【摘要】：目的利用三維有限元模擬頸椎在前屈、中立、后伸三種體位下行頸椎旋轉(zhuǎn)手法,探討該手法在不同體位下對(duì)頸椎間盤(pán)位移和內(nèi)在應(yīng)力的影響。方法 2016年11月對(duì)1例25歲健康成年女性志愿者的頸椎進(jìn)行CT掃描成像,應(yīng)用Mimics 10.01、Geomagic Studio、Solidworks 14.0等軟件建立頸椎C5-6實(shí)體CAD模型,然后將模型導(dǎo)入Ansys Workbench 14.5軟件進(jìn)行有效性驗(yàn)證及手法模擬。在頸椎前屈、中立、后伸三種體位下進(jìn)行手法分解,把各項(xiàng)力學(xué)參數(shù)代入三維有限元模型進(jìn)行計(jì)算分析。即時(shí)顯示手法作用時(shí)頸椎間盤(pán)的位移和內(nèi)在應(yīng)力的變化。結(jié)果在三種體位下,纖維環(huán)旋轉(zhuǎn)對(duì)側(cè)的后部均出現(xiàn)向前回縮變形,前屈位最大,中立位次之,后伸位最小;纖維環(huán)旋轉(zhuǎn)側(cè)的后部均出現(xiàn)向后膨出變形,前屈位最小,中立位次之,后伸位最大;椎間盤(pán)內(nèi)在應(yīng)力在三種體位下分別集中于旋轉(zhuǎn)對(duì)側(cè)后部、旋轉(zhuǎn)對(duì)側(cè)和旋轉(zhuǎn)側(cè)后部,其中前屈位最大,后伸位次之,中立位最小。結(jié)論從椎間盤(pán)安全性角度出發(fā),頸椎旋轉(zhuǎn)手法治療神經(jīng)根型頸椎病時(shí),建議向健側(cè)旋轉(zhuǎn),體位首選中立位,若療效欠佳再考慮使用前屈位。頸椎管狹窄的患者不宜使用頸椎旋轉(zhuǎn)手法治療。
[Abstract]:Objective to simulate the cervical spine rotation manipulation in flexion neutral and extension position by using three dimensional finite element method (FEM) and to explore the effect of the manipulation on the displacement and internal stress of cervical intervertebral disc in different posture. Methods the cervical spine of a 25-year-old female volunteer was scanned by CT in November 2016. The cervical C5-6 solid CAD model was established by using Mimics 10.01 Geomagic Studio Solidworks 14.0 software. Then the model was imported into Ansys Workbench 14.5 for validation and manual simulation. The mechanical parameters of cervical vertebrae were decomposed in three postures of flexion, neutral and extension, and the mechanical parameters were calculated and analyzed by three dimensional finite element model. The changes of displacement and internal stress of cervical intervertebral disc during manipulation were displayed immediately. Results in the three positions, the posterior part of the fiber ring rotated the opposite side showed forward retraction deformation, the largest anterior flexion position, the second neutral position, and the smallest extension position, the posterior part of the fiber ring rotated side showed backward bulging deformation, and the anterior flexion position was the smallest. The internal stress of the intervertebral disc was concentrated in the posterior part of the opposite side of the rotation, the opposite side of the rotation and the posterior part of the rotation side, respectively, in which the anterior flexion position was the largest, the extension position was the second, and the neutral position was the smallest. Conclusion from the point of view of the safety of intervertebral disc, it is suggested that the rotation of the cervical vertebrae should be made to the contralateral side and the neutral position should be preferred, and if the curative effect is not good, the anterior flexion should be considered. Patients with cervical spinal stenosis should not be treated with cervical rotation manipulation.
【作者單位】： 廣州中醫(yī)藥大學(xué)第一臨床醫(yī)學(xué)院;廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院脊柱骨科;
【基金】：廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院嶺南特色診療技藝應(yīng)用與推廣項(xiàng)目(No.2016JY03)
【分類(lèi)號(hào)】：R244.1

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