优值牵引法配合牵复三步法治疗神经根型颈椎病的临床疗效研究

目的:观察优值牵引法配合牵复三步法治疗神经根型颈椎病的疗效。方法:神经根型颈椎病的患者70例,随机分为常规组34例,联合治疗组36例。常规组采用颈部中药熏洗、颈部推拿、颈部常规牵引治疗;联合治疗组采用优值牵引法配合牵复三步法治疗。2组患者均于治疗前、治疗2周后采用神经根型颈椎病症状、体征积分表、疼痛视觉模拟评分表(VAS)作为临床观察指标。结果:治疗前,2组患者的神经根型颈椎病临床症状、体征积分和VAS评分差异无统计学意义。治疗2周后,2组患者的神经根型颈椎病临床症状、体征积分和VAS评分与治疗前及组间比较,差异均有统计学意义(P0.05)。常规组显效率为35.3%,联合治疗组显效率为58.3%,联合治疗组疗效明显优于常规治疗组,2组间疗效比较差异有统计学意义(P0.05)。结论:优值牵引法配合牵复三步法治疗神经根型颈椎病,具有疗程短、效果迅速、促使功能恢复快等优点,值得临床选用。     

不同的牵引方法对颈椎病疗效的影响

我们采用不同的牵引方法治疗颈椎病357例,全部病例均确诊后传入我科,其中颈型101例,神经根型256例:男性195人,女性162人:年龄在20～70岁之间,40岁以上多见,为300例。症状及体征:患者多以颈痛、肩臂手指疼痛或麻木来就诊,体征以椎旁压痛,颈肌紧张痉挛、棘椎棘突偏歪、压颈试经及上肢牵拉试验     

颈下部神经根阻滞治疗根型颈椎病47例

颈部硬膜外阻滞操作复杂，技术要求高，危险性大，难以在门诊进行。我院疼痛门诊采用颈下部神经根阻滞治疗根型颈椎病47例，效果满意。本组47例中男29例，女18例，34～68岁，病程2个月～5年。其中，21例病人经服药、牵引、推拿、按摩等多种治疗，效果欠佳。此47例中诊断为单纯神经根型颈椎病42例，混合型颈椎病5例（神经根型和椎动脉型混合者4例，神经根型和交感神经型混合者1例），单侧颈肩臂痛、手指麻木、颈肌痉挛、颈部活动受限者42例，双侧都有症状者5例，颈椎X片均显示颈椎曲度改变或骨质增生，其中13例示椎间隙变窄。方法：患者仰卧…     

微波、多角度分次牵引法在治疗神经根型颈椎病中的应用

疼痛、上肢麻木、颈部活动受限是神经根型颈椎病常见症状,采用颈椎牵引仍是治疗的方法.随着检测水平的提高,发现多节神经根受累的颈椎间盘突出或膨隆患者,在牵引中部分患者往往出现疼痛加剧和心悸、头晕、恶心、出冷汗等不良反应,为了提高牵引的耐受性和效果,根据神经根型颈椎病颈部解剖特点及神经根受压周围炎性病变特性,应用微波、多角度分次牵引方法治疗收到良好的效果.     

微波、多角度分次牵引法在治疗神经根型颈椎病中的应用

疼痛、上肢麻木、颈部活动受限是神经根型颈椎病常见症状，采用颈椎牵引仍是治疗的方法。随着检测水平的提高，发现多节神经根受累的颈椎间盘突出或膨隆患者，在牵引中部分患者往往出现疼痛加剧和心悸、头晕、恶心、出冷汗等不良反应，为了提高牵引的耐受性和效果，根据神经根型颈椎病颈部解剖特点及神经根受压周围炎性病变特性，应用微波、多角度分次牵引方法治疗收到良好的效果。     

穴位点按联合背景音乐在神经根型颈椎病牵引护理中的应用

[目的]探讨穴位点按联合背景音乐对神经根型颈椎病牵引效果的影响。[方法]将100例神经根型颈椎病行牵引治疗的病人随机分为对照组和观察组,每组50例,对照组给予牵引治疗及牵引常规护理,观察组在牵引治疗及常规护理的基础上联合运用穴位点按及背景音乐,观察两组干预后病人疼痛评分、症状体征和功能状态积分、改善指数。[结果]观察组干预后疼痛评分、症状体征和功能状态积分、改善指数明显优于对照组,经比较差异有统计学意义(P0.01)。[结论]穴位点按联合背景音乐能缓解疼痛,提高神经根型颈椎病改善指数、增强神经根型颈椎病牵引疗效。     

