颈部伸屈肌群静力增强训练治疗神经根型颈椎病的疗效观察

目的探讨神经根型颈椎病(cervical spondylotic radiculopathy,CSR)康复治疗过程中,辅以颈部伸屈肌群静力增强训练的临床作用。方法自2013-06-2014-08纳入160例CSR患者,采用随机数字表法,随机分为观察组与对照组各80例,对照组予以常规治疗,包括颈椎牵引、郑氏推拿手法;观察组在上述常规治疗基础上,给予颈部伸屈肌群静力增强训练。2个疗程后,进行各项指标对比。结果采用《颈椎病治疗成绩评分表》进行治疗前后的评分,治疗后,观察组的自觉症状、临床检查、生活动作评分和总分均显著高于对照组(P0.05)。观察组的总有效率为96.25%,显著高于对照组的88.75%(P0.05)。160例患者随访12-26个月,平均17.5个月,观察组复发7例,复发率为8.75%;对照组复发26例,复发率为32.5%。观察组复发率显著低于对照组(P0.01)。结论颈部伸屈肌群的静力增强训练有助于提高CSR患者康复治疗的疗效,降低其复发率,且简单易学、可操作性强,值得在临床推广应用。     

DAVID脊柱系统训练在慢性腰痛康复治疗中的作用分析

目的 探讨DAVID脊柱系统训练在慢性腰痛康复治疗中的临床疗效.方法 选择2018年2月～2021年2月于本院收治的80例慢性腰痛患者,随机均分为观察组与对照组各40例.对照组接受常规核心肌力训练,观察组采用DAVID脊柱系统训练.比较两组患者治疗前后的VAS评分、Roland-Morris功能障碍调查表(Roland Morris dysfunction questionnaire,RMDQ)得分、腰椎活动度(range of motion,ROM)以及腰椎各方向肌群肌力.结果 两组治疗后VAS评分、RMDQ评分均显著降低,且观察组显著低于对照组(P<0.05);两组治疗后前屈、后伸、左旋、右旋ROM,以及前屈、后伸、左旋、右旋最大等长肌力均显著增加,且观察组显著高于对照组(P<0.05).结论 DAVID脊柱系统训练在慢性腰痛的康复治疗中能够有效提升腰椎ROM及腰背部肌群肌力,降低疼痛症状,改善功能障碍.     

核心肌群稳定训练联合脊柱牵伸手法床治疗脊柱源性慢性腰腿痛

目的核心肌群稳定训练联合脊柱牵伸手法床治疗脊柱源性慢性腰腿痛的临床效果。方法选取60例诊断为脊柱源性慢性腰腿痛患者,采用随机数字表法分为对照组与研究组各30例,均予以脊柱牵伸手法床治疗,研究组在基础治疗上加用核心肌群稳定训练,连续干预12周。治疗结束后进行疗效评价。结果干预后,两组腰椎M-JOA、RMDQ和SF-MPQ评分均有显著改善(P0.05),但对照组上述指标均显著高于研究组(P0.05);干预后,对照组脊柱前凸角显著低于研究组,椎体偏移角显著高于研究组(P0.05)。结论核心肌群稳定训练联合脊柱牵伸手法床治疗脊柱源性腰腿痛,可有效改善患者症状、体征及腰椎形态,疗效可靠。     

强化本体感觉训练及等速肌力训练对前交叉韧带重建术患者康复效果的影响

目的 探讨强化本体感觉训练及等速肌力训练对前交叉韧带（ACL）重建术患者康复效果的影响。方法选取2020年1月至2022年12月在我院诊治的ACL重建术患者82例,随机分为2组,每组各41例。对照组给予常规训练,研究组给予强化本体感觉训练及等速肌力训练。比较两组训练前后的膝关节本体感觉功能、等速肌力、关节疼痛程度及膝关节稳定性,以及康复效果。结果 训练后,两组患侧15°重现差值、患侧45°重现差值、患侧75°重现差值较训练前均降低（P<0.05）,且研究组明显低于对照组（P<0.05）。训练后,两组伸屈膝相对峰力矩（PT/BW）、屈膝峰力矩值（PT）、伸膝PT、腘绳肌与股四头肌的肌力比值（H/Q）均较训练前升高（P<0.05）,且研究组明显高于对照组（P<0.05）。训练后,两组视觉模拟评分法（VAS）评分、Lachman试验胫骨前移较训练前均降低（P<0.05）,且研究组明显低于对照组（P<0.05）。研究组康复优良率为90.24%,明显高于对照组的73.17%(P<0.05)。结论 强化本体感觉训练及等速肌力训练应用于ACL重建术患者,可有...     

