卧式颈椎牵引配合按摩及电脑中频治疗椎动脉型颈椎病100例疗效观察

目的观察卧式颈椎牵引配合按摩及电脑中频治疗椎动脉型颈椎病的疗效。方法将100例椎动脉型颈椎病患者随机分组,综合组50例,卧牵组50例,经两个疗程临床观察,进行疗效对比。结果综合组比卧牵组疗效显著,差异有统计学意K（P〈0．025）。结论卧式颈椎牵引配合按摩及电脑中频治疗椎动脉型颈椎病,疗效优于单独卧式颈椎牵引法,提示卧式颈椎牵引配合按摩及电脑中频治疗椎动脉型颈椎病能缩短疗程。     

综合法治疗神经根型颈椎病

目的观察卧式牵引配合颈椎按摩及电脑中频治疗神经根型颈椎病的疗效。方法将120例神经根型颈椎病患者随机分组,综合组68例,卧牵组52例,经2疗程临床观察,进行疗效对比。结果综合组比卧牵组疗效显著(P<0.025)。结论卧式牵引配合颈椎按摩及电脑中频治疗神经根型颈椎病,疗效优于单独的卧式牵引法,提示综合法治疗神经根型颈椎病能有效缩短疗程。     

颈椎牵引加关节松动治疗颈椎小关节紊乱

目的：观察颈椎牵引加关节松动治疗颈椎小关节紊乱的疗效。方法： 该方法与传统的颈椎牵引加手法复位对照观察。结果：该法优良率明显高于传统疗法,且复发率明显降低。结论：该法是治疗颈椎小关节紊乱有效安全的方法     

颈椎牵引加关节松动治疗颈椎小关节紊乱

目的：观察颈椎牵引加关节松动治疗颈椎小关节紊乱的疗效。方法：该方法与传统的颈椎牵引加手法复位对照观察。结果;该法优良率明显高于传统疗法．且复发率明显降低。结论：该法是治疗颈椎小关节紊乱有效安全的方法。     

旋转复位为主治疗颈性眩晕的临床效果

目的探讨采用以旋转复位为主配合手法按摩治疗因颈椎环枢关节紊乱所致的颈性眩晕的临床效果。方法将门诊和住院的颈性眩晕患64例分为治疗组和对照组，治疗组32例采用以旋转复位为主配合手法按摩。对照组32例采用颈部牵引配合物理治疗。结果两组疗效有显差异。治疗组的疗效明显优于对照组，愈显率90．62％。结论因颈椎侧弯、后突、错位造成环枢关节紊乱致椎-基底动脉供血不足的颈性眩晕以旋转复位为主加手法按摩治疗，具有操作便利、轻巧、可靠、疗效迅速的特点。对颈件眩晕的治疗起主导作用。     

颈椎病影像研究及康复疗效分析

目的对600例颈椎X线平片影像分析,结合临床症状及体征,采用物理综合治疗,以探讨颈椎病的最佳疗效。方法采用手法推拿并颈椎牵引综合疗法(综合组),对200例颈椎病患者进行疗效观察,并与单纯手法推拿和单纯颈椎牵引治疗的各200例作对比,至治疗结束时评定疗效,统计数据经Ridit分析法处理。结果综合组治愈显效率、总有效率分别为64.5%及98%。单纯手法推拿组为58%及97%,单纯颈椎牵引组为54.5%及93.5%,综合组的治愈显效率明显优于其他2组(χ2=6,P＜0.05)。结论手法推拿并颈椎牵引治疗方法能明显提高疗效,具有较好的临床实用价值,宜推广应用。     

手法复位配合中药治疗椎动脉型颈椎病92例

由颈椎退行性变引起的肌痉挛、骨质增生、小关节紊乱、炎症等因素刺激椎动脉而导致的椎动脉型颈椎病,临床较常见.近年来,作者采用手法复位配合中药辨证治疗椎动脉型颈椎病92例,获得满意的疗效,现报告如下.     

