摘要:
BACKGROUND: Cervical spondylotic radiculopathy could be effectively treated by cervical rotatory manipulation, but the symptoms may be exacerbated when rotated to the wrong direction. OBJECTIVE: To simulate the cervical rotatory manipulation in left/right rotation by three-dimensional finite element, and then investigate the effect of this manipulation on the displacement of cervical disc and the volume of intervertebral foramen so as to provide a basis for effectiveness and safety of cervical rotatory manipulation in treating cervical spondylotic radiculopathy. METHODS: With Mimics10.01, Geomagic Studio and Solidworks 14.0 software, a three-dimensional geometric CAD model of C5-6was developed from the CT scan images of a 25-year-old normal adult female. The model was imported into Ansys Workbench 14.5, and a three-dimensional finite element model was verified and simulated the cervical rotatory manipulation. The cervical rotatory manipulation was decomposed by principium of manipulation in left lateral flexion and rotated to the left/right side. The parameter of mechanics was analyzed with the finite element system. The change of displacement in cervical disc and volume in intervertebral foramen simultaneously were displayed during simulating the manipulation. RESULTS AND CONCLUSION: In left lateral flexion and rotated to the left side, the posterior part of the left side of annulus fibers was expanded 0.46 mm into posterior, and the posterior part of the right side of annulus fibers was retracted 0.77 mm. The volume of left intervertebral foramen became small and the right side became large. However, in left lateral flexion and rotated to the right side, the posterior part of the left side of annulus fibers was retracted 0.71 mm, and the posterior part of the right side of annulus fibers was expanded 0.43 mm into posterior. The volume of left intervertebral foramen became large and the right side became small. Therefore, the posterior part of the rotated side of cervical disc was expanded into posterior, while the posterior part of the contralateral side of cervical disc was retracted. The volume of intervertebral foramen in rotated side became small, while the volume of intervertebral foramen in contralateral side became large. We should rotate to the contralateral side when cervical spondylotic radiculopathy was treated with cervical rotatory manipulation.%背景:旋转手法治疗神经根型颈椎病可迅速缓解根性疼痛,但旋转方向失当可加重原有症状.目的:利用颈椎三维有限元模型模拟旋转手法,探讨旋转方向对颈椎间盘位移和椎间孔容积的影响,为旋转手法治疗神经根型颈椎病的有效性和安全性提供依据.方法:对1名25岁健康成年女性志愿者的颈椎进行CT扫描成像,应用Mimics10.01、Geomagic Studio、Solidworks 14.0等软件建立颈椎C5-6实体CAD模型,然后将模型导入Ansys Workbench 14.5软件进行有效性验证及手法模拟.在颈椎左侧屈位下分别向左、右侧旋转,模拟旋转手法实施,把各项力学参数代入三维有限元模型进行计算分析.即时显示手法作用时颈椎间盘位移和椎间孔容积的变化.结果与结论:向左旋转时,椎间盘左侧后部向后位移0.46 mm,右侧后部向前位移0.77 mm,左侧椎间孔容积变小,右侧椎间孔容积变大;向右旋转时,椎间盘左侧后部向前位移0.71 mm,右侧后部向后位移0.43 mm,左侧椎间孔容积变大,右侧椎间孔容积变小.因此,旋转侧椎间盘后部向后位移,旋转对侧椎间盘后部向前位移,旋转侧椎间孔容积变小,旋转对侧椎间孔容积变大,若使用旋转手法治疗神经根型颈椎病,应向健侧旋转.