Lin Dongxin, He Zaopeng, Weng Rui, Zhu Yuhua, Lin Zhiwei, Deng Yuping, Yang Yang, Tan Jinchuan, Wang Mian, Li Yanbin, Huang Gang, Yu Guanghao, Cai Daozhang, Huang Xuecheng, Huang Wenhua
Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
Center for Orthopaedic Surgery, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Front Bioeng Biotechnol. 2023 Jul 27;11:1195583. doi: 10.3389/fbioe.2023.1195583. eCollection 2023.
The purpose of this study was to obtain the stress-strain of the cervical spine structure during the simulated manipulation of the oblique pulling manipulation and the cervical rotation-traction manipulation in order to compare the mechanical mechanism of the two manipulations. A motion capture system was used to record the key kinematic parameters of operating the two manipulations. At the same time, a three-dimensional finite element model of the C0-T1 full healthy cervical spine was established, and the key kinematic parameters were loaded onto the finite element model in steps to analyze and simulate the detailed process of the operation of the two manipulations. A detailed finite element model of the whole cervical spine including spinal nerve roots was established, and the validity of this 3D finite element model was verified. During the stepwise simulation of the two cervical spine rotation manipulations to the right, the disc (including the annulus fibrosus and nucleus pulposus) and facet joints stresses and displacements were greater in the oblique pulling manipulation group than in the cervical rotation-traction manipulation group, while the spinal cord and nerve root stresses were greater in the cervical rotation-traction manipulation group than in the oblique pulling manipulation group. The spinal cord and nerve root stresses in the cervical rotation-traction manipulation group were mainly concentrated in the C4/5 and C5/6 segments. The oblique pulling manipulation may be more appropriate for the treatment of cervical spondylotic radiculopathy, while cervical rotation-traction manipulation is more appropriate for the treatment of cervical spondylosis of cervical type. Clinicians should select cervical rotation manipulations for different types of cervical spondylosis according to the patient's symptoms and needs.
本研究的目的是获取在模拟斜扳手法和颈椎旋转牵引手法操作过程中颈椎结构的应力-应变情况，以便比较两种手法的力学机制。使用运动捕捉系统记录两种手法操作的关键运动学参数。同时，建立了C0-T1全健康颈椎的三维有限元模型，并将关键运动学参数逐步加载到有限元模型上，以分析和模拟两种手法操作的详细过程。建立了包括脊神经根在内的整个颈椎的详细有限元模型，并验证了该三维有限元模型的有效性。在对颈椎向右旋转的两种手法进行逐步模拟过程中，斜扳手法组椎间盘（包括纤维环和髓核）及小关节的应力和位移大于颈椎旋转牵引手法组，而颈椎旋转牵引手法组脊髓和神经根的应力大于斜扳手法组。颈椎旋转牵引手法组脊髓和神经根的应力主要集中在C4/5和C5/6节段。斜扳手法可能更适合用于治疗神经根型颈椎病，而颈椎旋转牵引手法更适合用于治疗颈型颈椎病。临床医生应根据患者的症状和需求，针对不同类型的颈椎病选择颈椎旋转手法。