颈椎手法结合关节松动术治疗颞下颌关节紊乱症的疗效观察

目的:探讨颈椎手法治疗结合关节松动术治疗颞下颌关节紊乱症的临床疗效观察。方法:将60例颞下颌关节紊乱症的患者按随机分为颈椎手法结合关节松动术(A组20例)、颈椎手法治疗组(B组20例)、关节松动术治疗组(C组20例)。比较3组患者治疗前后的VAS疼痛评分与临床疗效。结果:治疗20d后,3组的VAS评分均较治疗前明显降低(P0.01),而A组更低于B组、C组;3组的临床疗效比较,有效率均为100%,而A组的显效率均高于B组、C组(P0.05)。结论:颈椎手法结合关节松动术治疗颞下颌紊乱症的疗效优于单纯颈椎手法治疗和单纯关节松动术治疗。     

旋转复位与牵引治疗神经根型颈椎病的随机对照疗效分析

目的：探讨旋转复位手法治疗神经根型颈椎病的效果。方法：选择100例神经根型颈椎病患者，随机分为手法组和牵引组，两组均加物理因子治疗(超短波和电脑中频)。治疗4周及8周后评定疗效。结果：在4周后手法组有效43例，总有效率为86．0％；牵引组有效29例，总有效率为58．0％，两组差异有显著性意义(χ^2=5．49，P&;lt;0．05)；在8周后手法组总显效例数42例，总显效率为84．0％；牵引组总显效例数27例，总显效率54．0％，两组差异有显著性意义(χ^2=5．79，P&;lt;0．05)，说明手法组有效率较牵引组高。结论：旋转复位手法较颈椎牵引疗效佳。     

自制颈椎牵引摇摆按摩枕治疗颈椎病的临床研究

目的探讨方便、简单、成本低、无副作用、有效的防治颈椎病的方法.方法设计颈椎牵引、摇摆、按摩颈椎病治疗枕治疗120例,与传统枕颌布带颈椎牵引103例比较,观察临床疗效.结果研究组平均治疗4.03疗程,对照组平均治疗5.55疗程,明显缩短病程,痊愈率为P<0.01.结论颈椎牵引有利于增宽椎间隙,促进髓核位移或部分缩小.摇摆调整颈椎各小关节功能紊乱,使错位小关节恢复功能位,减少神经、血管压迫和刺激,纠正内平衡.多乳头交替按摩,松解颈背部软组织痉挛,改善外平衡.     

Cervical zygapophysial (facet) joint pain: effectiveness of interventional management strategies

Diagnostic facet joint nerve blocks have been utilized in the diagnosis of cervical facet joint pain in patients without disk herniation or radicular pain due to a lack of reliable noninvasive diagnostic measures. Therapeutic interventions include intra-articular injections, facet joint nerve blocks and radiofrequency neurotomy. The diagnostic accuracy and effectiveness of facet joint interventions have been assessed in multiple diagnostic accuracy studies, randomized controlled trials (RCTs), and systematic reviews in managing chronic neck pain.

This assessment shows there is Level II evidence based on a total of 11 controlled diagnostic accuracy studies for diagnosing cervical facet joint pain in patients without disk herniation or radicular pain utilizing controlled diagnostic blocks. Due to significant variability and internal inconsistency regarding prevalence in a heterogenous population; despite 11 studies, evidence is determined as Level II. Prevalence ranged from 36% to 67% with at least 80% pain relief as the criterion standard with a false-positive rate ranging from 27% to 63%.

The evidence is Level II for the long-term effectiveness of radiofrequency neurotomy and facet joint nerve blocks in managing cervical facet joint pain. There is Level III evidence for cervical intra-articular injections.     

颈椎后路单开门加侧块内固定治疗椎管狭窄伴不稳

目的 探讨颈椎侧块钢板内固定加后路单开门术治疗颈椎管狭窄合并颈椎不稳定的疗效。方法对21例颈椎管狭窄脊髓损伤合并颈椎不稳定病人，采用Ⅰ期后路单开门减压加侧块钢板内固定，椎间小关节植骨融合术。查体按日本矫形学会joA分级法评定，拍颈椎片观察小关节融合情况。结果经过平均9个月随访，本组术前平均评分为9．5分，术后评分为16．2分，平均改善率86．6％。术后4月复查椎间小关节已融合。CT复查片示开门侧未见有再关门现象。结论侧块内固定加单开门术治疗颈椎管狭窄伴不稳是疗效确切、术式简便的治疗方法。     

颈椎病的X线平片及螺旋CT征象探讨

目的探讨X线平片及螺旋CT扫描对颈椎小关节病变的诊断价值。方法回顾分析156例颈椎病的小关节X线平片及CT表现。结果颈椎小关节病变主要累及颈3～7，其中以颈4-6发生率最高，颈3～4及颈6～7次之。病变可累及多个小关节。结论常规X线平片及CT扫描能够清楚地显示椎小关节的解剖结构及病理改变，为颈椎病的临床的诊断和治疗提供了可靠的影像学依据。     

