手法治疗对颈曲改变颈椎病患者椎基底动脉血流速度的影响

背景颈曲值在相当程度上反应了颈椎退行性变的过程.目的手法恢复颈椎曲度已在临床上得到认同,探讨手法对颈椎病患者椎基底动脉血流状况的影响.设计非随机同期对照研究.单位一所大学医院的脊柱骨科及外科,一所中医学院的骨伤科研究所门诊.对象研究对象来自1999-01/2001-12广西中医学院附属瑞康医院脊柱骨科,第一附属医院外三科,广西中医学院骨伤科研究所门诊收治的颈椎病患者60例,分有颈曲异常的颈椎病组、无颈曲异常的颈椎病组,每组30例.另选30例健康者做对照组.方法颈椎病组施行手法治疗.观察对比颈椎病组治疗前后与对照组的颈曲值和左椎动脉、右椎动脉和基底动脉的血流速度,并统计它们的相关系数.主要观察指标①颈椎病组治疗前后及对照组颈曲值.②各组治疗前后收缩期峰值血流速度、舒张末期血流速度、平均血流速度值的变化.结果颈曲异常组左椎动脉、右椎动脉、基底动脉的收缩峰期血流速度、舒张末期血流速度、平均血流速度普遍降低,各血管收缩峰值血流速度低于对照组和颈曲正常组(P＜0.05).治疗后,3条血管的血流速度有明显提高,治疗前左椎动脉的收缩峰期血流速度、基底动脉的收缩峰期血流速度和平均血流速度变化与颈曲值呈相关性,治疗后左椎动脉的收缩峰期血流速度和平均血流速度、右椎动脉和基底动脉的收缩峰期血流速度与颈曲变化值相关.结论颈曲对椎基底动脉有内在的致病作用.手法可以恢复颈曲形状,促进椎基底动脉血流速度恢复正常.

Effect of manipulative therapy on blood flow velocity in vertebrobasilar arteries of patients with cervical spondylosis and abnormal curvature

BACKGROUND: Abnormal curvature of the cervical spine reflects in large measure the degenerative changes of the cervical vertebrae. OBJECTIVE: The effect of manipulative therapy has been recognized in restoring normal cervical curvature, and aimed to further probe into the effect of this therapy on blood flow velocity in the vertebrobasilar arteries of patients with cervical spondylosis. DESIGN: A non-randomized and controlled concomitant study. SETTING: Departments of Spinal Orthopaedics and General Sugery of a University hospital, and the Outpatient Department of Orthopaedic Institute of a college of Traditional Chinese Medicine. PARTICI PANTS: From January 1999 to December 2001, 60 patients with cervical spondylosis were treated in the Department of Spinal Orthopaedics in Ruikang Hospital, Third Department of Surgery, First Affiliated Hospital of Guangxi College of Traditional Chinese Medicine, and Outpatient Clinic of Institute of Orthopaedics, Guangxi College of Traditional Chinese Medicine. The patients were divided into spondylosis group with abnormal curvature(30 cases) and spondylosis group without normal curvature(30 cases) . Thirty healthy subjects were also included to serve as the control group.METHODS: Manipulation was applied in these patients and the cervical curvature and blood flow velocity in the left vertebral artery (LVA) and right vertebral artery(RVA) as well as in the basilar artery(BA) were measured before and after the treatment for comparison. The correlation coefficients between them were also calculated.MAIN OUTCOME MEASURES: ① The cervical curvature before and after manipulation in spondylosis group and control group; ② The blood flow velocity in maximal systolic phase and end-diastolic phase in the specified arteries.RESULTS: The blood flow velocity in maximal systolic phase and end-diastolic phase decreased in LVA, RVA and BA in patients with abnormal cervical curvature, whose blood velocities in maximal systolic phase in these arteries was less than those in control subjects and patients with normal curvature ( P ＜ 0.05). After manipulation, the velocity in these arteries in creased apparently in patients with abnormal curvature. The changes in systolic velocity in LVA and systolic in BA were correlated to the curvature before manipulation, and after that, the maximal systolic velocity in LVA,maximal systolic velocity in RVA and BA were all related to the changes of the cervical curvature. CONCLUSION: Abnormal cervical curvature is the anatomical basis for abnormalities of the vertebrobasilar arteries. Manipulative therapy can restore the cervical curve and blood flow velocity in these arteries.