“腰—盆—髋”模型模拟腰椎定点坐位旋转手法的有限元分析
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摘要
目的建立“腰椎-骨盆-股骨上端”三维有限元生物力学模型，验证所建模型的可靠性；利用所建立的“腰椎-骨盆-股骨上端”模型模拟腰椎定点坐位旋转手法，探索腰椎定点坐位旋转手法的作用机制，评价腰椎定点坐位旋转手法的安全性。
方法使用64层螺旋CT扫描志愿者第12胸椎以下双侧股骨上端以上范围，得到的CT原始影像图片879张，以DICOM格式存储；将DICOM格式的CT图片导入Mimics10.01软件进行“蒙面”编辑，利用其三维重建功能建立“腰椎-骨盆-股骨上端”几何模型；将模型导入geomagic12进行精修（减少噪音、松弛、删除钉状物、快速平滑、砂纸、填充孔、自动修补功能），以利于网格划分，确定三角形无自相交后输出模型；将geomagic12精修过的几何模型导入hypermesh10,划分四面体网格并添加椎间盘（区分纤维环和髓核）与相关韧带。参照相关文献设置模型各部分材料属性，以双侧股骨上端下表面为边界，模拟腰椎斜扳手法、坐位旋转手法以及牵扳手法加载三个不同工况(①工况1：不加载荷，单纯右旋15°；②工况2：前屈15°，纵向加载300N，右旋15°；③工况3：前屈15°，牵引300N右旋15°)，参考前期实验生物力学和有限元分析数据对模型进行加载，运算模拟腰椎三种手法下模型各部位的位移及应力分布，以验证模型的有效性。根据腰椎定点旋转手法的作用原理，将腰椎定点坐位旋转手法进行分解，改变腰椎前屈和侧弯参数，设计四种不同的工况(④X轴：前屈15°，Y轴：侧曲15°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩。⑤X轴：前屈15°，Y轴：侧曲9°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩。⑥X轴：前屈20°，Y轴：侧曲12°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩。⑦X轴：前屈15°，Y轴：侧曲20°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩)，将相关数据导入三维有限元模型，进行运算手法作用下各部位的位移及应力分布。
结果①得到腰椎-骨盆-股骨上端骨质（区别骨松质和骨密质）、椎间盘（区分纤维环和髓核）以及前纵韧带、后纵韧带、黄韧带、棘间韧带、棘上韧带、骶髂韧带、骶结节韧带、髂腰韧带、腹股沟韧带有限元模型。模型包括290771个节点，1321886个四面体单元，296个spring单元。②不加载荷，单纯旋转15°工况下，腰椎-骨盆-股骨上端骨质、椎间盘及各韧带的位移值和应力值与牵引和加载相比，各项指标明显普遍较小。③同时旋转15°，纵向加载和牵引，腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带位移值总体趋势自上而下逐步减小；应力集中分布在椎弓根、腰椎小关节、骶髂关节、股骨颈处，右侧更明显。④相同前屈角度（前屈15°）的情况下，随着侧曲角度的增加（9°-15°-20°），同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带位移增加。同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带的最大位移出现在前屈20°侧曲12°。⑤相同前屈角度（前屈15°）的情况下，随着侧曲角度的增加（9°-15°-20°），同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带应力增加。同平面腰椎-骨盆-股骨上端骨质以及各韧带的最大应力出现在前屈20°侧曲12°。椎间盘的最大应力出现在前屈15°侧曲20°。⑥模拟腰椎定点坐位旋转手法，观察腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带位移的变化趋势，出现自上而下，由右前上方向左后下方递减的趋势。同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带各部位移由右前方向左后方递减的趋势递减。观察腰椎-骨盆-股骨上端骨质以及各韧带位移：对骨质来讲，左髋关节以下基本没有什么位移，但是左髂腰韧带和、右骶棘韧带和右骶结节韧带却出现了明显的位移。⑦模拟腰椎定点坐位旋转手法，观察椎间盘以及各韧带应力的变化趋势，出现自上而下，由左后上方向右前下方递增的趋势。⑧模拟腰椎定点坐位旋转手法，腰椎-骨盆-股骨上端骨质的应力没有出现规律性分布，应力集中在腰椎椎体右前部、椎弓、椎间小关节、骶髂关节以及右股骨颈等处,右侧更明显。⑨纤维环和髓核做为一个整体，和腰椎并不存在同步位移，相邻的椎体和椎间盘的位移相差1-3mm。纤维环和髓核的应力分布并不同步，而且差别比较大。
结论1.所建立的“腰椎-骨盆-股骨上端”三维有限元模型有效，可以用于对“腰椎定点坐位旋转手法”进行有限元生物力学分析。2.在施行“腰椎定点坐位旋转手法”过程中，腰椎侧弯和前屈都是影响腰椎-骨盆-股骨上端骨质（区别骨松质和骨密质）、椎间盘（区分纤维环和髓核）以及各韧带位移和应力分布的因素。相对来说，前屈对骨质的影响较大，侧弯对椎间盘的影响较大。3.“腰椎定点坐位旋转手法”可以调整小关节结构，松解腰椎小关节粘连，缓解小关节结构紊乱以及滑膜嵌顿引起的腰腿疼痛症状。4.在施行“腰椎定点坐位旋转手法”时注意选择手法旋转的方向，以及手法操作的合适力度，以免加重临床症状或出现并发症。
Objective To bulid the three-dimensional finite elementbiomechanical model and Verify the reliability of the model;Usingthe established lumbar vertebra pelvic-proximal femur model，simulation Lumbar fixed-point Sitting-rotatory manipulation,Explore the mechanism of Lumbar fixed-point Sitting-rotatorymanipulation, and evaluate the safety of Lumbar fixed-pointSitting-rotatory manipulation.
