MSCT颈椎扫描重建评价推拿手法治疗神经根型颈椎病疗效的研究

目的：探讨MSCT颈椎扫描重建在推拿手法治疗神经根型颈椎病（CSR）疗效评价中的价值。方法：30例临床确诊的CSR患者，在推拿手法治疗前后分别行颈椎MSCT检查，并记录临床症状、体征及VAS疼痛评分。MSCT检查的观察指标包括颈椎曲度变化、寰枢关节关系、棘突与中线的关系、椎体前后径线和左右径线与中轴线角度、各椎体水平方向旋转角度、椎间孔及椎间盘的变化情况，并结合临床症状及体征进行分析。结果：经治疗，30例患者的临床症状及体征明显好转，VAS评分降低（8．20±0．92）分；测量发现，治疗前、后的平均颈椎弧度分别为（1．91±4．99）mm和（5．08±3．61）mm，差异有统计学意义（P=0．000，t=-4．27），治疗前后椎间孔狭窄改善（80／300下降为35／300）。治疗前、后颈椎齿状突与两侧块距离不等分别为15例（15／30）和2例（2／30），治疗前、后棘突与中线的距离分别为（2．11±1．68）mm和（o．87±1．70）mm，两者差异具有统计学意义（P=0．000，t=7．53）。治疗前后椎间盘突出及膨出的个数分别为63个和42个。结论：推拿治疗可以通过改善颈椎生理曲度、椎间孔大小及椎间小关节位置关系来改善CSR的症状，MSCT颈椎扫描重建对CSR的疗效评价具有重要参考价值。

Value of multi-slice spiral CT imaging and reformation in evaluating the clinical efficacy of tuina therapy in cervical spondylotic radiculopathy

Objective： To analyze the clinical efficacy of tuina therapy in the cervical spondylotic radiculopathy by multi-slice spi- ral CT imaging and reformation. Methods：Image data of thirty patients with cervical spondylotic radiculopathy were collected. All patients were performed twice cervical multi-slice spiral CT study before and after the tuina therapy,and all clinical symp- toms,signs and VAS score were recorded. The changes of cervical morphology in both MSCT studies were observed,including cervical curvature,atiantoaxial joint, the relationship of the spinous process and the midline of vertebral body position,interver- tebral foramen,intervertebral disc. These changes were comparatively analyzed with clinical symptoms and signs. Results：Aft6r tuina treatment,all patients had a significant improvement in the clinical symptoms and signs. VAS score was decreased by （8.20±0.92） points. The average values of cervical curvature before and after treatment were （1.91±4.99） mm and （5.08＋ 3.61） mm, there was significant difference between them （P： 0. 000;t=- 4.27）. There was 80/300 narrow intervertebral fo- ramen before treatment,the number was 35/300 after tuina therapy. The numbers of odontoid skew befor~ and after treatment were 15/30 and 2/30. The distances from the spinous to centerline before and after treatment were （2.11±1.68） mm and （0.87±1.70） mm （P：0. 000 t=7.53）. The numbers of intervertebral disk hernia and slipped disc were 63/120 and 42/120 before and after tuina therapy. Conclusion： Tuina therapy is effective for cervical spondylotic radiculopathy by improving the cervical curvature, foraminal size and the relationship of facet joint position. Multi-slice CT imaging and reformation have an im- portant referential value in the evaluation of clinical efficacy of tuina therapy in cervical spondylotie radiculopathy.