| 摘要: |
| 目的：通过三维有限元建模和基于脊柱4D姿态及运动分析系统的4D动态运动学分析，探讨后伸扳法对骶髂关节错位（后错位型）合并腰椎间盘突出症患者中的力学调整作用，分析其与骶髂关节错位（后错位型）患者的差异，揭示腰骶关节力学联动的核心机制。方法：研究包含两个部分。第一部分为有限元分析，招募骶髂关节错位（后错位型）与骶髂关节错位（后错位型）合并腰椎间盘突出症的患者各1 例，通过MRI扫描获取腰骶区域影像数据，构建三维有限元模型。模拟后伸扳法加载力，分析L4/L5应力分布及骶髂关节位移变化。第二部分为临床研究，招募40例骶髂关节错位（后错位型）患者，使用脊柱4D姿态及运动分析系统的4D动态运动学分析系统评估骶髂关节错位（后错位型）患者治疗前后骨盆倾斜距离、骨盆扭转角度及骨盆水平旋转角度的变化。〖JP2〗结果：有限元分析显示，骶髂关节错位（后错位型）合并腰椎间盘突出症患者的L4/L5应力显著高于骶髂关节错位（后错位型）患者，提示腰椎间盘突出对腰骶区域力学负荷的加剧作用。4D动态运动学分析显示，治疗后骶髂关节错位（后错位型）患者骨盆倾斜距离、骨盆扭转角度及骨盆水平旋转角度均有显著改善，且差异有统计学意义（P＜0.05）。结论：本研究通过有限元分析和脊柱4D动态运动学分析，揭示了后伸扳法通过腰骶关节力学联动改善力学异常的核心机制。研究进一步验证了手法治疗的生物力学效果，并提出基于腰骶关节力学联动的个性化治疗方案，为优化临床治疗策略提供了新方向。 |
| 关键词: 骶髂关节错位（后错位型） 腰椎间盘突出症 后伸扳法 腰骶关节力学联动 三维有限元分析 4D动态运动学分析 |
| DOI： |
|
|
| Biomechanical mechanisms of lumbosacral joint：An analysis based on three-dimensional finite element modeling and posterior extension manipulation |
| WENG Cai,WENG Punan,LIN Binqiang |
| (The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine，Fuzhou 350003，Fujian，China;Fujian University of Traditional Chinese Medicine，Fuzhou 350122，Fujian，China) |
| Abstract: |
| Objective：Objective: To explore the biomechanical adjustment effect of posterior extension manipulation on patients with sacroiliac joint misalignment (posterior type) combined with lumbar disc herniation through three-dimensional finite element modeling and four-dimensional dynamic kinematic analysis based on the spine posture and motion analysis system，analyze the differences between them and patients with simple sacroiliac joint misalignment (posterior type)，and reveal the core mechanism of the mechanical linkage of the lumbosacral joint. Methods: This study was divided into two parts. The first part was finite element analysis. One patient with sacroiliac joint misalignment (posterior type) combined with lumbar disc herniation and one patient with simple sacroiliac joint misalignment (posterior type) were recruited. MRI scans were performed to obtain lumbar imaging data and construct a three-dimensional finite element model. The posterior extension manipulation load was simulated to analyze the stress distribution of L4/L5 and the displacement of the sacroiliac joint. The second part was a clinical study，enrolling 40 patients with sacroiliac joint misalignment (posterior type). Four-dimensional dynamic kinematic analysis based on the spine posture and motion analysis system was used to evaluate the changes in pelvic tilt distance，pelvic rotation angle，and pelvic horizontal rotation angle before and after treatment. Results: Finite element analysis showed that the L4/L5 stress of patients with sacroiliac joint misalignment (posterior type) combined with lumbar disc herniation was significantly higher than that of patients with simple sacroiliac joint misalignment (posterior type)，suggesting that lumbar disc herniation increased the mechanical load on the lumbosacral region. Four-dimensional kinematic analysis showed that after treatment，the pelvic tilt distance，pelvic rotation angle，and pelvic horizontal rotation angle of patients with sacroiliac joint misalignment (posterior type) were significantly improved (P<0.05). Conclusion: Through finite element analysis and four-dimensional dynamic analysis，this study reveals the core mechanism of posterior extension manipulation improving biomechanical abnormalities through the mechanical linkage of the lumbosacral joint. This study further verifies the biomechanical effect of manipulation therapy and proposes an individualized treatment plan based on the mechanical linkage of the lumbosacral joint，providing a new direction for optimizing clinical treatment strategies. |
| Key words: sacroiliac joint misalignment (posterior type) lumbar disc herniation posterior extension manipulation mechanical linkage of lumbosacral joint three-dimensional finite element analysis four-dimensional dynamic kinematic analysis |