Method Using64slice Spiral computed tomography (CT), scanned thevolunteer from the inferior margin of12th thoracic vertebra to thesuperior margin of bilateral proximal femur. obtained879CTpictures about original image of the volunteer,and stored them withDICOM format. Imported those CT pictures which with DICOM formatinto Mimics10.01, masked and edited them. Use the function ofthree-dimensional reconstruction,built the model of lumbarvertebra-pelvic-proximal femur; Imported the model into geomagic12and further modified it (function of reducing noise, relaxating,removing nails, fastly smoothing, sandpaper, filling holes,automatic repairing) in order to make the meshing easily. Confirmed there were not self-intersecting triangles in the model, thenimported the model. Imported the geometric model into hypermesh10modified by geomagic12, divied the model with tetrahedron gridand added the inter-vertebral disc (distinguish the annulusfibrosus and nucleus pulposus) and relevant ligament. refer torelevant literature, set the material properties of each part ofthe model. set the surface of bilateral proximal femur’s bottomas boundary, simulation lumbar oblique-pulling manipulation,Lumbar stretch-pulling manipulation and lumbar Sitting rotatory manipulation. Designed three conditions. condition①: noload, dextrorotation15°; condition②: anteflexion15°,Vertical load300N, dextrorotation15°;condition③: anteflexion15°, tract300N, dextrorotation15°. Refer to the data obtainedby previous biological mechanics experiment and the finite elementanalysis loaded the model,in order to Verify the validity of themodel. According to the principle of the Lumbar fixed-pointSitting-rotatory manipul-ation, divided it and loded the modelwith four congitions by changing the angle of lumbar anteflexionand lateral flexion. Condition④: X-axis anteflexion15°, Y-axis lateral flexion15°, Z-axis dextrorotation15°, load300NVertically on L1vertebra body, load15Nm running torque towardsthe right on L1vertebra body, load15Nm running torque at L4spinous process towards left anterior30°; Condition⑤: X-axisanteflexion15°, Y-axis lateral flexion9°, Z-axisdextrorotation15°, load300N Vertically on L1vertebra body, load15Nm running torque towards the right on L1vertebra body, load15Nm running torque at L4spinous process towards left anterior30°; Condition⑥: X-axis anteflexion20°, Y-axis lateral flexion12°, Z-axis dextrorotation15°, load300N Verticallyon L1vertebra body, load15Nm running torque towards the righton L1vertebra body, load15Nm running torque at L4spinous processtowards left anterior30°; Condition⑦: X-axis anteflexion15°, Y-axis lateral flexion20°, Z-axis dextrorotation15°,load300N Vertically on L1vertebra body, load15Nm running torquetowards the right on L1vertebra body, load15Nm running torqueat L4spinous process towards left anterior30°.Imported therelated data into three-dimensional finite element model andoperated, to obtain the displacement and stress-distribution ineach part of the model effected by Lumbar fixed-point Sitting rotatory manipulation.
