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
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摘要
目的通过有限元分析方法,观察提拉旋转斜扳法操作时椎间盘应力及应变发生的变化规律,探寻手法治疗腰椎疾患的科学性和安全性。方法在构建的L_(4～5)节段腰椎模型上模拟加载提拉旋转斜扳手法,观察手法作用过程中椎间盘应力的分布及变化,髓核及纤维环的位移及应变。结果椎间盘应力变化从右后方开始出现,以弧形向周围传递扩散,应力的变化呈递减分布。椎间盘应变最小的位置在髓核偏后,以此为中心呈圆弧状向周围递增。应变最大的位置主要发生于纤维环,特别是椎间盘右侧外缘。结论手法操作中应力主要集中于后侧关节突关节,椎间盘的应力变化相对较小,提示手法治疗是安全的。纤维环后外侧在操作中有较明显的应变,局部的位移变化可能是手法疗效的机制之一。
Objective To observe the change rule of intervertebral disc stress and strain in the operation of tilting rotation by the method of finite element analysis, and to explore the scientificalness and safety of the method to treat lumbar spine disease. Methods Simulated loading of"Side bending-rotation manipulation"was loaded on lumbar L_(4～5) model. The distribution and change of technique effect in the process of intervertebral disc stress, displacement and strain of nucleus pulposus and annulus were observed.Results The changes of the stress in the intervertebral disc began to appear from the right rear, and spread around the arc, and the change of stress was reduced. Disc strain minimum position occurred in the nucleus and increased from the center to the periphery in an arched shape. The position of the maximum strain increment occurred mainly in fiber ring, especially in the right edge of intervertebral disc. Conclusions The stress in manipulation is mainly concentrated on the posterior small joints. The stress changes of the intervertebral disc are relatively small, suggesting that the manipulation is safe. There are obvious strains in the posterolateral operation of the annulus fibrosus, and the change of local displacement may be one of the mechanisms of therapeutic effect of manipulation.
Objective To observe the change rule of intervertebral disc stress and strain in the operation of tilting rotation by the method of finite element analysis, and to explore the scientificalness and safety of the method to treat lumbar spine disease. Methods Simulated loading of"Side bending-rotation manipulation"was loaded on lumbar L_(4～5) model. The distribution and change of technique effect in the process of intervertebral disc stress, displacement and strain of nucleus pulposus and annulus were observed.Results The changes of the stress in the intervertebral disc began to appear from the right rear, and spread around the arc, and the change of stress was reduced. Disc strain minimum position occurred in the nucleus and increased from the center to the periphery in an arched shape. The position of the maximum strain increment occurred mainly in fiber ring, especially in the right edge of intervertebral disc. Conclusions The stress in manipulation is mainly concentrated on the posterior small joints. The stress changes of the intervertebral disc are relatively small, suggesting that the manipulation is safe. There are obvious strains in the posterolateral operation of the annulus fibrosus, and the change of local displacement may be one of the mechanisms of therapeutic effect of manipulation.
引文
[1]吴山,马友盟,林应强.提拉旋转斜扳法治疗腰椎间盘突出症的临床研究[J].广州中医药大学学报, 2006, 23(4):311-314.
[2]赵亮,闫广华,瞿东滨,等.腰椎间盘退变对软骨终板生物力学特性影响的有限元分析[J].中国临床解剖学杂志, 2015, 33(4):455-460.
[3]范志勇,黄淑云,李黎,等.基于"法从手出"分析提拉旋转斜扳手法的数字化特征[J].中国组织工程研究, 2017, 21(27):4354-4359.
[4]田强,钟侨霖,郭汝松,等.两种腰椎脊柱推拿手法推扳力的研究[J].广州中医药大学学报, 2016, 33(3):324-326.
[5]李庆兵,冯跃,罗建,等.有限元分析在手法治疗腰椎间盘突出症中的研究进展[J].南京中医药大学学报, 2013, 29(1):94-96.
[6]王志鹏,张晓刚,赵文韬,等.有限元分析在腰椎手法治疗中的生物力学研究进展[J].医用生物力学, 2017, 32(3):293-298.
[7]魏晓宁,王艳,裴飞.腰椎间盘结构、盘内压力及不同载荷的影响:生物力学研究进展[J].中国组织工程研究, 2015, 19(20):3242-3247.