平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗神经根型颈椎病40例临床观察

目的：观察平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗神经根型颈椎病的临床疗效。方法：将80例神经根型颈椎病患者随机分为治疗组和对照组,每组40例。对照组采用肌骨超声引导下颈神经根阻滞治疗,治疗组采用平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗。观察2组患者治疗前后神经根型颈椎病症状体征积分及疼痛视觉模拟评分法（VAS）评分,并观察临床疗效。结果：治疗后、治疗后4周,2组患者症状体征积分较治疗前明显升高,VAS评分较治疗前明显降低,差异有统计学意义（P <0.05）。2组间比较,治疗组症状体征积分、VAS评分、疼痛改善程度明显优于对照组,差异有统计学意义（P <0.05）。2组患者治疗后及治疗后4周的疗效比较,治疗组均明显优于对照组,差异有统计学意义（P <0.05）。结论：平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗神经根型颈椎病疗效显著,标本兼治,值得临床推广应用。     

主动抗阻运动疗法治疗神经根型颈椎病的临床应用

目的探讨主动抗阻运动疗法治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的临床效果。方法纳入2015-09-2017-04于我院治疗的70例CSR患者,采用随机数字表法均分为观察组与对照组。给予对照组患者常规推拿、按摩治疗,观察组在此基础上进行主动抗阻运动疗法。连续治疗2周后,评价两组患者Mc Gill疼痛量表评分、颈椎功能障碍指数(the neckdisability index,NDI)评分,测定治疗前后颈部各肌群肌力,采用颈椎病临床评价量表(clinical assessment scale for cervical spondylosis,CASCS)评价临床疗效。结果观察组治疗总有效率为91.43%,显著高于对照组的71.43%,差异,有统计学意义(P0.05);两组治疗后Mc Gill疼痛量表视觉模拟(VAS)评分、疼痛强度(PPI)、分级指数(PRI)以及NDI评分均显著降低,且观察组显著低于对照组(P0.05);观察组治疗后伸、前屈、右侧屈、左侧屈肌力均显著高对照组(P0.05);对照组治疗前后颈部各肌群肌力的差异无统计学意义(P0.05)。结论主动抗阻运动疗法治疗CSR能显著降低疼痛、改善颈椎功能,提升颈部各肌群肌力,提高临床疗效。     

智能脉冲枪整脊治疗神经根型颈椎病的疗效研究

目的 研究智能脉冲枪整脊治疗神经根型颈椎病的疗效,为促进患者早日康复提供依据。方法 选择2018年12月～2020年7月本院收治的130例神经根型颈椎病患者,按随机数字表法分为研究组和对照组各65例。对照组采取关节松动术与整脊手法治疗,研究组在对照组的基础上给予智能脉冲枪整脊治疗。比较两组的疼痛VAS评分、颈椎功能NDI指数、临床疗效。结果 对照组治疗后的VAS评分和NDI指数显著高于研究组(P<0.05);对照组总有效率83.08%,显著低于研究组的95.38%,差异有统计学意义(P<0.05)。结论 智能脉冲枪整脊治疗神经根型颈椎病,可显著改善患者的临床症状和颈椎功能,从而提高临床疗效。     

