卧位颈椎保健操对颈型颈椎病老年患者的效果评价

目的 观察卧位颈椎保健操治疗老年颈型颈椎病患者的疗效。 方法 在老年人群中筛选颈型颈椎病患者72例，其中男42例，女30例，采用自编卧位颈椎保健操对上述患者进行治疗。于治疗前、治疗9周后分别采用视觉模拟评分法（VAS）、颈椎病颈椎功能评定表对入选患者疼痛程度及颈椎功能进行评定。 结果 经9周治疗后，入选患者疼痛程度及颈椎功能均较治疗前明显改善（P<0.05），临床治愈显效率为51.4%，总有效率为94.4%，总体疗效满意。 结论 卧位颈椎保健操对老年颈型颈椎病患者具有确切疗效，能明显缓解患者疼痛，增强颈椎功能，并且该疗法还具有操作简单、患者容易接受等优点，值得在颈椎病患者中推广、应用。     

后路单开门颈椎管扩大椎板成形术治疗OPLL效果分析

目的探讨后路单开门颈椎管扩大椎板成形术治疗颈椎后纵韧带骨化症患者的临床效果.方法将200例颈椎后纵韧带骨化症患者,根据手术方法不同分为研究组与对照组,每组100例,分别予以后路单开门椎管扩大成形术及前路椎体次全切减压融合术,术后观察12个月.于术前及术后1个月、12个月采用日本矫形外科协会评分系统评定神经功能,采用视觉模拟疼痛评分法评定疼痛状况;比较两组颈椎矢状位参数、颈椎脊髓整体后移距离、脊髓前缘后移距离、脊髓膨胀度.结果(1)术后1个月、12个月两组日本矫形外科协会评分系统评分均显著高于术前(P<0.01),视觉模拟疼痛评分法评分均显著低于术前(P<0.01);术前及术后1个月、12个月两组日本矫形外科协会评分系统、视觉模拟疼痛评分法评分比较差异均无统计学意义(P>0.05).(2)术后12个月两组颈椎矢状面轴向距离均较术前显著增大(P<0.01);术前及术后12个月两组颈椎Cobb角、颈椎矢状面轴向距离比较差异均无统计学意义(P>0.05).(3)术后12个月研究组颈椎脊髓整体后移距离为(2.21±0.54)mm、脊髓前缘后移距离为(1.85±0.37)mm,脊髓膨胀度测定值显著大于对照组(P<0.01).结论后路单开门颈椎管扩大椎板成形术治疗颈椎后纵韧带骨化症患者临床效果显著,对患者的颈椎脊髓整体后移距离、脊髓前缘后移距离、脊髓膨胀度的改善作用显著优于前路椎体次全切减压融合术.     

低温热塑颈椎矫形器在颈椎内固定术后的临床应用

目的：观察低温热塑颈椎矫形器在治疗颈椎内固定术后临床应用中的疗效.方法：颈椎内固定术后患者64例,随机分为观察组和对照组各32例,2组术后均进行康复训练,对照组使用常规颈托固定,观察组使用低温热塑颈椎矫形器固定.结果：术后,观察组下地活动时间明显早于对照组（P＜0.01）;颈椎活动度明显小于对照组（P＜0.01）.改良Barthel指数评分,观察组术后10d及术后1个月均明显高于对照组（P＜0.01）;术后6个月,观察组颈枕区疼痛VAS评分明显低于对照组（P＜0.01）.结论：低温热塑颈椎矫形器对颈椎内固定术后的固定安全有效,且固定较常规颈托固定更有利于颈部功能恢复.     

星状神经节及颈椎旁双阻滞治疗颈源性头痛66例疗效观察

[目的]探讨星状神经节及颈椎旁双阻滞治疗颈源性头痛的临床疗效.[方法]选择颈源性头痛的患者66例,分为观察组45例和对照组21例.对照组采用单纯颈椎旁阻滞治疗,观察组采用星状神经节及颈椎旁双阻滞治疗.比较两组患者治疗前,治疗后1h及治疗后1个月的疼痛程度数字评分(NRS).[结果]两组患者NRS评分治疗前比较差异无统计学意义(P＞0.05),而治疗后1h和1个月两组NRS之间差异均有统计学意义(P＜0.01);两组患者治疗后1h和治疗后1个月较治疗前NRS均明显降低,其差异有统计学意义(P＜0.05).[结论]星状神经节及颈椎旁双阻滞治疗颈源性头痛疗效确切并持久,值得临床推广.     

