模拟拔伸、按压、斜扳及其复合手法对各型腰突症三维有限元模型作用机制的研究

Lumbar intervertebral disc herniation is one of the important factors leading to labor force decline. The needs of prevention and control of this disease has been accelerated with the modern work and lifestyle changing. Manipulation is one of characteristics treatment of non-surgical treating for the disease. Three-dimensional finite element models of lumbar motion functional units based on the CT images establish from the healthy volunteer and patients with common and typical clinical types of lumbar intervertebral disc herniation. The intensity and varying of the traction，pressing，oblique-pulling and their combination manipulation loading to all types of finite element model in three kinds of body positions that ante-flexion, late-flexion and horizontal position will respectively be imitate after the model realistic and biomechanical properties scientific has been tested and verified, the organizations stress distribution and structural changes in cloud pictures and its corresponding displacement, stress and strain magnitude will be extracted and compared between various models, especially analyzing displacement between the disc posterolateral and nerve root. To reveal biomechanical mechanisms and relatively best operation intensity and position of these three kind of efficacy manipulations and their combination manipulation for treating lumbar intervertebral disc herniation models. Meanwhile, to clarify the possible biomechanical mechanism of injury, injury part and order caused by the blind and subjective manipulation for the treating of lumbar intervertebral disc herniation models, so as to provide theoretical basis of standardizing the operation intensity and position of those efficacy manipulation, conforming the manipulation safety range, defining manipulation operating accuracy to improve the clinical efficacy under research guidance.

腰椎间盘突出症是导致劳动力下降的重要因素之一，随着现代工作和生活方式的改变加速了本病的防治需求。手法是非手术治疗本病的特色治疗手段之一。 基于CT图像建立健康志愿者和临床常见类型典型腰突症患者腰椎运动功能单位三维有限元模型，在验证模型逼真和生物力学属性科学的基础上，分别模拟不同力度的拔伸、按压、斜扳及其复合手法载荷于各类有限元模型在前屈、后伸、水平不同体位时，提取和比较各类模型各组织的应力分布和结构变化云图及其对应的位移、应力和应变值，特别是分析椎间盘后外侧与神经根之间的位移变化，揭示三种手法及其复合手法治疗各型腰突症产生疗效的可能生物力学作用机制，探讨相对最佳的手法操作力度和作用体位；同时阐明盲目和主观的该类手法对腰突症患者造成损伤的生物力学作用机制（损伤部位和次序），从而为规范该类手法的操作力度和体位、明确该类手法的安全范围、优化该类手法操作的准确性提供理论依据，进而指导提高临床疗效。

腰椎间盘突出症是导致劳动力下降的重要因素之一，随着现代工作和生活方式的改变加速了本病的防治需求。手法是非手术治疗腰椎间盘突出症的特色治疗手段之一。本课题基于CT图像建立健康志愿者和临床常见类型典型的腰椎间盘突出症患者腰椎运动功能单位三维有限元模型，在验证模型逼真和生物力学属性科学的基础上，分别模拟不同力度的拔伸、按压、斜扳及其复合手法载荷于各类腰椎间盘突出三维有限元模型在前屈、后伸、水平不同体位时，提取和比较各类模型各组织的应力分布和结构变化云图及其对应的应力和应变值。分别模拟拔伸、按压、斜扳及其复合手法不同力度载荷于正常腰椎及退变腰椎和突出椎间盘运动功能单元三维有限元模型在前屈30°、后伸10°、水平位三种不同的体位时各组织应变值比较得出小关节面、纤维环、髓核和软骨终板的应变值和应力值较大，三种手法中拔伸按压斜扳复合手法的应变值最大，拔伸按压手法复合次之，拔伸手法最小；三种体位中前屈30°应变值最大，后伸10°次之，水平位最小。分别模拟拔伸、按压、斜扳及其复合手法不同力度载荷于正常腰椎及退变腰椎和突出椎间盘运动功能单元三维有限元模型在前屈30°、后伸10°、水平位三种不同的体位时各组织应力值比较，结果提示椎体皮质骨及附件结构的应力较大，三种手法中拔伸按压斜扳复合手法的应力值最大，拔伸按压复合手法次之，拔伸手法最小；三种体位中前屈30°体位应力值最大，后伸10°体位应力值次之，水平位应力值最小。本课题揭示了各种手法治疗各型腰椎间盘突出症产生疗效的可能部分生物力学作用机制，探讨了可能相对最佳的手法操作力度和作用体位；规范该类手法的操作力度和体位，为优化该类手法操作的准确性提供部分理论依据，进而指导提高手法治疗腰椎间盘突出症的临床疗效。