非手术脊柱减压系统治疗神经根型颈椎病的疗效分析及复发率研究

目的观察SDS9900颈椎脊柱减压系统治疗神经根型颈椎病患者的临床疗效及复发率。方法选取本院康复医学科门诊治疗的神经根型颈椎病患者112例并随机分为治疗组及对照组各56例。治疗组采用SDS9900颈椎脊柱减压系统及动态干扰电治疗,对照组则用常规颈椎牵引及动态干扰电治疗。于治疗前、治疗6周后对两组患者采用目测类比评分法(visual analog scales,VAS)及颈椎病临床评价量表(elinicol assessment scale for cervical spondylosis,CASCS)对两组患者进行评定,并于治疗结束后3个月、6个月、1年对患者进行随访。结果两组患者分别经6周治疗后,发现患者VAS评分及CASCS评分结果均较治疗前好转,上述指标均以治疗组的改善幅度较显著,与对照组间差异具有统计学意义(P0.05);3个月后随访,两组复发率无统计学差异;6个月后,治疗组复发率低于对照组(P0.05),1年后,治疗组复发率明显低于对照组(P0.01);结论SDS9900颈椎脊柱减压系统可有效缓解神经根型颈椎病患者的疼痛,提高颈椎功能,并具有较好的远期疗效且复发率低。     

改良后路手术治疗混合型颈椎病效果及对颈部生物力学相关参数变化的观察

目的分析改良后路手术治疗脊髓型合并神经根型颈椎病临床疗效及对颈部生物力学相关参数的影响,为脊髓+神经根型颈椎病临床治疗方案选择提供参考。方法选择2015年1月至2016年1月我院收治符合纳入条件的脊髓+神经根型颈椎病患者100例作为研究对象,所有患者按随机分配原则分为对照组和观察组,每组50例。对照组采用后前路联合手术治疗,观察组采用改良后路手术治疗。两组患者均随访2年以上,比较两组治疗前、术后6个月、1年、2年的日本骨科协会脊髓功能(Japanese orthopedic association scores,JOA)评分、JOA评分改善、颈椎功能残障指数表(neck disabilitv index,NDI)评分、疼痛视觉模拟评分(visual analogue scores,VAS)、颈椎活动度(range of motion,ROM)和颈椎被动活动度(passiverange of motion,PROM)的变化。术后6个月行根性症状疗效进行评价并比较。结果两组患者治疗前JOA评分、颈椎ROM、颈椎肌张力比较,差异均无统计学意义(P0.05)。观察组患者在术后6个月、1年、2年的JOA评分、JOA评分改善率、ROM和肌张力均明显高于对照组患者(P0.05),NDI评分和VAS评分明显低于对照组患者(P0.05)。术后6个月观察组患者的根性症状疗效优良率明显高于对照组患者(P0.05)。结论改良后路手术治疗脊髓型合并神经根型颈椎病疗效确切、安全性高,一次解决脊髓和神经根压迫,减轻患者身心痛苦及经济负担,对脊髓型+神经根型颈椎病患者具有较高的临床价值。     

中西医结合治疗膝关节骨性关节炎的临床研究

目的 观察中西医结合治疗膝骨性关节炎的临床疗效.方法 膝关节骨性关节炎患者120例,分为治疗组(中医手法结合超短波治疗组)60例,对照组(超声短波治疗组)60例.以症状体征分级量化评分、临床疗效评定和复发率为指标对两组进行对比分析.结果 治疗组治疗前后患者的症状体征评分有较明显改善(P＞0.05),治疗组的总有效率为91.7%,而对照组的总有效率为81.7%,两组间疗效比较有显著性差异(P＞0.05).结论 中西医结合治疗膝关节骨性关节炎能够有效改善膝骨性关节炎的症状体征,对膝骨性关节炎具有较好的临床疗效.     

颈椎不稳在交感型颈椎病发病中的作用

目的：研究交感型颈椎病的病理因素及治疗方法。方法：回顾分析了1988-2000年收治的20例手术治疗的交感型颈椎病患者。根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳。结果：20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果。每例患者均于不稳节段行颈前路融合术,手术有效率为90％。结论：颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法。     

Postoperative instability of cervical OPLL and cervical radiculomyelopathy

The presence of cervical spine instability with respect to preoperative and postoperative changes in angular, horizontal, and rotational displacement of the vertebral body were studied. With the anterior approach, the instability in the remaining unfused segments, and their relation to the kyphotic or lordotic fused segment were studied. With the posterior approach, postoperative ROM (range of motion) could be better maintained, and horizontal displacement was improved in more cases by laminoplasty compared with laminectomy. With the anterior approach, the compensatory function for the loss of motion of the segments resulting from fusion was most remarkable at the levels of C2-3 and C6-7. In the alignment of the anterior fused segments, it appears important that the physiologic lordotic position be maintained.     

