支具加拨针治疗脊柱侧凸的生物力学研究
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摘要
目的:探讨拨针干预脊柱侧凸支具治疗的临床生物力学原理。方法:根据拨针疗法新的设计思路建立实验力学模型,模拟选择7例脊柱侧凸尸体标本,先采用支具疗法干预测量,再在支具基础上增加拨针疗法干预测量。结果:两种方法实验力学模型能够实现拨针疗法对脊柱侧凸载荷的预测,验证了模型的精确性有效性,脊柱侧凸原始侧凸程度7例均值为(59.70±3.37)°,经支具矫正为(49.57±2.79)°,采用拨针疗法联合支具治疗,矫正为(39.43±1.94)°,后者具有明显优势(P<0.05)。从脊柱侧凸胸腰椎凹侧撑开力V,凸侧压缩力T,支具加拨针比单独使用支具省力45%～46%,旋转力矩M_W和压缩力矩M_V省力达45%～47%,对抗肌肉韧带的张力矩M_T也省52%,差异均有统计学意义(P<0.05)。结论:拨针疗法生物力学实验模型的结果证实,拨针干预支具治疗脊柱侧凸能显著降低Cobb角,提高支具校正效率,有利于提高矫正效果,是一种有效的治疗方式。
Objective:To investigate clinical biomechanical principle of brace with stiletto needle therapy for scoliosis.Methods:Based on design ideas of teasing needle therapy, building an experimental mechanical model was built,seven specimens with scoliosis were chosen,and treated by brace therapy and then added to stiletto needle therapy. Results:The two experimental mechanical model methods could predict load of scoliosis by stiletto needle therapy,and was verified accuracy and effectiveness of model. The degree of initial scoliosis of 7 patients was(59.7±3.37)°,improved to(49.57±2.79)° by correction of brace,and(39.43±1.94)°by correction of brace with stiletto needle therapy,had significant differences(P<0.05). Lateral distraction force of thoracolumbar fossa from scoliosis as V,compressive force of scoliosis as T,brace with stiletto needle therapy could save effort for 45% to 46% than that of brace,while running torque Mw and compressive torque Mv could save effort about 45% to 47%,save effort of tension torque MTof muscle and ligament for 52%,and had statistical difference(P<0.05).Conclusion:Experimental biomechanical model of teasing needle therapy confirmed that the therapy could significantly reduce Cobb angle,improve correction efficiency of brace and beneficial for correction effect. It is an effective treatment for scoliosis.
Objective:To investigate clinical biomechanical principle of brace with stiletto needle therapy for scoliosis.Methods:Based on design ideas of teasing needle therapy, building an experimental mechanical model was built,seven specimens with scoliosis were chosen,and treated by brace therapy and then added to stiletto needle therapy. Results:The two experimental mechanical model methods could predict load of scoliosis by stiletto needle therapy,and was verified accuracy and effectiveness of model. The degree of initial scoliosis of 7 patients was(59.7±3.37)°,improved to(49.57±2.79)° by correction of brace,and(39.43±1.94)°by correction of brace with stiletto needle therapy,had significant differences(P<0.05). Lateral distraction force of thoracolumbar fossa from scoliosis as V,compressive force of scoliosis as T,brace with stiletto needle therapy could save effort for 45% to 46% than that of brace,while running torque Mw and compressive torque Mv could save effort about 45% to 47%,save effort of tension torque MTof muscle and ligament for 52%,and had statistical difference(P<0.05).Conclusion:Experimental biomechanical model of teasing needle therapy confirmed that the therapy could significantly reduce Cobb angle,improve correction efficiency of brace and beneficial for correction effect. It is an effective treatment for scoliosis.
引文
[1]程永红.青少年特发性脊柱侧凸治疗研究进展[J].中国矫形外科杂志,2012,20(9):819-822.CHENG YH.Advances in the treatment of adolescent idiopathic scoliosis[J].Zhongguo Jiao Xing Wai Ke Za Zhi,2012,20(9):819-822.Chinese.
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[3]范宁,藏磊,海涌,等.脊柱侧凸有限元建模方法的应用进展[J].中国骨伤,2018,31(4):391-394.FAN N,ZANG L,HAI Y,et al.Progression on finite element modeling method in scoliosis[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(4):391-394.Chinese with abstract in English.
[4]朱晓华,朱力立,徐荣范.拨针疗法配合支具治疗青少年特发性脊柱侧凸疗效观察[J].上海针灸杂志,2017,36(3):331-333.ZHU XH,ZHU LL,XU RF.Observations on the efficacy of teasing needle therapy plus a brace for adolescent idiopathic scoliosis[J].Shang Hai Zhen Jiu Za Zhi,2017,36(3):331-333.Chinese.
[5]戴尅戎,俞昌泰,张先茷,等.脊柱侧凸的病理力学和对哈氏棒矫正术的改进[J].中华外科杂志,1983,21(1):27-30.DAI KR,YU CT,ZHANG XF,et al.Pathological mechanics of scoliosis and improvement of Harrington's epithesis[J].Zhonghua Wai Ke Za Zhi,1983,21(1):27-30.Chinese.
