定点旋转复位与斜扳手法对腰4/5椎间盘不同分区突出的作用差异的有限元分析

Fixed-point rotator reduction and oblique-pulling manipulation are classic in treating LDH. The same manipulation produces different effects, which result from different positions of protrusion of intervertebral disc. Based on Hu You gu 3-D partition, spiral CT and MRT were conducted to collect images of L4/L5 intervertebral disc protrusion in different sections from men ranging from 35 to 55. ABAQUS6.5 was used to establish finite element model and Mimics system was applied to modify the model so that fluid structure interaction 3-D finite element model containing L4/L5 intervertebral disc protrusion in different sections was completed. Forces applied in oblique-pulling manipulation and fixed-point rotator reduction from 6 angles and focuses were decomposed. Mechanical parameter was introduced in the model to study 3-D mechanical changes in model with different intervertebral disc protrusion under loading operations, including intervertebral disc, vertebral body and responses to forces from posterior structure and their displacement. Rules of non-linear variation in manipulations of the above mentioned circumstances and forms of mathematical function were summarized; the rules of protrusion of intervertebral disc in different sections coresponding manipulative treatments would be studied. The high occurrence of L4/L5 intervertebral disc protrusion with morphological representation, contributes to the choice of L4/L5 intervertebral disc protrusion as study subjects. This paper will provide theoretical evidence for the mechanism of TCM manipulation.

定点旋转复位与斜扳是治疗腰椎间盘突出症的核心手法，同样的操作获得的疗效有较大差异，重要原因应该与椎间盘突出位置相关。我们通过螺旋CT、MRI，按照胡有谷三维分区方法，提取不同分区突出的、35-55 岁男性腰4/5椎间盘突出影像，利用ABAQUS6.5 软件建立有限元模型，再经Mimics系统修饰，完成含不同分区间盘突出的腰4/5脊柱功能单位的流固耦合三维有限元模型。将斜扳、旋转复位手法6种不同角度与力聚合点操作进行力的分解,把参数带入模型，研究不同操作加载情况下，不同突出模型的三维力学变化，包括椎间盘、椎体及后部结构的应力及位移，最后对上述各情况下模型结构、特别是突出部分的非线性变化的规律以数学函数的形式总结，探讨各个分区突出椎间盘与相关手法对应规律。腰4/5椎间盘突出发生率高，有形态代表性，因此选作研究对象。研究将为揭示中医正骨类手法与突出椎间盘的内在联系提供理论依据。

目的：寻找不同操作方法的定点旋转复位法、斜扳法与对应的腰椎间盘突出的最佳治疗配合，阐明不同手法作用下， 不同分区突出的腰椎间盘的变化规律。方法：通过螺旋CT、MRI，按照胡有谷三维分区方法，提取不同分区突出的、35-55 岁男性腰4/5椎间盘突出影像，利用ABAQUS6.5 建立有限元模型，Mimics修饰，完成含不同分区间盘突出的腰4/5脊柱功能单位的流固耦合三维有限元模型。将斜扳、旋转复位手法6种不同角度与力聚合点操作进行力的分解,把参数带入模型，研究不同操作加载情况下不同突出模型的三维力学变化，最后对上述各情况下模型结构、特别是突出部分的非线性变化的规律以数学函数的形式总结，探讨各个分区突出椎间盘与相关手法对应规律。结果：①建立了1个正常和12种腰椎间盘突出类型的流固耦合有限元模型。能够更准确地模拟人体腰椎的力学特性，并且取得传统的体外实验难以取得的椎间盘液体相关力学性能数据。②在前屈分别为6°、9°、12°的三种旋转手法对单个突出类型产生的最大应力在位置和大小上较为相似，前屈角度越大能引起突出髓核更大的位移。旋转复位法对最常见突出类型在前屈12°时突出类型为I2a的应力最大，在前屈12°时突出类型为I1b的位移最大。③在不同力量组合的斜扳法对单个突出模型产生的最大应力在位置和大小上基本相同，但是在II1b型中能获得最大效应。斜扳法对最常见突出类型最大应力对应突出类型为I1a，最大位移对应突出类型为I2b。④建立了5个L4/5椎间盘突出症诊断判别回归方程Y1=0.849x2+8.709x4+1.426x6+1.289x7+19.196x8+14.794x9-22.264x10+15.134x12+10.739x14+11.184x17+24.003x18-30.402x20+17.5x24-3.25x26-5.352x27-17.996x29+15.941x32+22.249x42+23.103x47+14.184x52-212.847 等），该判别回归方程检验结果较为满意，可作为判别L4/5椎间盘突出症的重要参考。建立了L4/5椎间盘突出症胡有谷常见突出区域判别回归方程，该判别回归方程检验准确率较低。⑤进行了的督脉与脊柱相关性文献的纯理论分析。⑥对椎间盘突出病例与相关文献分析后，研究了椎间盘突出周围骨性结构产生的变化与力学变化。