文献类型：期刊文献

中文题名：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

英文题名：Effects of stress distribution of the degenerative intervertebral disc during lumbar pulling and pressing manipulation by Finite element analysis

作者：张晓刚[1];秦大平[1,2];宋敏[2];曹林忠[2];蒋宜伟[2];宋贵杰[2];武生智[3];李具宝[4]

第一作者：张晓刚

机构：[1]甘肃中医学院附属医院,兰州730020;[2]甘肃中医学院,兰州730000;[3]兰州大学土木工程与力学学院,兰州730000;[4]云南中医学院,昆明650500

第一机构：甘肃中医药大学第二附属医院

年份：2013

卷号：28

期号：10

起止页码：3108

中文期刊名：中华中医药杂志

外文期刊名：China Journal of Traditional Chinese Medicine and Pharmacy

收录：CSTPCD;;北大核心:【北大核心2011】；CSCD:【CSCD_E2013_2014】；

基金：甘肃省中医药管理局重点科研基金项目(No.GZK-2009-3)~~

语种：中文

中文关键词：拔伸按压手法;有限元法;模型;退变腰椎;生物力学

外文关键词：Pulling and pressing manipulation; Finite element method; Model; Degenerative lumbar; Biomechanics

摘要：目的:比较利用拔伸按压手法作用下正常腰椎节段与退变腰椎节段三维有限元模型的应力变化特点及量效关系,分析拔伸按压手法对退变腰椎节段力学调衡的作用机制。方法:选择患有椎间盘突出症和正常男性志愿者各1例,年龄(40±5)岁,身高(175±5)cm,体质量(70±5)kg,正常男性志愿者排除腰椎疾病史,志愿者对试验方案知情同意,且得到医院伦理道德委员会批准。进行CT扫描,扫描层厚0.3mm,共获得轴位断层图像376层,并储存于CT工作站主机硬盘内,然后以DICOM数据刻盘保存。将所有CT图像数据输入Mimics软件中进行分析。利用对退变腰椎间盘的数据,结合数字化的力学工程软件建立了人体脊柱退变腰椎节段(L1-L5)完整、真实的三维有限元模型,其模型高度模拟了腰椎的结构几何非线性、材料非线性与接触非线性,具有结构完整、空间结构的测量准确度高、单元划分精细、重点突出等优点,并模拟了腰椎节段前屈与后伸的生理活动。在加载外力即拔伸按压手法作用下分析退变腰椎节段的应力变化特点,外加载荷逐渐递增的过程中分析退变腰椎节段的应力变化的量效关系,并与正常腰椎节段的三维有限元模型作比对,分析拔伸按压手法对退变腰椎节段力学调衡作用机制。结果:拔伸按压手法对退变腰椎节段力学调衡作用主要表现在能改变椎间盘内的应力分布,一定程度的增大椎管内的空间,使神经根所受的应力减小,椎体、小关节应力、椎弓根应力后伸位大于前屈位;椎间盘内部应力前屈位大于后伸位;且均由上至下呈逐渐增大的趋势。结论:其结果能够反映通过拔伸按压手法对人体退变腰椎节段的力学环境的调衡起到改善和治疗腰椎间盘病变的目的。同时与人体正常腰椎节段三维有限元模型作对比,从生物力学环境与特性改变角的度研究腰椎退变的过程,能够为临床和科研提供一种有效地预防和治疗脊柱腰椎节段病损的方法。
Objective： In comparison of the stress characteristics and the dose-effect relationship of the three dimensional finite element model between the normal lumbar segment and the degeneration of the lumbar spine segments by press-pulling manipulation, to analysis of the mechanics balancing mechanism of the press-pulling manipulation on the degeneration of the lumbar segments. Methods： One male patient suffering from disc herniation and one normal male volunteer were selected, age of （40＋5）years old, height of （175_＋5）cm, body weight of （70＋_5）kg. The normal male volunteer without disease history of lumbar spinal diseases, with consent to the test program, and hospital ethical committee approval. Both of them were scaned by CT scans, with slice thickness of 0.3mm. 376 layers of axial tomography images were got and stored in the host hard disk of CT workstation, and saved in the DICOM （digital imaging and communications in medicine） data. All CT images data was input the Mimics software for analysis. Data of the degeneration of the lumbar segments combined with the mechanical engineering software were used to build a true three-dimensional finite element model of a complete lumbar intervertebral disc degeneration from L1 to L5. The height of the model simulated a high degree of lumbar geometrically nonlinear material nonlinearity and contact nonlinearity,with the advantage of structural integrity, high accuracy measurement of the spatial structure, the unit fine and the keypoints standout, etc. And it also simulated the physiological lumbar segmental flexion and extension activities. With loading external force that was pulling and pressing tactics to analyze the stress change characteristics of the degeneration of the lumbar segments. In the increasing process of the loading external force to analyze the stress changes in the dose-effect relationship of the degeneration of the lumbar segments, and make a comparison to a normal lumbar dimensional finite element model to analyze the mechanical tone scale mechanism of pulling and pressing manipulation on degenerative lumbar segments. Results： The effects of pulling and pressing manipulation on the mechanical balance of the degeneration of the lumbar segments mainly manifested that it could change the intradiscal stress distribution, and increase the space in the spinal canala in a certain degree which could reduce the stress on nerve root, and make the extension greater than flexion in the vertebral body, stress of the small joints, and the stress of the vertebral pedicle, and make the flexion greater than extension in the isc internal stress, with a gradually increasing trend from top to bottom. Conclusion： The results showed that the mechanical environment of the lumbar segments of the leveller could make an effect of improvement and the treatment of lumbar disc disease degeneration of the human body by pulling and pressing manipulation. At the same time, in comparison with the three-dimensional finite element model of normal human lumbar segments, from process of changing the angle of the biomechanical environment and characteristics of the lumbar degenerative process, it could provide a an effective prevention and treatment of lumbar spine segmental lesions approach for both clinic and research.