提拉旋转斜扳法操作时腰椎椎间盘应力及应变的有限元研究

目的　通过有限元分析方法，观察提拉旋转斜扳法操作时椎间盘应力及应变发生的变化规律，探寻手法治疗腰椎疾患的科学性和安全性。 方法　在构建的L4~5节段腰椎模型上模拟加载提拉旋转斜扳手法，观察手法作用过程中椎间盘应力的分布及变化，髓核及纤维环的位移及应变。 结果　椎间盘应力变化从右后方开始出现，以弧形向周围传递扩散，应力的变化呈递减分布。椎间盘应变最小的位置在髓核偏后，以此为中心呈圆弧状向周围递增。应变最大的位置主要发生于纤维环，特别是椎间盘右侧外缘。 结论　手法操作中应力主要集中于后侧关节突关节，椎间盘的应力变化相对较小，提示手法治疗是安全的。纤维环后外侧在操作中有较明显的应变，局部的位移变化可能是手法疗效的机制之一。

A finite element study on the stress and strain of lumbar intervertebral disc in side bending - rotary manipulation

Objective　To observe the change rule of intervertebral disc stress and strain in the operation of tilting rotation by the method of finite element analysis, and to explore the scientificalness and safety of the method to treat lumbar spine disease.　Methods　Simulated loading of “Side bending -rotation manipulation” was loaded on lumbar L4~5 model. The distribution and change of technique effect in the process of intervertebral disc stress, displacement and strain of nucleus pulposus and annulus were observed.　Results The changes of the stress in the intervertebral disc began to appear from the right rear, and spread around the arc, and the change of stress was reduced. Disc strain minimum position occurred in the nucleus and increased from the center to the periphery in an arched shape. The position of the maximum strain increment occurred mainly in fiber ring, especially in the right edge of intervertebral disc.　Conclusions　The stress in manipulation is mainly concentrated on the posterior small joints. The stress changes of the intervertebral disc are relatively small, suggesting that the manipulation is safe. There are obvious strains in the posterolateral operation of the annulus fibrosus, and the change of local displacement may be one of the mechanisms of therapeutic effect of manipulation.