美式整脊在社区治疗神经根型颈椎病中的应用效果研究
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摘要
背景我国颈椎病的患病率逐渐增加,逐渐成为中老年人的常见病,其中神经根型颈椎病患病率较高,治疗方式有药物治疗、颌带牵引、制动等,但是在治疗效果方面疗效不一,且治疗周期一般较长。目的探讨美式整脊在社区治疗神经根型颈椎病的效果。方法收集2017年1月—2018年4月于首都医科大学附属复兴医院月坛社区卫生服务中心康复科进行治疗的神经根型颈椎病的患者40例,按患者意愿分为两组,手法矫正组进行手法矫正治疗6次,牵引组进行电动牵引治疗6次,每次10 min,牵引重量为患者体质量的7%～10%。观察治疗前后患者X线中生理曲度、椎体角度位移、椎间孔面积变化的情况,并采用视觉模拟评分量表(VAS)评价治疗前后的治疗效果。结果两组患者性别、年龄、病程、VAS评分比较,差异无统计学意义(P>0.05)。两组治疗前后颈椎生理曲度、颈椎角度位移比较,差异无统计学意义(P<0.05)。治疗前两组椎间孔面积、VAS评分比较,差异无统计学意义(P>0.05);治疗后手法矫正组椎间孔面积、VAS评分高于牵引组,差异有统计学意义(P<0.05)。手法矫正组治疗后椎间孔面积、VAS评分高于治疗前,差异有统计学意义(P<0.05)。牵引组治疗后VAS评分高于治疗前,差异有统计学意义(P<0.05)。相关性分析结果显示,椎间孔改变与VAS评分变化呈线性正相关(r=0.564,P=0.023)。结论手法矫正治疗在改善患者椎间孔面积,改善患者症状方面有效果;牵引治疗在改善患者症状方面有效果;手法矫正在改善椎间孔面积方面,改善患者症状方面优于牵引治疗;改善椎间孔面积与改善患者症状方面呈正相关。
Background The incidence of cervical spondylosis in China is gradually increasing,and it has become a common disease in middle-aged and elderly people.In particular,the incidence of cervical spondylotic radiculopathy(CSR) is higher.Although there are many treatments,such as pharmacologic treatment,jaw traction and braking and so on,the therapeutic effects are different,and the treatment cycles are long in general.Objective To explore the effect of chiropractic therapy in community-based treatment of CSR.Methods 40 patients with CSR who were treated in Department of Rehabilitation,Yuetan Community Health Center,Fuxing Hospital,Capital Medical University from January 2017 to April2018 were recruited and divided into massage group and traction group according to the patient's self-reported preferred therapy.The former group received manual correction treatment for 6 times,while the latter received 6 times of 10-minute electric traction treatment,with an amount of traction of 7% to 10% of the body weight.The physiological curvature,angular displacement of the vertebral body and the area of the intervertebral foramen were observed before and after treatment by X-ray examinations.Therapeutic effects were evaluated by the Visual Analogue Score(VAS).Results There were no significant differences in gender ratio,average age,and distribution of course of CSR between the two groups(P>0.05).The cervical physiological curvature and angular displacement of the vertebral body showed no significant differences either before or after treatment between the groups(P<0.05).Although the average intervertebral foramen area and average VAS score were similar in both groups at baseline(P>0.05),the former was much larger and the latter was much higher in the massage group compared with traction group after treatment(P<0.05).After treatment,both the average intervertebral foramen area and VAS score increased significantly in the massage group,but only average VAS score increased significantly in the traction group(P<0.05).The results of correlation analysis showed that the change of intervertebral foramen was positively correlated with the change of the VAS score(r=0.564,P=0.023).Conclusion Massage correction therapy can effectively improve the intervertebral foramen area and symptoms of CSR patients,but traction therapy can only alleviate the symptoms,indicating that the former is superior to the latter in improving the aforementioned two aspects.Moreover,there is a positive correlation between the improvement of intervertebral foramen area and the alleviation of symptoms in CSR patients.
