倒悬旋转手法时腰椎各结构应力分布.docVIP

倒悬旋转手法时腰椎各结构应力分布 　 作者：桂志雄，严金林，严斌，张美超，李义凯 【摘要】 目的了解进行倒悬旋转手法时腰椎各结构的应力分布和变化的特点。方法使用正常L4-5腰椎CT片，以Mimics软件系统逐层重建，建立L4-5三维有限元模型。根据手法原理，将倒悬旋转手法进行分解，把各项力学参数代入三维有限元模型进行计算分析。 即时显示手法作用时腰椎各结构内在应力的变化。结果应力变化主要集中于终板及椎间盘，以后部更为明显；应力在终板和椎间盘上又集中左侧后部和右侧前部，外层的应力大于内层；髓核和后部结构的应力变化较小。结论倒悬旋转手法时，应力在腰椎中不是均匀分布；终板要比椎间盘更容易受到损伤；该手法对小关节是安全、有效的，但旋转角度不宜过大。 【关键词】 腰椎； 有限元； 倒悬旋转手法； 椎间盘； 终板； 应力 　　Abstract：ObjectiveTo study the trait of intra-stress distribution of lumbar unit during the hang upside down and rotatory manipulation. MethodsSectional constructed with Mimics software system by normal lumbar L4-5 CT images. Set up a 3D finite element system of lumbar L4-5. The hang upside down and rotatory manipulation was decomposed by principium of manipulation. The finite element system was analyzed with the parameter of mechanics. The change of intra-stress distribution in lumbar unit was displayed simultaneously during simulating manipulation. ResultsThe stress mainly distributed in the endplate and lumbar disc, especially in the posterior part. The stress distributed in the left-posterior part and the right- anterior part of the endplate and lumbar disc. The stress in the lateral of the endplate and lumbar disc was more than the inside. The intra-stress of nucleus and posterior area were less. ConclusionThe intra-stress distribution is not even during the hang upside down and rotatory manipulation. The endplate was more vulnerable than the lumbar disc. The manipulation was safe and effective for facet joints, but the rotatory levels of lumbar should not be too much during manipulation. 　　Key words：Lumbar; Finite element; Hang upside down and rotatory manipulation; Lumbar disc; Endplate; Stress 倒悬旋转手法是临床上一种有效的手法，但是其基础研究却相对较滞后。医生只能根据解剖学的知识，在头脑中构想腰椎倒悬时，在旋转力作用下的三维结构变化，推测手法的作用机理，因而缺少客观的科学分析与比较。近年来，计算机有限元技术成为研究脊柱推拿手法的新方法。通过计算机对脊柱推拿手法的模拟，直观地、实时地监测手法作用时腰椎结构的应力和应变，用以探讨倒悬旋转手法的作用机制，为该手法的临床应用和优化提供理论和试验依据。 　　1 材料与方法 　　1.1 建立第4腰椎和第5 腰椎（L4-5）的有限元模型取1具急性脑死亡的男性青年新鲜尸体的腰椎做标本。使用螺旋CT，以2 mm的间隔，沿轴向进行断层扫描，扫描数据经过插值、放大处理后，以1