Effects of lumbar stereotaxic oblique-pulling manipulation versus traditional oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints:a finite element analysis-based biomechanical study
Objective:To compare and analyze the effects of lumbar stereotaxic oblique-pulling manipulation versus traditional lumbar oblique-pulling manipulation on lumbar intervertebral discs and articular cartilage of lumbar zygapophysial joints.Methods:One male adult with L4-5 intervertebral disc herniation(herniated to left rear)was selected for lumbar spine and pelvis scanning by using a Siemens Light Speed 64-slice spiral CT,with a slice thickness of 0.5 mm.Based on the CT scanning data,a three-dimensional(3D)finite element model of lumbar spine-pelvis was established by using a 3D finite element modeling software.After verifying the validity of the model by comparing with the article data,the overall stress of the lumbar spine-pelvis model,the stresses and displacements of the L4-5 intervertebral disc and articular cartilage of L4-5 zygapophysial joint,and the relative spatial distance between the central points of upper and lower articular process surfaces at L4～5 segment under the action of stereotaxic oblique-pulling manipulation and traditional oblique-pulling manipulation were recorded and analyzed.Results:①The established lumbar spine-pelvis 3D finite element model consisted of 550 215 nodes and 344 359 elements,which highly simulated the structure and material properties of the lumbar spine-pelvis.Under the simulated loading con-ditions,the range of motion(ROM),including flexion-extension,lateroflexion,and axial rotation,of the L4-5 segment were basically the same as the results previously reported.②When the traditional oblique-pulling manipulation was performed on the lumbar spine-pelvis 3D finite element model,the maximum stress of the model was 5.31 Mpa,and mainly concentrated on the L1,L2,L4,and L5 vertebrae;while when the stereotaxic oblique-pulling manipulation was implemented,the maximum stress of the model was 29.30 Mpa,and mainly on L1 and L2 verte-brae as well as the L3,L4,and L5 vertebral pedicles.③Under the action of traditional lumbar oblique-pulling manipulation,the annulus fi-brosus of L4-5 intervertebral disc showed the average equivalent stress as1.12 Mpa,and the whole annulus fibrosus displaced leftward,for-ward,and downward,with an average displacement of 0.36,0.20,and 0.05 mm,respectively;the nucleus pulposus showed the average equivalent stress as 0.02 Mpa,and the whole nucleus pulposus displaced leftward,forward,and downward,with an average displacement of 0.35,0.24,and 0.06 mm,respectively.While,under the stereotaxic oblique-pulling manipulation,the annulus fibrosus of L4-5 interverte-bral disc exhibited the average equivalent stress as 1.14 Mpa,and the whole annulus fibrosus displaced leftward,forward,and downward,with an average displacement of 0.39,1.30,and 0.05 mm,respectively;the nucleus pulposus exhibited the average equivalent stress as 0.02 Mpa,and the whole nucleus pulposus displaced leftward,forward,and downward,with an average displacement of 0.38,1.30,and 0.07 mm,respectively.④In the case of the traditional oblique-pulling manipulation,the articular cartilage of zygapophysial joint at L4-5 showed the average equivalent stresses as 2.46 and 3.18 Mpa and the average displacements as 1.10 and 0.21 mm on the left side and right side,respectively.While,in the case of the stereotaxic oblique-pulling manipulation,the average equivalent stresses were 2.70 and 3.22 Mpa and the average displacements were 1.46 and 0.65 mm on the left side and right side,respectively.⑤The relative spatial dis-tances between the central points of the upper and lower articular process surfaces on the left side and right side at L4-5 were 0.75 and 0.34 mm in the case of traditional oblique-pulling manipulation,and 0.81 and 0.23 mm in the case of stereotaxic oblique-pulling manipula-tion.Conclusion:Both lumbar stereotaxic oblique-pulling manipulation and traditional lumbar oblique-pulling manipulation can cause stress and displacement in intervertebral discs and articular cartilage of zygapophysial joints of the affected segment in patients with lumbar disc herniation.Compared with the latter,the former can cause greater stress and displacement,which may be the reason why the former behaves better than the latter in the outcome in treating lumbar disc herniation.
tui na therapyfinite element analysisintervertebral disc displacementlumbar vertebraebiomechanics
NETL
NSTL
万方数据
维普
