基于有限元模型探讨不同角度肘按法对腰椎间盘位移的影响

Influence of Different Angle Elbow Press Method on the Displacement of Lumbar Disc Based on Finite Element Model

目的观察不同角度肘按法下腰椎间盘生物力学的改变情况,以探讨肘按法的作用机制及肘按法治疗腰椎间盘突出症的最适宜角度,为临床治疗本病提供部分实验依据。方法根据健康成人腰椎运动节段(L4-5)的CT影像学资料,运用Mimics 17.0、Geomagic 10.0软件,构建正常的腰椎间盘模型及突出腰椎间盘(L4-5)模型,利用Abaqus软件模拟正常腰椎间盘和突出腰椎间盘(L4-5)于轴向、扭转压力下前屈、后伸、侧屈、旋转载荷下生物力学参数,即时显示不同角度肘按法下正常腰椎间盘和突出腰椎间盘(L4-5)的位移变化。结果不同角度肘按法下,正常腰椎间盘与突出腰椎间盘位移分布趋势基本一致;与正常腰椎间盘相比,突出腰椎间盘位移量小,位移范围较集中。与正常腰椎间盘相比,应用15°~60°的按压角度,腰椎间盘突出部位向右、向前方位移;应用75°按压时,腰椎间盘突出部位向前位移;应用90°~165°按压时,腰椎间盘突出部位向左、向前方位移。不同角度肘按法下,正常模型与突出模型的腰椎间盘突出部位的位移值,组间比较差异无统计学意义(P>0.05);但是组内比较,采用15°按压时与运用30°~150°按压时相比较,腰椎间盘突出部位的位移值差异均有明显统计学意义(P<0.01)。结论肘按法发挥作用的机制可能与腰椎间盘后部的相对位移有关,且不同的按压角度会对腰椎间盘产生不一样的位移效果。

Objective To observe the changes of biomechanics of lumbar intervertebral disc under different angles of elbow press,in order to explore the mechanism of action of elbow press and the best angle of treatment of lumbar intervertebral disc protrusion,to provide some experimental basis for clinical treatment of this disease.Methods According to CT imaging data of lumbar motion segment(L4-5)in healthy adults,normal lumbar disc models and prolapsed lumbar disc models(L4-5)were established by using Mimics 17.0 and Geomagic 10.0 software.Abaqus software was used to simulate the biomechanical parameters of normal lumbar intervertebral disc and protruded lumbar intervertebral disc(L4-5)under axial,torsional pressure,flexion,extension,lateral flexion and rotation load,the displacement changes of normal and protruded lumbar intervertebral discs(L4-5)were observed through elbow press method at different angles.Results Under different angles of elbow press,the displacement of normal lumbar disc was similar to that of protruded lumbar disc,and the displacement of protruded lumbar disc was smaller and more concentrated than that of normal lumbar disc.Compared with the normal lumbar intervertebral disc,the position of lumbar intervertebral disc protrusion moved to the right and forward at the pressing angle of 15°~60°;the position of lumbar intervertebral disc protrusion moved to forward at the pressing angle of 75°;and the position of lumbar intervertebral disc protrusion moved to the left forward at the pressing angle of 90°~165°.There was no significant difference in displacement values of lumbar intervertebral disc protrusion between the normal model and the protrusion model(P>0.05);there were statistically significant differences in the displacement values of lumbar disc herniation when pressing at 15°compared with pressing at 30°~150°(P<0.01).Conclusion The mechanism of elbow press method may be related to the relative displacement of the posterior part of the lumbar intervertebral disc,and different pressing angles have different displacement effects on the lumbar intervertebral disc.