Result①Obtained the-dimensionalfinite element model including: bone of lumbar vertebra-pelvic-proximal femur (distinguish between Cancellous bone and Compactbone), lumbar inter-vertebral disc (distinguish between nucleuspulposus and annulus fibrosus), and Anterior longitudinalligament，Posterior longitudinal ligament，Liga-ment flava，Supraspinal ligament，Interspinal ligaments，Sacrospinou ligament,Sacrotuberous ligament, Iliolumbar ligament, Inguinal ligament.with which290771node,1321886tetrahedralsolid element and296spring element.②In the condition of no load, dextrorotation15°, compare the displacement and stress-distribution in the lumbarvertebra-pelvic-proximal femur, lumbar inter-vertebral discand each ligament with tracted and Vertical loaded, The value ofeach index is generally smaller obviously.③In the condition ofdextrorotation15°, tracted and Vertical loaded, the value of thedisplacement and stress-distribution in the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and each ligament decreasing from superior to inferior; the distribution ofstress concentrated upon vertebral pedicle, umbar facet joint,sacroiliac joint and collum femoris, right more obviously.④Inthe condition of anteflexion15°, change with the angle of lateralflexion（9°-15°-20°）, the value of displacement in the same planeof the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and each ligament increasing. The largest valueappear on the condition of anteflexion20°, lateral flexion12°.⑤In the condition of anteflexion15°, change with the angleof lateral flexion（9°-15°-20°）, the value of stress in the sameplane of the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and each ligament increasing. The largest valueof lumbar vertebra-pelvic-proximal femur appear on the conditionof anteflexion20°, lateral flexion12°, The largest value oflumbar inter-vertebral disc appear on the condition of anteflexion15°, lateral flexion20°.⑥In the condition of simulatingLumbar fixed-point Sitting-rotatory manipulation, the trendencyof displacement in the lumbar vertebra-pelvic-proximal femur,lumbar inter-vertebral disc and each ligament descreasing fromsuperior to inferior, and from the right antero-superior to leftpostero-inferior，and descreasing from the right antero-superiorto left postero-inferior in the same plane in the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and eachligament follow this law also. For the displacement of vertebra-pelvic-proximal femur, there almost little displacement below theleft articulatio coxa. But there was obvious displacement in leftIliolumbar ligament， right Sacrospinou ligament and rightSacrotuberous ligament.⑦In the condition of simulating Lumbar fixed-point Sitting-rotatory manipulation, the trendency ofstress in the lumbar inter-vertebral disc and each ligamentincreasing from superior to inferior, and from the leftposterosuperior to right anteroinferior.⑧In the condition ofsimulating Lumbar fixed-point Sitting-rotatory manipulation,the trendency of stress in the lumbar vertebra-pelvic-proximalfemur was not occurred any regular distribution. The distributionof stress concentrated upon vertebral pedicle, umbar facet joint,sacroiliac joint and collum femoris, right more obviously.⑨Asa whole，nucleus pulposus and annulus fibrosus have not synchronousdisplacement with adjacentlumbar.there was a relative displacementbetween adjacent lumbar and lumbar inter-vertebral disc,about1-3mm. at the same time, there was not synchronous stress betweennucleus pulposus and annulus fibrosus. What is more, differentsignificantly.
Conclusion1. Built the three-dimensional finite element model oflumbar vertebra-pelvic-proximal femur successfully，it can beused to simulate Lumbar fixed-point Sitting-rotatorymanipulation and make the finite element analysis.2. During theoperation of Lumbar fixed-point Sitting-rotatoryr manipulation,both anteflexion and lateral flexion was the main factor whicheffects the displacement and stress in the lumbar vertebra-pelvic-proximal femur (distinguish between Cancellous bone and Compactbone), lumbar inter-vertebral disc (distinguish between nucleuspulposus and annulus fibrosus), and each ligament. relativelyspeaking， anteflexion put more important influence on thebone(distinguish between Cancellous bone and Compact bone). andlateral flexion put more important influence on the lumbar inter -vertebral disc (distinguish between nucleus pulposus and annulusfibrosus).3. Those can occurre when the lumbar Sitting-rotatorymanipulation was operated, that disordered umbar facet joint wasadjusted, and adhered umbar facet joint was released. the pain inwaist and lower extremities caused by disoredered umbar facet jointand incarcerated synovial membrane was relieved accordingly.4.During the operation of lumbar Sitting-rotatory manipulation, wemust pay attention to the direction and the force ofmanipulation,lest aggravating clinical symptoms or giving rise tocomplications.
