基于有限元分析的推拿治疗肩袖撕裂的安全性研究

Study on the Safety of Massage in the Treatment of Rotator Cuff Tear Based on Finite Element Analysis

目的基于有限元分析方法,观察撕裂的肩袖在推拿手法作用下的应力情况,评估推拿手法的安全性。方法采集健康志愿者肩关节CT、MRI扫描数据,重建正常肩关节有限元模型,在此模型基础上,通过改变冈上肌腱与肱骨头表面的接触面积,建立10%、50%、90%三种不同撕裂程度的肩袖撕裂有限元模型。同时,对推拿手法的力学数据进行体外采集,在有限元分析软件上,将推拿手法的力学数据加载于不同撕裂程度的肩袖撕裂有限元模型之上,观察模型中冈上肌肌腱的应力改变,通过设定不同大小的推拿手法作用力,观察不同作用力下,不同模型之间冈上肌肌腱的应力差异。结果完成建立包含骨骼、肌肉、肌腱、韧带的完整肩关节模型,完成建立肩袖撕裂的有限元模型。成功采集掌按法的力学参数,加载于模型后发现,在300N、400N、500N的作用力下,10%撕裂程度模型的冈上肌腱撕裂尖端应力分别为5.27031 Mpa、7.02818 Mpa、8.78605 Mpa。50%撕裂程度模型的冈上肌腱撕裂尖端应力为9.20894 Mpa、12.2831 Mpa、15.3572 Mpa。90%撕裂撕裂程度模型的冈上肌腱撕裂尖端应力为19.9116 Mpa、26.5573 Mpa、33.2031 Mpa。结论在肩袖撕裂有限元模型中,相同撕裂程度下,推拿作用力越大,冈上肌肌腱撕裂尖端应力越大。而相同推拿作用力下,撕裂程度越严重,冈上肌肌腱撕裂尖端应力越大。提示临床进行推拿治疗时,应采取合适的推拿力度,对于撕裂程度较大的肩袖撕裂患者,不应采取推拿手法进行治疗。

Objective To observe the stress of rotator cuff tear under massage manipulation and evaluate the safety of massage manipulation based on the finite element analysis method.Methods CT and MRI scans of shoulder joints of healthy volunteers were collected to reconstruct the finite element model of normal shoulder joint.On the basis of this model,three finite element models of rotator cuff tear with different tear degrees,10%,50%,and 90%,were established by changing the contact area between supraspinatus tendon and humeral head surface.At the same time,the mechanical data of massage manipulation were collected in vitro.On the finite element analysis software,the mechanical data of massage manipulation were loaded on the finite element model of rotator cuff tear with different degrees of tear,and the stress changes of supraspinatus tendon in the model were observed.By setting different magnitudes of the force of massage manipulation,the stress of supraspinatus tendon between different models was observed under different forces.Results Complete shoulder joint model including bone,muscle,tendon and ligament was established,and finite element model of rotator cuff tear was established.The mechanical parameters of palmar-pressing method were successfully collected and loaded into the model.It was found that under the force of 300 N,400 N and 500 N,the tear tip stress of the supraspinatus tendon in the 10%tear degree model was 5.27031 Mpa,7.02818 Mpa and 8.78605 Mpa,respectively.The tear tip stress of supraspinatus tendon in 50%tear degree model was 9.20894 Mpa,12.2831 Mpa and 15.3572 Mpa.The tear tip stress of supraspinatus tendon in 90%tear degree model was 19.9116 Mpa,26.5573 Mpa and 33.2031 Mpa.Conclusion In the finite element model of rotator cuff tear,the greater the massage force,the greater the stress on the tear tip of the supraspinatus tendon at the same degree of tear.Under the same massage force,the more serious the tear,the greater the stress on the tear tip of the supraspinatus tendon.It suggests that appropriate massage strength should be adopted when clinical massage treatment is carried out.For patients with rotator cuff tear with greater degree of tear,massage should not be used for treatment.