坐位旋转手法时腰椎应力及位移的有限元分析
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摘要
目的
1、探讨两种坐位旋转手法对椎间盘及椎体内在应力及位移的影响。
2、探讨两种坐位旋转手法的作用机理及其合理性、安全性。
研究方法
1、应用压力传感器系统,测量并记录腰椎定点旋转手法作用过程中出现“咔哒”声时术者拇指推顶棘突的最大推扳力。
2、建立模型:使用螺旋CT,以1mm的间隔,对1具男性青年新鲜尸体的腰椎标本沿轴向进行断层扫描,以jpg格式将其断面图像输入计算机。利用三维重建软件Minics建立腰椎三维计算机模型。再经过自由造型Free Form系统的修改。应用L4-5的CT图像,逐层重建含有20781个结点,13632个立体单位的三维有限元模型。
3、根据手法原理,将两种坐位旋转手法进行分解,把力学参数带入三维有限元模型,利用Ansys 9.0软件进行计算。
研究结果
1、腰椎定点旋转手法出现“咔哒”声响时术者左、右拇指对受试者第四腰椎棘突的最大推扳力分别为4.98±1.24kg和6.71±1.66kg。
2、椎间盘位移和应力特点
腰椎定点旋转手法:椎间盘的应力及位移都不断增加。应力主要集中于纤维环的外侧,而髓核应力较小。位移方向与应力方向大致相同。位移从椎间盘左前缘呈弧形向右后侧递减。椎间盘左后缘位移大于右后缘。
直腰旋转手法:椎间盘的应力及位移都不断增加。椎间盘的应力从纤维环右侧缘向左侧递减。最终位移是以右侧髓核为中心向边缘逐渐增大。最大的位移位于椎间盘左侧缘。
结论
1、手法造成了椎间盘、关节突的位移,有利于解除神经根的粘连。
2、两种手法比较,脊柱定点旋转手法更具有效性及安全性。
Objective
1. To explore effects of sitting-rotatory manipulation on inner stress and displacement of lumbar intervertebral disc.
2. To explore the mechanism, rationality and security of sitting-rotation manipulation.
Method
1.The largest forces of thumb on the spinous process of fourth lumbar vertebra were tested and recorded with a press sensor testing system during cracking sounds of the lumbar located and rotatory manipulation.
2.Model establishing: one intact fresh young man cadaveric specimens was scanned with CT with 1mm interval through its lumbar vertebrae. Then, the jpg-format data of CT were inputted into computer and were utilized to establish the three-dimensional FEM by using software Mimics. Then the FEM was modified by Freeform system. The finite element system contained of 20781 nodes and 13632 elements.
3. Two kinds of sitting-rotation manipulations were decomposed by principium of manipulation. The parameters of mechanics wre analyzed with the three-dimensional finite element system and computed with software Ansys 9. 0.
Result
1. As the cracking sound , the forces to the fourth spinous process of lumbar vertebra were 4. 98±1. 24kg and 6. 71±1.66kg respectively in left and right thumbs.
2. Characteristic of stress, displacement of lumbar disc.
lumbar Rotatory Manipulation The stress, displacement of lumbar disc were increasing continuously during manipulation. The stress was concentrated around outlayer of annulus fibrous, which is bigger than the stress in nucleus pulposus. The stress was descended from left-anterior side of the lateral border to right-posterior side of the lateral border in a form of arc. The displacement, just as the stress, descended form left-anterior side of the lateral border to right-posterior side of the lateral border in a form of arc. The displacement of right-posterior region was larger than the left-posterior region.
Lumbar Erected and Rotatory Manipulation The stress , displacement of lumbar disc were increasing continuously during manipulation. The stress was descended from right side of the lateral border to left side. The final displacement is increased gradually centered around the right side of nucleus pulposus. The biggest displacement is located at the left side of the lateral border.
Conclusion
1. By causing the displacement of intervertebral disc and articular process, the manipulation was helpful to relieve the conglutination of nerve toot.