方法使用64层螺旋CT扫描志愿者第12胸椎以下双侧股骨上端以上范围，得到的CT原始影像图片879张，以DICOM格式存储；将DICOM格式的CT图片导入Mimics10.01软件进行“蒙面”编辑，利用其三维重建功能建立“腰椎-骨盆-股骨上端”几何模型；将模型导入geomagic12进行精修（减少噪音、松弛、删除钉状物、快速平滑、砂纸、填充孔、自动修补功能），以利于网格划分，确定三角形无自相交后输出模型；将geomagic12精修过的几何模型导入hypermesh10,划分四面体网格并添加椎间盘（区分纤维环和髓核）与相关韧带。参照相关文献设置模型各部分材料属性，以双侧股骨上端下表面为边界，模拟腰椎斜扳手法、坐位旋转手法以及牵扳手法加载三个不同工况(①工况1：不加载荷，单纯右旋15°；②工况2：前屈15°，纵向加载300N，右旋15°；③工况3：前屈15°，牵引300N右旋15°)，参考前期实验生物力学和有限元分析数据对模型进行加载，运算模拟腰椎三种手法下模型各部位的位移及应力分布，以验证模型的有效性。根据腰椎定点旋转手法的作用原理，将腰椎定点坐位旋转手法进行分解，改变腰椎前屈和侧弯参数，设计四种不同的工况(④X轴：前屈15°，Y轴：侧曲15°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩。⑤X轴：前屈15°，Y轴：侧曲9°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩。⑥X轴：前屈20°，Y轴：侧曲12°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩。⑦X轴：前屈15°，Y轴：侧曲20°，Z右旋15°，纵向加载300N，L1椎体上面15Nm右旋力矩，L4棘突3Nm左偏前30°旋转力矩)，将相关数据导入三维有限元模型，进行运算手法作用下各部位的位移及应力分布。
结果①得到腰椎-骨盆-股骨上端骨质（区别骨松质和骨密质）、椎间盘（区分纤维环和髓核）以及前纵韧带、后纵韧带、黄韧带、棘间韧带、棘上韧带、骶髂韧带、骶结节韧带、髂腰韧带、腹股沟韧带有限元模型。模型包括290771个节点，1321886个四面体单元，296个spring单元。②不加载荷，单纯旋转15°工况下，腰椎-骨盆-股骨上端骨质、椎间盘及各韧带的位移值和应力值与牵引和加载相比，各项指标明显普遍较小。③同时旋转15°，纵向加载和牵引，腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带位移值总体趋势自上而下逐步减小；应力集中分布在椎弓根、腰椎小关节、骶髂关节、股骨颈处，右侧更明显。④相同前屈角度（前屈15°）的情况下，随着侧曲角度的增加（9°-15°-20°），同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带位移增加。同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带的最大位移出现在前屈20°侧曲12°。⑤相同前屈角度（前屈15°）的情况下，随着侧曲角度的增加（9°-15°-20°），同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带应力增加。同平面腰椎-骨盆-股骨上端骨质以及各韧带的最大应力出现在前屈20°侧曲12°。椎间盘的最大应力出现在前屈15°侧曲20°。⑥模拟腰椎定点坐位旋转手法，观察腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带位移的变化趋势，出现自上而下，由右前上方向左后下方递减的趋势。同平面腰椎-骨盆-股骨上端骨质、椎间盘以及各韧带各部位移由右前方向左后方递减的趋势递减。观察腰椎-骨盆-股骨上端骨质以及各韧带位移：对骨质来讲，左髋关节以下基本没有什么位移，但是左髂腰韧带和、右骶棘韧带和右骶结节韧带却出现了明显的位移。⑦模拟腰椎定点坐位旋转手法，观察椎间盘以及各韧带应力的变化趋势，出现自上而下，由左后上方向右前下方递增的趋势。⑧模拟腰椎定点坐位旋转手法，腰椎-骨盆-股骨上端骨质的应力没有出现规律性分布，应力集中在腰椎椎体右前部、椎弓、椎间小关节、骶髂关节以及右股骨颈等处,右侧更明显。⑨纤维环和髓核做为一个整体，和腰椎并不存在同步位移，相邻的椎体和椎间盘的位移相差1-3mm。纤维环和髓核的应力分布并不同步，而且差别比较大。
结论1.所建立的“腰椎-骨盆-股骨上端”三维有限元模型有效，可以用于对“腰椎定点坐位旋转手法”进行有限元生物力学分析。2.在施行“腰椎定点坐位旋转手法”过程中，腰椎侧弯和前屈都是影响腰椎-骨盆-股骨上端骨质（区别骨松质和骨密质）、椎间盘（区分纤维环和髓核）以及各韧带位移和应力分布的因素。相对来说，前屈对骨质的影响较大，侧弯对椎间盘的影响较大。3.“腰椎定点坐位旋转手法”可以调整小关节结构，松解腰椎小关节粘连，缓解小关节结构紊乱以及滑膜嵌顿引起的腰腿疼痛症状。4.在施行“腰椎定点坐位旋转手法”时注意选择手法旋转的方向，以及手法操作的合适力度，以免加重临床症状或出现并发症。
Objective To bulid the three-dimensional finite elementbiomechanical model and Verify the reliability of the model;Usingthe established lumbar vertebra pelvic-proximal femur model，simulation Lumbar fixed-point Sitting-rotatory manipulation,Explore the mechanism of Lumbar fixed-point Sitting-rotatorymanipulation, and evaluate the safety of Lumbar fixed-pointSitting-rotatory manipulation.
