420例颈椎病患者相关资料统计分析

目的探讨颈椎病的有效防治措施。方法对本院康复医学专科收治的420例颈椎病进行分析。结果本病多在40岁左右发病，起病缓慢，呈反复发作难以彻底治愈。结论颈椎病是中老年多发病．影响着健康和生活质量。发挥医疗卫牛保健网功能，积极采用适官技术，能有效控制病情。恢复生理功能和生活、工作能力。     

椎动脉型颈椎病的彩色多普勒超声诊断

目的 :观察椎动脉型颈椎病的高频彩色多普勒表现和血流动力学变化。方法 :应用彩色多普勒超声诊断仪 (高频探头 ,频率 7～ 10MHz)检测 138例椎动脉型颈椎病患者 (颈椎病组 )的椎动脉 (VH)内径 (D)、血流速度 (V)和血流量 (Q)、阻力指数 (RI)和搏动指数 (PI) ,观察其形态结构、并与 10 0例 (对照组 )进行对照分析。结果 :颈椎病组VA的V(除平均血流速度外 )、D ,Q ,RI,PI与对照组比较差异有显著性 (P <0 0 1)。结论 :高频彩超显示的椎动脉形态和血流参数变化为临床评价椎动脉型颈椎病治疗效果提供了有价值的依据     

Preliminary findings on the effect of load-carrying to the structural integrity of the cervical spine

Summary Carrying loads on the head is a common practice in rural Zimbabwe. Headloading imposes a considerable amount of strain to the axial skeleton. The cervical spine, being the most cranial and mobile part of the vertebral column, may be susceptible to spondylosis or disc degeneration in headloading. Age as well as the effects of intrinsic factors on cervical spondylosis have been well documented. However, studies on the effect of extrinsic weight bearing to spondylosis on the cervical spine are lacking. In this study, the effect of headloading on the pattern of spondylosis attributed to aging was examined. Results indicated that age led to significant degeneration of the fifth intervertebral disc space (P<0.05) as well as significant straightening of the lordotic curve (P<0.01). Load carrying seems to accentuate the straightening of the curve (P<0.001). The results also suggest that headloading creates a shift in the degeneration from the fifth intervertebral disc space to higher levels. It is concluded that carrying heavy loads on the head alters the pattern of degenerative changes of the cervical spine.

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Etude préliminaire des effets des charges lourdes sur l'intégrité structurale de la colonne cervicale

Résumé Porter de lourdes charges sur la tête est une pratique habituelle au Zimbabwe dans les zones rurales. Le port céphalique de charge impose des contraintes considérables au squelette axial. La colonne cervicale, portion crâniale et mobile de la colonne vertébrale, peut présenter une cervicarthrose ou une altération discale en raison du port de charges sur la tête. L'âge et les facteurs intrinsèques déterminant une cervicarthrose ont été bien étudiés. Cependant, l'action éventuelle d'un poids supplémentaire contribuant à la genèse d'une cervicarthrose n'a pas été étudiée. Dans cette étude, les effets du port céphalique de charge sur l'importance d'une cervicarthrose attribuée au vieillissement, sont examinés. Les résultats indiquent que le vieillissement aboutit à une altération significative du 5ème espace intervertébral (P<0,05) ainsi qu'à un redressement significatif de la lordose (P<0.01). Le port de charge semble accentuer le redressement de la courbe (P<0,001). Les résultats suggèrent également que le port de charge sur la tête réalise un transfert des lésions du 5ème espace intervertébral vers des niveaux sujacents. On en déduit que le port de lourdes charges sur la tête modifie l'aspect des atteintes dégénératives de la colonne cervicale.

     

Hemodynamic Influence of Arteria Vertebralis Type Cervical Spondylosis Treated by Needling Yuzhen （BL 9） and Fengchi （GB 20）

为观察针刺治疗颈性眩晕的疗效及血流动力学改变,将66例患者随机分为玉枕和风池穴组、颈夹脊(C4-6)穴组,观察治疗前后颈性眩晕症状与功能评分变化及椎动脉彩色多普勒血流显像(CDFI)变化.两组治疗后评分增加,组间差异显著(P＜0.05),治疗后眩晕度评分增加,组间差异显著(P＜0.05).针刺玉枕和风池穴能显著改善颈性眩晕症状,增加椎动脉血流速度,且疗效优于夹脊穴.     

Treatment of 116 cases of vertebral artery type of cervical spondylopathy by electroacupuncture plus tuina

电针风池穴和C2-5夹脊穴,然后拔罐,并配合端提旋转扳法,治疗了116例椎动脉型颈椎病患者.结果治愈89例,好转21例,无效6例.总有效率94.8%.     

