颈椎病常见压痛点的临床观察
摘要
近年来,颈椎病的发病率呈现上升的趋势。其病因有：颈椎退行性改变、创伤、劳损、发育性椎管狭窄等。近年来,对颈肌的重视及对颈椎生物力学的研究进展,为颈椎病的病因学研究开辟了新思路。颈椎生物力学致病因素可分为内源性和外源性两方面,内源性因素为：椎体、椎弓及其突起、椎间盘和相连的韧带等结构受到的不平衡机械应力促进颈椎退行性病变；外源性因素主要是颈肌运动的不平衡导致了肌肉力量的不均衡,加剧了颈椎病的发生和发展。颈椎病致痛机制有：椎间盘源性、神经根性、硬脊膜、韧带与关节囊源性以及肌源性。
颈椎病患者病变相关软组织都存在压痛点,有学者认为压痛点与生物力学密切相关,多位于肌肉的起点和作用力方向纵轴所经过的直线上机械应力比较集中的部位。它对颈椎病的诊断与治疗有重要意义。
中医认为,颈椎病乃本虚标实之证,其本为肝肾亏虚,标为瘀血阻滞。风、寒、湿邪侵袭、劳损和外伤是发病的重要因素,总的病机为肝肾亏虚,筋骨失养,经脉闭阻,气血运行不畅,出现不通则痛或不荣则痛。颈椎病的临床表现与经筋病的表现极为相似。经筋理论对颈椎病的诊断及治疗具有重要的指导意义。经筋的结聚、“会于节”的地方是痛点容易出现的地方,“以痛为腧”是经筋病的重要治疗法则。
现代医学对颈椎病的治疗方法杂多,然而实践证实,以压痛点加针灸辨证取穴治疗本病疗效佳,副作用少,故寻找并确定压痛点是诊疗的一个重要环节。但是文献中,鲜有对压痛点具体位置的探讨,更少有对压痛点分布规律的观察研究。
目的：观察117例颈椎病患者常见压痛点的分布规律,为临床诊治提供依据。
研究方法：按照从骨骼到肌肉,从上至下,从健侧到患侧的顺序,有序的查找患者颈肩及上臂部的压痛点。研究中,要求检查者用力均衡,并标记VAS评分4分以上的压痛点。最后对压痛点进行归纳分析,总结分布规律。
结果显示：
(1)在不同的位置,压痛点有点、束、片状分布的不同；(2)压痛点多位于关节周围；(3)压痛点多位于肌肉的起止点、骨边、肌肉与肌肉或肌腱之间；(4)在肢体部的经筋多为束状,其压痛点多处于筋束之间；在胸背部经筋多为片状,而压痛点多在经筋之上；(5)压痛点多分布于手足三阳经筋上,并与经筋的“交合结聚”密切相关；(6)52.7%的压痛点与经穴或经外奇穴位置相近或相重,69.4%的压痛点位于经脉循行线上；(7)颈部的压痛点不仅分布于颈椎后面,在侧面及前面均有分布；(8)与椎体相关的压痛点主要位于横突以及病变所累及的棘突附近,疼痛程度以横突为甚；(9)肩胛骨周围是压痛点出现的高频区域,特别是冈下窝,而且此处痛点疼痛较甚；(10)压痛点不仅限于患侧,健侧亦有出现,且疼痛程度不一定低于患侧。
In recent years, the incidence of cervical spondylosis is upward trend. The causes are: Cervical vertebra degenerative changes, trauma, strain, developmental spinal stenosis. In recent years, the importance of the neck muscle and the cervical spine biomechanics research, as the etiology of cervical disease has opened up new ideas. Pathogenic factors of cervical spine biomechanics can be divided into endogenous and exogenous both endogenous factors:body of vertebra, vertebral arch and its processes, intervertebral disc and associated ligaments and other structures subject to mechanical stress imbalance in the promotion of cervical degenerative lesions; exogenous factors are mainly cervical muscle movement imbalance of muscle strength imbalance, increasing the occurrence and development of cervical spondylosis. Spondylosis pain mechanisms:discogenic nerve root, dura, ligament and joint capsule and muscle-derived origin.
Related cervical lesions in patients with soft tissue tenderness are present, there are some scholars believe that the tender point is closely related with the biological mechanics, and more in the direction of muscle force starting point and vertical line through which mechanical stress concentrated on the site. Its diagnosis and treatment of cervical spondylosis have this significance.
Chinese medicine (TCM), cervical spondylosis is evidence of the vacuity of its being the liver and kidney deficiency, marked blood stasis. Wind, cold, wet attacks, fatigue and injuries is an important factor in the disease, the overall pathogenesis for the liver and kidney deficiency, bones dystrophy, Meridian closed resistance, blood runs sluggish, there is not pain or General Wing is pain. The clinical performance of cervical disease and the performance by the tendons are very similar. A meridian on the diagnosis and treatment of cervical disease has important significance. The tendon of the knot together, "festival will be" the place is prone to pain point where the "pain as the Meridian" is an important treatment by the law of tendon disease.
