【作者】 田强；

【导师】 吴山；

【作者基本信息】 广州中医药大学 ， 中医学， 2008， 硕士

【摘要】 目的1、探讨两种坐位旋转手法对椎间盘及椎体内在应力及位移的影响。2、探讨两种坐位旋转手法的作用机理及其合理性、安全性。研究方法1、应用压力传感器系统,测量并记录腰椎定点旋转手法作用过程中出现“咔哒”声时术者拇指推顶棘突的最大推扳力。2、建立模型:使用螺旋CT,以1mm的间隔,对1具男性青年新鲜尸体的腰椎标本沿轴向进行断层扫描,以jpg格式将其断面图像输入计算机。利用三维重建软件Minics建立腰椎三维计算机模型。再经过自由造型Free Form系统的修改。应用L4-5的CT图像,逐层重建含有20781个结点,13632个立体单位的三维有限元模型。3、根据手法原理,将两种坐位旋转手法进行分解,把力学参数带入三维有限元模型,利用Ansys 9.0软件进行计算。研究结果1、腰椎定点旋转手法出现“咔哒”声响时术者左、右拇指对受试者第四腰椎棘突的最大推扳力分别为4.98±1.24kg和6.71±1.66kg。2、椎间盘位移和应力特点腰椎定点旋转手法:椎间盘的应力及位移都不断增加。应力主要集中于纤维环的外侧,而髓核应力较小。位移方向与应力方向大致相同。位移从椎间盘左前缘呈弧形向右后侧递减。椎间盘左后缘位移大于右后缘。直腰旋转手法:椎间盘的应力及位移都不断增加。椎间盘的应力从纤维环右侧缘向左侧递减。最终位移是以右侧髓核为中心向边缘逐渐增大。最大的位移位于椎间盘左侧缘。结论1、手法造成了椎间盘、关节突的位移,有利于解除神经根的粘连。2、两种手法比较,脊柱定点旋转手法更具有效性及安全性。更多还原

【Abstract】 Objective1. To explore effects of sitting-rotatory manipulation on inner stress and displacement of lumbar intervertebral disc.2. To explore the mechanism, rationality and security of sitting-rotation manipulation.Method1.The largest forces of thumb on the spinous process of fourth lumbar vertebra were tested and recorded with a press sensor testing system during cracking sounds of the lumbar located and rotatory manipulation.2.Model establishing: one intact fresh young man cadaveric specimens was scanned with CT with 1mm interval through its lumbar vertebrae. Then, the jpg-format data of CT were inputted into computer and were utilized to establish the three-dimensional FEM by using software Mimics. Then the FEM was modified by Freeform system. The finite element system contained of 20781 nodes and 13632 elements.3. Two kinds of sitting-rotation manipulations were decomposed by principium of manipulation. The parameters of mechanics wre analyzed with the three-dimensional finite element system and computed with software Ansys 9. 0.Result1. As the cracking sound , the forces to the fourth spinous process of lumbar vertebra were 4. 98±1. 24kg and 6. 71±1.66kg respectively in left and right thumbs.2. Characteristic of stress, displacement of lumbar disc.lumbar Rotatory Manipulation The stress, displacement of lumbar disc were increasing continuously during manipulation. The stress was concentrated around outlayer of annulus fibrous, which is bigger than the stress in nucleus pulposus. The stress was descended from left-anterior side of the lateral border to right-posterior side of the lateral border in a form of arc. The displacement, just as the stress, descended form left-anterior side of the lateral border to right-posterior side of the lateral border in a form of arc. The displacement of right-posterior region was larger than the left-posterior region.Lumbar Erected and Rotatory Manipulation The stress , displacement of lumbar disc were increasing continuously during manipulation. The stress was descended from right side of the lateral border to left side. The final displacement is increased gradually centered around the right side of nucleus pulposus. The biggest displacement is located at the left side of the lateral border.Conclusion1. By causing the displacement of intervertebral disc and articular process, the manipulation was helpful to relieve the conglutination of nerve toot.2. Cmparing the two kinds of manipulation , the lumbar rotatory manipulation is more effective and safty.更多还原