Adductor T reflex abnormalities in patients with decreased patellar reflexes

The adductor reflex (AR) is a tendon reflex that has various features that differ from other tendon reflexes. This reflex was tested in different disorders presenting with diminished patellar reflexes such as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), L2–L4 radiculopathy, and distal symmetric diabetic neuropathy (diabetic PNP). The AR and crossed‐AR (elicited by tapping the contralateral patellar tendon) were recorded using concentric needle electrodes. Additionally, the patellar T reflex (vm‐TR) and vastus medialis H reflex (vm‐HR) were recorded using surface electrodes. AR was recorded in only one out of eight patients with DLRPN, but it was recorded in 21 out of 22 patients with L2–L4 radiculopathy (95.5%). Of these reflexes, only AR showed prolonged latency in the L2–L4 radiculopathy group. The latencies of AR, vm‐TR, and vm‐HR were prolonged in patients with diabetic PNP. We conclude that AR can be useful in the differential diagnosis of some lower motor neuron disorders that present with patellar reflex disturbance. Muscle Nerve 40: 264–270, 2009     

低温等离子髓核成形术治疗神经根型颈椎病的临床观察

目的:评估低温等离子髓核成形术治疗神经根型颈椎病的临床疗效并探讨其作用机制。方法 :2015年1月至2017年1月应用低温等离子髓核成形术治疗神经根型颈椎病21例,男8例,女13例;年龄43~61岁,平均49.6岁;病程1~6个月,中位数4个月;单节段病变3例,双节段9例,3节段7例,4节段2例。比较手术前后椎间盘压力、VAS评分;通过影像学资料测量手术椎体角度位移和椎体水平位移,观察颈椎的稳定性;采用改良Mac Nab评定标准评定疗效。结果:20例患者均获得随访,时间6~12个月,平均8.6个月。术前及术后即刻椎间盘内压力分别为(32.0±5.26)cm H2O和(21.0±7.18)cm H2O,差异有统计学意义(P=0.003)。术前椎体角度位移、椎体水平位移为(3.85±1.26)°和(1.23±0.58)mm;术后6个月为(4.18±1.31)°和(1.69±0.46)mm,差异无统计学意义(P0.05)。术后3 d、3个月和6个月VAS评分分别为3.51±0.49、2.63±0.61、2.56±0.71,较术前的7.49±0.53明显改善(P0.05)。术后3 d、3个月、6个月采用改良Mac Nab评价疗效,优分别为6、10、12例,良分别为7、5、6例,可分别为4、3、1例,差分别为3、2、1例。术后6个月疗效优于术后3 d和术后3个月(P0.05),术后3个月优于术后3 d(P0.05)。结论 :低温等离子髓核成形术治疗神经根型颈椎病可以有效缓解颈肩臂痛,并可以缓解头痛、头晕等伴随症状。     

定点侧屈旋扳整颈手法对神经根型颈椎病椎间孔的形态学影响

目的 基于三维重建技术分析定点侧屈旋扳整颈手法治疗神经根型颈椎病（cervical spondylotic radiculopathy, CSR）患者椎间孔形态的变化,为手法治疗的有效性提供依据。方法 对40例CSR患者给予定点侧屈旋扳整颈手法治疗,隔日1次,共治疗7次,2周为1个疗程。利用多功能CT、Mimics 21.0、Geomagic、SolidWorks 2017软件对患者治疗前后CT数据进行三维重建分析,分别测量患者治疗前后椎间孔面积、椎间孔前后径、椎间孔上下径以及双侧颈肩部、上肢前侧、上肢后侧红外热成像温差值,并观察患者治疗前以及治疗7、14 d和1月随访时的VAS评分。结果 40例患者治疗后椎间孔面积、前后径、上下径较治疗前均得到改善,治疗前后患者红外热成像温差值均具有统计学意义。患者VAS评分呈逐级递减式下降。结论 定点侧屈旋扳整颈手法可以显著改善CSR患者的椎间孔形态,以此达到解除神经压迫的治疗目的。     

Measurement of outcomes for patients with centralising versus non-centralising neck pain

Objective: The purpose of this study is to determine whether individuals with neck pain who demonstrate centralisation of symptoms have more favourable outcome than individuals who do not demonstrate centralisation.

Methods: Eleven subjects with neck pain were evaluated and treated by two physical therapists certified in Mechanical Diagnosis and Therapy (MDT). Eleven physical therapy patients underwent a routine initial evaluation and were treated 2–3 times per week using MDT principles and other physical therapy interventions. The Neck Disability Index (NDI) tool was administered at the initial examination, approximately 2?weeks following the initial examination, each subsequent re-evaluation, and at discharge from the study to measure changes in functional outcomes for each subject. Patients continued with treatments until they were discharged or removed from the study. Four subjects were referred back to their physician by treating physical therapist secondary to non-centralisation (NC) and worsening of symptoms.