整脊手法配合加味葛根汤治疗神经根型颈椎病疗效观察

目的：观察整脊手法与加味葛根汤联合治疗神经根型颈椎病的临床效果。方法：将60例神经根型颈椎病患者随机分为治疗组和对照组各30例。治疗组采用整脊手法配合加味葛根汤治疗,对照组采用整脊手法治疗。比较两组临床疗效及疼痛评分。结果：治疗组治疗总有效率为96.7%,高于对照组的73.3%,差异具有统计学意义（P＜0.05）。两组治疗前疼痛评分比较无显著性差异（P＞0.05）;治疗组治疗后疼痛评分低于对照组,差异具有统计学意义（P＜0.05）。结论：整脊手法配合加味葛根汤治疗神经根型颈椎病能有效改善患者颈椎失稳的病况,有效恢复颈椎生理曲度,同时缓解颈部周围组织对神经根部的压迫,改善临床症状。     

优值牵引法配合旋转手法复位治疗神经根型颈椎病的护理

神经根型颈椎病是颈椎病最常的一种,占颈椎病大约65％,患者主要表现为颈肩部疼痛,还有颈神经刺激症状,向上臂前臂或手指放射与脊神经根分部区相一致的感觉、运动障碍。常见上肢疼痛或手指麻木有触电感,时有上肢握力减弱,持物有失落感。因颈部屈伸旋转而上述症状加重。2008--2009年我院采取优值角度牵引法配合转手法复位治疗神经根型颈椎病182例,效果满意,现将护理体会报道如下。     

中医导引与整脊治疗神经根型颈椎病的疗效分析

目的探讨中医导引与整脊手法治疗神经根型颈椎病的疗效,观察骨质增生与神经根受压致痛的关系.方法治疗组采用中医导引与整脊治疗,对照组采用中频牵引治疗分析比较两组的疗效.结果治疗组治愈率 84.6 %,总有效率 96.66 %,中频牵引对照组治愈率 56.17 %,总有效率 80.89 %.中医导引与整脊治疗效果好于中频牵引治疗.结论导引整脊法治疗神经根型颈椎病效果佳,安全可靠,有明显缓解疼痛效果.     

负压干扰波配合牵引治疗神经根型颈椎病的疗效观察

目的探讨负压干扰波配合牵引治疗神经根型颈椎病的有效性,为神经根型颈椎病的治疗提供科学的治疗方法。方法将120例神经根型颈椎病患者随机分为两组,对照组50例予以单纯牵引治疗,观察组70例以负压干扰波配合牵引治疗。结果两组患者在症状、体征变化上有显著差异,经统计分析,治疗组疗效优于对照组（P〈0.01）。结论负压干扰波配合牵引治疗神经根型颈椎病,发挥了两种疗法的协同作用,提高了疗效。     

微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的对比研究

目的探讨微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的疗效。方法统计贵阳医学院附属医院2011年5月至2012年5月收治的微创保胆取石治疗胆结石患者100例和腹腔镜胆囊切除治疗胆结石患者173例,保胆患者作为治疗组术后均口服牛磺熊去氧胆酸,胆囊切除患者作为对照组术后给予常规抗炎支持治疗,所有患者术后平均随访时间为1年,统计各组患者胆石症状改善情况和治疗组患者的胆囊壁厚、胆囊功能水平和结石复发率。结果治疗组患者手术前胆绞痛、腹胀、右上腹不适发生率分别为47.1%、21.8%、100%,胆囊壁厚为(3.42±0.49)mm,手术后1年胆绞痛、腹胀、右上腹不适发生率分别为2.3%、9.2%、2.3%,胆囊壁厚为(2.57±0.69)mm;胆囊结石患者组胆囊排空指数为43.11±20.82,保胆取石术后两年患者组胆囊排空指数为56.00±10.77,正常组胆囊排空指数为56.65±13.45,患者手术前后胆石症状、胆囊壁厚的差异均具有统计学意义(P<0.05),保胆取石术后两年患者组胆囊排空指数与正常组差异无统计学意义(P>0.05),而与胆囊结石组患者组差异有统计学意义(P<0.05);术后1年治疗组患者腹泻、腹胀、右上腹不适症状发生率分别为2.3%、9.2%、2.3%,对照组患者腹泻、腹胀、右上腹不适症状发生率分别为33.6%、25.5%、17.3%,两组之间胆石症状的差异均具有统计学意义(P<0.05),治疗组患者术后胆固醇结石复发率有降低趋势。结论保胆取石术后口服牛磺熊去氧胆酸对术后患者胆囊功能的恢复及预防胆囊胆固醇结石的复发有重要意义。     

