中医斜扳疗法治疗腰椎间盘突出的生物力学研究

Biomechanical study on oblique-pulling manipulation in traditional Chinese medicine for treating lumbar intervertebral disc protrusion

目的对椎间盘突出等腰椎病中医推拿斜扳疗法进行生物力学建模分析研究,比对脉冲激励的传统斜扳法和简谐激励的改良斜扳法两种不同手法的力学特性。方法假设椎骨为刚体,椎间盘及周围韧带等软组织为黏弹性体,建立模拟L1～5的5自由度振动系统,对基本方程进行解析求解。结果简谐激励改良斜扳法的疗效与频率有关。在频率≤1的简谐激励改良斜扳法作用下,病变节段最大位移都大于脉冲激励传统斜扳法下的最大位移。随着病变位置下移,简谐激励改良斜扳法的损伤比相比脉冲激励传统斜扳法逐渐下降,安全性增高。结论使用频率≤1的简谐激励改良斜扳法,治疗效果优于脉冲激励传统斜扳法,且可控制损伤。

Objective To analyze and study the biomechanical model of oblique-pulling manipulation in traditional Chinese medicine for the treatment of lumbar disc disease such as intervertebral disc protrusion, and compare the mechanical properties of two different manipulations, i.e. traditional oblique-pulling manipulation under impulse excitation and improved oblique-pulling manipulation under harmonic excitation. Methods The vertebra was set as rigid body, while the intervertebral disk and surrounding ligaments as viscoelastic body. A vibration system with 5-degree freedom for simulating lumbar L1-L5 was established. The basic vibration equation was solved using analytical method. Results The effect of improved oblique-pulling manipulation was related to the frequen- cy of harmonic excitation. If the frequency of harmonic excitation was not higher than l, the maximum displace- ment of the diseased segment under harmonic excitation was larger than that of traditional oblique-pulling manipu- lation under impulse excitation. With the lesion location shifted downward, the damage ratio （DR） under harmon- ic excitation was gradually decreased as compare to that under impulse excitation, indicating the safety of the im- proved oblique-pulling manipulation increasing. Conclusions The curative effect of oblique-pulling manipulation under harmonic excitation at the frequency lower than 1 was better than that of traditional oblique-pulling manipula- tion under impulse excitation, especially in that the medical injury can be controlled by oblique-pulling manipulation under harmonic excitation at the frequency no higher than 1.