| 基于影像学的美式整脊干预第三腰椎横突综合征生物力学有限元分析 |
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投稿时间：2024-05-30
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| 作者 | Author | 单位 | Address | E-Mail |
| 朱凌峰 |
ZHU Ling-feng |
舟山市中医院推拿科, 浙江 舟山 316000 |
Department of Massage, Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China |
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| 俞海捷 |
YU Hai-jie |
舟山市中医院推拿科, 浙江 舟山 316000 |
Department of Massage, Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China |
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| 应海芬 |
YING Hai-fen |
舟山市中医院推拿科, 浙江 舟山 316000 |
Department of Massage, Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China |
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| 陈本宝 |
CHEN Ben-bao |
舟山市中医院推拿科, 浙江 舟山 316000 |
Department of Massage, Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China |
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| 熊小春 |
XIONG Xiao-chun |
舟山市中医院推拿科, 浙江 舟山 316000 |
Department of Massage, Zhoushan Hospital of TCM, Zhoushan 316000, Zhejiang, China |
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| 吕立江 |
LYU Li-jiang |
浙江中医药大学附属第三医院推拿科, 浙江 杭州 310053 |
Department of Massage, the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310053, Zhejiang, China |
731577158@qq.com |
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| 期刊信息：《中国骨伤》2025年，第38卷，第4期，第403-410页 |
| DOI：10.12200/j.issn.1003-0034.20221031 |
| 基金项目:浙江省舟山市科技局市级公益类科技项目(编号:2021C31064);舟山市中青年临床名中医项目(编号:舟财社2024[52]号) |
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中文摘要:
目的: 基于有限元分析方法探讨美式整脊法干预第三腰椎综合征模型后的位移及压力分布。
方法: 2021年3月选取1例23岁男性右侧第三腰椎横突综合征患者的CT及MRI图像,采用Mimics、CATIA建立3D stl模型,将数据导入Hypermesh、Abaqus&ANSYS软件,调整患侧材料的弹性模量、泊松比,建立其有限元模型。依据美式整脊法与腰椎斜扳法两者操作体位与动作套路接近但着力点与施力方向存在区别设计对照比较,试验组模拟美式整脊法以模型健侧(左侧)卧位,其L3的上终板,L3以下部分随体位相应扭动,对L4、L5棘突及L4上关节突形成的平面施加垂直向前大小为246 N的推力;对照组模拟腰椎斜扳法,要求模型健侧(左侧)卧位,固定L4上终板,沿L3椎体纵轴做水平旋后的扭动,将此时扭向上的接触力大小设为246 N。比较两种手法干预后L1-L5椎体、椎间盘、关节突、横突间肌的位移及应力差异。
结果: (1)荷载安全状态下,对模型施加246 N测试力,最大椎体位移发生在对照组L3椎体右侧(1.197 mm),试验组L1-L5椎体位移均小于对照组,差异有统计学意义(P<0.05)。(2)最大椎体应力发生在对照组L3椎体右侧(98.425 MPa),试验组各椎体应力均小于对照组,差异有统计学意义(P<0.05)。(3)最大椎间盘应力发生在对照组L2,3椎间盘右侧(6.282 MPa)。(4)最大关节突应力发生在试验组L4上关节突右侧(1.587 MPa),试验组L1下左侧及L2上下左侧关节突应力小于对照组,差异有统计学意义(P<0.05)。(5)最大横突间肌应力在对照组L3,4右侧近L3横突端(31.960 MPa),试验组横突间肌L2与L4,3,5应力小于对照组,差异有统计学意义(P<0.05)。
结论: 美式整脊治疗L3横突综合征能够精确打击目标痛点,形成小应力低牵张状态,从而减少组织间因椎间关节运动后形成高张而再损伤的可能性,较为安全。美式整脊手法的应用将是对第三腰椎横突综合征传统治疗方案的新补充。 |
| 【关键词】第三腰椎横突综合征 有限元分析 美式整脊 腰椎斜扳法 骨科手法 生物力学试验 |
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| Biomechanical finite element analysis of American Chiropractic intervention on the third lumbar transverse process syndrome based on imaging |
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ABSTRACT
Objective To explore the displacement and pressure distribution of American Chiropractic in a model of third lumbar syndrome based on finite element analysis.