颈椎牵引、针灸推拿及运动训练综合治疗神经根型颈椎病分析

目的:探讨颈椎牵引、针灸推拿及运动训练综合治疗神经根型颈椎病的临床疗效。方法:选取2017年6月～2019年6月收治的神经根型颈椎病患者46例为研究对象,按照随机数字表法分为对照组和研究组,各23例。对照组采用针灸推拿治疗,研究组采用颈椎牵引、针灸推拿及运动训练综合治疗。比较两组临床疗效,治疗前后肌力、疼痛及生活质量(躯体健康评分、心理健康评分)评分。结果:研究组治疗总有效率高于对照组(P0.05);两组治疗后肌力、躯体健康和生理健康评分均明显高于治疗前,疼痛评分明显低于治疗前(P0.05),且研究组治疗后肌力、躯体健康和生理健康评分显著高于对照组,疼痛评分明显低于对照组(P0.05)。结论:颈椎牵引、针灸推拿及运动训练综合治疗神经根型颈椎病患者临床疗效显著,可减轻患者疼痛,有效提高患者肌力和生活质量。     

综合护理对颈椎综合征患者疼痛敏感的临床效果

目的：探讨综合护理对颈椎综合征患者疼痛敏感的临床疗效。方法选取确诊为颈椎综合征的患者100例,随机分为实验组和对照组,每组50例。两组患者均给予患者药物、物理疗法、针灸、手法推拿等治疗,同时观察组实施综合护理。对比两组患者治疗前后的临床症状及功能评分、VAS评分、FS－CSA评分和SF－36评分及临床疗效。结果两组患者治疗后的眩晕、头痛、颈肩痛、心理及社会适应、日常生活及工作评分均显著高于治疗前（均P＜0.05）,实验组患者治疗后的眩晕、头痛、颈肩痛、心理及社会适应、日常生活及工作评分均显著高于对照组（均P＜0.05）。两组患者治疗后VAS评分、FS－CSA评分显著低于治疗前（均P＜0.05）,SF－36评分显著高于治疗前（P＜0.05）;实验组患者治疗后的VAS评分、FS－CSA评分显著低于对照组（均P＜0.05）,SF－36评分显著高于对照组（P＜0.05）。实验组患者临床疗效显著优于对照组（P＜0.05）。结论采用综合护理干预结合传统治疗可以有效地改善颈椎综合征患者的疼痛症状和生活质量。     

虎符铜砭刮痧干预颈椎病的临床效果分析

目的:探讨虎符铜砭刮痧干预颈椎病( CS )的临床效果。 方法:选取 2021 年 1 月至 2023 年 1 月河南省郑州中医骨伤病医院收治的 CS 患者 90 例为研究对象,依据随机数字表法分为对照组与观察组,每组 45 例。 对照组采用常规治疗,观察组在对照组基础上加用虎符铜砭刮痧治疗,两组均连续治疗 2 周。 比较两组临床疗效、中医证候积分、疼痛程度、颈部功能和颈椎活动度。 结果:观察组临床总有效率高于对照组( P<0.05 );治疗后观察组中医证候积分、疼痛程度、颈部功能评分均低于对照组,颈椎后伸、前屈及左右旋转、侧屈活动度均大于对照组( P<0.05 )。 结论:虎符铜砭刮痧干预颈椎病效果显著,可有效减轻患者疼痛,改善患者颈椎功能,提高临床疗效。     

系统康复治疗对颈前路术后轴性症状的影响

目的 观察手术前、后系统康复治疗对脊髓型颈椎病患者行颈椎前路手术后颈部轴性症状(AS)的影响.方法 共选取102例脊髓型颈椎病患者,采用随机数字表法将其分为康复组及对照组,2组患者均给予颈椎前路手术治疗,康复组患者于手术前、后给予系统康复治疗.于术前、术后3、6、12及24个月时采用日本整形外科协会(JOA)评分对2组患者脊髓功能进行评定,并对比2组患者在各随访时间点的AS发生率及病情程度.结果 2组患者经手术治疗后,发现其脊髓功能均较治疗前明显改善(P＜0.05),且组间差异无统计学意义(P＞0.05);术后3个月时2组患者AS发生率组间差异无统计学意义(P＞0.05);术后6、12及24个月时康复组患者AS发生率明显低于对照组水平(P＜0.05).结论 手术前、后辅以系统康复治疗有助于颈椎前路术后患者AS病情缓解,但对于AS的预防作用有待提高.     

