整复颈椎筋出槽骨错缝手法力学机制的三维有限元分析与研究

The manual rectification of TCM is a common approach for the treatment of cervical spondylosis and related diseases, which has been identified for its efficacy and safety. Based cervical "Jin Chu Cao and Gu Cuo Feng" is the key pathogenesis of cervical diseases, we would apply a combination of methods for observation of virtual three-dimensional simulation technology in parallel with the follow-up clinical diagnosis and treatment, which aimed to study the biomechanical mechanisms of Cervical "Jin Chu Cao and Gu Cuo Feng" and the manual rectification of TCM. Firstly, the real data of the subjects were measured respectively, for buliding a normal and "Jin Chu Cao and Gu Cuo Feng" FEMs of the cervical spine, then we would observe the static and dynamic effects and hemodynamic changes on the model; Secondly , we would simulate the manual rectification of TCM on these FEMs, which the three-dimensional motion capture system would be used for the mechanical parameter measurement, for observation of the effects on the models. Finally , according the real test data of the subjects after treatments, the parameters of the original FEMs would be adjusted, then record the state of stress and strain and hemodynamic changes on new models again. This program would like to verify cervical "Jin Chu Cao and Gu Cuo Feng" biomechanics through the lateral observation between the normal model and the pathological one, meanwhile the longitudinal comparison with the pathological model before and after treatment would be recorded as well. Moreover, through the simulation of the manual techniques loading, we hope to depth reveal the biomechanics of the manual rectification of TCM for cervical spondylosis.

整复手法是治疗颈椎病的常见方法，其疗效及安全性已得到确证。基于颈椎"筋出槽骨错缝"是颈椎病发病的关键病机的认识，本课题采用虚拟三维仿真技术与临床平行观察相结合的方法，对颈椎"筋出槽骨错缝"生物力学基础和手法力学机制进行研究。首先，采集受试者真实测量数据，分别创建正常人与"筋出槽骨错缝"的颈椎有限元模型，观察模型动静态应力应变效应与血流动力学变化；其次，采用三维动态捕捉系统测量手法运动学与动力学参数，并仿真加载于上述模型，观察手法的力学效应；最后，参照临床治疗后患者的真实检测数据，调整同一受试者的原有模型参数，对比观察模型的生物力学状态。通过横向观察受试者的正常与病理模型，并纵向对比治疗前后的力学效应，进一步验证和完善颈椎"筋出槽骨错缝"的生物力学基础；同时，通过仿真手法加载，揭示整复手法治疗颈椎病的力学作用机制。

本研究采用虚拟三维有限元仿真技术与临床平行观察相结合对比的方法，对颈椎“筋出槽骨错缝”生物力学基础和手法力学机制进行研究。实验构建、验证并两度优化了研究所需的正常人全颈椎有限元模型和颈椎“筋出槽骨错缝”病理有限元模型；采集、分析、归纳和总结了“筋出槽骨错缝”整复手法的生物力学参数，特点并对该手法的参数与观察因素的相关性进行了比较；对颈椎韧带力学性能、关节突关节角度等对颈椎生物力学的影响进行了细致的分析；对整复颈椎“筋出槽骨错缝”手法之定点旋扳法进行了全方位的仿真模拟和有限元数据分析，从骨性结构、韧带、椎间盘、椎动脉等结构进行该手法力学机制的阐述；对整复颈椎“筋出槽骨错缝”手法之颈椎仰卧位拔伸手法进行了生物力学分析。实验综合运用了计算机三维有限元分析技术、动态捕捉系统、力学测量系统、在体测量技术、颈椎CT/MRI扫描技术等多种多学科交叉技术和手段，对颈椎“筋出槽骨错缝”的生物力学和手法力学机制进行了阐述。结果显示：经过改良和优化的正常人全颈椎有限元模型外形逼真，清晰完整地模拟了颈椎的几何特性和内在材料属性，成为了有限元模型研究的理想数字平台，病理有限元模型在骨性结构、韧带、椎间盘、椎动脉等结构上与正常人模型均有较大差异，这些差异反应了病理颈椎模型的异常应力状态，能够大致解释和反应临床病理颈椎的主要特征，经过计算机仿真模拟和有限元分析，整复颈椎“筋出槽骨错缝”手法可以改变病理颈椎原有的异常应力状态，使整个颈椎及其附件的应力发生改变和重新分配，从而从治疗上取得临床疗效，同时，仰卧位拔伸手法可以降低椎间盘髓核内压，起到临床治疗作用。以上研究可以初步证实，通过手法作用力干预颈椎结构，改变病理状态下颈椎骨性结构及其附件等力学性能，使得颈椎椎体及其他结构应力分布更加趋于合理化和良性化。