Background The incidence of cervical spondylosis in China is gradually increasing,and it has become a common disease in middle-aged and elderly people.In particular,the incidence of cervical spondylotic radiculopathy(CSR) is higher.Although there are many treatments,such as pharmacologic treatment,jaw traction and braking and so on,the therapeutic effects are different,and the treatment cycles are long in general.Objective To explore the effect of chiropractic therapy in community-based treatment of CSR.Methods 40 patients with CSR who were treated in Department of Rehabilitation,Yuetan Community Health Center,Fuxing Hospital,Capital Medical University from January 2017 to April2018 were recruited and divided into massage group and traction group according to the patient's self-reported preferred therapy.The former group received manual correction treatment for 6 times,while the latter received 6 times of 10-minute electric traction treatment,with an amount of traction of 7% to 10% of the body weight.The physiological curvature,angular displacement of the vertebral body and the area of the intervertebral foramen were observed before and after treatment by X-ray examinations.Therapeutic effects were evaluated by the Visual Analogue Score(VAS).Results There were no significant differences in gender ratio,average age,and distribution of course of CSR between the two groups(P>0.05).The cervical physiological curvature and angular displacement of the vertebral body showed no significant differences either before or after treatment between the groups(P<0.05).Although the average intervertebral foramen area and average VAS score were similar in both groups at baseline(P>0.05),the former was much larger and the latter was much higher in the massage group compared with traction group after treatment(P<0.05).After treatment,both the average intervertebral foramen area and VAS score increased significantly in the massage group,but only average VAS score increased significantly in the traction group(P<0.05).The results of correlation analysis showed that the change of intervertebral foramen was positively correlated with the change of the VAS score(r=0.564,P=0.023).Conclusion Massage correction therapy can effectively improve the intervertebral foramen area and symptoms of CSR patients,but traction therapy can only alleviate the symptoms,indicating that the former is superior to the latter in improving the aforementioned two aspects.Moreover,there is a positive correlation between the improvement of intervertebral foramen area and the alleviation of symptoms in CSR patients.
引文
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[3]张明才,程英武,詹洪生,等.神经根型颈椎病椎间孔狭窄因素的影像学分析[J].北京中医药大学学报,2009,32(3):199-203.DOI:10.3321/j.issn:1006-2157.2009.03.015.ZHANG M C,CHENG Y W,ZHAN H S,et al.Imaging analysis on factors of intervertebral foramen stenosis of nerve root cervical spondylosis[J].Journal of Beijing University of Traditional Chinese Medicine,2009,32(3):199-203.DOI:10.3321/j.issn:1006-2157.2009.03.015.
[4]王亦璁.骨与关节损伤[M].2版.北京:人民卫生出版社,1996:57.
[5]王德利,李曙明,杨敏杰,等.神经根型颈椎病的解剖学基础及其进展[J].颈腰痛杂志,2001,22(4):332-334.DOI:10.3969/j.issn.1005-7234.2001.04.042.WANG D L,LI S M,YANG M J,et al.Anatomical basis and progress of cervical spondylotic radiculopathy[J].The Journal of Cervicodynia and Lumbodynia,2001,22(4):332-334.DOI:10.3969/j.issn.1005-7234.2001.04.042.
[6]李英平,郭瑞芳.神经根型颈椎病解剖因素探讨[J].解剖学进展,2003,9(2):141-143.DOI:10.3969/j.issn.1006-2947.2003.02.013.LI Y P,GUO R F.Anatomical factors of cervical spondylotic radiculopathy[J].Progress of Anatomical Sciences,2003,9(2):141-143.DOI:10.3969/j.issn.1006-2947.2003.02.013.
[7]郭凯,李林,詹红生,等.手法治疗神经根型颈椎病的临床随机对照试验的系统评价[J].环球中医药,2012,5(1):3-7.DOI:10.3969/j.issn.1674-1749.2012.01.001.GUO K,LI L,ZHAN H S,et al.Manipulation treatment on nerve-root-type cervical spondylosis systematic review of clinical randomized controlled trials[J].Global Traditional Chinese Medicine,2012,5(1):3-7.DOI:10.3969/j.issn.1674-1749.2012.01.001.
[8]王艳国,郭秀琴,张琪,等.手法治疗神经根型颈椎病的系统评价[J].中华中医药杂志,2013,2(28):499-503.WANG Y G,GUO X Q,ZHANG Q,et al.Systematic evaluation of manipulation for cervical spondylotic radiculopathy[J].China Journal of Traditional Chinese Medicine and Pharmacy,2013,2(28):499-503.