Method Using64slice Spiral computed tomography (CT), scanned thevolunteer from the inferior margin of12th thoracic vertebra to thesuperior margin of bilateral proximal femur. obtained879CTpictures about original image of the volunteer,and stored them withDICOM format. Imported those CT pictures which with DICOM formatinto Mimics10.01, masked and edited them. Use the function ofthree-dimensional reconstruction,built the model of lumbarvertebra-pelvic-proximal femur; Imported the model into geomagic12and further modified it (function of reducing noise, relaxating,removing nails, fastly smoothing, sandpaper, filling holes,automatic repairing) in order to make the meshing easily. Confirmed there were not self-intersecting triangles in the model, thenimported the model. Imported the geometric model into hypermesh10modified by geomagic12, divied the model with tetrahedron gridand added the inter-vertebral disc (distinguish the annulusfibrosus and nucleus pulposus) and relevant ligament. refer torelevant literature, set the material properties of each part ofthe model. set the surface of bilateral proximal femur’s bottomas boundary, simulation lumbar oblique-pulling manipulation,Lumbar stretch-pulling manipulation and lumbar Sitting rotatory manipulation. Designed three conditions. condition①: noload, dextrorotation15°; condition②: anteflexion15°,Vertical load300N, dextrorotation15°;condition③: anteflexion15°, tract300N, dextrorotation15°. Refer to the data obtainedby previous biological mechanics experiment and the finite elementanalysis loaded the model,in order to Verify the validity of themodel. According to the principle of the Lumbar fixed-pointSitting-rotatory manipul-ation, divided it and loded the modelwith four congitions by changing the angle of lumbar anteflexionand lateral flexion. Condition④: X-axis anteflexion15°, Y-axis lateral flexion15°, Z-axis dextrorotation15°, load300NVertically on L1vertebra body, load15Nm running torque towardsthe right on L1vertebra body, load15Nm running torque at L4spinous process towards left anterior30°; Condition⑤: X-axisanteflexion15°, Y-axis lateral flexion9°, Z-axisdextrorotation15°, load300N Vertically on L1vertebra body, load15Nm running torque towards the right on L1vertebra body, load15Nm running torque at L4spinous process towards left anterior30°; Condition⑥: X-axis anteflexion20°, Y-axis lateral flexion12°, Z-axis dextrorotation15°, load300N Verticallyon L1vertebra body, load15Nm running torque towards the righton L1vertebra body, load15Nm running torque at L4spinous processtowards left anterior30°; Condition⑦: X-axis anteflexion15°, Y-axis lateral flexion20°, Z-axis dextrorotation15°,load300N Vertically on L1vertebra body, load15Nm running torquetowards the right on L1vertebra body, load15Nm running torqueat L4spinous process towards left anterior30°.Imported therelated data into three-dimensional finite element model andoperated, to obtain the displacement and stress-distribution ineach part of the model effected by Lumbar fixed-point Sitting rotatory manipulation.