2. Cmparing the two kinds of manipulation , the lumbar rotatory manipulation is more effective and safty.
1、探讨两种坐位旋转手法对椎间盘及椎体内在应力及位移的影响。
2、探讨两种坐位旋转手法的作用机理及其合理性、安全性。
研究方法
1、应用压力传感器系统,测量并记录腰椎定点旋转手法作用过程中出现“咔哒”声时术者拇指推顶棘突的最大推扳力。
2、建立模型:使用螺旋CT,以1mm的间隔,对1具男性青年新鲜尸体的腰椎标本沿轴向进行断层扫描,以jpg格式将其断面图像输入计算机。利用三维重建软件Minics建立腰椎三维计算机模型。再经过自由造型Free Form系统的修改。应用L4-5的CT图像,逐层重建含有20781个结点,13632个立体单位的三维有限元模型。
3、根据手法原理,将两种坐位旋转手法进行分解,把力学参数带入三维有限元模型,利用Ansys 9.0软件进行计算。
研究结果
1、腰椎定点旋转手法出现“咔哒”声响时术者左、右拇指对受试者第四腰椎棘突的最大推扳力分别为4.98±1.24kg和6.71±1.66kg。
2、椎间盘位移和应力特点
腰椎定点旋转手法:椎间盘的应力及位移都不断增加。应力主要集中于纤维环的外侧,而髓核应力较小。位移方向与应力方向大致相同。位移从椎间盘左前缘呈弧形向右后侧递减。椎间盘左后缘位移大于右后缘。
直腰旋转手法:椎间盘的应力及位移都不断增加。椎间盘的应力从纤维环右侧缘向左侧递减。最终位移是以右侧髓核为中心向边缘逐渐增大。最大的位移位于椎间盘左侧缘。
结论
1、手法造成了椎间盘、关节突的位移,有利于解除神经根的粘连。
2、两种手法比较,脊柱定点旋转手法更具有效性及安全性。
Objective
1. To explore effects of sitting-rotatory manipulation on inner stress and displacement of lumbar intervertebral disc.
2. To explore the mechanism, rationality and security of sitting-rotation manipulation.
Method
1.The largest forces of thumb on the spinous process of fourth lumbar vertebra were tested and recorded with a press sensor testing system during cracking sounds of the lumbar located and rotatory manipulation.
2.Model establishing: one intact fresh young man cadaveric specimens was scanned with CT with 1mm interval through its lumbar vertebrae. Then, the jpg-format data of CT were inputted into computer and were utilized to establish the three-dimensional FEM by using software Mimics. Then the FEM was modified by Freeform system. The finite element system contained of 20781 nodes and 13632 elements.
3. Two kinds of sitting-rotation manipulations were decomposed by principium of manipulation. The parameters of mechanics wre analyzed with the three-dimensional finite element system and computed with software Ansys 9. 0.
Result
1. As the cracking sound , the forces to the fourth spinous process of lumbar vertebra were 4. 98±1. 24kg and 6. 71±1.66kg respectively in left and right thumbs.
2. Characteristic of stress, displacement of lumbar disc.
lumbar Rotatory Manipulation The stress, displacement of lumbar disc were increasing continuously during manipulation. The stress was concentrated around outlayer of annulus fibrous, which is bigger than the stress in nucleus pulposus. The stress was descended from left-anterior side of the lateral border to right-posterior side of the lateral border in a form of arc. The displacement, just as the stress, descended form left-anterior side of the lateral border to right-posterior side of the lateral border in a form of arc. The displacement of right-posterior region was larger than the left-posterior region.
Lumbar Erected and Rotatory Manipulation The stress , displacement of lumbar disc were increasing continuously during manipulation. The stress was descended from right side of the lateral border to left side. The final displacement is increased gradually centered around the right side of nucleus pulposus. The biggest displacement is located at the left side of the lateral border.
Conclusion
1. By causing the displacement of intervertebral disc and articular process, the manipulation was helpful to relieve the conglutination of nerve toot.
2. Cmparing the two kinds of manipulation , the lumbar rotatory manipulation is more effective and safty.
引文
[1]张显崧,章莹.腰椎旋转手法治疗腰椎间盘突出症的机理:附20例磁共振成像分析[J].中医正骨,1993,5(3):5-6.
[2]马达,蒋位庄.脊柱旋转手法治疗腰椎间盘突出症的实验研究[J].中国骨伤,1994,7(5):7-9.
