleus pulposus.In the M1 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc nucleus pulposus was 0.35 and 0.32 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc nucleus pulposus was 0.10,0.46,and 0.41 mm,respectively,and that of the L5S1 was 0.08,0.40,and 0.40 mm,respectively.In the M2 mode,the maximum equivalent stress of L4-5 and L5S1 intervertebral disc nucleus pulposus was 0.34 and 0.31 MPa,respectively; the maximum leftward,forward,and upward displacement of the L4-5 intervertebral disc nucleus pulposus was 0.23,0.46,and 0.41 mm,respectively,and that of the L5S1 was 0.09,0.45,and 0.40 mm,respectively.⑤Contact force and strain of the zygapophysial articular cartilages.In the M1 mode,the articular cartilages of the left and right zygapophyses at L4-5 segment showed the maximum contact force of 17.0 and 15.8 MPa,and the maximum strain values of 0.34% and 0.32%,respectively,and that of L5S1 showed the maximum contact force of 9.7 and 9.4 MPa,and the maximum strain values of 0.33% and 0.27%,respectively.In the M2 mode,the articular cartilages of the left and right zygapophyses at L4-5 segment showed the maximum contact force of 15.0 and 13.0 MPa,and the maximum strain value of 0.31% and 0.27%,respectively,and that of L5S1 showed the maximum contact force of 10.0 and 8.4 MPa,and the maximum strain value of 0.29% and 0.24%,respectively.Conclusion:The lumbar fixed-point rotation manipulation in treating LDH at L4-S1 segments can induce certain stress changes and displacement in the L4-5 and L5S1 intervertebral discs,which promot the sliding of zygapophyseal joints.The biomechanical effects are stronger if the thumb pushes on the L4 spinous process in the process of manipulation.

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备注/Memo

备注/Memo:
基金项目: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)
通讯作者:周红海 E-mail:1310803699@qq.com
更新日期/Last Update: 1900-01-01