【作者】 毕胜； 王福根； 李义凯；

【Author】 Bi Sheng, Wang Fu Gen, Li Yi Kai, et al.Department of rehabilitation. PLA General Hospital, Beijing, 100853

【机构】 解放军总医院康复医学科；

【摘要】 目的 应用生物力学方法和三维有限元模型,模拟不同腰部推拿手法,比较其腰椎内部结构的变化.方法 标本固定于生物力学材料实验机(MTS)应用计算机定量控制,同时使用ABAQUS6.1有限元软件建立腰椎L4—5有限元模型,分别模拟斜扳手法、坐位旋转和牵扳手法的条件.结果 斜扳手法和坐位旋转手法髓核内压力明显升高,牵扳手法髓核内压力降低和轻度升高;神经根与椎间盘之间有一位移,腰椎小关节内应力低于关节内骨折的限度.有限元模型模拟手法作用时椎间盘内髓核内压力坐位旋转手法最高,牵扳手法最低为负值.三种手法小关节合力无明显差别;斜扳手法和坐位旋转手法外层纤维环应力最大,牵扳手法内层纤维环应力最大,三种手法在椎间盘的后外侧均有位移.结论 模拟手法作用时椎间盘与相邻神经根之间有一相对位移,这可能是其治疗机制,有的手法作用时髓核内压升高,应注意其安全性.同时应用三维有限元模型可以很好的模拟各种腰部推拿手法的状态,并得到与生物力学实验基本一致的结果.更多还原

【Abstract】 Objective To study the changes of interior lumbar vertebrae comparing different lumbar manipulations applied by biomechanics and a three - dimensional finite element model. Method 7 cadaver lumbar spines were loaded on a on a Material Test System, and applied by a computer quantitative control to simulate three manipulations. The three - dimensional finite element model of an intact L4 - L5 lumbar motion segment was created using ABAQUS6. 1. The conditions of rotation manipulation, sitting -rotation manipulation and traction- rotation manipulation were simulated. Results The pressure of lumbar nucleus pulposus for rotation manipulation and sitting - rotation manipulation were apparently increased, and the pressure of lumbar nucleus pulposus for traction - rotation manipulation were deduced or slightly increased; there were displacements between the nerve roots and lumbar disc;The stress of lumbar facet were lower than the limitation of lumbar facet fracture. The finite element model shows that the pressure of lumbar nucleus for rotation manipulation was highest and for sitting - rotation manipulation was lowest negative value when simulating the manipulations The force of lumbar facet were not obuious different in three manipulations. The stress of external annulus fibrosus was largest in rotation manipulation and sitting - rotation manipulation and the stress of interior annulus fibrosus was largest. There were displacements in posterolateral disc for three manipulations. Conclusion The mechanism of manipulation may be the relative displacement between the nerve roots and lumbar disc. The pressure of lumbar nu-clueus pulposus were increased, we should pay attention to the security. The three - dimensional finite element model can be used for study lumbar vertebrae in manipulations, and can get approximately identical results comparing biomechanic research.更多还原