[9]WALKERBF,HEBERTJJ,STOMSKINJ.Short-term usual chiropractic care for spinal pain:a randomized controllde trial[J].Spine,2013,38(24):2071-2078.DOI:10.1097/01.brs.0000435032.73187.c7.
[10]NEIL M,PAIGE M D.Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain:systematic review and meta-analysis[J].JAMA,2017,317(14):1451-1460.DOI:10.1001/jama.2017.3086.
[11]ANITA G,PIERRE L.Manipulation and mobilisation for neck pain contrasted against an inactive control or another active trea treatment[J].John Wiley&Sons,2015,9(9):cd004249.
[12]YANG F,LI W X.Balance chiropractic therapy for cervical spondulotic radiculopathy:study protocol for a randomized controlled trial[J].Trials,2016,17(1):513.
[13]SUH S I,KOH S B,CHOI E J.Intacranial hypotension induced by cervical chiropractic manipulaition[J].Spine,2005,30(12):e340-342.DOI:10.1097/01.brs.0000166511.59868.b7.
[14]SOLHEIM O,JORGENSON J V.Lumbar epidural hematoma after chiropractic manipulation for lower-back pain:case report[J].Neurosurgery,2007,61(1):e376.DOI:10.1227/01.NEU.0000333963.32597.49.
[15]THIEF H W,BOLTON J E.Safety of chiropractic manipulation of the cervical spine:a prospective national survey[J].Spine,2010,11(s1):47.
[16]JOEL G,PICKAR D C.Neurophysiological effects of spinal manipulation[J]The Spine Journal,2002,2(5):357-371.DOI:10.1016/S1529-9430(02)00400-X.
[17]SONGXJ,GANQ.Spinalmanipulationreducespainand hyperalgesia after lumbar intervertebral foramen inflammation in the rat[J].J Manipulative Physiol Ther,2006,29(1):5-13.DOI:10.1016/j.jmpt.2005.10.001.
[18]吴昌林,易丙奎,何阶清.神经根型颈椎病手术治疗临床分析[J].中国医药指南,2016,6(17):173-174.WU C L,YI B K,HE J Q.Clinical analysis of surgical treatment of cervical spondylotic radiculopathy[J].Guide of China Medicine,2016,6(17):173-174.
[19]喻忠,龚建平,钱铭辉,等.神经根型颈椎病三维CT诊断的临床相关性研究[J].颈腰痛杂志,2003,24(1):7-10.DOI:10.3969/j.issn.1005-7234.2003.01.003.YU Z,GONG J P,QIAN M H,et al.Clinical correlation ofthree-dimensionalCTdiagnosisofcervicalspondylotic radiculopathy[J].TheJournalofCervicodyniaand Lumbodynia,2003,24(1):7-10.DOI:10.3969/j.issn.1005-7234.2003.01.003.
[20]李曙明,尹站海.神经根型颈椎病的影像学特点和分型[J].中国矫形外科杂志,2013,1(21):7-11.DOI:10.3977/j.issn.1005-8478.2013.01.02.LI S M,YIN Z H.Imaging characteristics and classification of cervical spondylotic radiculopathy[J].Orthopedic Journal of China,2013,1(21):7-11.DOI:10.3977/j.issn.1005-8478.2013.01.02.
[21]NADINE G,ANITA G,CHARLES H G.Mechanical traction for neck pain with or without radiculopathy[J].Cochrane Database of Systematic Reviews,2008,3(3):CD006408
[22]CRUE B L.Importance of flextion in cervical halter traction for radiculitis[J].United States Armed Forces Medical Journal,1957,8:374-378.
[23]吴连霞,赵媛,吴开亚,等.中国人口老龄化区域差异及驱动机制研究[J].地理科学,2018,38(6):877-844.DOI:10.13249/j.cnki.sgs.2018.06.006.WU L X,ZHAO Y,WU K Y,et al.Regional variations and driving mechamism of aging population in China[J].Scientia GeographicaSinica,2018,38(6):877-844.DOI:10.13249/j.cnki.sgs.2018.06.006.
[24]张可可,朱鸣雷.北京部分社区老年人共病及老年综合征调查[J].中国实用内科杂志,2016,5(36):419-420.ZHANG K K,ZHU M L.Investigation of comorbidity and geriatric syndrome among the elderly in some communities of Beijing[J].Chinese Journal of Practical Internal Medicine,2016,5(36):419-420.
