手法治疗颈椎病意外事件分析与预防策略思考

目的:回顾手法治疗颈椎病发生意外事件的病例,分析手法治疗的风险和收益。方法:检索1979年至2011年3月期间中文期刊数据库关于手法治疗颈椎病发生意外的临床病例报告、文献综述等。统计意外事件资料,对数据进行提取分析,并提出对策建议。结果:共40篇文献,150例病例符合纳入标准。意外事件共156例(如果1例患者同时存在骨折和脱位,则计为2例意外事件),最常见的是晕厥占28.85%(45例);颈髓轻度损伤或压迫占21.79%(34例);神经根损伤占15.38%(24例);无效或症状加重占7.05%(11例);颈椎骨折占7.05%(11例);脱位或半脱位占3.85%(6例);软组织损伤1.92%(3例);严重意外事件包括瘫痪、死亡和脑血管意外病例占14.70%(22例),其中54.55%(12例)存在其他原发疾病。意外损伤手法类型包括:旋转复位法占42.00%(63例);强刺激按揉穴位引起的占28.00%(42例)。最终结局:66.67%(100例)恢复或基本恢复,14.00%(21例)好转或改善;2.67%(4例)恶化或加重;3.33%(5例)死亡。结论:医师使用手法治疗前,需要对患者进行详细检查和明确诊断,并对治疗术式的潜在风险与收益进行评估。排除禁忌和潜在风险、规范评价标准和准入资格,提高安全认识与风险评估、加强手法意外事件的监测,可将意外事件发生率降至最低。

Retrospective analysis and prevention strategies for accidents associated with cervical manipulation in China

Objective: To review previously reported injuries cases which were associated with cervical manipulation in China,and to describe the risks and benefits of the therapy. Methods: Relevant case reports,review articles,surveys,and investigations regarding treatment of cervical spondylosis with cervical manipulation involving accidents and associated complication were retrived with a search of the literature from SinoMed,CNKI,CQVIP,and Wanfang digital databases between 1979 to March 2011. The data were extracted and statistically analyzed. Results: Total of 150 cases of injury reported in 40 articles corresponded the inclusion criteria. Accidents occurred in 156 cases,of them,syncope was in 45 cases(28.85%),mild spinal cord injury or compression was in 34 cases (21.79%),nerve root injury was in 24 cases (15.38%),ineffective or symptom increased was in 11 cases (7.05%);cervical spine fracture was in 11 cases (7.05%),dislocation or semiluxation was in 6 cases (3.85%),soft tissue injury was in 3 cases (1.92%),serious accident was 22 cases(14.70%,including paralysis,death and cerebrovascular accident). In cases of serious accident,12 cases(54.55%) had the other primary diseases. Types of related manipulation including rotation reduction(42.00%,63 cases),rubbing points or muscle resulting strong stimulation( 28.00%,42 cases). 100 cases (66.67%) obtained cured or basically recovered results,21 cases(14.00%) improved,4 cases (2.67%) deterioration and 5 cases(3.33%) died. Conclusion: It is imperative for practitioners to complete the patients' management and assessment before manipulation. That the practitioners conduct a detailed physical examination and make a correct diagnosis would be a pivot method of avoiding accidents. Excluding contraindications and potential risks,standardizing evaluation criteria and practitioners' qualification,increasing safety awareness and risk assessment and strengthening the monitoring of the accidents could decrease the incidence of accidents.