The modern treatment of cervical spondylosis heteropoly, however, practice showed that differentiation to tender point acupuncture acupoints good therapeutic effect, less side effects, so look for and identify tenderness is an important part of treatment. Review of the literature, few of the specific location of tender point, even fewer tender points on the observation of distribution.
Objective:117 cases of cervical tenderness in patients with common point of distribution, provide the basis for clinical diagnosis and treatment.
Methods:In accordance to the muscle from the bone, from top to bottom, from the contra lateral to the affected side of the order, ordered to find patients with neck and shoulder and upper arm of the tender point. Tender points and regular analysis, summarized the law. Study, asked the examiner force balance, and mark VAS score of 4 or tender spot. Finally consolidation of tender points, tender points summed up on the patients in the cervical distribution.
The results showed:
(1) in different locations, tender point a bit, beam, the distribution of the different sheet; (2) tender points were located around the joints; (3) tender point over the start and end points in the muscle, bone side, between the muscle and the muscle or tendon;(4) in the body mostly by the Ministry of tendon bundles, the tenderness between many points in the reinforcement beams; in the chest and back by the bar over the sheet, and point tenderness over the tendons on by; (5) tender points are distributed in the hand, foot Sanyang meridians on, and by the reinforcement of the "intercourse gather for" closely related; (6) 52.7% of the tender points and acupoints or meridian Extra points are located close to or overlapping,69.4% of the tender point in the meridian line;(7) neck tenderness point behind not only found in cervical, were distributed in the side and front; (8) tender points associated with the vertebral transverse process and the lesions are mainly located at the spinal process involved close to transverse staggering pain; (9) is tender points around the scapula emerging high-frequency region, in particular, infraspinatus fossa, and the point of pain, pain here than even; (10) tender points are not limited to the affected side, there appeared unaffected, and the pain is not necessarily lower than the affected side.
颈椎病患者病变相关软组织都存在压痛点,有学者认为压痛点与生物力学密切相关,多位于肌肉的起点和作用力方向纵轴所经过的直线上机械应力比较集中的部位。它对颈椎病的诊断与治疗有重要意义。
中医认为,颈椎病乃本虚标实之证,其本为肝肾亏虚,标为瘀血阻滞。风、寒、湿邪侵袭、劳损和外伤是发病的重要因素,总的病机为肝肾亏虚,筋骨失养,经脉闭阻,气血运行不畅,出现不通则痛或不荣则痛。颈椎病的临床表现与经筋病的表现极为相似。经筋理论对颈椎病的诊断及治疗具有重要的指导意义。经筋的结聚、“会于节”的地方是痛点容易出现的地方,“以痛为腧”是经筋病的重要治疗法则。
现代医学对颈椎病的治疗方法杂多,然而实践证实,以压痛点加针灸辨证取穴治疗本病疗效佳,副作用少,故寻找并确定压痛点是诊疗的一个重要环节。但是文献中,鲜有对压痛点具体位置的探讨,更少有对压痛点分布规律的观察研究。
目的：观察117例颈椎病患者常见压痛点的分布规律,为临床诊治提供依据。
研究方法：按照从骨骼到肌肉,从上至下,从健侧到患侧的顺序,有序的查找患者颈肩及上臂部的压痛点。研究中,要求检查者用力均衡,并标记VAS评分4分以上的压痛点。最后对压痛点进行归纳分析,总结分布规律。
结果显示：
(1)在不同的位置,压痛点有点、束、片状分布的不同；(2)压痛点多位于关节周围；(3)压痛点多位于肌肉的起止点、骨边、肌肉与肌肉或肌腱之间；(4)在肢体部的经筋多为束状,其压痛点多处于筋束之间；在胸背部经筋多为片状,而压痛点多在经筋之上；(5)压痛点多分布于手足三阳经筋上,并与经筋的“交合结聚”密切相关；(6)52.7%的压痛点与经穴或经外奇穴位置相近或相重,69.4%的压痛点位于经脉循行线上；(7)颈部的压痛点不仅分布于颈椎后面,在侧面及前面均有分布；(8)与椎体相关的压痛点主要位于横突以及病变所累及的棘突附近,疼痛程度以横突为甚；(9)肩胛骨周围是压痛点出现的高频区域,特别是冈下窝,而且此处痛点疼痛较甚；(10)压痛点不仅限于患侧,健侧亦有出现,且疼痛程度不一定低于患侧。
In recent years, the incidence of cervical spondylosis is upward trend. The causes are: Cervical vertebra degenerative changes, trauma, strain, developmental spinal stenosis. In recent years, the importance of the neck muscle and the cervical spine biomechanics research, as the etiology of cervical disease has opened up new ideas. Pathogenic factors of cervical spine biomechanics can be divided into endogenous and exogenous both endogenous factors:body of vertebra, vertebral arch and its processes, intervertebral disc and associated ligaments and other structures subject to mechanical stress imbalance in the promotion of cervical degenerative lesions; exogenous factors are mainly cervical muscle movement imbalance of muscle strength imbalance, increasing the occurrence and development of cervical spondylosis. Spondylosis pain mechanisms:discogenic nerve root, dura, ligament and joint capsule and muscle-derived origin.
