中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (21): 5396-5402.doi: 10.12307/2026.605

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

斜扳手法治疗C5/6节段不同退变程度椎间盘的生物力学评价

黄学成1，蔡其锐2，翁  汭3，陈采睿4，杨  耿4，林东鑫4   

  1. 1广州中医药大学深圳医院(福田)，广东省深圳市  518000；2深圳市中医院，广东省深圳市  518000；南方医科大学，3中医药学院，4基础医学院人体解剖学教研室，广东省广州市  510515
  • 接受日期:2025-03-08 出版日期:2026-07-28 发布日期:2026-03-03
  • 通讯作者: 林东鑫，博士，医师，南方医科大学基础医学院人体解剖学教研室，广东省广州市 510515
  • 作者简介:黄学成，男，1988年生，广东省台山市人，汉族，博士，主治医师，硕士生导师，主要从事脊柱伤病的基础与临床康复方面的研究。
  • 基金资助:
    国家自然科学基金青年项目(82205301)，课题名称：基于椎间孔容积及椎间盘力学特性变化探讨颈椎旋转手法侧屈体位的生物力学机制，项目负责人：黄学成；深圳市自然科学基金面上项目(JCYJ20240813160702004)，课题名称：颈椎关节突关节三维角度不对称与颈椎间盘突出的相关性研究，项目负责人：黄学成；广州中医药大学校院联合科技创新基金项目(GZYFT2024G09)，课题名称：颈椎关节突关节三维角度不对称介导颈椎间盘突出的生物力学机制，项目负责人：黄学成

Biomechanical evaluation of oblique pulling manipulation on C5/6 intervertebral discs with different levels of degeneration

Huang Xuecheng1, Cai Qirui2, Weng Rui3, Chen Cairui4, Yang Geng4, Lin Dongxin4   

  1. 1Shenzhen Hospital (Futian), Guangzhou University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China; 2Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518000, Guangdong Province, China; 3School of Traditional Chinese Medicine, 4Department of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • Accepted:2025-03-08 Online:2026-07-28 Published:2026-03-03
  • Contact: Lin Dongxin, MD, Physician, Department of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • About author:Huang Xuecheng, MD, Attending physician, Master’s supervisor, Shenzhen Hospital (Futian), Guangzhou University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China
  • Supported by:
    National Natural Science Foundation of China (Youth Project), No. 82205301 (to HXC); Shenzhen Natural Science Foundation (General Project), No. JCYJ20240813160702004 (to HXC); Joint Science and Technology Innovation Fund Project of Guangzhou University of Chinese Medicine, No. GZYFT2024G09 (to HXC)

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摘要：


文题释义：

有限元分析：是一种强大的计算机模拟技术，它可以构建颈椎的详细三维模型并模拟施加手法前后的生物力学变化。通过有限元分析，研究者能够在微观层面上分析斜扳手法如何影响颈椎的力学环境，包括压力分布、应力和应变的变化等，尤其对于不同退变程度的椎间盘，有限元分析可以揭示斜扳手法对这些不同条件下颈椎的具体生物力学作用机制。
颈椎斜扳手法：法是一种结合旋转与牵拉力的中医推拿技术，临床操作时通过向患侧斜上方(如右后45°方向)施加精准角度(通常5°-7°)的瞬时动力性载荷，旨在动态调整颈椎三关节复合体(椎间盘、双侧关节突关节)的力学失衡。斜扳手法的作用机制表现为：旋转力矩可调控椎间盘-神经根的相对位移，实现机械性减压，同时将应力从损伤的小关节转移至退变椎间盘的纤维环区域，促进代偿性力学再平衡。

摘要
背景：颈椎斜扳手法治疗颈椎病具有良好的效果，但该治疗手法对不同退变程度椎间盘的生物力学作用机制尚不明确。
目的：通过三维有限元模型探讨斜扳手法对不同退变程度椎间盘的生物力学作用机制。
方法：通过运动捕捉系统测量斜扳手法操作时关键步骤的运动学参数。建立C5/6 节段轻、中、重度退变椎间盘的全颈椎三维有限元模型，将斜扳手法的运动学参数转换成力矩分步加载至轻、中、重度退变椎间盘全颈椎三维有限元模型上，获得模拟斜扳手法操作时模型中各结构的应力应变等生物力学参数。
结果与结论：①在模拟斜扳手法向右侧扳动时，随着椎间盘退变程度的增加，纤维环Von-Mise应力逐渐变大，应力均集中在纤维环右外侧；髓核Von-Mise应力减小，应力集中于髓核和纤维环交界位置；椎间盘整体位移减小，左侧小关节应力减小，脊髓Von-Mise应力增大，脊髓应力集中于上颈椎。②在模拟斜扳手法向右侧扳动时，随着椎间盘退变程度的增加，C5/6节段椎间盘整体应变、髓核内压、左侧神经根应力减小，椎间盘剪切力增大，左侧神经根与椎间盘的相对距离加大，右侧神经根与椎间盘的相对距离变化不明显。③结果表明，颈椎斜扳手法通过调整小关节应力及增大神经根间距改善轻、中度退变椎间盘的生物力学失衡，但对于重度退变椎间盘可能因纤维环应力剧增与脊髓受压风险需谨慎使用。



中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


关键词: 斜扳手法, 神经根型颈椎病, 椎间盘退变程度, 有限元分析, 运动捕捉, 生物力学

Abstract: BACKGROUND: The oblique pulling manipulation has good therapeutic effects on cervical spondylosis, but its biomechanical mechanism of action on intervertebral discs with different degrees of degeneration is not clear.
OBJECTIVE: To explore the biomechanical mechanism of the oblique pulling manipulation on the discs with different degrees of degeneration through three-dimensional finite element model.
METHODS: The motion capture system was used to measure the kinematic parameters of the key steps during the oblique pulling manipulation, and a three-dimensional finite element model of the whole cervical spine of the C5/6 mildly, moderately, and severely degenerated intervertebral discs was established. The kinematic parameters were converted into moments and loaded onto the whole cervical spine of the mildly, moderately, and severely degenerated intervertebral discs in a step-by-step manner, so as to obtain the biomechanical parameters of the stress-strain of each structure during the simulated oblique pulling manipulation. 
RESULTS AND CONCLUSION: (1) In the simulation of the oblique pulling manipulation to the right side, with the increase of disc degeneration, the Von-Mise stress of the annulus fibrosus gradually increased, and the stress was concentrated on the right outer side of the annulus fibrosus. The stress of the nucleus pulposus decreased and the stress was concentrated at the junction of the nucleus pulposus and the annulus fibrosus. The overall displacement of the intervertebral disc decreased; the stress of the left facet joints decreased; the Von-Mise stress of the spinal cord increased, and the stress of the spinal cord was concentrated in the upper cervical spine. (2) In the simulation of the oblique pulling manipulation to the right side, with the increase of disc degeneration, the overall strain of the C5/6 segment disc, the pressure inside the nucleus pulposus, and the stress of the left nerve root decreased; the disc shear force increased; the relative distance between the left nerve root and the disc increased, and the relative distance between the right nerve root and the disc did not change significantly. (3) These results indicate that the cervical oblique-pulling manipulation improves biomechanical imbalances in mild-to-moderately degenerated intervertebral discs by modulating facet joint stress and increasing the distance between nerve roots and intervertebral discs. However, its application in severely degenerated discs requires caution due to a sharp rise in annulus fibrosus stress and potential spinal cord compression risks.

Key words: oblique pulling manipulation, radiculopathy, intervertebral disc degeneration degree, finite element analysis, motion capture, biomechanics

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