Result①Obtained the-dimensionalfinite element model including: bone of lumbar vertebra-pelvic-proximal femur (distinguish between Cancellous bone and Compactbone), lumbar inter-vertebral disc (distinguish between nucleuspulposus and annulus fibrosus), and Anterior longitudinalligament，Posterior longitudinal ligament，Liga-ment flava，Supraspinal ligament，Interspinal ligaments，Sacrospinou ligament,Sacrotuberous ligament, Iliolumbar ligament, Inguinal ligament.with which290771node,1321886tetrahedralsolid element and296spring element.②In the condition of no load, dextrorotation15°, compare the displacement and stress-distribution in the lumbarvertebra-pelvic-proximal femur, lumbar inter-vertebral discand each ligament with tracted and Vertical loaded, The value ofeach index is generally smaller obviously.③In the condition ofdextrorotation15°, tracted and Vertical loaded, the value of thedisplacement and stress-distribution in the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and each ligament decreasing from superior to inferior; the distribution ofstress concentrated upon vertebral pedicle, umbar facet joint,sacroiliac joint and collum femoris, right more obviously.④Inthe condition of anteflexion15°, change with the angle of lateralflexion（9°-15°-20°）, the value of displacement in the same planeof the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and each ligament increasing. The largest valueappear on the condition of anteflexion20°, lateral flexion12°.⑤In the condition of anteflexion15°, change with the angleof lateral flexion（9°-15°-20°）, the value of stress in the sameplane of the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and each ligament increasing. The largest valueof lumbar vertebra-pelvic-proximal femur appear on the conditionof anteflexion20°, lateral flexion12°, The largest value oflumbar inter-vertebral disc appear on the condition of anteflexion15°, lateral flexion20°.⑥In the condition of simulatingLumbar fixed-point Sitting-rotatory manipulation, the trendencyof displacement in the lumbar vertebra-pelvic-proximal femur,lumbar inter-vertebral disc and each ligament descreasing fromsuperior to inferior, and from the right antero-superior to leftpostero-inferior，and descreasing from the right antero-superiorto left postero-inferior in the same plane in the lumbar vertebra-pelvic-proximal femur, lumbar inter-vertebral disc and eachligament follow this law also. For the displacement of vertebra-pelvic-proximal femur, there almost little displacement below theleft articulatio coxa. But there was obvious displacement in leftIliolumbar ligament， right Sacrospinou ligament and rightSacrotuberous ligament.⑦In the condition of simulating Lumbar fixed-point Sitting-rotatory manipulation, the trendency ofstress in the lumbar inter-vertebral disc and each ligamentincreasing from superior to inferior, and from the leftposterosuperior to right anteroinferior.⑧In the condition ofsimulating Lumbar fixed-point Sitting-rotatory manipulation,the trendency of stress in the lumbar vertebra-pelvic-proximalfemur was not occurred any regular distribution. The distributionof stress concentrated upon vertebral pedicle, umbar facet joint,sacroiliac joint and collum femoris, right more obviously.⑨Asa whole，nucleus pulposus and annulus fibrosus have not synchronousdisplacement with adjacentlumbar.there was a relative displacementbetween adjacent lumbar and lumbar inter-vertebral disc,about1-3mm. at the same time, there was not synchronous stress betweennucleus pulposus and annulus fibrosus. What is more, differentsignificantly.
Conclusion1. Built the three-dimensional finite element model oflumbar vertebra-pelvic-proximal femur successfully，it can beused to simulate Lumbar fixed-point Sitting-rotatorymanipulation and make the finite element analysis.2. During theoperation of Lumbar fixed-point Sitting-rotatoryr manipulation,both anteflexion and lateral flexion was the main factor whicheffects the displacement and stress in the lumbar vertebra-pelvic-proximal femur (distinguish between Cancellous bone and Compactbone), lumbar inter-vertebral disc (distinguish between nucleuspulposus and annulus fibrosus), and each ligament. relativelyspeaking， anteflexion put more important influence on thebone(distinguish between Cancellous bone and Compact bone). andlateral flexion put more important influence on the lumbar inter -vertebral disc (distinguish between nucleus pulposus and annulusfibrosus).3. Those can occurre when the lumbar Sitting-rotatorymanipulation was operated, that disordered umbar facet joint wasadjusted, and adhered umbar facet joint was released. the pain inwaist and lower extremities caused by disoredered umbar facet jointand incarcerated synovial membrane was relieved accordingly.4.During the operation of lumbar Sitting-rotatory manipulation, wemust pay attention to the direction and the force ofmanipulation,lest aggravating clinical symptoms or giving rise tocomplications.
引文
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