Chiropractic management of a professional hockey player with recurrent shoulder instability

OBJECTIVE: To describe the clinical management of recurrent shoulder instability in a professional hockey player by using chiropractic management and rehabilitation exercises. CLINICAL FEATURES: A 23-year-old professional hockey player with recurrent left shoulder pain and instability. He had two previous unsuccessful shoulder operations to correct the instability. He reported that the shoulder "slips out" in positions of abduction and external rotation or when the left arm is moved suddenly above shoulder height. The patient was still playing hockey professionally at the time of the initial visit and did not want to have to take time off for another surgery, so he chose to attempt a conservative approach. INTERVENTION AND OUTCOME: The patient had undergone strength training for rehabilitation after each of the previous two shoulder operations and had very strong rotator cuff and scapular musculature. Proprioceptive testing revealed a poor response in the left shoulder compared with the right shoulder. Two subjective outcome measures were used to determine the effectiveness of the treatment protocol in reducing the symptoms of recurrent shoulder instability. Much of the treatment focused on proprioceptive training, soft tissue mobilization, and improving joint function. CONCLUSION: This case demonstrates the potential benefit of chiropractic management and proprioceptive exercises to decrease the symptoms of recurrent shoulder instability.     

“蠲痹益颈方”治疗风寒湿型颈椎病的临床研究

目的 观察探讨“蠲痹益颈方”治疗风寒湿型颈椎病的临床疗效。方法 选取符合纳入标准的风寒湿型颈椎病患者随机分为两组各30例。试验组予自拟方“蠲痹益颈方”治疗,对照组予以“颈复康颗粒”治疗。观察4个时间节点的视觉模拟评分法（Visual Analogue Scale,简称 VAS评分）、颈椎功能障碍指数评分（Neck Disability Index,简称 NDI评分）及中医证候评分。结果 两组患者的一般资料及治疗前的观察指标均无统计学差异（P＞0.05）,具有可比性;治疗后1周、治疗后2周及治疗2周后随访两组患者的VAS评分、NDI评分及中医证候评分各自进行组间比较,得出蠲痹益颈方及颈复康颗粒均能缓解风寒湿型颈椎病患者疼痛、改善患者颈部障碍及颈肩部症状（P＜0.05）;蠲痹益颈方在治疗风寒湿型颈椎病方面其缓解患者疼痛、改善患者颈部功能障碍及颈肩部症状方面疗效要优于颈复康颗粒（P＜0.05）;蠲痹益颈方能够有效治疗风寒湿型颈椎病。结论 蠲痹益颈方在缓解风寒湿型颈椎病患者的疼痛、改善患者颈部功能障碍及颈肩部症状方面的疗效佳,值得临床推广使用。     

康复治疗改善乳腺癌患者患侧上肢肿胀、疼痛及功能的临床疗效

目的:观察上肢强化锻炼结合加压按摩对乳腺癌根治术后序贯化放疗患者上肢活动度、疼痛、麻木及及水肿情况的影响。方法:收集乳腺癌患者60例,随机分为观察组及对照组各30例,2组患者均行根治术及术后序贯化放疗。观察组在放射治疗开始后给予患侧上肢强化锻炼及加压按摩3个月。治疗前后评估2组患者治疗前后患肢的活动度、患侧上肢/健侧上肢周径差、患肢疼痛及患肢麻木情况。结果:放疗后,2组患者肩关节各方向活动度均较治疗前明显减小(P0.05),但观察组活动度明显大于对照组(P0.05)。放疗后,2组患侧疼痛VAS评分及患、健上臂周径差均较放疗前明显增加(P0.05),但观察组VAS评分及患、健上臂周径差均明显小于对照组(P0.05)。放疗后,对照组麻木率较放疗前明显增加(P0.05),观察组较放疗前差异无统计学意义,并明显低于对照组治疗后(P0.05)。结论:乳腺癌根治术及术后序贯化放疗可导致患者上肢活动度受限、疼痛、麻木和水肿,而上肢强化锻炼结合加压按摩可以减轻患者患肢淋巴水肿,改善乳腺癌患者上肢运功功能,疼痛及麻木症状。     