[3]毕胜,李义凯,赵卫东等.模拟腰部斜扳手法的生物力学研究[J].中国运动医学杂志,2002,21(3):323-324.
[4]王国林,李义凯,张美超等.坐位腰椎旋转手法时腰椎单元内在应力和位移的实时监测[J].中国骨伤,2007,20(3):173-175.
[5]侯筱魁,董凡.斜搬时腰椎后部结构的动态观察和生物力学分析[J].中华骨科杂志,1993,13(1):51-54.
[6]侯筱魁,董凡.斜扳时完整腰椎三维立体运动的研究[J].中国骨伤,1996,9(4):5-7.
[7]张勇,毕胜,赵卫东等.腰椎旋转手法对髓核内压力和神经根位移的影响[J].颈腰痛杂志,2001,22(3):184-185.
[6]徐海涛,张美超,李义凯等.坐位旋转手法对正常腰椎间盘内在应力和位移的实时监测的实验研究[J].中国康复医学杂志,2005,20(8):563-565.
[7]毕胜,李义凯,赵卫东等.腰部推拿手法生物力学和有限元比较研究[J].中华物理医学与康复杂志,2002,24(9):525-528.
[8]李星,蒋位庄.手法治疗脊柱滑脱症的临床与实验研究[J].中国骨伤,1994,7(6):5。
[9]徐海涛,徐传达,李云贵.坐位旋转手法时退变腰椎间盘内在应力和位移的有限元分析[J].中国康复医学杂志,2007,22(9):769-771.
[10]蒋位庄,周卫,李星等.腰后关节紊乱症的病机和手法治疗生物力学研究[J].中国骨伤,1994,7(3):5-8.
[11]刘雷等.胸腰椎脊柱损伤的生物力学及有限元分析.实用骨科杂志,2001,7(5):35 5-356.
[12]Brekelmans WAN,et al.A new method to analysis the mechanical behavior of skeletal parts[J].Acta Orthop Scand,1972,43:301.
[13]Rybicki EF.et al.Orthe mathematical analysis of stress in the human femur [J].Biomech,1972,5:203.
[14]Huiskes R and Chao EYS.Asurvey of Finite element analysis in orohnpedie biomeehaniesi the first fecade[J].J Biomech,1983,16:385.
[15]Liu YK.The resistance of the lumbar spine to direct shear orthop clin North Am.1975,6:33.
[16]Schroeder Y,Wilson W,Huyghe JM,et al.Osmoviscoelastic finite element model of the intervertebral disc[J].Bur Spine J,2OO6,15(Suppl)3:S36I-S371.
[17]李韵等.有限元分析在脊柱生物力学领域的应用.生物医学工程学杂志,2001,18(2):288-289.
[18]谭军,万卫平,王鸣鹏等.应用三维有限元法分析正常人腰椎椎体的应力分布。第二军医大学学报,1997,18(6):566-568.
[19]戴力扬,屠开元,徐印坎等.腰椎椎体应力分布的三维有限元分析[J].中国临床解剖学杂志,1991,9:46-48.
[20]Eswaran SK,Gupta A,Adams MF,et al.Cortical and trabecular load sharing in the human vertebral body[J].J Bone Miner Res,2006,21(2):307-314.
[21]Shirazi-Adl A.Nonlinear stress analysis of the whole lumbar spine in torsion-mechanics of facet articulation[J].J Biomech,1994,27(3):289-299.
[22]Zander T,Rohlmann A,Burra NK,et al.Estimation of muscle forces in the lumbar spine during upper-body inclination[J].Clin Biomech(Bristol,Avon),2001,16(Suppl 1):S73-S80.
[23]Sharma M,Langrana NA,Rodriguez J.Role of ligament and facets in lumbar spinal stability[J].Spine,1995,20:887-900.
[24]Liu L,Pei F,Song Y,et al.The influence of the intervertebral disc on stress distribution of the thOracOlumbar vertebrae under destructive load [J].Chin J Traumatol,2002,5(5):279-283.
[25]Konz RJ,Goel VK,Grobler LJ,et al.The pathomechainsom of Spondylolytic spondylolisthesis in immature primate lumbar spines in vitro and finite element assessments.Spine,2001,26(4):E38-E49.