主动抗阻运动疗法治疗慢性颈部疼痛的临床研究

目的观察主动抗阻运动疗法对于慢性颈部疼痛患者的治疗效果。方法门诊选择39例病程超过6个月的女性慢性颈部疼痛的患者作为治疗组;选择21例正常女性作为对照组。对照组不进行功能锻炼。治疗组应用主动抗阻运动疗法进行功能锻炼。治疗前、治疗后12个月,观察颈椎生理曲度、项背肌肌肉CT值、项背肌肌力和耐力、颈部疼痛视觉模拟评分。结果与对照组相比,治疗组治疗前颈椎生理曲度降低(P<0.05),治疗前后无显著性差异(P>0.05)。年长对照组的颈椎后部肌肉总体平均CT值较年轻对照组降低(P<0.05);治疗组项背肌肌肉总体平均CT值比对照组降低(P<0.05);治疗组治疗前后项背肌肌肉总体平均CT值无显著性差异(P>0.05)。治疗组较对照组项背肌肌肉的肌力和耐力降低(P<0.05);治疗后治疗组项背肌肌力和耐力都较治疗前提高(P<0.05)。治疗组在治疗后1个月疼痛评分改善(P<0.05),治疗后1年所有患者疼痛完全消失。结论主动抗阻运动疗法能够提高项背肌肌力和耐力,消除疼痛。     

逐瘀颈康汤加味联合颈三针对神经根型颈椎病患者颈椎功能及复发率的影响分析

目的探究逐瘀颈康汤加味联合颈三针对神经根型颈椎病患者颈椎功能及复发率的影响。方法选取2017年3月～2019年3月就诊于我院的神经根型颈椎病患者80例,采用随机数字表法分为对照组和观察组各40例。对照组采用颈三针治疗,在此基础上,观察组联合逐瘀颈康汤加味治疗。比较两组颈椎功能活动度、视觉模拟评分法(VAS)评分与复发率。结果观察组治疗1个月后的左、右侧屈及旋转度均高于对照组,VAS评分低于对照组,差异均有统计学意义(P<0.05);治疗后6个月内,观察组的疾病复发率低于对照组,差异有统计学意义(P<0.05)。结论逐瘀颈康汤加味联合颈三针治疗可促进神经根型颈椎病患者的颈椎功能恢复,缓解疼痛,降低疾病复发率。     

“三位一体”筋肉康复操在颈椎病治疗中的作用

目的探讨"三位一体"筋肉康复操在治疗颈椎病中的作用效果。方法选择颈椎病患者120例,采用随机数字表法分为实验组和对照组,每组各60例。对照组采用传统康复训练指导,实验组在此基础上采用本院设计的"三位一体"筋肉康复操进行康复训练指导。观察康复训练后10 d、1个月及3个月两组患者的疗效。结果康复训练后1个月和3个月,实验组疗效优于对照组,两组比较,均P<0.01,差异具有统计学意义。结论应用"三位一体"筋肉康复操对治疗颈椎病的疗效显著。本套康复操锻炼方法简单,患者易于接受和坚持,值得临床推广应用。     

量身定制颈椎枕对颈椎病患者颈部肌力平衡的影响

目的探讨量身定制颈椎枕对颈椎病患者颈部肌力平衡的影响。方法选择颈椎病患者60例随机分成实验组和对照组,每组各30例,两组患者均接受康复科常规治疗和护理,实验组在此基础上使用量身定制的颈椎枕,每日使用8h,疗程为1个月,两组分别采用症状和功能评估表评分、临床疗效评定及多功能颈椎康复治疗系统（MCU）进行等长肌肌力和颈椎活动度评定。结果干预后1个月实验组症状和功能评估总分为（24．84±2．341）分,对照组为（20．65±2．134）分,差异有统计学意义（t=3．024,P〈0．05）;实验组临床痊愈率为60．0％,对照组为30．0％,差异有统计学意义（χ2=5．455,P〈0．05）;实验组等长肌肌力和颈椎活动度改善均优于对照组（P〈0．05）。结论量身定制颈椎枕能促进颈椎病患者颈部肌力平衡、加强颈椎稳定性,改善症状,是颈椎病的一种具有较大应用价值的辅助治疗方法。     