肩部常见软组织压痛点的临床研究

目的: 明确肩部软组织损伤性疾病常见压痛点的分布规律及临床特征。方法:对54例主诉肩部疼痛的患者行仔细的局部压痛点指压检查及解剖定位,并进行视觉模拟评分（VAS）疼痛量化评分。结果: 按压痛的发生率,肩部软组织损伤的常见压痛点主要分布于上斜方肌、冈下肌、肩峰下、喙突、肱骨结节间沟、喙突与肱骨小结节间、肱骨小结节以及肩胛骨外侧缘等处,且以上斜方肌、冈下肌、喙突、肱骨小结节和肩峰下等处的压痛最明显。结论: 肩部压痛点分布广泛,以三角肌区前部和肩胛区的压痛点最多且压痛最明显。肩部软组织损伤以肌筋膜痛多见,其压痛多为1处;而冻结肩和肩袖损伤的压痛点则较多。临床诊治肩部软组织痛时,应考虑上述特点。     

Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial

Regular physical exercise is a cornerstone in rehabilitation programs, but adherence to comprehensive exercise remains low. This study determined the effectiveness of small daily amounts of progressive resistance training for relieving neck/shoulder pain in healthy adults with frequent symptoms; 174 women and 24 men working at least 30 h per week and with frequent neck/shoulder pain were randomly assigned to resistance training with elastic tubing for 2 or 12 minutes per day 5 times per week, or weekly information on general health (control group). Primary outcomes were changes in intensity of neck/shoulder pain (scale 0 to 10), examiner-verified tenderness of the neck/shoulder muscles (total tenderness score of 0 to 32), and isometric muscle strength at 10 weeks. Compared with the control group, neck/shoulder pain and tenderness, respectively, decreased 1.4 points (95% confidence interval −2.0 to −0.7, p < 0.0001) and 4.2 points (95% confidence interval −5.7 to −2.7, p < 0.0001) in the 2-minute group and 1.9 points (95% confidence interval −2.5 to −1.2, p < 0.0001) and 4.4 points (95% confidence interval −5.9 to −2.9, p < 0.0001) in the 12-minute group. Compared with the control group, muscle strength increased 2.0 Nm (95% confidence interval 0.5 to 3.5 Nm, p = 0.01) in the 2-minute group and 1.7 Nm (95% confidence interval 0.2 to 3.3 Nm, p = 0.02) in the 12-minute group. In conclusion, as little as 2 minutes of daily progressive resistance training for 10 weeks results in clinically relevant reductions of pain and tenderness in healthy adults with frequent neck/shoulder symptoms.Trial registration: www.isrctn.org/ISRCTN60264809.     

Chiropractic treatment of postsurgical neck syndrome with mechanical force, manually assisted short-lever spinal adjustments

