三维平衡正脊手法治疗神经根型颈椎病的有限元分析

目的:探讨"三维平衡正脊"手法治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的生物力学特点。方法:将1例CSR患者行"三维平衡正脊"手法治疗,并在治疗过程中运用力学检测系统监测手法过程中的力学变化。利用螺旋CT对患者颈部进行断层扫描获取DICOM数据,依次运用Mimics软件、Geomagic Studio软件、ANSYS Workbench软件建立神经根型颈椎病三维有限元模型;模拟加载"三维平衡正脊"手法,将各部分力学参数代入有限元模型,运用ANSYS软件进行有限元分析,研究"三维平衡正脊"作用下患者的椎体、椎间盘的内部应力变化及位移变形情况。结果:建立的CSR患者C_3-C_7有限元模型包括5节椎体、4节椎间盘、3种韧带,涉及153 471个节点,64 978个单元。手法完全加载后,C_3-C_7椎体应力部位主要在C_5棘突前部及根部、椎弓及二者联合处,最大应力达到17.781 MPa;变形部位主要集中在C_3椎体关节突、横突前部,以及C_4椎体上关节突、横突,C5椎体关节突。C_3-C_7椎间盘应力主要分布于C_(3,4)椎间盘前部及C_(4,5)、C_(5,6)髓核部;位移情况扩展到C_(3,4)髓核中后部,C_(4,5)、C_(5,6)髓核周围及颈间盘前部。结论:C_3-C_7神经根型颈椎病患者三维有限元模型的建立较能真实地模拟颈椎几何形态及材料属性,亦较准确地反映颈椎的生物力学特性,验证"三维平衡正脊"手法对CSR的内在作用机制,证明治疗的安全性及成效性,指导更规范的手法操作,避免医疗事故的发生。

Finite element analysis of the treatment of cervical spondylotic radiculopathy with three dimensional balanced manipulation

Objective: To explore the biomechanical characteristics of "three-dimensional balanced manipulation" for the treatment of cervical spondylotic radiculopathy (CSR).Methods: A CSR patient was treated with "three-dimensional balanced manipulation",and the mechanical changes during the manipulation were monitored by mechanical testing system. Using spiral CT to scan the neck of the patient to obtain DICOM data. The three-dimensional finite element model of cervical spondylotic radiculopathy was established by using Mimics software,Geographic Studio software. The "three-dimensional balance manipulation" was simulated and loaded,and the mechanical parameters of each part were replaced into the finite element model,and the finite element analysis was carried out by using ANSYS software to study the internal stress changes and displacement deformation of vertebral body and intervertebral disc under the action of "three-dimensional balance manipulation".Results: The established C₃-C₇ finite element model of the CSR patient consisted of 5 vertebrae,4 intervertebral discs and 3 ligaments,involving 153 471 nodes and 64 978 units. The stress of C₃-C₇ vertebral body was mainly located in anterior and root of C₅ spinous processes,arch,vertebral arch and the combination of the two after full loading of manipulation,and the maximum stress was 17.781 MPa. The deformation sites were mainly concentrated in articular processes and anterior transverse processes of C₃,superior articular processes and transverse processes of C₄,articular processes of C₅. The stress of C₃-C₇ intervertebral disc mainly distributed in the anterior part of C_3,4 intervertebral disc and the nucleus pulposus of C_4,5 and C_5,6. The displace mentextended to the middle and posterior part of C_3,4 nucleus pulposus,around the nucleus of C_4,5 and C_5,6 and anterior part of cervical intervertebral disc.Conclusion: The establishment of three-dimensional finite element model of C₃-C₇ cervical spondylotic radiculopathy can simulate the geometry and material properties of cervical spine,and also accurately reflects the biomechanical characteristics of cervical spine,verifys the internal mechanism of "three-dimensional balanced manipulation" on CSR,proves the safety and effectiveness of treatment,guides more standardized manipulation,and avoids medical accidents.