基于多体动力学方法构建颈部主要肌群在动伸推拿中的运动轨迹

Moving-extending TUINA is a clinical effective manipulation therapy for the cervical vertebra disease as the scrunching and plucking actions are applied with the muscle being stretched or contracted. This method makes the action force prone to reach the pathological position with less energy expenditure. Simulated data for displacement, deformation or qualitative change of muscle group in dynamic and static conditions during the Moving-extending process could be obtained and analyzed. In this project, the magnetic resonance imaging (MRI) and computerized tomography (CT) would be used to obtain the image of cervical muscle group under various cervical movement states. Tomographical data would be processed by Mimics, and the 3D entity geometrical mode obtained from the converse engineering code Geomagic Studio. The finite element model of rigid and flexible body combination of cervical muscle group would be built using multi-body dynamics program ADAMS. For the first time, the numerical simulation would be resorted, employing the basic theory of rigid and flexible multi-body dynamics, to obtain the basic rules of movement, deformation, and stress distribution of normal and abnormal tissues during Moving-extending TUINA. The transfer way of action force during manipulation treatment would be studied as well. Simulated data for displacement, deformation or qualitative change of muscle group in dynamic and static conditions during the Moving-extending process could be obtained and analyzed, which would demonstrate the mechanical characteristics of high stress resulted from low forces by the Moving-extending TUINA. That would demonstrate the damage mechanism of the muscle group and the anti-damage mechanism resulted from low forces by the Moving-extending TUINA.Present study will illuminates the mechanical foundation during manipulation treatment of cervical spondylosis using Moving-extending TUINA, and provide novel thoughts for clinical optimization and innovation of manipulation treatment.

动伸推拿是在对颈部疾病的患者施以手法治疗时，对肌群作伸展、收缩运动，并同时行揉、拨等手法，临床时效性较佳。该手法使作用力易达病所，能量损耗少。本项目应用MRI、CT获取颈部不同活动状况下颈部肌群的图像，采用Mimics分析断层扫描数据、逆向工程软件Geomagic Studio创建颈部肌群的三维实体几何模型；应用得到的几何模型在多体动力学软件ADAMS中构建颈部肌群三维刚柔混合有限模型。首次结合刚柔多体动力学的基本原理，通过数值模拟，获得动伸推拿过程中正常和非正常组织运动、变形和受力分布的基本规律以及肌肉在被动受力中的运动轨迹，得到本手法在运用过程中的作用力传导方式；获取肌群在动伸过程中动态与静态的工况下，同样的外力致肌群位移、变形或质变的模拟数据，从而分析出外力致使肌群等的损伤机制及手法干预后的反损伤机制。从而阐明动伸推拿治疗颈椎病的力学基础，为手法医学的临床优化与创新提供新的思路和理念

动伸推拿是在对颈部疾病的患者施以手法治疗时，对肌群作伸展、收缩运动，并同时行揉、拨等手法，临床时效性较佳。该手法使作用力易达病所，能量损耗少。本项目应用MRI、CT获取颈部不同活动状况下颈部肌群的图像，采用Mimics分析断层扫描数据、逆向工程软件Geomagic Studio创建颈部肌群的三维实体几何模型；应用得到的几何模型在多体动力学软件ADAMS中构建颈部肌群三维刚柔混合有限模型。首次结合刚柔多体动力学的基本原理，通过数值模拟，获得动伸推拿过程中正常和非正常组织运动、变形和受力分布的基本规律以及肌肉在被动受力中的运动轨迹，得到本手法在运用过程中的作用力传导方式；获取肌群在动伸过程中动态与静态的工况下，同样的外力致肌群位移、变形或质变的模拟数据，通过对60例患者动伸推拿后对患侧胸锁乳突肌治疗前后的横截面积及容积的测量，或呈增大趋势或变小趋势，对比动伸推拿治疗颈椎病前后的MRI形态变化，动伸推拿治疗前后患者原有骨质改变、椎间盘突出情况MRI无显著差异，而患者病损部位肌群左右最长径和前后最长径经动伸推拿治疗后数值呈呈双向性。从而分析出外力致使肌群等的损伤机制及手法干预后的反损伤机制。颈椎病治疗的重点是肌肉形态力学 的恢复，而颈椎病的病机病理也主要是颈部肌群应力的失衡导致颈部骨质结构的失衡变形。为颈椎病的诊断及推拿疗法治疗颈椎病提供新的理论依据。阐明了动伸推拿治疗颈椎病的力学基础，为手法医学的临床优化与创新提供新的思路和理念。