OBJECTIVE: To describe a case of postsurgical neck pain, after multiple spinal surgeries, that was successfully treated by chiropractic intervention with instrumental adjustment of the cervical spine. CLINICAL FEATURES: A 35-year-old woman had chronic neck pain for over 5 years after two separate surgeries of the cervical spine: a diskectomy at C3/4 and a fusion at C5/6. Surgeries were performed 6 months apart in an attempt to resolve persistent neck pain and spasm of the cervical musculature. Neither surgery was effective in relieving the patient's pain. Five years after the second surgery, a third surgery was recommended by the patient's physicians to alleviate the chronic pain. The patient sought chiropractic evaluation of her condition to avoid further surgical intervention. INTERVENTION AND OUTCOME: The patient was treated with conservative instrumental chiropractic manipulation, consisting of mechanical force, manually assisted short-lever spinal adjustments rendered with an Activator Adjusting Instrument (AAI) II. She comfortably tolerated the treatment and responded favorably to this therapy. All chronic symptoms had resolved within 30 days of instituting the chiropractic instrumental adjustments with an AAI. More interestingly, longitudinal examination over the next 2 years showed that the patient experienced no residual effects or further recurrences of her previous chronic problem after her initial course of chiropractic care. CONCLUSION: Chiropractic treatment of postsurgical neck syndrome may be effectively treated, in certain cases, by mechanical force, manually assisted adjusting procedures with an AAI. The use of instrumental adjustment methodology may provide chiropractic physicians with an effective alternative to manual manipulation in those cases in which the patient's surgical history or presenting symptoms make forceful manipulation of the spine, particularly performed at end range, inappropriate. This approach may be contemplated by physicians faced with managing this type of condition. Further study should be made in this regard, in an academic research setting, to determine the safest and most effective approaches to managing postsurgical patients in a chiropractic setting.     

微创去腐技术治疗龋齿的临床观察

目的：评价微创技术在龋齿治疗中的去腐效果。方法：选择有龋齿的患者90例（112颗）按门诊就诊顺序随机分为试验组和对照组,每组各45例。试验组用Carisolv（伢典）微创去腐技术去龋,对照组用传统高速牙钻机械去腐备洞,随访18个月,评价治疗过程中的疼痛程度及远期疗效。结果：微创去腐技术治疗的远期效果与传统机械法相比无显著差异（P〉0.05）,但治疗过程中疼痛程度极低。结论：微创去腐技术治疗龋病有去腐效果,该法安全、有效、无痛,有临床应用价值。     

肌内效贴对脑卒中患者肩关节半脱位后肩痛的疗效观察

目的:观察肌内效贴对脑卒中患者偏瘫侧肩关节半脱位后肩痛的疗效。方法:56例脑卒中肩关节半脱位后肩痛患者,按照随机数字表法分为治疗组与对照组(各28例),两组患者均实施常规康复治疗及宣教,治疗组在此基础上结合肌内效贴干预。分别于治疗前和治疗6周后通过X线测量法测量肩峰与肱骨头间距(AHI)、肩关节视觉模拟评分(VAS)疼痛、Fugl-Meyer上肢功能评分、肩痛侧腋神经及肌皮神经的运动神经传导测定,对两组治疗结果进行疗效评价。结果:治疗前,两组患者AHI值、VAS评分、Fugl-Meyer上肢功能评分无明显差异(P0.05),且检测所有患者肩痛侧腋神经(刺激部位:Erb点;记录部位:三角肌)及肌皮神经(刺激部位:Erb点;记录部位:肱二头肌)后发现两组中某些患者肌皮神经(30例,53.57%)、腋神经(31例,55.36%)波幅明显低于正常值,而潜伏期轻度延长或正常(提示轴索损伤)。两组治疗6周后,治疗组各项评分改善优于对照组(P0.05)且无不良事件发生。结论:在常规康复治疗的基础上,肌内效贴在脑卒中患者偏瘫侧肩关节半脱位后肩痛早期防治中,具有良好的疗效,其相应机制有待进一步研究。     

高位结扎联合腔内钬激光治疗大隐静脉曲张的疗 效

目的 探讨高位结扎联合腔内钬激光治疗大隐静脉曲张的临床疗效.方法 将90例大隐静脉曲张患者按治疗方法不同分为2组：微创组40例采用高位结扎联合腔内钬激光治疗,对照组50例采用传统手术方法治疗.比较2组的手术时间、术后住院时间、切口数目、复发率及皮下淤血、小腿皮肤麻木感发生情况.结果 微创组患者伤口均一期愈合,无感染病例,大部分患者下肢症状减轻或消失.所有患者随访1～20个月,均无活动障碍及下肢深静脉血栓形成.微创组的手术时间、切口数目、术后住院时间及皮下淤血、小腿皮肤麻木感发生率都较对照组明显减少,差异有统计学意义（P＜0.05）.结论 高位结扎联合腔内钬激光治疗与传统手术方法比较具有切口少、手术时间短、恢复快、住院时间短、术后并发症少等优点;但在临床广泛应用仍有其局限性.