Finite element analysis of oblique-pulling manipulation in the treatment of lumbar synovial incarceration

doi:10.12307/2023.619

Abstract

Abstract: BACKGROUND: Oblique-pulling manipulation has a reliable curative effect on lumbar synovial incarceration, and it has been widely used in the clinic. However, the related research on the treatment of lumbar synovial incarceration by oblique-pulling manipulation is still relatively lacking.
OBJECTIVE: To analyze the biomechanical mechanism and effect of oblique-pulling manipulation in the treatment of lumbar synovial incarceration by three-dimensional finite element method, and provide theoretical basis for the treatment of lumbar synovial incarceration by oblique-pulling manipulation.
METHODS: The CT data of patients with lumbar synovial incarceration were collected, and the three-dimensional finite element model of L4-5 motor unit of spine was established by using Mimics and Ansys software. The operation process of the oblique-pulling manipulation in the left lateral position was simulated, and the influence of the oblique-pulling manipulation on the biomechanics, morphological changes and facet joint contact area of each tissue structure of L4-5 segment of lumbar spine was analyzed.
RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of lumbar L4-5 segment was established, and the validity of the model was verified. (2) Before and after the oblique-pulling manipulation was applied, the stress of left facet joint cartilage increased from 2.959 MPa to 14.35 MPa; the strain increased from 0.078 34 to 0.345 1, and the contact area of articular cartilage increased from 20.806 2 mm2 to 94.872 7 mm2. On the other hand, the stress of the right facet joint cartilage decreased from 3.127 MPa to 0 MPa; the strain decreased from 0.081 96 to 0, and the articular cartilage contact surface decreased from 16.705 3 mm2 to 0 mm2 on the right. (3) It is concluded that oblique-pulling manipulation has a good effect on patients with lumbar synovial incarceration. It can change the stress and strain of the articular process and the contact area of the upper and lower articular processes, fully release and open the articular process, and achieve the therapeutic purpose of reducing the articular process and relieving the synovial incarceration.

Key words: lumbar facet joint, three-dimensional finite element, synovial incarceration, oblique-pulling manipulation, biomechanics

CLC Number:

Lu Yu, Xiang Junyi, Yin Benjing, Bao Chaoyu, Bi Heng, Li Jizheng, Chen Shuai, He Guangxiong, Li Jubao. Finite element analysis of oblique-pulling manipulation in the treatment of lumbar synovial incarceration[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(27): 4271-4276.

