【摘要】 目的:探讨进行坐位旋转手法时退变腰椎间盘的内在应力及位移分布的特点,以分析手法的机制、安全性与合理性。方法:使用腰椎CT片,以Mimics软件系统逐层重建L4-5三维有限元模型,通过设定结构的参数完成退变腰椎间盘模型。将向右侧旋转的坐位腰椎旋转手法进行分解,把各项力学参数代入模型进行计算分析。即时显示手法作用时退变腰椎间盘的内在应力和位移的变化。结果:椎间盘的应力、应变及位移都不断增加。应力从腰椎间盘右前侧的外缘呈弧形向左后侧的外缘递减。椎间盘右后侧外缘的压应力较大。位移从右前侧向左后侧呈层状递减。位移方向与应力方向大致相同。相应位置椎间盘右后侧位移大于左后侧位移。最终应变:右后角中下部有明显的变形,向后内侧突出,左后侧部变形最小。结论:手法增加了旋转侧椎间盘的位移,有利于解除神经根的粘连,但同时增加了对神经根的压迫。向突出椎间盘的对侧旋转较为安全。腰椎椎管狭窄患者不宜用本手法。更多还原

【Abstract】 Objective: To study the trait of displacement and intra-stress distribution of lumbar disc of degenerative during rotatory manipulation. Method: A 3-D finite element system of lumbar L4-5 was sectionally constructed with Mimics software system by lumbar CT images. The system was turned into a finite element system of degenerative lumbar by modified it′s material parameter. The lumbar rotatory manipulation was decomposed by principium of manipulation. The parameter of mechanics was analyzed with the finite element system. The change of intra-stress distribution and displacement in lumbar disc were displayed simultaneous during simulating manipulation. Result: The intra-stress, displacement and distortion of lumbar disc were increasing continuously during manipulation. The stress descended from right-anterior side of the lateral border to left-posterior side of the lateral border in a form of arc. The stress in right-posterior side of lateral border was bigger. The displacement, just as the stress, descended from right-anterior side of lateral border to left-posterior side of lateral border in a form of layer. The right-posterior region′s displacement was larger than left-posterior′s in the same level, just as the same as distortion. Conclusion: By adding the displacement,the manipulation was helpful to relieve the conglutination of nerve root, but increased the stress at nerve root. It was safer to rotate lumbar toward opposite side of the extrusive disc. The manipulation was not applicable to lumbar spinal stenosis.更多还原