不同體位下頸椎牽引之生物力學分析

Biomechanical Analysis of Cervical Traction in Different Position

黃文奇(Wen-chi Huang)

指導教授 ： 陳文斌

中原大學/工學院/生物醫學工程學系/碩士(2008年)

https://doi.org/10.6840/cycu200900412

摘要

頸椎病指因頸椎椎間盤退變本身及其繼發性改變,刺激或壓迫臨近組織而引起的一系列症狀和体徵。治療方面，手術有嚴格的適應症，不做首選。更多的是選擇非手術療法，如針灸、理療、按摩、牽引等。 頸椎牽引可以改善頸椎曲度，增寬椎間隙(intervertebral space)，擴大椎間孔(foramen)，減少椎間盤壓力，解除嵌壓，使神經根所受刺激和壓迫得到緩和，使扭曲的椎動脈得到伸張 。
頸椎牽引可分坐位牽引及臥位牽引兩種。但二種牽引方式條件顯然不同: 坐式牽引須先克服頭部本身重力，而臥式牽引除了重力之外，尚須考慮頭部和牀之間的摩擦力。目前罕見文獻討論坐式及臥式頸椎牽引之差異，因此本研究經由利用人體之頸椎電腦斷層（CT）影像，透過影像重建軟體圈選頸椎輪廓，建立元素網格，完成有限元素模型，最後經由有限元素分析軟體MARC（MSC software corporation, Los Angeles, USA），在50、100、150牛頓三種牽引力量以及0°、15°、30°三種不同角度下分析已完成的有限元素實體模型。得知頸椎牽引後間距的變化以及應力分佈情形，以比較坐式及臥式頸椎牽引在不同的牽引力量及角度下之生物力學。
結果顯示牽引的力量與角度愈大，所產生的拉伸距離(椎體間距)也愈大，但在0°牽引時，牽引後的椎體間距反而減小，可見頸椎牽引最好有一個角度。另外，在相同的牽引力量與牽引角度下，坐式牽引產生的拉伸距離稍大於臥式牽引。因此，如欲達到相同的拉伸距離，臥式牽引是需要較大的牽引力量的。

關鍵字

有限元素分析 ； 頸椎病 ； 生物力學 ； 頸椎牽引

並列摘要

Disorders of the neck(cervical disease) are a common source of pain. The neck has a great deal of functionality but is also subject to a lot of stress. Common sources of neck pain (and related pain syndromes, such as pain that radiates down the arm) include: strained muscle or other soft tissue injury, cervical herniated disc with radiculopathy, degenerative disease such as OA ,and vascular disorders etc.
Treatment for neck pain generally starts with a conservative approach. Neck surgery is usually considered after conservative treatment methods such as physical therapy, home exercise programs, injections, and other methods have failed after six months or longer of treatment.
Cervical traction is a common physical therapy to treat cervical radiculopathy and degenerative disc disease. It is believed that it can reduce disk herniations, decompress the nerve root, or stretch ligaments and dural sheaths, thus reducing symptomatology.
There are two commonly used positions for cervical traction: sit and supine. But there is few literature investigated the differences between these two positions. The objective of this study was to use a computational finite element method to generate the cervical spine model(c3-c7)from the digitized human neck CT scan images and applied traction forces of 50,100,150 NT and traction angles of 0°,15°,30° to analyze the traction length in sit and supine position.
The results showed that larger traction length resulted from larger traction force and 0° traction angle had a negative effect for the intervertebral space. It revealed that cervical traction needs a suitable “traction angle”. Besides, the traction length of sit position load cases are larger than the supine position load cases for the same traction force and angle. It indicated that for supine position traction, it needs larger traction force to attain the same traction length.

並列關鍵字

Finite element analysis ； Cervical disease ； Biomechanics ； Cervical traction

參考文獻

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