Treatment of cervical spondylosis in 73 cases by warm acupuncture plus traction

用颈枕牵引带作颈椎牵引,在牵引过程中针刺百劳、风池、天柱、肩井、天宗和手三里穴,得气后温针,治疗了73例颈椎病患者,2个疗程后痊愈60例,显效8例,有效2例,无效3例,总有效率为95.9%.     

从五脏辨证施针论治颈椎病

颈椎病是常见病、多发病,临床治疗多从心肾施针,然笔者通过查阅文献,结合多年临床经验,认为其与五脏皆有关,故从心、肝、脾、肺、肾五脏进行辨证施针论治,取得了较好的治疗效果。现将其总结归纳如下,供广大学者参考。     

中医误诊误治举隅

年轻医生初入临床,误诊误治难免发生,总结3则误诊误治医案,于自己,希望将来能少出差错;于广大年轻医生,亦可引以为鉴。     

Abstracts from the 43rd Annual Scientific Conference of the American Paraplegia Society—September 2-4, 1997, Las Vegas,Nevada

Abstract

Background: Diagnosing patients with cervical cord compressive myelopathy in a timely manner can be challenging due to varying clinical presentations, the absence of pathognomonic findings, and symptoms that are usually insidious in nature.

Objective: To describe the clinical course of a patient with primary complaint of left medial knee pain that was nonresponsive to surgical and conservative measures; the patient was subsequently diagnosed with cervical cord compressive myelopathy.

Design: Case report.

Subject: A 63-year-old man with a primary complaint of left medial knee pain.

Findings: Physical examination of the left knee was normal except for slight palpable tenderness over the medial joint line. During treatment, he noted loss of balance during activities of daily living. Reassessment revealed bilateral upper extremity hyperreflexia, bilateral Babinski reflex, and positive bilateral Hoffman reflex. Magnetic resonance imaging of the cervical spine demonstrated moderately severe spinal stenosis at the C3-C4, C5-C6, and C6-C7 levels. After C3-C7 laminoplasty for cervical cord compressive myelopathy, he reported substantial improvement of his left medial knee. Three years later, he had no complaint of knee pain.

Conclusion: Appropriate diagnosis and treatment of cervical cord compressive myelopathy may avoid unnecessary diagnostic imaging, medical evaluations, invasive procedures, and potential neurologic complications.     

Interrater and intrarater agreements of magnetic resonance imaging findings in the lumbar spine: significant variability across degenerative conditions

Background context

Magnetic resonance imaging (MRI) is frequently used in the evaluation of degenerative conditions in the lumbar spine. The relative interrater and intrarater agreements of MRI findings across different pathologic conditions are underexplored, as most studies are focused on specific findings.

Purpose

The purpose of this study was to characterize the interrater and intrarater agreements of MRI findings used to assess the degenerative lumbar spine.

Study design

A retrospective diagnostic study at a large academic medical center was undertaken with a panel of orthopedic surgeons and musculoskeletal radiologists to assess lumbar MRIs using standardized criteria.

Patient sample

Seventy-five subjects who underwent routine lumbar spine MRI at our institution were included.

Outcome measures

Each MRI study was assessed for 10 lumbar degenerative findings using standardized criteria. Lumbar vertebral levels were assessed independently, where applicable, for a total of 52 data points collected per study.

Methods

T2-weighted axial and sagittal MRI sequences were presented in random order to the four reviewers (two orthopedic spine surgeons and two musculoskeletal radiologists) independently to determine interrater agreement. The first 10 studies were reevaluated at the end to determine intrarater agreement. Images were assessed using standardized and pilot-tested criteria to assess disc degeneration, stenosis, and other degenerative changes. Interrater and intrarater absolute percent agreements were calculated. To highlight the most clinically important MRI disagreements, a modified agreement analysis was also performed (in which disagreements between the lowest two severity grades for applicable conditions were ignored). Fleiss kappa coefficients for interrater agreement were determined.

Results

The overall absolute and modified interrater agreements were 76.9% and 93.5%, respectively. The absolute and modified intrarater agreements were 81.3% and 92.7%, respectively. Average Fleiss kappa coefficient was 0.431, suggesting moderate overall agreement. However, when stratified by condition, absolute interrater agreement ranged from 65.1% to 92.0%. Disc hydration, disc space height, and bone marrow changes exhibited the lowest absolute interrater agreements. The absolute intrarater agreement had a narrower range, from 74.5% to 91.5%. Fleiss kappa coefficients ranged from fair-to-substantial agreement (0.282–0.618).

Conclusions

Even in a study using standardized evaluation criteria, there was significant variability in the interrater and intrarater agreements of MRI in assessing different degenerative conditions of the lumbar spine. Clinicians should be aware of the condition-specific diagnostic limitations of MRI interpretation.