三种腰椎前屈状态下坐位腰椎旋转手法比较研究

目的探讨三种前屈状态下坐位腰椎旋转手法对退变椎间盘的影响,从而为优化手法提供依据。方法使用正常L4-5腰椎CT片,以Mimics软件系统逐层重建,建立退变的腰椎间盘的L4-5三维有限元模型,根据手法原理,将坐位腰椎旋转手法进行分解,按A、B、C三种腰前屈角度（A=6°;B=9°;C=12°）把各项力学参数代入三维有限元模型进行计算分析。结果随着屈度的增加,旋转侧椎间盘的后外侧应力不断增加。除去C状态外,A、B两种状态的椎间盘两后外侧位移相近。C状态旋转侧后外部明显向后内侧突出。增加了该部位位移。结论从解除粘连的考虑,旋转手法时,屈度不能太大,具有使椎间盘突出的危险,向健侧旋转优于向患侧旋转。

Comparison of lumbar rotation manipulation in three lumbar flexion levels

Objective To explore the effect of the lumbar rotated and localized manipulation in three lumbar flexion levels on degenerate lumbar disc and to provide the evidence for optimizing the manipulation. Methods Sectional constructed with Minincs software system by normal lumbar L4-5 CT images. Set up a 3 dimension finite element model of manipulation,according to flexion angle, applying the manipulation in three levels： A （ 6° ） ; B （ 9° ） ; C （ 12° ）respectively. Then loading the parameter of mechanics on the finite element system and making analysis. Results With the increase of the flexion angle,the stress in the anterior part of the rotation side of lumbar disc was increasing gradually during rotation manipulation. The displacement of two posterior-lateral side were same under A and B state,but the displacement of the rotation side was more than the opposite side＇ because of the protrusion distortion. Conctusion In the view of removing the conglutination,during lumbar rotation manipulation the bigger flexion adds the fatalness of the disc rupture, so it is more rational for rotation manipulation in a small flexion angle toward the healthy side.