[26]Sairyo K,Katoh S,Sasa T,et al.Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis:a clinical and biomechanical study[J].Am J Sports Med,2005,33(4):583-590.
[27]Sairyo K,Goel VK,Masuda A,et al.Three-dimensionat finite element analysis of the pediatric lumbar spine.Part Ⅰ:pathomechanism of apophyseal bony ring fracture[J].Eur Spine J,2006,15(6):923-929.
[28]Wilcox R,KAllen DJ,Hall RM,et al.A dynamic investigation of the burst fracture process using a combined experimental and finite element approach [J].Eur Spine J,2004,13(6):481-488.
[29].Natarajan RN.Andersson GB,Patwardhan AG,et al.Study on effect of graded facetectomy on change in lumbar motion segment torsional flexibility using three-dimensional continuum contact representation for facet joint[J].J Biomeeh,1999,121:215-221.
[30]Chen CS,Cheng CK,Liu CL,et al.Stress analysis of the disc adjacent to interbody fusion in lumbar spine.Med Eng Phys,2001,23(7):483-491.
[31]Lieschner MA.Rosennberg WS,Keaveny TM.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty.Spine,2001,26(14):1547-1554.
[32]Lim TH,Kim JG.Fujiwara A.et al.Biomechanical evaluation of diagonal fixation in pedicle screw instrumentation.Spine,2001,26(22):2498-2503.
[33]Dooris AP,Goel VK,Grostand NM,et al.Load-sharing between anterior and posterior elements in a lumbar motion segment implanted with and artificial disc.Spine,2001,26(6):122-129.
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[36]Rohimann A.Zander T.Schmidt H,et al.Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method[J].Clin Biomech(Bristol,Avon),2006,9(5):145-158.
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[40]张美超,程立明,李义凯等.三维有限元在正常与后凸畸形胸腰椎体力学性能比较中的应用[J].中国运动医学杂志,2004,23(5):480.
[41]章婴,汪青春,张显崧.手法治疗腰椎间盘突出症的生物力学研究[J].中国骨伤,1992,5(2):7.
[42]张显崧,章莹.腰椎旋转手法治疗腰椎间盘突出症的机理:附20例磁共振成像分析[J].中医正骨,1993,5(3):5-6.
[43]Schmidt TA,An HS,Lim TH et al.The stiffness of lumbar spinal motton segments with a high-intensity zone in the annulus fibrosus[J].Spine,1983,23(20):2167-2173.
[44]许文根,黄宏前,杨永等.腰椎间盘突出症解剖分型及临床意义[J].颈腰痛杂志,1999,20(4):251-253.
[45]Adams MA,Hutton WC.The effect of fatigue on the lumbar intervertebral disc.J Bone Joint Surg(Br),1983,65(2):199-203.
[46]Farfan HF.Mechanical disorders of the lowack[M].Philadelphia:Lea &Febiger,1973,6:292.
[47] Shirazi-Adla,Nonlinera stress analysis of the whole lumbar spine in torsion-mechanics of facet articulation[J]. J Biomech, 1994, 27(3):289-299
[2]马达,蒋位庄.脊柱旋转手法治疗腰椎间盘突出症的实验研究[J].中国骨伤,1994,7(5):7-9.
[3]毕胜,李义凯,赵卫东等.模拟腰部斜扳手法的生物力学研究[J].中国运动医学杂志,2002,21(3):323-324.
[4]王国林,李义凯,张美超等.坐位腰椎旋转手法时腰椎单元内在应力和位移的实时监测[J].中国骨伤,2007,20(3):173-175.
[5]侯筱魁,董凡.斜搬时腰椎后部结构的动态观察和生物力学分析[J].中华骨科杂志,1993,13(1):51-54.
[6]侯筱魁,董凡.斜扳时完整腰椎三维立体运动的研究[J].中国骨伤,1996,9(4):5-7.
[7]张勇,毕胜,赵卫东等.腰椎旋转手法对髓核内压力和神经根位移的影响[J].颈腰痛杂志,2001,22(3):184-185.