Figures/Tables 9

References

[1] FABER F. Lumbar facet joint disease: Classification, clinical diagnostics, and minimally invasive treatment. Orthopade. 2019;48(1):77-83.
[2] YU X, ZHANG J, WANG MY, et al. Clinical Effects and Safety of the Use of Methylene Blue for the Treatment of Lumbar Facet Joint Syndrome. Pain Physician. 2022;25(1):E15-E26.
[3] JACOBSON RE, PALEA O, GRANVILLE M. Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management. Cureus. 2017;9(9):e1635.
[4] 谢幸财.腰椎小关节紊乱症的发病机理及手法治疗探讨[J].中国中医骨伤科杂志,2006,14(S2):17-20.
[5] SAE-JUNG S, JIRARATTANAPHOCHAI K. Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial. Int Orthop. 2016;40(6):1091-1098.
[6] WU T, ZHAO WH, DONG Y, et al. Effectiveness of Ultrasound-Guided Versus Fluoroscopy or Computed Tomography Scanning Guidance in Lumbar Facet Joint Injections in Adults With Facet Joint Syndrome: A Meta-Analysis of Controlled Trials. Arch Phys Med Rehabil. 2016;97(9):1558-1563.
[7] 王志恒. 旋转复位法治疗急性腰椎后关节滑膜嵌顿症186例[J]. 中国临床康复,2002,6(8):1186.
[8] 王亚楠,赵锦秀,侯海涛,等.消肿止痛胶囊联合腰椎斜扳法治疗急性腰扭伤的临床观察[J].中国中医急症,2022,31(3):456-458.
[9] 祝波,张卓,蒋灼,等.体外冲击波联合手法复位治疗腰椎小关节紊乱疗效观察[J].颈腰痛杂志,2020,41(4):496-497.
[10] 卢钰,郑太才,王琪,等.不同体位下斜扳手法治疗腰椎间盘突出的三维有限元分析[J].中国组织工程研究,2021,25(36):5872-5877.
[11] 王辉昊,王宽,邓真,等.定位与非定位颈椎旋转手法应力作用比较:三维有限元分析[J].医用生物力学,2019,34(S1):55.
[12] ZHONG ZC, WEI SH, WANG JP, et al. Finite element analysis of the lumbar spine with a new cage using a topology optimization method. Med Eng Phys. 2006; 28(1):90-98.
[13] DU HG, LIAO SH, JIANG Z, et al. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint. Saudi Pharm J. 2016;24(3):305-311.
[14] 黄学成,叶林强,梁德, 等.三维有限元模型分析旋转手法中旋转方向对颈椎间盘位移和椎间孔容积的影响[J].中国组织工程研究,2018,22(3):404-408.
[15] LEE SH, IM YJ, KIM KT, et al. Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis. Spine. 2011;36(9):700-708.
[16] MO Z, ZHAO Y, DU C, et al. Does location of rotation center in artificial disc affect cervical biomechanics? Spine. 2015;40(8):E469-E475.
[17] YAMAMOTO I, PANJABI MM, CRISCO T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine. 1989;14(11):1256-1260.
[18] XIAO Z, WANG L, GONG H, et al. Biomechanical evaluation of three surgical scenarios of posterior lumbar interbody fusion by finite element analysis. Biomed Eng Online. 2012;11:31.
[19] 徐海涛, 李松, 刘澜, 等. 腰椎斜扳手法时椎间盘的有限元分析 [J].中国组织工程研究与临床康复,2011,15(13):2335-2338.
[20] PEROLAT R, KASTLER A, NICOT B, et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018;9(5):773-789.
[21] DE ANDRÉS ARES J, GILSANZ F. Diagnostic nerve blocks in the management of low back pain secondary to facet joint syndrome. Rev Esp Anestesiol Reanim (Engl Ed). 2019;66(4):213-221.
[22] KARKUCAK M, BATMAZ I, KERIMOGLU S, et al. Comparison of clinical outcomes of ultrasonography-guided and blind local injections in facet syndrome: A 6-week randomized controlled trial. J Back Musculoskelet Rehabil. 2020;33(3):431-436.
[23] WON HS, YANG M, KIM YD. Facet joint injections for management of low back pain: a clinically focused review. Anesth Pain Med (Seoul). 2020;15(1):8-18.
[24] MOUSSA WM, KHEDR W. Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome. Clin Neurol Neurosurg. 2016; 150:96-104.
[25] Walter SG, Struwe C, Scheidt S, et al. Endoscopic facet joint denervation for treatment of chronic lower back pain. Clin Neurol Neurosurg. 2020;195:105904.
[26] YUAN HJ, WANG CY, WANG YF. Endoscopic joint capsule and articular process excision to treat lumbar facet joint syndrome: A case report. World J Clin Cases. 2021;9(28):8545-8551.
[27] GÜNDOğDU Z, ÖTERKUş M, KARATEPE Ü. Evaluation of the Effect of Radiofrequency Denervation on Quality of Life of Patients with Facet Joint Syndrome by Oswestry Disability Index Score and Visual Analogue Scale Score. Prague Med Rep. 2021;122(4):278-284.
[28] 刘德华. 腕踝针、芒针透刺结合腰部斜扳法治疗腰椎后关节滑膜嵌顿40例[J]. 辽宁中医杂志,2015,42(6):1317-1318.
[29] XIE Y, WANG X, JIAN Q, et al. Three dimensional finite element analysis used to study the influence of the stress and strain of the operative and adjacent segments through different foraminnoplasty technique in the PELD: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore). 2020;99(15):e19670.
[30] CAO S, CHEN Y, ZHANG F, et al. Clinical Efficacy and Safety of “Three-Dimensional Balanced Manipulation” in the Treatment of Cervical Spondylotic Radiculopathy by Finite Element Analysis. Biomed Res Int. 2021;2021:5563296.
[31] DEHGHAN-HAMANI I, ARJMAND N, SHIRAZI-ADL A. Subject-specific loads on the lumbar spine in detailed finite element models scaled geometrically and kinematic-driven by radiography images. Int J Numer Method Biomed Eng. 2019; 35(4):e3182.
[32] FAN W, GUO LX. Biomechanical comparison of the effects of anterior, posterior and transforaminal lumbar interbody fusion on vibration characteristics of the human lumbar spine. Comput Methods Biomech Biomed Engin. 2019;22(5): 490-498.
[33] 李民,周灵,汪桂珍,等.不同腰椎生理曲度下牵引的三维有限元分析[J].中国组织工程研究,2020,24(20):3162-3167.
[34] YIN J, LIU Z, LI C, et al. Effect of facet-joint degeneration on the in vivo motion of the lower lumbar spine. J Orthop Surg Res. 2020;15(1):340.
[35] URITS I, BURSHTEIN A, SHARMA M, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019;23(3):23.
[36] 贺志亮,王德成,张慧. 脊柱定点旋转复位法结合小针刀松解治疗腰椎小关节紊乱症的临床疗效分析[J]. 中国中西医结合外科杂志,2019,25(6):991-997.
[37] 刘慧,沈国权,张喜林,等.肌肉加载下腰椎间盘突出的有限元研究[J].医用生物力学,2019,34(5):493-499.
[38] GALBUSERA F, CINA A, PANICO M, et al. Image-based biomechanical models of the musculoskeletal system. Eur Radiol Exp. 2020;4(1):49.
[39] GRAY RJ, THOM M, RIDDLE M, et al. Image-Based Comparison Between the Bilateral Symmetry of the Distal Radii Through Established Measures. J Hand Surg Am. 2019;44(11):966-972.
[40] MONTEFIORI E, MODENESE L, DI MARCO R, et al. An image-based kinematic model of the tibiotalar and subtalar joints and its application to gait analysis in children with Juvenile Idiopathic Arthritis. J Biomech. 2019;85:27-36.
[41] LANDGRAEBER S, PAULI J. Kinematic examination of the musculoskeletal system: Use of methods of image and image sequence analyses as well as shape and motion models. Orthopade. 2018;47(10):834-841.
[42] ESKANDARI AH, ARJMAND N, SHIRAZI-ADL A, et al. Hypersensitivity of trunk biomechanical model predictions to errors in image-based kinematics when using fully displacement-control techniques. J Biomech. 2019;84:161-171.
[43] ESKANDARI AH, ARJMAND N, SHIRAZI-ADL A, et al. Subject-specific 2D/3D image registration and kinematics-driven musculoskeletal model of the spine. J Biomech. 2017;57:18-26.
[44] BONARETTI S, SEILER C, BOICHON C, et al. Image-based vs. mesh-based statistical appearance models of the human femur: implications for finite element simulations. Med Eng Phys. 2014;36(12):1626-1635.