The Prevalence of Facet Joint-Related Chronic Neck Pain in Postsurgical and Nonpostsurgical Patients: A Comparative Evaluation

Background: Facet (zygapophysial) joints may be clinically important sources of chronic cervical spinal pain. Previous studies have demonstrated the value and validity of controlled, comparative local anesthetic blocks in the diagnosis of facet joint pain, and reported an overall prevalence of 36% to 67% facet joint involvement in cervical spinal pain. The reports of lumbar facet joint‐involvement in postsurgery syndrome have been shown to be highly variable with prevalence ranging from 8% to 32%. To date, however, the prevalence of postsurgical facet joint‐related pain in the cervical spine has not been evaluated. In light of this, the present retrospective study was conducted to assess and compare the prevalence of chronic postsurgical facet joint cervical spinal pain to nonsurgical, chronic cervical facet joint pain. Methods: Patients presenting with chronic neck pain were studied. The procedures were performed by a single physician in an interventional pain management ambulatory surgery center. The prevalence of cervical facet joint pain in postsurgical patients was assessed and compared to nonsurgical patients. Results: A total of 251 patients (45 postsurgery vs. 206 nonsurgical patients) with chronic persistent neck pain were evaluated using controlled, comparative local anesthetic blocks in accordance with IASP criteria. The prevalence of the cervical facet joint pain and false‐positive rate of single blocks in postsurgical patients were 36% and 50% compared with 39% and 43% in nonsurgical patients. Conclusions: Cervical facet joints are clinically important pain generators in a significant proportion of patients with chronic persistent neck pain after surgical intervention(s). The prevalence of cervical facet joint pain was similar in both postsurgical and nonsurgical patients. ?     

颈椎间关节面的形态和面积与颈椎病的关系

目的探讨颈椎间关节面的形态和面积与颈椎病的关系。方法在 5 0套增生的成套颈椎骨中 ,调查了不同颈椎的骨质增生率及椎体不同部位的增生率。同时观测另 45套正常成人颈椎标本椎间关节面的形态和面积。结果颈椎间关节面的形态分为圆型、椭圆型和不规则型 ,以椭圆型占优势 ,各节段下关节面的面积均大于上关节面的面积。但仅在C4— 5和C5— 6有显著性差异 (t =2 .0 0 -2 .2 4,P <0 .0 5 )。结论颈椎间关节面的面积和形态与其骨质增生有一定的关系。     

Utilization of Facet Joint and Sacroiliac Joint Interventions in Medicare Population from 2000 to 2014: Explosive Growth Continues!

Increasing utilization of interventional techniques in managing chronic spinal pain, specifically facet joint interventions and sacroiliac joint injections, is a major concern of healthcare policy makers. We analyzed the patterns of utilization of facet and sacroiliac joint interventions in managing chronic spinal pain. The results showed significant increase of facet joint interventions and sacroiliac joint injections from 2000 to 2014 in Medicare FFS service beneficiaries. Overall, the Medicare population increased 35 %, whereas facet joint and sacroiliac joint interventions increased 313.3 % per 100,000 Medicare population with an annual increase of 10.7 %. While the increases were uniform from 2000 to 2014, there were some decreases noted for facet joint interventions in 2007, 2010, and 2013, whereas for sacroiliac joint injections, the decreases were noted in 2007 and 2013. The increases were for cervical and thoracic facet neurolysis at 911.5 % compared to lumbosacral facet neurolysis of 567.8 %, 362.9 % of cervical and thoracic facet joint blocks, 316.9 % of sacroiliac joints injections, and finally 227.3 % of lumbosacral facet joint blocks.     

Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study

Purpose

The aim of this study was to determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction.

Methods

Sixty ambulatory women between the ages of 18 and 40 years with cervical facet joint pain of more than 30-day duration and normal neurologic examination were randomized to receive 1 of 3 treatment options: (1) CMT of the cervical spine, (2) LLLT applied to the cervical facet joints, or (3) a combination of CMT and LLLT. Each participant received 6 treatments in 3 weeks. The main outcome measures were as follows: the Numerical Pain Rating Scale, Neck Disability Index, Cervical Range of Motion Instrument, and Baseline Digital Inclinometer. Measurements were taken during weeks 1 (baseline), 2, 3, and 4.

Results

No differences existed between the 3 groups at baseline. A significant difference was seen between groups 1 (CMT) and 2 (LLLT) for cervical flexion, between groups 1 (CMT) and 3 (CMT + LLLT) for cervical flexion and rotation, and between groups 2 (LLLT) and 3 (CMT + LLLT) for pain disability in everyday life, lateral flexion, and rotation.

