斜扳手法和拔伸按压斜扳复合手法治疗腰椎间盘突出症的有限元对比分析

Finite element comparative analysis on treatment of lumbar disc herniation by the oblique wrench method and the combination of traction,pressing,and oblique pulling

背景:中医传统手法治疗腰椎间盘突出症历史悠久、应用广泛,疗效显著,深受广大患者青睐,但是具体使用手法多种多样,各种手法的作用机制优劣和疗效差异尚不明确。目的:使用三维有限元分析方法对比斜扳手法和拔伸按压斜扳复合手法治疗腰椎间盘突出症的生物力学作用机制,分析其疗效差异。方法:收集腰椎间盘突出症患者的腰椎CT图像,建立腰椎间盘突出症患者L_(4-5)运动功能单元三维有限元模型。分别模拟斜扳手法和拔伸按压斜扳复合手法,分析不同手法对腰椎运动单元各个组织应力、应变、位移的影响,从而对比其力学作用机制并评估疗效差别。结果与结论:①成功建立了腰椎L_(4-5)节段三维有限元模型,并验证了其有效性;②在施加斜扳手法时,椎间盘前方应力最大,突出位置的应力最小,右侧后部的纤维环出现向右、向后的应变,左侧(突出侧)后部的纤维环出现向右、向前的应变,椎间盘整体发生向前、向右的位移,左侧神经根向前移动,而右侧神经根则向后移动;③而在施加拔伸按压斜扳复合手法时,其应力分布、应变趋势、位移方向与斜扳手法类似,但是其应力、应变、位移都更大;④提示斜扳手法和拔伸按压斜扳复合手法对于腰椎间盘突出症患者都具有良好的疗效,使突出椎间盘收缩和回纳,增加突出椎间盘和神经根之间的距离,减轻神经压迫症状,其中复合手法疗效更佳。

BACKGROUND:Traditional Chinese medicine manipulation for the treatment of lumbar intervertebral disc herniation has a long history,wide application and remarkable curative effect,and is favored by the majority of patients.However,there are various specific methods of use,and the advantages and disadvantages of various methods and the differences in efficacy are not yet clear.OBJECTIVE:To compare the biomechanical mechanism and efficacy of the oblique wrench method and the combined manipulation of traction,pressing,and oblique pulling in the treatment of lumbar disc herniation using the three-dimensional finite element analysis.METHODS:Based on the CT images of the lumbar spine in patients with lumbar disc herniation,three-dimensional finite element models of the L_(4-5) motor function unit in patients with lumbar disc herniation were established.The oblique wrench method and the combination of oblique wrench method and the combined manipulation of traction,pressing,and oblique pulling were simulated to analyze the influence of different methods on the stress,strain and displacement of each tissue of the lumbar motor unit,so as to compare the mechanical mechanism and evaluate the difference in efficacy.RESULTS AND CONCLUSION:(1)The three-dimensional finite element model of the L_(4-5) segment was successfully established and its effectiveness was verified.(2)When the oblique wrench method was applied,the stress in the front of the intervertebral disc was largest,and the stress in the protruding position was smallest;the strain direction of the annulus fibrosus in the posterior right side was rightward and backward,and the strain direction of the annulus fibrosus in the posterior part of the left(protruding side)was rightward and anterior.The intervertebral disc moved forward and rightward,the left nerve root moved forward,and the right nerve root moved backward.(3)When the combination of traction,pressing,and oblique pulling was applied,the stress distribution,strain trend and displacement direction were similar to those of the oblique wrench method,but the stress,strain and displacement were larger.(4)It is indicated that the oblique wrench method and the combination of traction,pressing,and oblique pulling have a good effect on lumbar disc herniation patients,which can shrink and retract the herniated intervertebral disc,increase the distance between the disc and the nerve root,relieve the symptoms of nerve compression.The combined manipulation is more effective.