Open experience with a new myorelaxant agent for low back pain

INTRODUCTION: Eperisone hydrochloride has been recently proposed as a muscle relaxant for the treatment of muscle contracture and chronic low back pain (LBP) as it is devoid of clinically relevant sedative effects on the central nervous system (CNS). We tested this hypothesis by performing a study of patients with LBP and muscle contracture who were treated with full-dose eperisone. METHODS: Patients with moderate to severe, acute, or relapsing LBP received eperisone 100 mg three times daily for 10 consecutive days. Assessments included: spontaneous pain, pain on movement, resistance to passive movement, antalgic rigidity, and tolerability. RESULTS: In total, 100 patients were enrolled into the study. The treatment achieved a consistent analgesic and muscle relaxant activity across all patients. Both spontaneous pain and pain on movement were significantly decreased, as was resistance encountered by the investigator to passive movements, antalgic rigidity, and muscle contracture. As a consequence, treatment with eperisone resulted in a lower rigidity of the lower back and an improved motility for patients. Only seven adverse reactions were reported, including light-headedness (1), occasional vertigo and/or loss of equilibrium (3), mild somnolence (2), and epigastric pain (1). In almost all cases, there was no need to interrupt the treatment and the adverse reaction resolved spontaneously. CONCLUSIONS: Eperisone had an analgesic and muscle relaxant effect in patients with LBP. It should be noted that while it is common practice in rheumatology to combine a pain killer with a muscle relaxant in order to achieve a satisfactory result on both symptoms, the present results with eperisone were achieved with a single drug. With an improved tolerability profile compared with nonsteroidal anti-inflammatory drugs, and a lack of significant adverse effects on the CNS, eperisone hydrochloride represents a valuable alternative to traditional analgesics and muscle relaxants for the treatment of LBP.     

The relationship beween posture and back muscle endurance in industrial workers with flexion-related low back pain

This preliminary cross-sectional study was undertaken to determine if there were measurable relationships between posture, back muscle endurance and low back pain (LBP) in industrial workers with a reported history of flexion strain injury and flexion pain provocation. Clinical reports state that subjects with flexion pain disorders of the lumbar spine commonly adopt passive flexed postures such as slump sitting and present with associated dysfunction of the spinal postural stabilising musculature. However, to date there is little empirical evidence to support that patients with back pain, posture their spines differently than pain-free subjects. Subjects included 21 healthy industrial workers and 24 industrial workers with flexion-provoked LBP. Lifestyle information, lumbo-pelvic posture in sitting, standing and lifting, and back muscle endurance were measured. LBP subjects had significantly reduced back muscle endurance (P < 0.01). LBP subjects sat with less hip flexion, (P = 0.05), suggesting increased posterior pelvic tilt in sitting. LBP subjects postured their spines significantly closer to their end of range lumbar flexion in 'usual' sitting than the healthy controls (P < 0.05). Correlations between increased time spent sitting, physical inactivity and poorer back muscle endurance were also identified. There were no significant differences found between the groups for the standing and lifting posture measures. These preliminary results support that a relationship may exist between flexed spinal postures, reduced back muscle endurance, physical inactivity and LBP in subjects with a history of flexion injury and pain.     

心理治疗对颈椎病康复疗效的影响

目的:探讨介入心理治疗对颈椎病康复疗效的影响。方法:将108例颈椎病患者随机分为对照组58例和治疗组50例。对照组病人给予常规的颈椎病非手术治疗方法治疗;治疗组除给予常规的颈椎病非手术治疗方法治疗外,还介入心理治疗。于初诊及治疗1个月后用症状自评量表(SCL-90)评定患者的躯体化症状和心理状况。结果:治疗前两组病人的躯体症状和心理状况没有统计学差异(P>0.05),不良心理状况主要表现为焦虑情绪和抑郁情绪;治疗后,对照组和治疗组病人的躯体症状和心理状况均有改善,但治疗组的改善程度较对照组病人明显(P<0.01)。结论:心理治疗的介入有助于提高颈椎病的康复治疗效果,有助于病人实现全面康复。     

综合性干预对改善社区颈椎病患者知信行状态的效果观察

目的探讨综合性干预对改善社区颈椎病患者知识-态度-行为状态的影响。方法由社区颈椎病综合干预团队对200例社区颈椎病患者实施为期6个月的包括健康教育、心理疏导、饮食干预、行为干预等内容的综合性干预措施,采用自行设计的社区颈椎病患者知信行评估问卷对干预前后患者的知识-态度-行为情况进行调查。结果实施综合性干预后社区颈椎病患者知信行总分及患者对颈椎病知识的知晓率、态度和行为较干预前有明显提高(P<0.01)。结论通过对社区颈椎病患者进行系统的综合性干预,使社区颈椎病患者能正确认识颈椎病,采用健康的行为方式,有效改善社区颈椎病患者的知识-态度-行为状态。     

Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures

The aim of this study was to evaluate the thickness of the transversus abdominis (TrA) muscle in three basic postures in subjects with and without chronic low back pain. Subjects were classified into a chronic low back pain group (n = 27) and a healthy control group (n = 23). The thickness of the TrA muscle was measured at rest and during the abdominal drawing-in manoeuvre (ADIM) in supine, sitting and standing postures using B-mode ultrasound imaging. Contraction ratio (TrA thickness during the ADIM/TrA thickness at rest) was calculated for each posture. At rest, the TrA thickness in the sitting and standing postures was significantly greater than in the supine posture (p < 0.017) in the control group, but similar in all three postures in the low back pain group. TrA thickness was similar in the low back pain and control group in all three postures. During the ADIM, TrA thickness was significantly greater in the control group than in the chronic low back pain group in all three postures. The contraction ratio was also significantly higher in the control group than in the chronic low back pain group in all three postures. These results indicate that the automatic postural contraction of the TrA observed in the control subjects in the sitting and standing postures was not demonstrated in subjects with chronic low back pain. The present study revealed the one aspect of different response of the TrA muscle to changing posture between two groups.     

Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms.

For years enhancement of a patient's level of physical fitness has been an important goal in rehabilitation treatment in chronic low back pain (CLBP), based on the hypothesis that physical deconditioning contributes to the chronicity of low back pain. However, whether this hypothesis in CLBP holds is not clear. In this paper, possible mechanisms that contribute to the development of physical deconditioning in CLBP, such as avoidance behaviour and suppressive behaviour, are discussed. The presence of both deconditioning-related physiological changes, such as muscle atrophy, changes in metabolism, osteoporosis and obesity as well as deconditioning related functional changes, such as a decrease in cardiovascular capacity, a decrease in muscle strength and impaired motor control in patients with CLBP are discussed. Results of studies on the level of physical activities in daily life (PAL) and the level of physical fitness in patients with CLBP compared to healthy controls were reviewed. In studies on PAL results that were either lower or comparable to healthy subjects were found. The presence of disuse (i.e., a decrease in the level of physical activities in daily life) in patients with CLBP was not confirmed. The inconclusive findings in the papers reviewed may partly be explained by different measurement methods used in research on PAL in chronic pain. The level of physical fitness of CLBP patients also appeared to be lower or comparable to the fitness level of healthy persons. A discriminating factor between fit and unfit patients with back pain may be the fact that fit persons more frequently are still employed, and as such may be involved more in physical activity. Lastly some suggestions are made for further research in the field of disuse and deconditioning in CLBP.     

颈椎病慢性颈肩痛的多模态MRI研究进展

颈椎病是一种慢性退行性疾病,颈椎间盘退变是其主要表现之一,临床上多表现为颈肩背部疼痛、上肢麻木等。功能磁共振成像可准确评估颈椎间盘形态改变,反映慢性疼痛引起的大脑、脊髓结构与功能的细微变化,为神经病理学机制的研究及临床疗效的评估提供依据。作者主要综述多模态MRI(常规MRI、扩散张量成像、基于体素的形态学分析、血氧水平依赖功能MRI、磁共振波谱)在颈椎病慢性疼痛中的研究现状和进展。     

The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle

Decreases in the size of the multifidus muscle have been consistently documented in people with low back pain. Recently, ultrasound imaging techniques have been used to measure contraction size of the multifidus muscle, via comparison of the thickness of the muscle at rest and on contraction. The aim of this study was to compare both the size (cross-sectional area, CSA) and the ability to voluntarily perform an isometric contraction of the multifidus muscle at four vertebral levels in 34 subjects with and without chronic low back pain (CLBP). Ultrasound imaging was used for assessments, conducted by independent examiners. Results showed a significantly smaller CSA of the multifidus muscle for the subjects in the CLBP group compared with subjects from the healthy group at the L5 vertebral level (F = 29.1, p = 0.001) and a significantly smaller percent thickness contraction for subjects of the CLBP group at the same vertebral level (F = 6.6, p = 0.02). This result was not present at other vertebral levels (p > 0.05). The results of this study support previous findings that the pattern of multifidus muscle atrophy in CLBP patients is localized rather than generalized but also provided evidence of a corresponding reduced ability to voluntarily contract the atrophied muscle.