Conclusion

All 3 groups showed improvement in the primary and secondary outcomes. A combination of CMT and LLLT was more effective than either of the 2 on their own. Both therapies are indicated as potentially beneficial treatments for cervical facet dysfunction. Further studies are needed to explore optimal treatment procedures for CMT and LLLT and the possible mechanism of interaction between therapies.     

Morphologic Evaluation of Cervical and Lumbar Facet Joints: Intra‐Articular Facet Block Considerations

Study Design: Needle orientations for lumbar and cervical facet injection were measured in cadavers and compared with facet angles measured on magnetic resonance images (MRIs). Objectives: To establish facet orientation relative to clinical procedures of a facet joint block in the cervical and lumbar spine. Methods: Needle orientation angles were measured from 20 unembalmed human cadaveric specimens (13 cervical and 7 lumbar). Spinal needles were inserted into the midpoints of the facet joint spaces from C3 to C7 and L1 to L5. Needle trajectories were measured with an optical tracking system. For comparison, facet angles from 100 clinical MRIs of lumbar spines were also measured. Facet orientations on MRIs were measured at their intersection with the transverse plane, and angles were quantified using image analysis software. Results: Typical angles for insertion of the needle into the cervical facets were oriented closer to the coronal plane, whereas insertion angles for lumbar needles were oriented closer to the sagittal plane. Relative to the sagittal plane, the mean cervical angle was 72 degrees and the mean lumbar angle was 33 degrees. The insertion points of the cervical facets were a mean of 29 mm from the midsagittal plane compared with a mean of 22 mm for the lumbar facets. MRI‐based facet joint angles correlated poorly with actual injection angles, which were overestimated 5 to 23 degrees, depending on the lumbar level. Conclusions: Knowledge of the quantitative anatomy of the facets may help improve clinical diagnosis and treatment. These data also may aid in constructing more realistic computer simulations.     

A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation

Objectives:

Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Rotatory thrust manipulation applied to the lower cervical segments is associated with controversy and the potential for eliciting adverse reactions (AR). The purpose of this clinical trial was to describe two translatory non-thrust mobilization techniques and evaluate their effect on cervical pain, motion restriction, and whether any adverse effects were reported when applied to the C7 segment.

Methods:

This trial included 30 participants with painful and restricted cervical rotation. Participants were randomly assigned to receive one of the two mobilization techniques. Active cervical rotation and pain intensity measurements were recorded pre- and post-intervention. Within group comparisons were determined using the Wilcoxon signed-rank test and between group comparisons were analyzed using the Mann–Whitney U test. Significance was set at P = 0.05.

Results:

Thirty participants were evaluated immediately after one of the two mobilization techniques was applied. There was a statistically significant difference (improvement) for active cervical rotation after application of the C7 facet distraction technique for both right (P = 0.022) and left (P = 0.022) rotation. Statistically significant improvement was also found for the C7 facet gliding technique for both right (P = 0.022) and left rotation (P = 0.020). Pain reduction was statistically significant for both right and left rotation after application of both techniques. Both mobilization techniques produced similar positive effects and one was not statistically superior to the other.

Discussion:

A single application of both C7 mobilization techniques improved active cervical rotation, reduced perceived pain, and did not produce any AR in 30 patients with neck pain and movement limitation. These two non-thrust techniques may offer clinicians an additional safe and effective manual intervention for patients with limited and painful cervical rotation. A more robust experimental design is recommended to further examine these and similar cervical translatory mobilization techniques.     

颈椎小关节切除前后的蠕变特性

背景：创伤和颈椎退变都会使颈椎丧稳定性,需手术治疗,有时需切除小关节,目前对单独切除小关节后的蠕变特性评价鲜有报道。目的：比较正常颈椎标本和切除颈椎C5~6小关节的蠕变力学特性,确定小关节切除是否对蠕变力学特性造成影响。方法：在日本岛津电子万能试验机上对正常和切除小关节标本进行蠕变实验,模拟人体温在（36.5±0.5）℃的温度场下以5%/s的应变增加速度对标本施加应力,设定时间为7200s。采集100个数据采用三参数模型计算蠕变方程。结果与结论：正常和小关节切除颈蠕变曲线是以指数关系变化的,在最初600s应变变化较快,随时间延长应变缓慢上升,正常和小关节切除组7200s蠕变量差异显著（P〈0.05）。说明三参数模型计算简便,能很好的拟合蠕变曲线,通过这种理想化的方程,可以定量说明两组标本差异显著。