Related cervical lesions in patients with soft tissue tenderness are present, there are some scholars believe that the tender point is closely related with the biological mechanics, and more in the direction of muscle force starting point and vertical line through which mechanical stress concentrated on the site. Its diagnosis and treatment of cervical spondylosis have this significance.
Chinese medicine (TCM), cervical spondylosis is evidence of the vacuity of its being the liver and kidney deficiency, marked blood stasis. Wind, cold, wet attacks, fatigue and injuries is an important factor in the disease, the overall pathogenesis for the liver and kidney deficiency, bones dystrophy, Meridian closed resistance, blood runs sluggish, there is not pain or General Wing is pain. The clinical performance of cervical disease and the performance by the tendons are very similar. A meridian on the diagnosis and treatment of cervical disease has important significance. The tendon of the knot together, "festival will be" the place is prone to pain point where the "pain as the Meridian" is an important treatment by the law of tendon disease.
The modern treatment of cervical spondylosis heteropoly, however, practice showed that differentiation to tender point acupuncture acupoints good therapeutic effect, less side effects, so look for and identify tenderness is an important part of treatment. Review of the literature, few of the specific location of tender point, even fewer tender points on the observation of distribution.
Objective:117 cases of cervical tenderness in patients with common point of distribution, provide the basis for clinical diagnosis and treatment.
Methods:In accordance to the muscle from the bone, from top to bottom, from the contra lateral to the affected side of the order, ordered to find patients with neck and shoulder and upper arm of the tender point. Tender points and regular analysis, summarized the law. Study, asked the examiner force balance, and mark VAS score of 4 or tender spot. Finally consolidation of tender points, tender points summed up on the patients in the cervical distribution.
The results showed:
(1) in different locations, tender point a bit, beam, the distribution of the different sheet; (2) tender points were located around the joints; (3) tender point over the start and end points in the muscle, bone side, between the muscle and the muscle or tendon;(4) in the body mostly by the Ministry of tendon bundles, the tenderness between many points in the reinforcement beams; in the chest and back by the bar over the sheet, and point tenderness over the tendons on by; (5) tender points are distributed in the