[6]徐海涛,张美超,李义凯等.坐位旋转手法对正常腰椎间盘内在应力和位移的实时监测的实验研究[J].中国康复医学杂志,2005,20(8):563-565.
[7]毕胜,李义凯,赵卫东等.腰部推拿手法生物力学和有限元比较研究[J].中华物理医学与康复杂志,2002,24(9):525-528.
[8]李星,蒋位庄.手法治疗脊柱滑脱症的临床与实验研究[J].中国骨伤,1994,7(6):5。
[9]徐海涛,徐传达,李云贵.坐位旋转手法时退变腰椎间盘内在应力和位移的有限元分析[J].中国康复医学杂志,2007,22(9):769-771.
[10]蒋位庄,周卫,李星等.腰后关节紊乱症的病机和手法治疗生物力学研究[J].中国骨伤,1994,7(3):5-8.
[11]刘雷等.胸腰椎脊柱损伤的生物力学及有限元分析.实用骨科杂志,2001,7(5):35 5-356.
[12]Brekelmans WAN,et al.A new method to analysis the mechanical behavior of skeletal parts[J].Acta Orthop Scand,1972,43:301.
[13]Rybicki EF.et al.Orthe mathematical analysis of stress in the human femur [J].Biomech,1972,5:203.
[14]Huiskes R and Chao EYS.Asurvey of Finite element analysis in orohnpedie biomeehaniesi the first fecade[J].J Biomech,1983,16:385.
[15]Liu YK.The resistance of the lumbar spine to direct shear orthop clin North Am.1975,6:33.
[16]Schroeder Y,Wilson W,Huyghe JM,et al.Osmoviscoelastic finite element model of the intervertebral disc[J].Bur Spine J,2OO6,15(Suppl)3:S36I-S371.
[17]李韵等.有限元分析在脊柱生物力学领域的应用.生物医学工程学杂志,2001,18(2):288-289.
[18]谭军,万卫平,王鸣鹏等.应用三维有限元法分析正常人腰椎椎体的应力分布。第二军医大学学报,1997,18(6):566-568.
[19]戴力扬,屠开元,徐印坎等.腰椎椎体应力分布的三维有限元分析[J].中国临床解剖学杂志,1991,9:46-48.
[20]Eswaran SK,Gupta A,Adams MF,et al.Cortical and trabecular load sharing in the human vertebral body[J].J Bone Miner Res,2006,21(2):307-314.
[21]Shirazi-Adl A.Nonlinear stress analysis of the whole lumbar spine in torsion-mechanics of facet articulation[J].J Biomech,1994,27(3):289-299.
[22]Zander T,Rohlmann A,Burra NK,et al.Estimation of muscle forces in the lumbar spine during upper-body inclination[J].Clin Biomech(Bristol,Avon),2001,16(Suppl 1):S73-S80.
[23]Sharma M,Langrana NA,Rodriguez J.Role of ligament and facets in lumbar spinal stability[J].Spine,1995,20:887-900.
[24]Liu L,Pei F,Song Y,et al.The influence of the intervertebral disc on stress distribution of the thOracOlumbar vertebrae under destructive load [J].Chin J Traumatol,2002,5(5):279-283.
[25]Konz RJ,Goel VK,Grobler LJ,et al.The pathomechainsom of Spondylolytic spondylolisthesis in immature primate lumbar spines in vitro and finite element assessments.Spine,2001,26(4):E38-E49.
[26]Sairyo K,Katoh S,Sasa T,et al.Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis:a clinical and biomechanical study[J].Am J Sports Med,2005,33(4):583-590.
[27]Sairyo K,Goel VK,Masuda A,et al.Three-dimensionat finite element analysis of the pediatric lumbar spine.Part Ⅰ:pathomechanism of apophyseal bony ring fracture[J].Eur Spine J,2006,15(6):923-929.
[28]Wilcox R,KAllen DJ,Hall RM,et al.A dynamic investigation of the burst fracture process using a combined experimental and finite element approach [J].Eur Spine J,2004,13(6):481-488.
[29].Natarajan RN.Andersson GB,Patwardhan AG,et al.Study on effect of graded facetectomy on change in lumbar motion segment torsional flexibility using three-dimensional continuum contact representation for facet joint[J].J Biomeeh,1999,121:215-221.
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