不同体位下颈椎旋转手法对颈椎间盘位移和内在应力的影响

发布时间：2018-08-18 15:19

【摘要】：目的利用三维有限元模拟颈椎在前屈、中立、后伸三种体位下行颈椎旋转手法,探讨该手法在不同体位下对颈椎间盘位移和内在应力的影响。方法 2016年11月对1例25岁健康成年女性志愿者的颈椎进行CT扫描成像,应用Mimics 10.01、Geomagic Studio、Solidworks 14.0等软件建立颈椎C5-6实体CAD模型,然后将模型导入Ansys Workbench 14.5软件进行有效性验证及手法模拟。在颈椎前屈、中立、后伸三种体位下进行手法分解,把各项力学参数代入三维有限元模型进行计算分析。即时显示手法作用时颈椎间盘的位移和内在应力的变化。结果在三种体位下,纤维环旋转对侧的后部均出现向前回缩变形,前屈位最大,中立位次之,后伸位最小;纤维环旋转侧的后部均出现向后膨出变形,前屈位最小,中立位次之,后伸位最大;椎间盘内在应力在三种体位下分别集中于旋转对侧后部、旋转对侧和旋转侧后部,其中前屈位最大,后伸位次之,中立位最小。结论从椎间盘安全性角度出发,颈椎旋转手法治疗神经根型颈椎病时,建议向健侧旋转,体位首选中立位,若疗效欠佳再考虑使用前屈位。颈椎管狭窄的患者不宜使用颈椎旋转手法治疗。
[Abstract]:Objective to simulate the cervical spine rotation manipulation in flexion neutral and extension position by using three dimensional finite element method (FEM) and to explore the effect of the manipulation on the displacement and internal stress of cervical intervertebral disc in different posture. Methods the cervical spine of a 25-year-old female volunteer was scanned by CT in November 2016. The cervical C5-6 solid CAD model was established by using Mimics 10.01 Geomagic Studio Solidworks 14.0 software. Then the model was imported into Ansys Workbench 14.5 for validation and manual simulation. The mechanical parameters of cervical vertebrae were decomposed in three postures of flexion, neutral and extension, and the mechanical parameters were calculated and analyzed by three dimensional finite element model. The changes of displacement and internal stress of cervical intervertebral disc during manipulation were displayed immediately. Results in the three positions, the posterior part of the fiber ring rotated the opposite side showed forward retraction deformation, the largest anterior flexion position, the second neutral position, and the smallest extension position, the posterior part of the fiber ring rotated side showed backward bulging deformation, and the anterior flexion position was the smallest. The internal stress of the intervertebral disc was concentrated in the posterior part of the opposite side of the rotation, the opposite side of the rotation and the posterior part of the rotation side, respectively, in which the anterior flexion position was the largest, the extension position was the second, and the neutral position was the smallest. Conclusion from the point of view of the safety of intervertebral disc, it is suggested that the rotation of the cervical vertebrae should be made to the contralateral side and the neutral position should be preferred, and if the curative effect is not good, the anterior flexion should be considered. Patients with cervical spinal stenosis should not be treated with cervical rotation manipulation.
【作者单位】：广州中医药大学第一临床医学院;广州中医药大学第一附属医院脊柱骨科;
【基金】：广州中医药大学第一附属医院岭南特色诊疗技艺应用与推广项目(No.2016JY03)
【分类号】：R244.1

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