hand, foot Sanyang meridians on, and by the reinforcement of the "intercourse gather for" closely related; (6) 52.7% of the tender points and acupoints or meridian Extra points are located close to or overlapping,69.4% of the tender point in the meridian line;(7) neck tenderness point behind not only found in cervical, were distributed in the side and front; (8) tender points associated with the vertebral transverse process and the lesions are mainly located at the spinal process involved close to transverse staggering pain; (9) is tender points around the scapula emerging high-frequency region, in particular, infraspinatus fossa, and the point of pain, pain here than even; (10) tender points are not limited to the affected side, there appeared unaffected, and the pain is not necessarily lower than the affected side.
引文
[1]孙宇,李贵存.第二届颈椎病专题座谈会纪要[J]解放军医学杂志,1994,(02)
[2]胡亚明,廖祥洲,叶立汉,等.肇庆市居民颈椎病流行病学调查[J].现代康复2000,(3)：378-379
[3]叶菊风,云雪霞,廖一钒,古迪,李丹,陈清,等.广州市城区居民慢性病患病及其影响因素分析[J].华南预防医学,2007,6(33),3：24-26
[4]王冰,段义萍,张友常,王启明,黄兆民,樊振勇,卓尚丕,等.颈椎病患病特征的流行病学研究[J].中南大学学报(医学版),2004,29(4)472-474
[5]王灿,金长山,于柏松,李春泉,等.中学教师常见疾病及患病相关因素调查分析[J].沈阳医学院学报,2004,12(6),4：239
[6]吴德升,芮永,林研,赵卫东,祝建光,刘凡,于彬,等.陆家嘴地区金融从业人员颈椎病现状的流行病学调查和预防对策的研究[J].脊柱外科杂志,2006,6(4)3：150-154
[7]张雅萍,李康秀,张志英,陈新梅,尚亚婷,等.兰州市22个职业从业人员颈椎病的流行病学调查[J].临床荟萃,2008,12(23)：868-870
[8]王海泉,孟迎春,孙广恭,张力琴,等.中学教师使用电脑及颈椎健康状况的流行病学调查[J].现代预防医学,2010,37(3)：403-406
[9]Irvine D H. Prevalence of cervical spondylosis in a general practice [J]. Lancet,1965,14:1089-1092
[10]Miller A. Lumbar disc degradation:correlation with age. sex. and spine level in 600 autopsy specimens [J]. Spine,1988,9(11):172-173
[11]Miyakoshi N, Itoi E,Murai H,et al. Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration[J].Spine,2003,28(5): 492-495
[12]李颖丽,崔玉贵.颈椎病与职业、年龄、性别的关系[J].职业与健康,2004,3(20)3：104-105
[13]唐品恺,李卫,王莉,等.颈椎病与职业年龄性别的关系[J].镇江医学院学报,2000,10(4)：750-751
[14]王宝琴.青少年颈椎病的临床观察[J].中国康复医学杂志,2004,19(5)：336
[15]王拥军,万超.颈椎病病因病机的再认识[J].上海中医药大学学报,1999,3(13)：37-38
[16]李小勇.试从生物力学角度探讨颈椎病发病及其牵引治疗的机理[J],继续医学教 育,2006,32(20)：52-53
[17]王拥军,施杞,沈培芝,等.动静力失衡性大鼠颈椎间盘退变模型的动态观察[J].中国中西医结合杂志,2001,21(3)：199-202
[18]刑泽军,马迅,等.下颈椎在屈伸运动时的应力分布研究[J],颈腰痛杂志2004(25)：382-384
[19]杨阳明,于彦铮,等.颈椎的应力分布与骨质增生[J],中华骨科杂志,1985.5(3)：148—150
[20]董蔚青,李镇中,等.青年颈椎病的生物力学探讨[J],现代医用影像学2009,6(18)3：136-138
[21]贾连顺.颈椎病研究的现状进展和展望[J].中国矫形外科杂志,2001,8(8)：733-334
[22]Anita N. V, MS, Siping L, PhD, Scott L. D, PhD. Influence of Muscle Morphometry and Moment Arms on the Moment-Generating Capacity of Human Neck Muscles[J]. Spine,1998,23(4):412-422
[23]Hannecke V,Mayoux Benhamou MA, Bonni-chon P, et al.Metabolic different-tiation of thehuman longus colli muscle[J].Mophologie,2001,85(269):9-12