[25]安徽省颈椎病分级诊疗指南[J].安徽医学,2017,38(9):1-8.Guidelines for grading diagnosis and treatment of cervical spondylosis in Anhui Province[J].Anhui Medical Journal,2017,38(9):1-8.
[26]齐明珠,董玉珍.北京市区县间医疗资源配置的人口公平性研究[J].北京社会科学,2010,25(5):27-33.DOI:10.3969/j.issn.1002-3054.2010.05.005.QI M Z,DONG Y Z.Analysis on population equity of medical resourcesallocationamong18districtsandcountiesin Beijing[J].Social Science of Beijing,2010,25(5):27-33.DOI:10.3969/j.issn.1002-3054.2010.05.005.
[2]胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,1993:126-130.
[3]张明才,程英武,詹洪生,等.神经根型颈椎病椎间孔狭窄因素的影像学分析[J].北京中医药大学学报,2009,32(3):199-203.DOI:10.3321/j.issn:1006-2157.2009.03.015.ZHANG M C,CHENG Y W,ZHAN H S,et al.Imaging analysis on factors of intervertebral foramen stenosis of nerve root cervical spondylosis[J].Journal of Beijing University of Traditional Chinese Medicine,2009,32(3):199-203.DOI:10.3321/j.issn:1006-2157.2009.03.015.
[4]王亦璁.骨与关节损伤[M].2版.北京:人民卫生出版社,1996:57.
[5]王德利,李曙明,杨敏杰,等.神经根型颈椎病的解剖学基础及其进展[J].颈腰痛杂志,2001,22(4):332-334.DOI:10.3969/j.issn.1005-7234.2001.04.042.WANG D L,LI S M,YANG M J,et al.Anatomical basis and progress of cervical spondylotic radiculopathy[J].The Journal of Cervicodynia and Lumbodynia,2001,22(4):332-334.DOI:10.3969/j.issn.1005-7234.2001.04.042.
[6]李英平,郭瑞芳.神经根型颈椎病解剖因素探讨[J].解剖学进展,2003,9(2):141-143.DOI:10.3969/j.issn.1006-2947.2003.02.013.LI Y P,GUO R F.Anatomical factors of cervical spondylotic radiculopathy[J].Progress of Anatomical Sciences,2003,9(2):141-143.DOI:10.3969/j.issn.1006-2947.2003.02.013.
[7]郭凯,李林,詹红生,等.手法治疗神经根型颈椎病的临床随机对照试验的系统评价[J].环球中医药,2012,5(1):3-7.DOI:10.3969/j.issn.1674-1749.2012.01.001.GUO K,LI L,ZHAN H S,et al.Manipulation treatment on nerve-root-type cervical spondylosis systematic review of clinical randomized controlled trials[J].Global Traditional Chinese Medicine,2012,5(1):3-7.DOI:10.3969/j.issn.1674-1749.2012.01.001.
[8]王艳国,郭秀琴,张琪,等.手法治疗神经根型颈椎病的系统评价[J].中华中医药杂志,2013,2(28):499-503.WANG Y G,GUO X Q,ZHANG Q,et al.Systematic evaluation of manipulation for cervical spondylotic radiculopathy[J].China Journal of Traditional Chinese Medicine and Pharmacy,2013,2(28):499-503.
[9]WALKERBF,HEBERTJJ,STOMSKINJ.Short-term usual chiropractic care for spinal pain:a randomized controllde trial[J].Spine,2013,38(24):2071-2078.DOI:10.1097/01.brs.0000435032.73187.c7.
[10]NEIL M,PAIGE M D.Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain:systematic review and meta-analysis[J].JAMA,2017,317(14):1451-1460.DOI:10.1001/jama.2017.3086.
[11]ANITA G,PIERRE L.Manipulation and mobilisation for neck pain contrasted against an inactive control or another active trea treatment[J].John Wiley&Sons,2015,9(9):cd004249.
[12]YANG F,LI W X.Balance chiropractic therapy for cervical spondulotic radiculopathy:study protocol for a randomized controlled trial[J].Trials,2016,17(1):513.
