基于中医整体观念结合局部有限元分析探讨屈髋屈膝手法治疗骶髂关节错位作用机制

To Discuss the Mechanism of Hip Flexion and Knee Manipulation in the Treatment of Sacroiliac Joint Dislocation Based on the Holistic Concept of Traditional Chinese Med-icine and Local Finite Element Analysis

摘要: 目的：探讨屈髋屈膝手法治疗骶髂关节错位的作用机制，为临床治疗提供理论依据。方法：包含中医整体观念(整体研究)和局部有限元分析(局部研究)研究。整体研究在中医整体观指导下，结合现代科学技术DIERS-4D脊柱云纹系统对受试者脊柱形态、骨盆位置及步态进行采集分析；局部研究基于磁共振图像的三维有限元技术分析屈髋屈膝手法对骶髂关节错位病变局部骨关节及周围韧带的应力应变影响。结果：第一部分整体研究发现屈髋屈膝手法治疗前后对于病变局部“骨盆扭转角及骨盆旋转角改变无明显差异(P > 0.05)”，但是治疗后患者胸椎后凸角、腰椎前凸角、骨盆倾斜距离均较前减小，差异有统计学意义(P < 0.05)，治疗后步频减小，跨步时间延长，左单支撑相较前增加，右步幅较前增大，步态不对称系数较前减小，差异有统计学意义(P < 0.05)；第二部分局部研究发现屈髋屈膝手法复位手法可导致骶髂关节发生位移，但位移量均较小。此外，屈髋屈膝复位手法可以导致周围韧带发生不同程度的应变。结论：屈髋屈膝手法可能通过改变骶髂关节周围韧带应力及“脊柱–骨盆–下肢”整体生物力学平衡达到治疗骶髂关节错位的作用。

Abstract: Objective: To investigate the mechanism of hip flexion and knee manipulation in the treatment of sacroiliac joint dislocation, and to provide theoretical basis for clinical treatment. Methods: The study included the holistic concept of TRADITIONAL Chinese medicine (holistic study) and local fi-nite element analysis (local study). Under the guidance of holistic concept of Traditional Chinese medicine, the spinal morphology, pelvic position and gait of subjects were collected and analyzed in combination with modern science and technology DIERS-4D spinal moire system. Local study based on three-dimensional finite element technique of magnetic resonance image was to analyze the ef-fect of hip flexion and knee manipulation on the stress and strain of local bone joint and surround-ing ligaments in sacroiliac joint dislocation lesions. Results: The first part of the overall study found before and after hip flexion knee treatment for local lesion, “torsional Angle of the pelvis and pelvic rotation Angle change has no obvious difference (P > 0.05)”, but after the treatment of patients, thoracic convex Angle, lumbar lordosis Angle, pelvic tilt distance decreased from all the previous, and the difference was statistically significant (P < 0.05), after treatment stride length decreases and stride time is longer. The left single strut increased, the right stride increased, and the gait asymmetry coefficient decreased, with statistical significance (P < 0.05). The second part of the local study found that the reduction of hip flexion and knee manipulation could lead to the displacement of the sacroiliac joint, but the displacement was small. In addition, hip flexion and knee reduction can cause varying degrees of strain in the surrounding ligaments. Conclusion: Hip flexion and knee manipulation may play a role in the treatment of sacroiliac joint dislocation by changing the stress of ligaments around the sacroiliac joint and the overall biomechanical balance of spine, pelvis and lower limbs.