[24]郝永强,施杞.实验性颈椎动力平衡失调后髓核超微结构观察[J].临床骨科杂志,1999,2(4)：245-246
[25]武震,刘晓化,张军,唐东听,孙树椿,等.颈后肌受长期应力作用家兔血清cK和LDH含量观察[J].中国骨伤,2007,5(20)：61-62
[26]房敏,姜淑云,洪水棕,严隽陶,孙武权,刘玉超,左亚忠,等.颈伸肌群对颈椎间盘和小关节内压力变化的影响[J].中国组织工程研究与临床康复,2008,15(12)：2847-2850
[27]房敏,沈国权,严隽陶,等.颈椎主要结构生物力学特性实验研究[J].颈腰痛杂志,2002,23(2)：89-92
[28]叶伟胜,万瑜,方欢,等.骨科疾病的矫形按摩[M].天津：天津翻译出版公司,2004.159
[29]Gogia PP, Sabbahi MA. Electromyographicanalysis of neck muscle fatigue in patientswith osteoarthritis of the cervical spine[J]. Spine,1994,19(5):502-506
[30]Lee H,Nicholson LL, Adams RD,et al. Proprioception and rotation range sensitization associated with subclinical neck pain. Spine2005; 30(3):E60-E67
[31]Jeri Ylinen,MD,Petri Salo,PT,Matti Nykanen, MD,et al.Decreased isometr-ic neck strength in women with chronic neck pain and the repeatability of neck strength measurements[J]. Arch Phys Med Rehabil,2004,85 (8):1303-1308
[32]方健辉,林志达,林俊文,等.广东省专业运动员颈椎病调查分析[J].中国运动医学杂志.2005,24(3)：348-349
[33]冯金升,李义凯,邹建荣,等.颈源性头痛的诊断与治疗[J].中国脊柱脊髓杂志2001,11(1)：45-46
[34]Lwamura Y,Onari K,Kondo S, et al. Cervical intradural disc hemiation. Spine 2001; 26(6):698-702
[35]胡有谷,李放,张永刚,宋跃明,郑召民,等.椎间盘源性腰痛[J],中国脊柱脊髓杂志2004,6(14)：327-330
[36]Hakahashi H, Suguro T, Okazima Y, et al. Inflammatory cytokines in the herniated disc of the lumbar[J]. Spine,1996,21:218-224
[37]Cavanaugh JM. Neural Mechanisms of Idiopathic Low Back Pain[M]. In:Weine-stein JN,Gordon SL, eds.Low Back Pain:A Scientific and Clinical Everview Rosement. IL:AAOS,1996.583-605
[38]何兴川等·脊神经根压迫与根性疼痛的相关分析遵义医学院学报2001,4,(24)：337-338
[39]万超,神经根痛的解剖学和病理生理学基础[J],中医正骨,1999,3(11)：49-50
[40]段昌平,卢鼎厚,傅湘琦,赵天德,等.针刺和静力牵张对延迟性酸痛过程中骨骼肌超微结构的影响[J],北京体育学院学报,1984(4)：8-19
[41]陈英杰,郭庆芳,等.延迟性肌肉损伤与自由基代谢异常——运动延迟性肌肉损伤机制探讨之二[J],中国运动医学杂志,1993,12(2)：65-69
[42]卢鼎厚,人体运动功能和肌肉损伤[J],体育与科学,2006,9(27),5：65-70
[43]张培苏,郭庆芳,等.被动收缩所致家兔肌肉早期僵硬及其超微结构的变化[J],中国运动医学杂志,1988,7(1)：1-9
[44]吴文豹,徐光耀,饶小康.人体软组织损伤学[M].南宁：广西科学出版社,2000：16-36,86-92
[45]宣蜇人,软组织外科理论与实践[M].北京：人民军医出版社,1994：3,265-279
[46]侯鲁铭,生物力学在软组织疼痛中的应用[J],全国中西医结合软组织疾病学术会议论文汇编,北京1990：29—30
[47]陶胜国,对运动性软组织损伤中压痛点的探讨[J],吉林体育学院学报,2004,3(20)：140-141
[48]毕胜,王福根,等.人体软组织痛点的病理学研究进展[J],中国疼痛医学杂志,1998,4(3)：181-184
[49]归良祯,王炳森,等.椎管内外软组织损害的组织病理学观察[J],中华病理学杂志,1984,1：30-32
[50]陈稢,浅谈压痛点[J],上海针灸杂志,1997,5(16)：32-33
[51]陈旭清,邹展,等.颈椎病常见压痛点及封闭后的疗效探讨,广西医学,2005,27(11)：1738-1739
[52]陈小勇,徐维章,汪德英,王兴顺,徐元生,鲁海娟.电针配合牵引及痛点阻滞治疗颈椎病420例,颈腰痛杂志,2001,22(2)：116
[53]张倩,杨桂芝,电脑控制牵引联合痛点注射综合治疗颈椎病60例,中华临床医药杂志,2003,2(60)：9965-9966
[54]陈立,龙欣,吴靖伟,等.痛点局部注射配合拔罐治疗颈肩肌筋膜炎18例[J],中国民间疗法2004,2,2(12)：37-38
[55]王元伟,穴位按摩加痛点封闭治疗落枕88例[J],临床军医杂志,2004,6,3(32)：32122-123
[56]刘立明,朱才兴,成忠实,等.颈部压痛点处的手法治疗对紧张型头痛的效果[J],中国临床康复,17(8)：3418-3419
[57]唐学章,丁海涛,痛点推拿与传统推拿治疗背肌筋膜炎的疗效评价中华中医药杂志2009,7,7(24)：908-909
[58]俞阳,压痛点强刺激推拿治疗神经根型颈椎病53例[J],浙江中医杂志2009,3,3(44)：213