Results: Of the 11 subjects, six demonstrated centralisation (CEN) and five demonstrated NC. At initial evaluation, the average NDI score for the CEN group was 51.0 (SD?±?19.4) and 56.4 (SD?±?17.6) for the NC group. For the CEN group, the average change in NDI score between initial evaluation and discharge was 41.2 (SD?±?13.2 and 12.2 (SD?±?13.0) for the NC group. The correlation coefficient of CEN and change in NDI score was 0.772 and was statistically significant (P?=?0.005).

Conclusions: In this limited sample, people with neck pain demonstrated more favourable outcomes when the CEN phenomenon was observed. Future research on CEN should be investigated with a larger sample size and with a greater number of clinicians trained in the MDT approach.     

康复疗法治疗神经根型颈椎病150例

目的观察康复疗法治疗神经根型颈椎病的临床疗效。方法将240例神经根型颈椎病患者随机分为治疗组（150例）和对照组（90例）;治疗组采用按摩、颈牵引、理疗等康复治疗,对照组采用颈部枕颌带牵引和药物治疗,疗程60天。结果治疗组的总有效率为89.3%,对照组为83.3%;两组总有效率比较,差异有统计学意义（P〈0.05）。结论康复疗法治疗神经根型颈椎病的临床疗效确切。     

中药内服外治结合手法治疗神经根型颈椎病临床观察

目的:观察中药内服外治结合手法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与对照组各40例,治疗组予中药内服外治(熏洗治疗)并结合手法治疗;对照组予颈椎牵引及口服扶他林肠溶片(双氯芬酸纳缓释片),两组均以2周为1个疗程,比较两组疗效。结果:治疗组治愈11例,好转28例,无效1例;对照组治愈7例,好转22例,无效11例;两组疗效经统计学处理P<0.01,差异有统计学意义。结论:中药内服外治结合手法治疗神经根型颈椎病是有效的方法。     

侧卧位手法治疗神经根型颈椎病的疗效观察

神经根型颈椎病是临床上最为常见的颈椎病类型,多发于中老年人,是由于颈椎间盘退行性改变、颈椎骨质增生及颈部损伤等原因引起脊柱内、外平衡失调,刺激或压迫神经根而引起。推拿治疗时患者一般都采用坐位接受手法治疗。近年来,我院以侧卧体位下利用手法治疗神经根型颈椎病95例,     

单开门椎板成形术联合椎间孔切开术治疗脊髓型合并神经根型颈椎病疗效分析

目的评价颈后路单开门椎管成形术联合椎间孔切开术在治疗颈椎管狭窄症合并单侧神经根型颈椎病中的作用。方法回顾性研究2006年7月至2009年1月44例颈椎管狭窄症合并单侧神经根压迫症状患者,行颈后路单开门椎管成形术联合椎间孔切开术治疗的23例患者为A组,单纯行颈后路单开门椎管成形术治疗的21例患者为B组。引起椎间孔狭窄的原因:椎间盘突出、钩椎关节骨赘形成、关节突增生。神经根症状主要表现为单侧上肢疼痛、感觉减退、肌力下降和反射减弱。A组手术为颈后路单开门椎管成形术联合椎间孔切开术,关节突内侧缘切除范围均小于等于50%;B组仅行颈后路单开门椎管成形术。结果术后随访20～36个月,平均28个月。采用日本骨科协会评分法计算两组髓性症状术后改善率,差异无统计学意义;根性症状术后临床效果评价:A组优18例,良3例,一般2例;B组优7例,良3例,一般9例,差2例。结论对合并有单侧神经根型的颈椎管狭窄症患者,采用颈后路单开门椎管成形术联合椎间孔切开术可取得良好的手术效果。     

Maitland手法结合牵引推拿TDP治疗神经根型颈椎病的临床研究

目的观察Maitland手法结合牵引、推拿、特定电磁波辐射仪(TDP)治疗神经根型颈椎病(cervical spondylotic radicu-lopathy,CSR)的临床疗效和安全性。方法采用随机对照临床试验的方法,将146例CSR患者分为治疗组、对照A组和对照B组进行3个疗程(30 d)的治疗观察。治疗组采用Maitland手法、牵引、推拿、TDP疗法治疗,对照A组采用推拿、牵引、TDP疗法治疗,对照B组采用牵引、TDP疗法治疗。比较3组临床疗效及疼痛评分、颈椎功能评分改善情况。结果治疗结束时,治疗组、对照A组和对照B组的总有效率分别为97.9%、85.7%和65.3%;1个月后随访,3组的总有效率分别为93.7%,77.6%和57.1%;治疗组的总有效率优于对照A组和对照B组(均P0.01)。治疗组疼痛评分差值和颈椎评分差值分别为4.5±1.5和10.4±3.5,对照A组的分别为3.2±1.9和7.6±2.9,对照B组的分别为2.4±1.5和5.2±2.9,治疗组的疼痛评分差值和颈椎评分差值优于对照A组和对照B组(均P0.01)。结论 Maitland手法结合牵引、推拿和TDP治疗CSR具有一定临床时效性、科学性,值得推广。