基于多刚体力学模型腰椎推拿斜扳法的优化

目的 综合考虑推拿的有效性和安全性，提出一种评价振荡激励和脉冲激励腰椎推拿斜扳法优劣的方法，并对振荡激励腰椎推拿斜扳法进行优化。方法 建立多刚体胸-腰椎生物力学模型，手法作用力作为模型的输入力，运用MATLAB/Simulink进行仿真，模拟得到腰椎各节段位移和加速度随时间变化的情况，对腰椎推拿手法行优化时，改变推拿作用力的核心要素频率f和操作次数n，比较腰椎各节段最大相对位移和最大加速度，并提出一种新的指标z，对推拿手法的有效性和安全性进行综合评价。结果 两种激励腰椎推拿斜扳法作用时，腰椎各节段最大相对位移没有差异；振荡激励腰椎推拿斜扳法作用时，腰椎各节段的最大加速度均明显小于脉冲激励腰椎推拿斜扳法作用时的最大加速度。当f=1～2.5 Hz时，推拿整体效果比较好，且整体效果与操作数无关，推拿作用力持续1个操作数即可；当f=3.33 Hz，n≥5时，推拿治疗效果最好，但此时腰椎各节段承受力也相对较大；当f≥5 Hz时，推拿整体表现不佳。结论 振荡激励腰椎推拿斜扳法比脉冲激励腰椎推拿斜扳法更安全，研究结果为医生提供一个比较合理的振荡激励腰椎推拿斜扳法操作参数的范围。

Optimization of Lumbar Oblique-Pulling Manipulation Based on Multi-Rigid Body Mechanical Model

Objective Comprehensively considering the effectiveness and safety of massage, a method for evaluating the pros and cons of oscillation excitation and pulse excitation for lumbar oblique-pulling manipulation was proposed, and lumbar oblique-pulling manipulation under oscillation excitation was optimized. Methods A multi-rigid body biomechanical model of thoracolumbar spine was established. The manipulation force was used as the input force of the model. Using MATLAB/Simulink, variation of the displacement and acceleration of each lumbar segment with time was simulated. For the optimization of lumbar massage manipulation, the core elements of massage force, namely, frequency (f) and operand (n) were changed, and then the maximum relative displacement and maximum acceleration of each lumbar segment were compared. A new index z was proposed to comprehensively evaluate effectiveness and safety of the manipulation. Results The maximum relative displacement of each lumbar segment was almost equal when lumbar oblique-pulling manipulation under two kinds of excitation was applied. For lumbar oblique-pulling manipulation, the maximum acceleration of each lumbar segment under oscillation excitation was significantly smaller than that under pulse excitation. When the frequency of massage was 1-2.5 Hz, the overall effect of massage was better, and the overall effect had no relation with the operands, and the force of massage lasted for one operand; when the frequency of message was 3.33 Hz and the operands were more than 5, the massage had the best effect, meanwhile the strength of each lumbar segment was relatively large; when the frequency of massage exceeded 5 Hz, and the overall performance of massage was not good. Conclusions Lumbar oblique-pulling manipulation under oscillation excitation is safer than that under pulse excitation. The research findings provide doctors with a reasonable range of operating parameters for lumbar oblique-pulling manipulation under pulse excitation.