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[9]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一应变特性初探[J].浙江中医药大学学报, 2013(10):1156-1159.
[10]徐海涛,李松,刘澜,等.腰椎斜扳手法时椎间盘的有限元分析[J].中国组织工程研究, 2011, 15(13):2335-2338.
[11]冯宇,高燕,张国荣,等.椎体位移与椎间盘内压力变化的实验研究[J].中国骨伤, 2001, 14(2):83-84.
[12]王沛,董强,雪原.腰椎间盘突出病变部的压力测定及其病理学意义[J].中华骨科杂志, 2002, 22(3):129-133.
[13]冯宇,高燕,冯天有.脊柱定点旋转复位法治疗腰椎间盘突出症的临床和影像学疗效观察[J].中国骨伤, 2011, 24(1):30-33.
[14]郭伟,韩磊,闵亚青,等.腰椎手法关节和椎间盘压力的力学研究[J].颈腰痛杂志, 2016, 37(4):263-267.
[15]张晓刚,董建华,杨学峰,等.三维有限元腰椎节段模型上模拟拨伸按压手法的生物力学分析[J].中国组织工程研究, 2010, 14(22):4000-4004.
[16]张晓刚,秦大平,宋敏,等.拔伸按压手法对退变腰椎节段应力分布影响的有限元分析[J].中华中医药杂志, 2013(10):3108-3114.
[17]徐海涛,徐达传,李云贵,等.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.
[2]赵亮,闫广华,瞿东滨,等.腰椎间盘退变对软骨终板生物力学特性影响的有限元分析[J].中国临床解剖学杂志, 2015, 33(4):455-460.
[3]范志勇,黄淑云,李黎,等.基于"法从手出"分析提拉旋转斜扳手法的数字化特征[J].中国组织工程研究, 2017, 21(27):4354-4359.
[4]田强,钟侨霖,郭汝松,等.两种腰椎脊柱推拿手法推扳力的研究[J].广州中医药大学学报, 2016, 33(3):324-326.
[5]李庆兵,冯跃,罗建,等.有限元分析在手法治疗腰椎间盘突出症中的研究进展[J].南京中医药大学学报, 2013, 29(1):94-96.
[6]王志鹏,张晓刚,赵文韬,等.有限元分析在腰椎手法治疗中的生物力学研究进展[J].医用生物力学, 2017, 32(3):293-298.
[7]魏晓宁,王艳,裴飞.腰椎间盘结构、盘内压力及不同载荷的影响:生物力学研究进展[J].中国组织工程研究, 2015, 19(20):3242-3247.
[8]姚女兆,蒋杰,彭理良,等.推拿对腰椎运动单元生物力学影响的实验研究[J].中国临床解剖学杂志, 2014, 32(6):721-724.
[9]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一应变特性初探[J].浙江中医药大学学报, 2013(10):1156-1159.
[10]徐海涛,李松,刘澜,等.腰椎斜扳手法时椎间盘的有限元分析[J].中国组织工程研究, 2011, 15(13):2335-2338.
[11]冯宇,高燕,张国荣,等.椎体位移与椎间盘内压力变化的实验研究[J].中国骨伤, 2001, 14(2):83-84.
[12]王沛,董强,雪原.腰椎间盘突出病变部的压力测定及其病理学意义[J].中华骨科杂志, 2002, 22(3):129-133.
[13]冯宇,高燕,冯天有.脊柱定点旋转复位法治疗腰椎间盘突出症的临床和影像学疗效观察[J].中国骨伤, 2011, 24(1):30-33.
[14]郭伟,韩磊,闵亚青,等.腰椎手法关节和椎间盘压力的力学研究[J].颈腰痛杂志, 2016, 37(4):263-267.
[15]张晓刚,董建华,杨学峰,等.三维有限元腰椎节段模型上模拟拨伸按压手法的生物力学分析[J].中国组织工程研究, 2010, 14(22):4000-4004.
[16]张晓刚,秦大平,宋敏,等.拔伸按压手法对退变腰椎节段应力分布影响的有限元分析[J].中华中医药杂志, 2013(10):3108-3114.
[17]徐海涛,徐达传,李云贵,等.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.