定点旋扳法对颈椎间盘突出的应力再分配机制研究

The internal and external abnormal mechanical environment changes of cervical spine casused by intervertebral disc herniation is one of the important pathological links through the occurrence and development of cervical spondylosis. The applicant had constructed and validated a healthy normal finite element cervical model and a pathology model of cervical "Gu Cuo Fen and Jin Chu Cao". The two models were used to simulate the process of cervical manipulation therapy and the effect was analysised. We found an obvious abnormal stress concentration phenomenon in cervical bone and intervertebral disc of pathological model. The concentrate stress area changed when manipulation therapy was loaded on the model. However, the specific mechanism and regular characteristics were still unclear. Based on the finished study, this project puts forward the scientific hypothesis that the fixed point rotation therapy aiming at redistributing the mechanical distribution between the prominent nucleus pulosus and anulus fibrosus and peripheral nerve as well as spinal cord to an equilibrium state. This program is going to use the motion capture system to acquisition technique objective parameters of the therapy. Different types of 3D finite element pathological cervical models will be built based on the MRI data from the subjects. Then, the finite element analysis technique combine with the motion capture system will be used to simulate the manipulation therapy after loading with different mechanical parameters to the models. After analysis, we will summary the biomechanical characteristics and mechanism of the therapy to verify the proposed hypothesis. It is expected that the results will further enrich the theoretical knowledge of manipulation therapy biomechanics, and help to guide the clinical improvement of the safety and effectiveness of the therapy.

椎间盘突出引起的颈椎内外力学环境异常变化是颈椎病发生、发展的重要因素之一。申请人既往采用三维有限元技术构建了正常人和全颈椎“筋出槽骨错缝”病理模型，并模拟手法治疗过程，分析结果显示，病理模型存在明显应力异常集中区，手法治疗瞬间颈椎间盘及其周围组织的应力分布发生改变，但其具体机制和规律特征尚不清楚。本课题据此提出假说：定点旋扳法可针对性调整突出髓核与纤维环及其周围神经根、脊髓等组织的应力分布，改变应力异常集中区，良性调整应力分布状态。拟采用动作捕捉系统采集手法客观参数，结合有限元分析技术，基于不同突出类型的颈椎MRI影像建立具有针对性的颈椎病理三维有限元模型，通过数据加载模拟手法的治疗过程，从动力学和运动学角度归纳定点旋扳法的生物力学特征，分析手法作用的应力再分配机制和生物力学特点，验证本假说。预期结果将进一步丰富手法生物力学机制的理论知识，并有助于指导临床提高手法治疗的安全性和有效性。

颈椎椎间盘突出引起的颈椎内外力学环境异常变化是颈椎病发生、发展的重要因素之一。课题组既往采用三维有限元技术构建了正常人和全颈椎“筋出槽骨错缝”病理模型，并模拟手法治疗过程，分析结果显示，病理模型存在明显应力异常集中区，手法治疗瞬间颈椎间盘及其周围组织的应力分布发生改变，但其具体机制和规律特征尚不清楚。本课题据此提出假说：定点旋扳法可针对性调整突出髓核与纤维环及其周围神经根、脊髓等组织的应力分布，改变应力异常集中区，良性调整应力分布状态。本项目拟采用动作捕捉系统采集手法客观参数，结合有限元分析技术，基于不同突出类型的颈椎MRI影像建立具有针对性的颈椎病理三维有限元模型，通过数据加载模拟手法的治疗过程，从动力学和运动学角度归纳定点旋扳法的生物力学特征，分析手法作用的应力再分配机制和生物力学特点，验证本项目提出的假说。结果将进一步丰富手法生物力学机制的理论知识，并有助于指导临床提高手法治疗的安全性和有效性。