体位对颈椎旋转手法整复神经根型颈椎病关节突关节骨错缝的有限元分析

Finite element analysis of position effects on reduction of facet joint displacement by cervical rotatory manipulation for cervical spondylotic radiculopathy

背景:颈椎旋转手法的操作体位主要包括前屈位、中立位、后伸位和旋转方向,关于选用哪种体位实施颈椎旋转手法更有利于整复关节突关节骨错缝治疗神经根型颈椎病,目前尚不清晰。目的:比较不同体位实施颈椎旋转手法整复关节突关节骨错缝治疗神经根型颈椎病的生物力学差异。方法:建立并验证C_(5)-C_(6)正常三维有限元模型,分别模拟前屈、中立、后伸体位往右侧旋转实施颈椎旋转手法,比较不同体位实施颈椎旋转手法时C_(5)双侧下关节突的前后方向和上下方向位移分布。选取整复侧C_(5)下关节突的相同结点作为位移值参考点,比较不同体位实施颈椎旋转手法时整复侧C_(5)下关节突的前后方向和上下方向位移值。结果与结论:①在前屈、中立和后伸3种体位实施颈椎旋转手法,旋转侧C_(5)下关节突均向后下滑动,旋转对侧C_(5)下关节突均向前上滑动,所以C_(5)下关节突的滑动趋势与旋转方向有明显相关性,而与前屈、中立和后伸体位没有明显相关性;②在前屈、中立、后伸体位实施颈椎旋转手法,旋转对侧C_(5)下关节突的向前位移值分别是1.32,1.22和0.77 mm,向上位移值分别是1.49,1.29和0.29 mm;③结果显示,前屈位实施颈椎旋转手法使旋转对侧下关节突的前上位移值最大,说明前屈位往健侧旋转实施颈椎旋转手法可能更有利于整复关节突关节骨错缝治疗神经根型颈椎病。

BACKGROUND:Positions of cervical rotatory manipulation mainly include flexion,neutral,extension and rotation direction.It is still not clear which positions are more beneficial for cervical rotatory manipulation to reduce facet joint displacement in treatment of cervical spondylotic radiculopathy.OBJECTIVE:To compare biomechanical effects of positions on reduction of facet joint displacement by cervical rotatory manipulation in treatment of cervical spondylotic radiculopathy.METHODS:A three-dimensional finite element model of the normal C_(5)-C_(6) was constructed and validated.Cervical rotatory manipulation was simulated with rotation to the right side in flexion,neutral and extension,respectively.Displacement distributions in forward-backward and upward-downward directions of C_(5) bilateral inferior articular processes were compared among cervical rotatory manipulation performed in different positions.The same node in C_(5) inferior articular process of the reduced side was selected as reference point for displacement value.Displacement values in forward-backward and upward-downward directions of C_(5) inferior articular process of the reduced side were compared among cervical rotatory manipulation performed in different positions.RESULTS AND CONCLUSION:(1)With cervical rotatory manipulation performed in flexion,neutral and extension,ipsilateral C_(5) inferior articular process of rotation moved backward and downward while contralateral C_(5) inferior articular process of rotation moved forward and upward.Thus,the sliding trend of C_(5) inferior articular process was significantly correlated with the direction of rotation,but not with positions of flexion,neutral and extension.(2)When cervical rotatory manipulation was performed in flexion,neutral and extension,forward displacement of contralateral C_(5) inferior articular process of rotation was 1.32,1.22 and 0.77 mm,respectively,and upward displacement was 1.49,1.29 and 0.29 mm,respectively.(3)The findings showed that forward-upward displacement of contralateral inferior articular process of rotation was maximum in flexion,indicating that rotation to the healthy side in flexion might be more beneficial for cervical rotatory manipulation to reduce facet joint displacement in treatment of cervical spondylotic radiculopathy.