[13]SUH S I,KOH S B,CHOI E J.Intacranial hypotension induced by cervical chiropractic manipulaition[J].Spine,2005,30(12):e340-342.DOI:10.1097/01.brs.0000166511.59868.b7.
[14]SOLHEIM O,JORGENSON J V.Lumbar epidural hematoma after chiropractic manipulation for lower-back pain:case report[J].Neurosurgery,2007,61(1):e376.DOI:10.1227/01.NEU.0000333963.32597.49.
[15]THIEF H W,BOLTON J E.Safety of chiropractic manipulation of the cervical spine:a prospective national survey[J].Spine,2010,11(s1):47.
[16]JOEL G,PICKAR D C.Neurophysiological effects of spinal manipulation[J]The Spine Journal,2002,2(5):357-371.DOI:10.1016/S1529-9430(02)00400-X.
[17]SONGXJ,GANQ.Spinalmanipulationreducespainand hyperalgesia after lumbar intervertebral foramen inflammation in the rat[J].J Manipulative Physiol Ther,2006,29(1):5-13.DOI:10.1016/j.jmpt.2005.10.001.
[18]吴昌林,易丙奎,何阶清.神经根型颈椎病手术治疗临床分析[J].中国医药指南,2016,6(17):173-174.WU C L,YI B K,HE J Q.Clinical analysis of surgical treatment of cervical spondylotic radiculopathy[J].Guide of China Medicine,2016,6(17):173-174.
[19]喻忠,龚建平,钱铭辉,等.神经根型颈椎病三维CT诊断的临床相关性研究[J].颈腰痛杂志,2003,24(1):7-10.DOI:10.3969/j.issn.1005-7234.2003.01.003.YU Z,GONG J P,QIAN M H,et al.Clinical correlation ofthree-dimensionalCTdiagnosisofcervicalspondylotic radiculopathy[J].TheJournalofCervicodyniaand Lumbodynia,2003,24(1):7-10.DOI:10.3969/j.issn.1005-7234.2003.01.003.
[20]李曙明,尹站海.神经根型颈椎病的影像学特点和分型[J].中国矫形外科杂志,2013,1(21):7-11.DOI:10.3977/j.issn.1005-8478.2013.01.02.LI S M,YIN Z H.Imaging characteristics and classification of cervical spondylotic radiculopathy[J].Orthopedic Journal of China,2013,1(21):7-11.DOI:10.3977/j.issn.1005-8478.2013.01.02.
[21]NADINE G,ANITA G,CHARLES H G.Mechanical traction for neck pain with or without radiculopathy[J].Cochrane Database of Systematic Reviews,2008,3(3):CD006408
[22]CRUE B L.Importance of flextion in cervical halter traction for radiculitis[J].United States Armed Forces Medical Journal,1957,8:374-378.
[23]吴连霞,赵媛,吴开亚,等.中国人口老龄化区域差异及驱动机制研究[J].地理科学,2018,38(6):877-844.DOI:10.13249/j.cnki.sgs.2018.06.006.WU L X,ZHAO Y,WU K Y,et al.Regional variations and driving mechamism of aging population in China[J].Scientia GeographicaSinica,2018,38(6):877-844.DOI:10.13249/j.cnki.sgs.2018.06.006.
[24]张可可,朱鸣雷.北京部分社区老年人共病及老年综合征调查[J].中国实用内科杂志,2016,5(36):419-420.ZHANG K K,ZHU M L.Investigation of comorbidity and geriatric syndrome among the elderly in some communities of Beijing[J].Chinese Journal of Practical Internal Medicine,2016,5(36):419-420.
[25]安徽省颈椎病分级诊疗指南[J].安徽医学,2017,38(9):1-8.Guidelines for grading diagnosis and treatment of cervical spondylosis in Anhui Province[J].Anhui Medical Journal,2017,38(9):1-8.
[26]齐明珠,董玉珍.北京市区县间医疗资源配置的人口公平性研究[J].北京社会科学,2010,25(5):27-33.DOI:10.3969/j.issn.1002-3054.2010.05.005.QI M Z,DONG Y Z.Analysis on population equity of medical resourcesallocationamong18districtsandcountiesin Beijing[J].Social Science of Beijing,2010,25(5):27-33.DOI:10.3969/j.issn.1002-3054.2010.05.005.