Methods On March 2021,CT and MRI images of a 23 year old male patient with right third lumbar syndrome were selected. A 3D stl model was established using Mimics and CATIA,and the data was imported into Hypermesh,Abaqus & ANSYS. The elastic modulus and Poisson's ratio of the affected side material were adjusted to establish its finite element model. Based on the comparison of the operating positions and routines of the American Chiropractic and the lumbar spine oblique pull method,but with differences in the focus and direction of force,the experimental group simulated the American Chiropractic with the healthy side (left side) lying position of the model. The upper endplate of L3 and the lower part below L3 twisted accordingly with the body position,we applied a vertical forward thrust of 246 N to the plane formed by the L4,L5 spinous processes and L4 upper articular processes;The control group simulates the oblique pull method of the lumbar spine,requiring the model to lie on the healthy side (left side),fix the upper endplate of L4,and perform a horizontal rotation along the longitudinal axis of L3 vertebral body. At this time,the contact force in the upward direction is al-so set to 246 N. Compare the displacement and stress differences between the L1-L5 intervertebral bodies,intervertebral discs, articular processes,and transverse process muscles in two intervention models.
Results ① Under safe load conditions,a test force of 246 N was applied to the model,and the maximum vertebral displacement occurred on the right side of the L3 vertebral body (1.197 mm) after manual intervention in the control group. The vertebral displacement between L1-L5 induced by manual intervention in the experimental group was smaller than that of the control group's manual intervention (P<0.05). ② The maximum vertebral body stress occurred on the right side of the L3 vertebral body after manual intervention in the control group (98.425 MPa). The stress on each vertebral body formed by the experimental group's manual intervention was lower than that of the control group's manual intervention (P<0.05). ③The maximum intervertebral disc stress occurred on the right side of the L2,3 intervertebral disc (6.282 MPa) after manual intervention in the control group. ④ The maximum joint process stress occurred on the right side of the L4 upper joint process after manual intervention in the experimental group (1.587 MPa). The joint process stress on the left side below L1 and the left side above and below L2 induced by manual intervention in the experimental group was lower than that of the control group (P<0.05). ⑤The maximum stress on the intertransverse process muscle was observed at the right lateral L3 process end (31.960 MPa) of L3,4 in the control group after manual intervention. The stress on the L2,3 and L4,5 segments of the intertransverse process muscle induced by manual intervention in the experimental group was lower than that of the control group's manual intervention (P<0.05).
Conclusion The mechanical feedback of the L1-L5 vertebral body,the lower left side of the articular process L1,the upper and lower left side of the articular process L2,and the L2,3 and L4,5 segments of the transverse process muscle in the model indicates that performing American Chiropractic for the treatment of third lumbar transverse process syndrome can accurately hit the target pain point and allow the patient's tissue to form a low stress and low tension state after manual operation,thereby reducing the possibility of tissue damage caused by hypertonia after intervertebral joint movement,making it relatively safe. The application of American Chiropractic will be a new supplement to the traditional treatment plan for third lumbar transverse process syndrome. |
| KEY WORDS The third lumbar transverse process syndrome Finite element analysis American Chiropractic Lumbar oblique pulling Orthopedic manipulation Biomechanical test |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朱凌峰,俞海捷,应海芬,陈本宝,熊小春,吕立江.基于影像学的美式整脊干预第三腰椎横突综合征生物力学有限元分析[J].中国骨伤,2025,38(4):403~410 |
| 英文格式: | ZHU Ling-feng,YU Hai-jie,YING Hai-fen,CHEN Ben-bao,XIONG Xiao-chun,LYU Li-jiang.Biomechanical finite element analysis of American Chiropractic intervention on the third lumbar transverse process syndrome based on imaging[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(4):403~410 |
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