[59]刘义,舒春华,推拿椎旁压痛点治疗颈椎病的临床观察[J],中华现代医学与临床,2007,3,6(6)：12-13
[60]张乾军,传统医学对神经根型颈椎病的认识及其治疗进展[J],中医研究,2005,18(9)：54-56
[61]张伯臾,中医内科学(第5版)[M],上海,上海科学技术出版社,1985,10：265
[62]郭霭春.黄帝内经素问语译[M].人民卫生出版社,1995
[63]巢元方.诸病源候论校释[M],人民卫生出版社,1983
[64]张介宾.类经.中国中医药出版社,1997
[65]河北医学院.灵枢经校释[M].人民卫生出版社,1995
[66]严永和,重辑严氏济生方[M],中国中医药出版社,2007
[67]林佩琴,类证治裁[M],中国中医药出版社,2008
[68]张机.金匮要略方论[M].人民卫生出版社,1956
[69]王肯堂.证治准绳[M].上海科学技术出版社,1984
[70]龚信辑,古今医鉴[M],中国中医药出版社,2007
[71]张璐,张氏医通[M],中国人民卫生出版社,2006
[72]吴谦.医宗金鉴.北京：人民卫生出版,1963
[73]蔺道人.仙授理伤续断秘方[M].人民卫生出版社,1957
[74]虞抟.医学正传[M].人民卫生出版社,1963
[75]国家中医药管理局.中华人民共和国中医药行业标准—中医病症诊断疗效标准[M],南京大学出版社,1994,186
[76]中国卫生部,中药新药指导原则[M],2002
[77]皇甫谧.针灸甲乙经校注[M].人民卫生出版社,1982
[78]杨上善,黄帝内经太素[M],学苑出版社,2007
[79]许慎,说文解字[M],中华书局,2006
[80]房敏,朱清广,洪水棕,经筋在颈椎病发病中的生物力学作用[J],上海中医药大学学报,2009,9,5(23)：4-6
[81]Pope M H, Panjabi M. Biomechanical definitions of spinal instability [J]. Spine,1985,10(3):255-256
[82]孙思邈.千金方[M],中国中医药出版社,1998
[83]孙思邈.备急千金要方.江户医学影北宋本.北京：人民卫生出版社,1982
[84]汤军燕,浅谈《灵枢·经筋》对目前针灸临床认识及治疗软组织疼痛的指导作用[J],中国中医基础医学杂志,1998,8,(4)：166-167
[85]周世华,十二经筋与运动创伤的关系及临床应用[J],安徽中医临床杂志,2003,10,5(15)：418-419
[86]何生华,经筋理论在治疗颈椎病中的作用探讨[J],时珍国医国药2005,3(16)：181-182
[87]范志勇,钟伟,郭汝松,赖淑华,等.吴山教授辨治颈椎病经验介绍[J],新中医2007,9,9,(39)：14-15
[88]胡娟,经筋手法结合牵引、药枕治疗神经根型颈椎病[J],按摩与导引,2007,1,1,(23)：15-17
[89]梁树勇,韦英才,梁启成,等.经筋疗法治疗神经根型颈椎病128例疗效观察[J].世界中医骨科杂志,2007,7(2)：169-172
[90]谭涛,王世成,张贵娟,等.经筋刺法及理筋手法对颈椎病手术后上肢屈肌痉挛患者肌电F波的影响[J].中国针灸,2006,26(10)：725-728
[91]何常春,尹林玉,等.经筋针刺法治疗神经根型颈椎病60例临床观察[J],中医药导报,2009,4,4(15)：66-67
[92]朱鸣镝,汤锦波,凌树才,等.肩关节运动时肌肉力臂改变的实验研究[J].中国临床医学,2007,14(2)：221-225
[93]Ward SR, Hentzer ER, Smallwood LH, et al. Rotator cuff muscle architectu-re[J]. Clinical Orthopaedics andRelated Research,2006,448:157-163
[94]郭世绂,临床骨科解剖学[M],天津：天津科学技术出版社,1988：394-395
[95]王桂生,朱通伯,吴祖饶·骨科手术学[M],北京：人民卫生出版社,1991：394-395
[2]胡亚明,廖祥洲,叶立汉,等.肇庆市居民颈椎病流行病学调查[J].现代康复2000,(3)：378-379
[3]叶菊风,云雪霞,廖一钒,古迪,李丹,陈清,等.广州市城区居民慢性病患病及其影响因素分析[J].华南预防医学,2007,6(33),3：24-26
[4]王冰,段义萍,张友常,王启明,黄兆民,樊振勇,卓尚丕,等.颈椎病患病特征的流行病学研究[J].中南大学学报(医学版),2004,29(4)472-474
[5]王灿,金长山,于柏松,李春泉,等.中学教师常见疾病及患病相关因素调查分析[J].沈阳医学院学报,2004,12(6),4：239
[6]吴德升,芮永,林研,赵卫东,祝建光,刘凡,于彬,等.陆家嘴地区金融从业人员颈椎病现状的流行病学调查和预防对策的研究[J].脊柱外科杂志,2006,6(4)3：150-154
[7]张雅萍,李康秀,张志英,陈新梅,尚亚婷,等.兰州市22个职业从业人员颈椎病的流行病学调查[J].临床荟萃,2008,12(23)：868-870
[8]王海泉,孟迎春,孙广恭,张力琴,等.中学教师使用电脑及颈椎健康状况的流行病学调查[J].现代预防医学,2010,37(3)：403-406
[9]Irvine D H. Prevalence of cervical spondylosis in a general practice [J]. Lancet,1965,14:1089-1092
[10]Miller A. Lumbar disc degradation:correlation with age. sex. and spine level in 600 autopsy specimens [J]. Spine,1988,9(11):172-173
[11]Miyakoshi N, Itoi E,Murai H,et al. Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration[J].Spine,2003,28(5): 492-495
