【作者】 金凤；

【导师】 丁光宏；

【作者基本信息】 复旦大学 ， 生物力学， 2011， 博士

【摘要】 随着人类长期从事伏案工作等原因,腰椎病成为一种常见病和多发病,引起腰痛,甚至下肢麻木,威胁到人类的生活质量。目前临床上多采用保守治疗方法和手术治疗方法。根据综述可知,针刀具有显著的治疗效果,治疗机制中生物力学因素起到相当重要的作用。对腰椎的力学分析,挖掘应力对腰椎的影响,可以更好的指导临床。本研究通过大鼠爬行体位、直立体位、针刀配合手法治疗及恢复爬行体位,结合形态学观察、影像学观察,为针刀配合手法治疗大鼠腰椎退变的疗效提供实验依据。在数值分析中,基于所建的正常大鼠、直立大鼠的有限元模型的基础上通过减掉韧带、缩小椎间隙、减小杨氏模量,具体分析针刀配合手法治疗、恢复体位后,静载荷下的应力场、应变场以及位移场的分布变化。首先,使用X线腰椎侧位片观察方法,发现仅截肢因素对腰椎影响不大,长期直立状态对腰椎的影响比较大,说明该模型较适合本研究。结合组织形态学的观察,直立大鼠出现腰椎曲度变直、椎间隙变窄,骨赘的形成、椎间盘退变、软骨终板钙化、胶原纤维结构排列较疏散、扭曲,染色变淡,并伴有断裂、挛缩现象。经过针刀配合手法、恢复体位后发生不同程度的好转。证明针刀配合手法治疗大鼠腰椎退变的明确疗效。其次,基于拉伸压缩试验,首次获得大鼠的杨氏模量,采用Micro-CT扫描以及Mimics软件构建了正常大鼠、直立大鼠第3-6腰椎段的三维数字模型。根据动物实验,针对第4-5腰椎功能单元,进一步模拟针刀组、恢复体位组,分析二种治疗方法的综合效果。同时观察随着退变的发生,韧带应力、椎间盘应变、位移最大值变化规律,将力学分析结果对应于实验结果,挖掘生理病理意义,明确针刀配合手法治疗大鼠腰椎退变的力学机制。最后,根据动物实验和力学分析的结果比较可知,针刀配合手法和恢复体位的方法有效地恢复了力学环境,治疗大鼠腰椎退变具有明确的治疗作用。说明针刀、手法配合整复、牵引等恢复体位的方法可以有效地治疗腰椎退变引起的相关疾病。将上述研究结果应用于临床可知,棘上韧带要承受更大的应力,所以施术于棘上韧带的效果高于棘间韧带。由于力学分析结果可知,经治疗后应力值改变最大的地方为棘上和棘间韧带交界与棘突的附着处,所以治疗的时候针刀松解异常应力就应该着重于此部位,这样效果最好。本研究通过动物实验,验证了针刀配合手法治疗大鼠腰椎退变的治疗作用。同时,建立了相应的有限元模型,进行数值模拟,将生物力学和针刀基础研究结合起来。一方面动物实验验证了所建有限元模型的合理性。另一方面通过数值模拟,认识治疗方法的力学机制,进行定量的分析,结果可应用于临床操作方法的改善。最后,将大鼠直立模型的研究应用于中医理论的研究,进一步发展了传统医学的研究方法,认识到生物力学在腰椎病研究中的重要作用,为治疗肾脏病提供新的思路。更多还原

【Abstract】 As the persons worked on the table for a long time and other reasons, lumbar disease become common and frequent, causing low back pain, numbness and even threaten the quality of human life. More conservative therapy and surgical treatment were used currently. We found that Acupotomy had significant therapeutic effect from the review. Biomechanical factors in the pathogenesis played a very important role in the mechanism of this disease. The impact of stress on the lumbar was analyzed by mechanics can guide the clinic.In this study, the morphology and imaging observation of rats with crawling posture, upright posture, treated by Acupotomy and recovery posture provided an experimental proof of treating the degenerative disc disease by Acupotomy combined with manipulation. In the numerical analysis, based on the finite element model of the normal rats and upright posture rats, the distribution changes of the stress, strain and displacement of the treatment called Acupotomy and recovery posture under static load were analyzed specifically through reducing ligament, narrowing disc space, reducing the Young’s modulus.First, we found that only amputation had little effect on the lumbar with X ray, but long-term upright posture had impact on lumbar spine. It meant the model was more suitable for this study. Combination of histological observation, the upright posture rats had intervertebral space narrowing, osteophyte formation, disc degeneration, cartilage endplate calcification, evacuated structural arrangement and twisted collagen, pale staining, and associated with fracture, contracture. It proved that degenerative disc disease treated by Acupotomy and recovery posture had the clear effect. Secondly, based on tensile and compression test, we built the L3-6 three-dimensional digital models of the normal and upright posture rats and got the Young’s modulus in rats using Micro-CT scanning and Mimics software for the first time. According to animal experiments, the Acupotomy group, recovery posture group and the combined effect of two treatment methods were further simulated for the L4-5 functional unit. To observe the occurrence of degeneration and the variation of the ligament stress, intervertebral disc strain, the maximum displacement. The mechanical analysis was corresponded to the experimental results. We could know the physiological and pathological significance and the mechanism of treating the degenerative disc disease by Acupotomy with manipulation clearly.Finally, Acupotomy with manipulation and recovery posture were effective in restoring the mechanical environment, compared the animal experiments to the results of mechanical analysis, and had a clear therapeutic effect on degenerative disc disease. It meant that Acupotomy, manipulation, traction and other recovery methods could cure the degenerative disc disease effectively. According to the result that the supraspinous ligament was bore more stress, the effect of treating on the supraspinous ligament was better than that the interspinous ligament. Because the location of the largest stress changes was the junction adhere to spinous between the supraspinous ligament and interspinous ligament. We should choose this location to cure this disease.In this study, animal experiments to verify the effect of treating the degeneration disc disease by Acupotomy with manipulation. While establishing the corresponding finite element model and numerical simulation, it combined biomechanics with Acupotomy basic research. On the one hand the animal experiments demonstrate the rationality of the finite element model. On the other hand the numerical simulation helped us to understand the mechanism of treatment, quantitative analysis and to apply the results to improve clinical effect. Finally, the rats used in vertical model of traditional Chinese medicine theory, the upright posture rats were used to do the research on the theory of traditional Chinese medicine and developed the research methods. We recognized that biomechanics played an important role in the lumbar disease research and provided a new way of curing kidney disease.更多还原