Anterior cervical foramenotomy for cervical radiculopathy

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩

目的 观察颈横动脉颈段皮支皮瓣修复颈部瘢痕挛缩的临床效果.方法 笔者单位1988-2011年收治颈前区烧伤后瘢痕挛缩患者66例.采用颈横动脉颈段皮支皮瓣修复患者颈部瘢痕,包括岛状皮瓣55例(其中9例行预扩张)、非岛状皮瓣11例(其中1例行预扩张).术中先切除、松解患者颈部瘢痕,在锁骨上、下及前胸区设计颈横动脉颈段皮支皮瓣,其轴心血管为颈横动脉在胸锁乳突肌、肩胛舌骨肌交界处穿出的皮动脉.皮瓣后界达斜方肌前缘,外侧界达三角肌中段,内侧界达胸骨中线,下界达乳头下3.0 ～4.0 cm处.术中先切开皮瓣外、下、内缘,锐性分离达锁骨平面后改为钝性剥离,分离到蒂部后,分离深度以皮瓣旋转后可无张力覆盖创面为度.其中预扩张的皮瓣供区直接拉拢缝合,非预扩张皮瓣供区植皮封闭.结果 本组患者中64例术后皮瓣成活良好;2例术后皮瓣下血肿致尖端部分坏死,经补充植皮后治愈;供区均愈合.所有皮瓣色泽、质地与周围组织匹配良好;皮瓣感觉功能术后初期恢复为胸部感觉,6个月后完全恢复为颈部感觉.结论 颈横动脉颈段皮支皮瓣血供恒定,解剖操作相对简便,皮瓣色泽、质地与颈部相近,是修复颈部严重瘢痕挛缩的良好选择.     

经皮髓核成形术与椎间盘切除术治疗退变性颈椎间盘突出症

目的比较经皮髓核成形术与经皮椎间盘切除术治疗退变性颈椎间盘突出症的临床疗效及对颈椎稳定性的影响。方法2002年7月至2004年12月共收治退变性颈椎间盘突出症患者80例,行经皮髓核成形术42例(PCN组),经皮椎间盘切除术38例(PCD组)。回顾性分析两组的临床资料,比较两组在手术时间、临床效果及颈椎稳定性等的差异。结果所有病例随访6~26个月,PCN组平均(12±5)个月;PCD组平均(12±4)个月。两组手术均获成功。两组手术时间有显著差异(t=-21·70,P=0·000);两组手术临床效果(JOA评分)经自身配对t检验显示均有显著性差异(PCN:t=14·05,P=0·000;PCD:t=-14·79,P=0·000),即两组均有效;两组手术临床效果(Williams评分)经Kruskal-Wallis检验无显著差异(z=-0·377,P=0·706,>0·05),即两组临床效果相似。两组手术后均无颈椎不稳病例发生,颈椎稳定性手术前后均无显著差异(P>0·05)。结论经皮髓核成形术与经皮椎间盘切除术治疗颈椎间盘突出症的临床疗效优良,对颈椎稳定性影响小,不会造成颈椎失稳的发生。     

颈椎不稳致交感型颈椎病的诊断和治疗

目的 探讨交感型颈型病的发病机制及有效的治疗方法。方法 回顾了1989-1998年应用颈前路间盘切除加植骨融合术治疗的交感型颈椎病患者18例,分析了患者产及术后颈椎伸、屈侧位X光片。结果 18例患者术前均有颈椎不稳,不稳定节段为1个者6例,2个者9例,3个者3例;颈椎不稳主要发生于C3-C4和C4-C5,偶见于C5-C6和C6-C7。14例患者术前行颈椎高位硬膜外封闭,11例有效;于不稳定节段行颈前路间盘切除加植骨融合术,18例均获随访,平均随访时间为1年9个月,术后有效率为88.9%,结论 颈椎不稳定是交感型颈椎病发病的重要因素。颈椎高位硬膜外封闭具有重要的诊断价值。颈前路间盘切除加植骨融合术是治疗交感型颈椎病的有效方法。     