[12]李颖丽,崔玉贵.颈椎病与职业、年龄、性别的关系[J].职业与健康,2004,3(20)3：104-105
[13]唐品恺,李卫,王莉,等.颈椎病与职业年龄性别的关系[J].镇江医学院学报,2000,10(4)：750-751
[14]王宝琴.青少年颈椎病的临床观察[J].中国康复医学杂志,2004,19(5)：336
[15]王拥军,万超.颈椎病病因病机的再认识[J].上海中医药大学学报,1999,3(13)：37-38
[16]李小勇.试从生物力学角度探讨颈椎病发病及其牵引治疗的机理[J],继续医学教 育,2006,32(20)：52-53
[17]王拥军,施杞,沈培芝,等.动静力失衡性大鼠颈椎间盘退变模型的动态观察[J].中国中西医结合杂志,2001,21(3)：199-202
[18]刑泽军,马迅,等.下颈椎在屈伸运动时的应力分布研究[J],颈腰痛杂志2004(25)：382-384
[19]杨阳明,于彦铮,等.颈椎的应力分布与骨质增生[J],中华骨科杂志,1985.5(3)：148—150
[20]董蔚青,李镇中,等.青年颈椎病的生物力学探讨[J],现代医用影像学2009,6(18)3：136-138
[21]贾连顺.颈椎病研究的现状进展和展望[J].中国矫形外科杂志,2001,8(8)：733-334
[22]Anita N. V, MS, Siping L, PhD, Scott L. D, PhD. Influence of Muscle Morphometry and Moment Arms on the Moment-Generating Capacity of Human Neck Muscles[J]. Spine,1998,23(4):412-422
[23]Hannecke V,Mayoux Benhamou MA, Bonni-chon P, et al.Metabolic different-tiation of thehuman longus colli muscle[J].Mophologie,2001,85(269):9-12
[24]郝永强,施杞.实验性颈椎动力平衡失调后髓核超微结构观察[J].临床骨科杂志,1999,2(4)：245-246
[25]武震,刘晓化,张军,唐东听,孙树椿,等.颈后肌受长期应力作用家兔血清cK和LDH含量观察[J].中国骨伤,2007,5(20)：61-62
[26]房敏,姜淑云,洪水棕,严隽陶,孙武权,刘玉超,左亚忠,等.颈伸肌群对颈椎间盘和小关节内压力变化的影响[J].中国组织工程研究与临床康复,2008,15(12)：2847-2850
[27]房敏,沈国权,严隽陶,等.颈椎主要结构生物力学特性实验研究[J].颈腰痛杂志,2002,23(2)：89-92
[28]叶伟胜,万瑜,方欢,等.骨科疾病的矫形按摩[M].天津：天津翻译出版公司,2004.159
[29]Gogia PP, Sabbahi MA. Electromyographicanalysis of neck muscle fatigue in patientswith osteoarthritis of the cervical spine[J]. Spine,1994,19(5):502-506
[30]Lee H,Nicholson LL, Adams RD,et al. Proprioception and rotation range sensitization associated with subclinical neck pain. Spine2005; 30(3):E60-E67
[31]Jeri Ylinen,MD,Petri Salo,PT,Matti Nykanen, MD,et al.Decreased isometr-ic neck strength in women with chronic neck pain and the repeatability of neck strength measurements[J]. Arch Phys Med Rehabil,2004,85 (8):1303-1308
[32]方健辉,林志达,林俊文,等.广东省专业运动员颈椎病调查分析[J].中国运动医学杂志.2005,24(3)：348-349
[33]冯金升,李义凯,邹建荣,等.颈源性头痛的诊断与治疗[J].中国脊柱脊髓杂志2001,11(1)：45-46
[34]Lwamura Y,Onari K,Kondo S, et al. Cervical intradural disc hemiation. Spine 2001; 26(6):698-702
[35]胡有谷,李放,张永刚,宋跃明,郑召民,等.椎间盘源性腰痛[J],中国脊柱脊髓杂志2004,6(14)：327-330
[36]Hakahashi H, Suguro T, Okazima Y, et al. Inflammatory cytokines in the herniated disc of the lumbar[J]. Spine,1996,21:218-224
[37]Cavanaugh JM. Neural Mechanisms of Idiopathic Low Back Pain[M]. In:Weine-stein JN,Gordon SL, eds.Low Back Pain:A Scientific and Clinical Everview Rosement. IL:AAOS,1996.583-605
[38]何兴川等·脊神经根压迫与根性疼痛的相关分析遵义医学院学报2001,4,(24)：337-338
[39]万超,神经根痛的解剖学和病理生理学基础[J],中医正骨,1999,3(11)：49-50
[40]段昌平,卢鼎厚,傅湘琦,赵天德,等.针刺和静力牵张对延迟性酸痛过程中骨骼肌超微结构的影响[J],北京体育学院学报,1984(4)：8-19
[41]陈英杰,郭庆芳,等.延迟性肌肉损伤与自由基代谢异常——运动延迟性肌肉损伤机制探讨之二[J],中国运动医学杂志,1993,12(2)：65-69
[42]卢鼎厚,人体运动功能和肌肉损伤[J],体育与科学,2006,9(27),5：65-70
