1.上海理工大学 医疗器械与食品学院;2.上海大学期刊社;3.上海健康医学院 医疗器械学院;4.上海中医药大学 附属岳阳中西医结合医院
目的 综合考虑推拿的有效性和安全性提出一种评价振荡激励和脉冲激励腰椎推拿斜扳法优劣的方法,并对振荡激励腰椎推拿斜扳法进行优化。方法 建立多刚体胸-腰椎生物力学模型,手法作用力作为模型的输入力,运用MATLAB /Simulink进行仿真,模拟得到腰椎各节段的位移和加速度随时间变化的情况,对腰椎推拿手法行优化时,改变推拿作用力的核心要素频率和操作次数,比较腰椎各节段的最大相对位移和最大加速度,并提出一种新的指标z对推拿手法的有效性和安全性进行综合评价。结果 两种激励腰椎推拿斜扳法作用时,腰椎各节段的最大相对位移几乎相等；振荡激励腰椎推拿斜扳法作用时,腰椎各节段的最大加速度均明显小于脉冲激励腰椎推拿斜扳法作用时的最大加速度；进一步对不同频率,不同操作次数条件下的振荡激励腰椎推拿斜扳法进行仿真,得到以下结果：当频率为1-2.5 Hz时,各操作数下的指标z均较小；当频率为3.33 Hz,操作数大于等于5时,腰椎各节段的最大相对位移和最大加速度最大(腰椎L1-L5节段的最大相对位移分别为：1.40 mm,0.38 mm,0.45 mm,0.45 mm,0.3 mm；腰椎各节段最大加速度分别为：1.35 m.s-2,0.71 m.s-2,0.54 m.s-2,0.54 m.s-2,0.14 m.s-2)；当频率大于等于5Hz时,各操作数下的指标z均较大。结论 振荡激励腰椎推拿斜扳法比脉冲激励腰椎推拿斜扳法更安全；当推拿频率为1-2.5 Hz时,推拿整体效果比较好,且整体效果与操作数无关,推拿作用力持续一个操作数即可；当频率为3.33 HZ,操作数≥5时,推拿治疗效果最好,但此时腰椎各节段承受的力也相对较大；推拿频率不宜≥5 Hz,此时推拿整体表现不佳。
Objective Comprehensively considering the effectiveness and safety of massage, a method for evaluating the pros and cons of the oscillation excitation and pulse excitation of the lumbar oblique-pulling manipulation is proposed, and the oscillation excitation of the lumbar oblique-pulling manipulation is optimized. Methods A multi rigid body biomechanical model of thoracolumbar spine was established. The manipulation force was used as the input force of the model. Using MATLAB/Simulink to simulate the changes in the displacement and acceleration of each segment of the lumbar spine over time. When the lumbar massage manipulation was optimized, the frequency and operand the core elements of massage force were changed, and then the maximum relative displacement and maximum acceleration of each lumbar segment were compared. A new index Z was proposed to comprehensively evaluate the effectiveness and safety of the manipulation, and we proposed a new index z to comprehensively evaluate the effectiveness and safety of the massage technique. Results The maximum relative displacement of each segment of the lumbar spine was almost equal when the two lumbar oblique-pulling manipulation of two excitation were applied. The maximum acceleration of each segment of lumbar vertebra was significantly smaller than that of pulse excitation lumbar oblique-pulling manipulation when the oscillation excitation lumbar oblique-pulling manipulation worked. Furthermore, we simulated the oscillation excitation of lumbar oblique-pulling manipulation under different frequencies and operand, and the following results are obtained: When the frequency is 1-2.5 Hz, the index z under each operand is small; when the frequency is 3.33 Hz and the operand is greater than or equal to 5, the maximum relative displacement and maximum acceleration of each segment of the lumbar spine is the largest (the maximum relative displacements of the lumbar L1-L5 segments are: 1.40 mm, 0.38 mm, 0.45 mm, 0.45 mm, 0.3 mm; the maximum accelerations of the lumbar L1-L5 segments are: 1.35 m.s-2, 0.71 m.s-2, 0.54 m.s-2, 0.54 m.s-2, 0.14 m.s-2); when the frequency is greater than or equal to 5Hz, the index z under each operand is larger. Conclusions Oscillation excitation lumbar oblique-pulling manipulation is safer than pulse excitation lumbar oblique-pulling manipulation. When the frequency of massage was 1-2.5 Hz, the overall effect of massage was better, and the overall effect had nothing to do with the operands, and the force of massage lasts for one operand; when the frequency is 3.33 Hz and the operands were ≥ 5 the effectiveness of massage had the best effect, but at this time, the strength of each segment of the lumbar spine was relatively large; the frequency of massage should not be ≥5 Hz, and the overall performance of massage was not good.