颈椎自锁PEEK椎间融合器在颈椎病治疗中的应用

目的评价应用颈椎自锁PEEK椎间融合器前路减压治疗颈椎病的疗效。方法应用颈椎自锁PEEK椎间融合器治疗颈椎病患者18例,观察椎间融合器的稳定性和融合情况,采用Borden法测量椎间隙高度、颈椎曲度,对术前和术后JOA评分、椎间隙高度、颈椎曲度等指标进行统计学分析。结果 18例患者均获随访,时间6～42个月,未见严重并发症。术后6个月提示椎间骨性融合。椎间高度:术前为(3.26±0.68)mm,术后1周为(6.03±0.89)mm(P<0.01);术后6个月为(5.89±0.78)mm,与术后1周比较变化不大(P>0.05)。颈椎生理弧度:术前为(2.55±0.48)mm,术后1周为(3.24±0.67)mm(P>0.05);术后6个月为(8.14±1.17)mm,与术后1周比较明显改善(P<0.01)。末次随访根据JOA评分法进行疗效评价:优4例,良9例,可3例,差2例。结论颈椎自锁PEEK椎间融合器可以有效恢复颈椎生理曲度及椎间隙高度,可以获得满意的融合率,改善颈脊髓功能。     

Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation

Background contextAlthough anterior cervical discectomy and fusion (ACDF) is an effective treatment option for patients with cervical disc herniation, it limits cervical range of motion, which sometimes causes discomfort and leads to biomechanical stress at neighboring segments. In contrast, cervical artificial disc replacement (ADR) is supposed to preserve normal cervical range of motion than ACDF. A biomechanical measurement is necessary to identify the advantages and clinical implications of ADR. However, literature is scarce about this topic and in those available studies, authors used the static radiological method, which cannot identify three-dimensional motion and coupled movement during motion of one axis.PurposeThe purpose of this study was to compare the clinical parameters and cervical motion by three-dimensional motion analysis between ACDF and ADR and to investigate the ability of ADR to maintain cervical kinematics.Study designThis was a prospective case control study.Patient samplePatients who underwent ADR or ACDF for the treatment of single-level cervical disc herniation.Outcome measuresVisual analog scale (VAS), Korean version of Neck Disability Index (NDI, %), and three-dimensional motion analysis were used.MethodsThe patients were evaluated by VAS and the Korean version of the NDI (%) to assess pain degree and functional status. Cervical motions were assessed by three-dimensional motion analysis in terms of sagittal, coronal, and horizontal planes. Markers of 2.5 cm in diameter were attached at frontal polar (Fpz), center (Cz), and occipital (Oz) of 10–20 system of electroencephalography, C7 spinous process, and both acromions. These evaluations were performed preoperatively and 1 month and 6 months after surgery.ResultsThe ACDF and ADR groups revealed no significant difference in VAS, NDI (%), and cervical range of motion preoperatively. After surgery, both groups showed no significant difference in VAS and NDI (%). In motion analysis, significantly more range of motion was retained in flexion and extension in the ADR group than the ACDF group at 1 month and 6 months. There was no significant difference in lateral tilt and rotation angle. In terms of coupled motion, ADR group exhibited significantly more preserved sagittal plane motion during right and left rotation and also showed significantly more preserved right lateral bending angle during right rotation than ACDF group at 1 month and 6 months. There was no significant difference in other coupled motions.ConclusionThree-dimensional motion analysis could provide useful information in an objective and quantitative way about cervical motion after surgery. In addition, it allowed us to measure not only main motion but also coupled motion in three planes. ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF. ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.     

Posterior cervical laminoplasty formultilevel cervical spine stenosis

Cervical laminoplasty for treating multilevel spinal stenosis appears to be a good surgical alternative to the more traditional laminectomy or anterior decompression and fusion. This procedure avoids the morbidity associated with extensive anterior procedures and also appears not to be associated with late kyphosis, which can be seen in patients after a laminectomy. This review outlines the rationale, indications, contraindications, and early clinical results for patients undergoing a posterior laminoplasty.