[6]杜红根,徐金元,蒋忠,等.脊柱平衡疗法对青少年特发性脊柱侧凸患者肺功能及表面平均肌电比值的影响[J].中国骨伤,2016,29(4):316-319.DU HG,XU JY,JIANG Z,et al.Influences of spine balanced therapies of traditional Chinese medicine in adolescent idiopathic scoliosis in pulmonary function and average ratio of the surface electromyogram[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(4):316-319.Chinese with abstract in English.
[7]Gardner Morse M,Stokes IA.Three dimensional simulations of the scoliosis derotation maneuver with Cotrel Dubousset instrumentation[J].J Biomech,1994,27(2):177-181.
[8]Liu CL,Kao HC,Wang ST,et al.Biomechanical evaluation of a central rod system in the treatment of scoliosis[J].Clin Biomech(Bristol,Avon),1998,13(7):548-559.
[9]翁习生,王胜利,徐宏光,等.矫形支具对青春期特发性脊柱侧凸的治疗价值[J].中华骨科杂志,2003,23(3):49-52.WENG XS,WANG SL,XU HG,et al.Therapeutic value of orthotic braces for adolescent idiopathic scoliosis[J].Zhonghua Gu Ke Za Zhi,2003,23(3):49-52.Chinese.
[10]张宇鹏,史亚民,王华东,等.脊柱侧凸数字导航模板的准确性与安全性的病例对照研究[J].中国骨伤,2015,28(10):945-950.ZHANG YP,SHI YM,WANG HD,et al.Case control study on accuracy and safety of patient specific drill guide templates used in scoliosis cases[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(10):945-950.Chinese with abstract in English.
[11]Chan A,Lou E,Hill D.Review of current technologies and methods supplementing brace treatment in adolescentidiopathic scoliosis[J].J Child Orthop,2013,7(4):309-316.
[12]Maruyama T,Kobayashi Y,Miura M,et al.Effectiveness of brace treatment for adolescent idiopathic scoliosis[J].Scoliosis,2015,10(Suppl 2):S12.
[2]Zaina F,De Mauroy JC,Grivas T,et al.Bracing for scoliosis in2014:state of the art[J].Eur J Phys Rehabil Med,2014,50(1):93-110.
[3]范宁,藏磊,海涌,等.脊柱侧凸有限元建模方法的应用进展[J].中国骨伤,2018,31(4):391-394.FAN N,ZANG L,HAI Y,et al.Progression on finite element modeling method in scoliosis[J].Zhongguo Gu Shang/China J Orthop Trauma,2018,31(4):391-394.Chinese with abstract in English.
[4]朱晓华,朱力立,徐荣范.拨针疗法配合支具治疗青少年特发性脊柱侧凸疗效观察[J].上海针灸杂志,2017,36(3):331-333.ZHU XH,ZHU LL,XU RF.Observations on the efficacy of teasing needle therapy plus a brace for adolescent idiopathic scoliosis[J].Shang Hai Zhen Jiu Za Zhi,2017,36(3):331-333.Chinese.
[5]戴尅戎,俞昌泰,张先茷,等.脊柱侧凸的病理力学和对哈氏棒矫正术的改进[J].中华外科杂志,1983,21(1):27-30.DAI KR,YU CT,ZHANG XF,et al.Pathological mechanics of scoliosis and improvement of Harrington's epithesis[J].Zhonghua Wai Ke Za Zhi,1983,21(1):27-30.Chinese.
[6]杜红根,徐金元,蒋忠,等.脊柱平衡疗法对青少年特发性脊柱侧凸患者肺功能及表面平均肌电比值的影响[J].中国骨伤,2016,29(4):316-319.DU HG,XU JY,JIANG Z,et al.Influences of spine balanced therapies of traditional Chinese medicine in adolescent idiopathic scoliosis in pulmonary function and average ratio of the surface electromyogram[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(4):316-319.Chinese with abstract in English.
[7]Gardner Morse M,Stokes IA.Three dimensional simulations of the scoliosis derotation maneuver with Cotrel Dubousset instrumentation[J].J Biomech,1994,27(2):177-181.
[8]Liu CL,Kao HC,Wang ST,et al.Biomechanical evaluation of a central rod system in the treatment of scoliosis[J].Clin Biomech(Bristol,Avon),1998,13(7):548-559.
[9]翁习生,王胜利,徐宏光,等.矫形支具对青春期特发性脊柱侧凸的治疗价值[J].中华骨科杂志,2003,23(3):49-52.WENG XS,WANG SL,XU HG,et al.Therapeutic value of orthotic braces for adolescent idiopathic scoliosis[J].Zhonghua Gu Ke Za Zhi,2003,23(3):49-52.Chinese.
[10]张宇鹏,史亚民,王华东,等.脊柱侧凸数字导航模板的准确性与安全性的病例对照研究[J].中国骨伤,2015,28(10):945-950.ZHANG YP,SHI YM,WANG HD,et al.Case control study on accuracy and safety of patient specific drill guide templates used in scoliosis cases[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(10):945-950.Chinese with abstract in English.
[11]Chan A,Lou E,Hill D.Review of current technologies and methods supplementing brace treatment in adolescentidiopathic scoliosis[J].J Child Orthop,2013,7(4):309-316.
[12]Maruyama T,Kobayashi Y,Miura M,et al.Effectiveness of brace treatment for adolescent idiopathic scoliosis[J].Scoliosis,2015,10(Suppl 2):S12.