[43]张培苏,郭庆芳,等.被动收缩所致家兔肌肉早期僵硬及其超微结构的变化[J],中国运动医学杂志,1988,7(1)：1-9
[44]吴文豹,徐光耀,饶小康.人体软组织损伤学[M].南宁：广西科学出版社,2000：16-36,86-92
[45]宣蜇人,软组织外科理论与实践[M].北京：人民军医出版社,1994：3,265-279
[46]侯鲁铭,生物力学在软组织疼痛中的应用[J],全国中西医结合软组织疾病学术会议论文汇编,北京1990：29—30
[47]陶胜国,对运动性软组织损伤中压痛点的探讨[J],吉林体育学院学报,2004,3(20)：140-141
[48]毕胜,王福根,等.人体软组织痛点的病理学研究进展[J],中国疼痛医学杂志,1998,4(3)：181-184
[49]归良祯,王炳森,等.椎管内外软组织损害的组织病理学观察[J],中华病理学杂志,1984,1：30-32
[50]陈稢,浅谈压痛点[J],上海针灸杂志,1997,5(16)：32-33
[51]陈旭清,邹展,等.颈椎病常见压痛点及封闭后的疗效探讨,广西医学,2005,27(11)：1738-1739
[52]陈小勇,徐维章,汪德英,王兴顺,徐元生,鲁海娟.电针配合牵引及痛点阻滞治疗颈椎病420例,颈腰痛杂志,2001,22(2)：116
[53]张倩,杨桂芝,电脑控制牵引联合痛点注射综合治疗颈椎病60例,中华临床医药杂志,2003,2(60)：9965-9966
[54]陈立,龙欣,吴靖伟,等.痛点局部注射配合拔罐治疗颈肩肌筋膜炎18例[J],中国民间疗法2004,2,2(12)：37-38
[55]王元伟,穴位按摩加痛点封闭治疗落枕88例[J],临床军医杂志,2004,6,3(32)：32122-123
[56]刘立明,朱才兴,成忠实,等.颈部压痛点处的手法治疗对紧张型头痛的效果[J],中国临床康复,17(8)：3418-3419
[57]唐学章,丁海涛,痛点推拿与传统推拿治疗背肌筋膜炎的疗效评价中华中医药杂志2009,7,7(24)：908-909
[58]俞阳,压痛点强刺激推拿治疗神经根型颈椎病53例[J],浙江中医杂志2009,3,3(44)：213
[59]刘义,舒春华,推拿椎旁压痛点治疗颈椎病的临床观察[J],中华现代医学与临床,2007,3,6(6)：12-13
[60]张乾军,传统医学对神经根型颈椎病的认识及其治疗进展[J],中医研究,2005,18(9)：54-56
[61]张伯臾,中医内科学(第5版)[M],上海,上海科学技术出版社,1985,10：265
[62]郭霭春.黄帝内经素问语译[M].人民卫生出版社,1995
[63]巢元方.诸病源候论校释[M],人民卫生出版社,1983
[64]张介宾.类经.中国中医药出版社,1997
[65]河北医学院.灵枢经校释[M].人民卫生出版社,1995
[66]严永和,重辑严氏济生方[M],中国中医药出版社,2007
[67]林佩琴,类证治裁[M],中国中医药出版社,2008
[68]张机.金匮要略方论[M].人民卫生出版社,1956
[69]王肯堂.证治准绳[M].上海科学技术出版社,1984
[70]龚信辑,古今医鉴[M],中国中医药出版社,2007
[71]张璐,张氏医通[M],中国人民卫生出版社,2006
[72]吴谦.医宗金鉴.北京：人民卫生出版,1963
[73]蔺道人.仙授理伤续断秘方[M].人民卫生出版社,1957
[74]虞抟.医学正传[M].人民卫生出版社,1963
[75]国家中医药管理局.中华人民共和国中医药行业标准—中医病症诊断疗效标准[M],南京大学出版社,1994,186
[76]中国卫生部,中药新药指导原则[M],2002
[77]皇甫谧.针灸甲乙经校注[M].人民卫生出版社,1982
[78]杨上善,黄帝内经太素[M],学苑出版社,2007
[79]许慎,说文解字[M],中华书局,2006
[80]房敏,朱清广,洪水棕,经筋在颈椎病发病中的生物力学作用[J],上海中医药大学学报,2009,9,5(23)：4-6
[81]Pope M H, Panjabi M. Biomechanical definitions of spinal instability [J]. Spine,1985,10(3):255-256
[82]孙思邈.千金方[M],中国中医药出版社,1998
[83]孙思邈.备急千金要方.江户医学影北宋本.北京：人民卫生出版社,1982
[84]汤军燕,浅谈《灵枢·经筋》对目前针灸临床认识及治疗软组织疼痛的指导作用[J],中国中医基础医学杂志,1998,8,(4)：166-167
[85]周世华,十二经筋与运动创伤的关系及临床应用[J],安徽中医临床杂志,2003,10,5(15)：418-419
[86]何生华,经筋理论在治疗颈椎病中的作用探讨[J],时珍国医国药2005,3(16)：181-182
[87]范志勇,钟伟,郭汝松,赖淑华,等.吴山教授辨治颈椎病经验介绍[J],新中医2007,9,9,(39)：14-15
[88]胡娟,经筋手法结合牵引、药枕治疗神经根型颈椎病[J],按摩与导引,2007,1,1,(23)：15-17
[89]梁树勇,韦英才,梁启成,等.经筋疗法治疗神经根型颈椎病128例疗效观察[J].世界中医骨科杂志,2007,7(2)：169-172
[90]谭涛,王世成,张贵娟,等.经筋刺法及理筋手法对颈椎病手术后上肢屈肌痉挛患者肌电F波的影响[J].中国针灸,2006,26(10)：725-728
[91]何常春,尹林玉,等.经筋针刺法治疗神经根型颈椎病60例临床观察[J],中医药导报,2009,4,4(15)：66-67
[92]朱鸣镝,汤锦波,凌树才,等.肩关节运动时肌肉力臂改变的实验研究[J].中国临床医学,2007,14(2)：221-225
[93]Ward SR, Hentzer ER, Smallwood LH, et al. Rotator cuff muscle architectu-re[J]. Clinical Orthopaedics andRelated Research,2006,448:157-163
[94]郭世绂,临床骨科解剖学[M],天津：天津科学技术出版社,1988：394-395
[95]王桂生,朱通伯,吴祖饶·骨科手术学[M],北京：人民卫生出版社,1991：394-395