椎动脉型颈椎病中医多途径治疗的临床观察

目的：观察中医多途径综合治疗椎动脉型颈椎病的临床疗效。方法：将180例椎动脉型颈椎病患者随机分治疗组120例和对照组60例。治疗组采用中药辨证施治配合牵引、针灸、推拿、针刀、导引、高压氧治疗;对照组采用单纯中药治疗。均连续治疗23天,观察治疗前后的主要症状与体征,有效者临床症状改善时间。结果：治疗组治疗后临床症状包括眩晕、头痛、记忆、颈部酸痛、颈部活动、颈部肌肉痉挛、颈椎棘突旁压痛和旋颈试验与对照组比较,差异有统计学意义（P〈0.05）;治疗组中有效者临床症状改善时间较对照明显缩短（P〈0.01）。结论：中医多途径综合疗法能明显改善椎动脉型颈椎病主症及体征,且疗效确切,起效迅速。     

环锯法颈椎前路手术治疗脊髓型颈椎病

采用环锯法颈椎前路手术治疗１１例脊髓型颈椎病患者，根据北医三院疗效标准，术后病人均获得随访，结果优良率达８１．８％，有效率达１００％。该法是在传统环锯法基础上作了改进，要求做到解剖熟悉，手法轻巧，切忌粗暴；另外，术前要明确诊断；认为一经确诊应尽早手术，彻底减压，椎间融合，方能保证良效。     

低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果

目的 评价低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果.方法 具有头痛、头晕、颈肩臂痛等症状的颈椎病患者56例,年龄33～61岁,采用随机数字表法,将患者随机分为2组(n=28):胶原酶盘外溶解术组(C组)和低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术组(R组).两组手术均在CT引导下进行,术后6个月采用改良划线法评价疗效.结果 C组患者头痛、头晕和颈肩臂痛缓解率分别为86％、79％和93％,R组分别为96％、93％和100％,差异均有统计学意义(P＜0.05).结论 低温等离子射频盘内髓核消融术联合胶原酶盘外溶解术治疗颈椎间盘突出症的效果优于单独应用胶原酶盘外溶解术.     

Differential Diagnosis and Treatment of Chronic Neck and Upper Trapezius Pain and Upper Extremity Paresthesia: A Case Study Involving the Management of an Elevated First Rib and Uncovertebral Joint Dysfunction

Abstract

Diagnosis and effective treatment of patients presenting with cervicobrachial symptoms are often challenging due to the large number of potential pain sources and the high degree of convergence of sensory afference in the cervical region. A 42-year-old female presented in the clinic with a six-month history of neck pain, upper trapezius pain, and upper extremity paresthesia. A careful history, specific functional examination, and selected special tests led to diagnosis-specific orthopedic manual therapy management of this patient. The patient fully recovered within 6 physical therapy treatment sessions, which included management of an elevated first rib, double-crush phenomenon, uncovertebral joint dysfunction, and careful ergonomic intervention with home instructions. Although controlled trials are needed to evaluate the effectiveness of these techniques and allow generalizability of such interventions, the recovery of this patient suggests the efficacy of manual techniques and ergonomic intervention in the management of uncovertebral joint dysfunction and thoracic outlet syndrome associated with a double-crush phenomenon.     

Cervical musculoskeletal impairments in cervicogenic headache: a systematic review and a meta-analysis

Abstract

The differential diagnosis of cervicogenic headache (CEH) requires the presence of a pattern of symptoms and cervical musculoskeletal signs that distinguishes it from other types of headaches. The investigation of cervical musculoskeletal impairments (CMI) can help in the diagnosis and treatment of the CEH. In order to assess the evidence concerning CMI in CEH subjects, a systematic review and a meta-analysis was performed. Several electronic databases were searched. A checklist was used to identify suitable articles and a methodological scale was used to analyse their quality. Ten articles met the inclusion criteria. Based on our meta-analysis, patients with CEH have altered range of motion in rotation, flexion-extension, cervical rotation with cervical flexion, altered cervical flexor strength, and altered cervical flexor endurance. More controlled studies investigating the cervical impairments in CEH, with a clear history of patients, and greater sample sizes, are necessary.     

Clustered clinical findings for diagnosis of cervical spine myelopathy

Abstract

Cervical spine myelopathy (CSM) is a clinical diagnosis made with imaging confirmation. At present, most clinical tests used to identify CSM are specific and no clusters of tests have proven more beneficial than stand alone tests in guiding treatment decision making. This study endeavored to produce a cluster of predictive clinical findings for a sample of patients using a clinical diagnosis/imaging confirmation as the reference standard for cervical spine myelopathy. Data from 249 patients with various conditions associated with cervical spine dysfunction were analyzed to determine which clinical tests and measures, when clustered together, were most diagnostic for CSM. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a definitive cluster was identified. Thirteen clinical findings were investigated for capacity to diagnosis CSM. Five clinical: (1) gait deviation; (2) +Hoffmann's test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years, were demonstrated the capacity when clustered into one of five positive tests to rule out CSM (negative likelihood ratio=0.18; 95% CI=0.12–0.42), and when clustered into three of five positive findings to rule in CSM (positive likelihood ratio=30.9; 95% CI=5.5–181.8). This study found clustered combinations of clinical findings that could rule in and rule out CSM. These clusters may be useful in identifying patients with this complex diagnosis in similar patient populations.     

Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice

Abstract

Many studies of vertebral artery (VA) blood flow changes related to cervical spine rotation have been published, but the findings are controversial and the evidence unconvincing. Recent Doppler measurements suggest that contralateral VA blood flow is compromised on full rotation in both healthy subjects and patients. More rigorous research is needed, and it was the aim of this study to conduct a meta-analysis of published data to inform professional practice. A systematic literature search, including only Doppler studies of VA blood flow velocity associated with cervical spine rotation in adults, yielded nine reports with published data. Using weighted means of the pooled data, the magnitude of the effect size (Cohen's d) was calculated for differences between patients and subjects, sitting or lying supine for testing, the parts of the VA insonated, and the changes recorded after cervical spine rotation. From this meta-analysis, VA blood flow velocity was found to be compromised more in patients than healthy individuals, on contralateral rotation, with the subject sitting, and more in the intracranial compared to the cervical part of the VA. Possible reasons for these findings are suggested, and it is advised that sustained end-of-range rotation and quick-thrust rotational manipulations be avoided until there is a stronger evidence base for clinical practice.     

多节段脊髓型颈椎病的前后路术式疗效分析

【目的】分析和比较前后路术式治疗多节段脊髓型颈椎病的临床效果。【方法】对48例多节段脊髓型颈椎病患者分别采用颈前路2个（或2个以上）椎体次全切除脊髓减压、钛网植骨支撑融合内固定术（A组27例）及颈后路脊髓受压段全椎板切除减压、植骨加侧块螺钉内固定术（B组21例）治疗,术后根据JOA评分及X线表现比较两组病例的改善率、植骨融合率及颈椎生理曲度恢复情况。【结果】平均随访2年3个月,对两组术前、术后JOA评分进行统计处理,差异具有统计学意义（P〈0．05）;A组平均改善率70．20％,优良率为81．48％,B组平均改善率65．15％,优良率80．95％,两组疗效差异无显著性意义（P〉0．05）,A组1例植骨未融合,植骨融合率96．30％,B组3例植骨未融合,植骨融合率85．71％,两组颈椎生理曲度均有不同程度恢复。【结论】两种术式疗效相近,但前路多个椎体次全切除脊髓减压、钛网植骨支撑融合内固定术植骨融合率高、术时短,较之后路术式更安全有效;合理选择适应证及手术方法可提高脊髓型颈椎病的临床改善率,减少并发症的发生。     

传统康复疗法治疗颈椎病临床研究

对１１８例颈椎病患者采用按摩、拔火罐加辨证论治内服中药综合疗法治疗，并与单纯用中药治疗１００例对照比较。结果：综合治疗组显效４２例，有效７４例，总有效率９８．３％，无效２例。与对照组（显效１９例，有效５７例，总有效率７６％）比较，经统计学处理有显著性意义（Ｐ＜０．０５），说明对颈椎病采用综合治疗优于单纯中药治疗。对颈椎局部组织按摩和拨火罐可能起疏通经络、活血祛瘀、理筋整复、解痉镇痛作用。中药葛根、天麻、田七三药对颈椎病也有其独特疗效。     

The effect of oral versus vaginal misoprostol on cervical dilatation in first-trimester abortion: a double-blind,randomized study

Objective: To determine the effect of oral versus vaginal misoprostol on cervical dilatation in first-trimester intrauterine evacuation or menstrual regulation (MR). Design and methods A total of 120 patients were randomly assigned to a double-blind prestudy. Four groups, each consisting of 30 cases, were administered one of four regimens: 200 μg misoprostol orally, 200 μg misoprostol intravaginally, placebo orally, or placebo intravaginally, 10 h before MR, respectively. Age, number of births and abortions, birth methods, date of last delivery and last abortion were recorded. The gestational age was determined by ultrasonography. Prior to MR, data regarding the time of the application of the drug, the presence of placenta in the cervical canal, the degree of cervical dilatation, the duration of MR and patients' complaints were recorded. The MRs were performed by the same physician. The statistical analyses were evaluated with the χ² test and Fisher's exact test in the Aegean University Science Faculty Department of Statistics. Results: In the oral misoprostol group, four patients had cervical bleeding and one had intracervical placenta. In the intravaginal misoprostol group, cervical bleeding was observed in seven patients and intracervical placenta was recorded in four cases. Cervical bleeding was observed in one case and intracervical placenta was also observed in one case in the oral placebo group. Cervical dilatation reached 8 mm in seven patients in the oral misoprostol group and in three patients in the intravaginal group, with none in the placebo group. Symptoms such as pelvic pain, headache and nausea were observed in 11 cases in the oral and 14 cases in the vaginal misoprostol groups. Conclusion: Different methods of misoprostol administration may not be equivalent in terms of efficacy and side-effects. Therefore, we decided to extend the study to include more patients so as to achieve statistically significant results.