整骨手法联合颈椎后路椎间孔减压术治疗神经根型颈椎病

目的：探讨整骨手法联合经皮颈椎后路椎间孔减压术（percutaneous endoscopic cervical decompression，PECD）治疗难治性神经根型颈椎病（cervical spondylotic radiculopathy，CSR）的安全性和临床疗效。方法：2016年5月至2018年5月收治29例CSR患者，所有患者经6周以上保守治疗，疗效欠佳，采用联合治疗方案。先予PECD治疗，常规护理4周后再予整骨手法治疗4周。共23例患者完成随访，男14例，女9例；年龄29~78（50.30±12.28）岁；病程3~24（9.74±5.76）月。涉及节段：C_4，5 4例，C_5，6 13例，C_6，7 6例。观察患者手术前后的颈肩疼痛视觉模拟评分（visual analogue scale，VAS），颈椎功能障碍指数（neck disability index，NDI），颈椎生理曲度变化和稳定性情况，以及不良事件。随访时间点为术前，术后1 d，术后1、3、6个月。结果：所有患者顺利完成手术，手法治疗4~8次。29例中23例患者获得6个月以上的随访，治疗及随访期间未出现脊髓及神经根损伤情况。手术时间80~120 min，中位数90 min；术中出血35~80 ml，中位数50 ml。PECD术后各个时期的颈部及肩臂部VAS、NDI与术前比较均有明显降低（P<0.05），而颈椎生理曲度和目标节段椎间隙高度差异无统计学意义（P>0.05）；椎体间稳定性无明显改变（P>0.05）。整骨手法治疗后，NDI与手法治疗前比较差异有统计学意义（P<0.05）；但颈部和肩臂部VAS、颈椎生理曲度和目标节段椎间隙高度与手法治疗前比较差异均无统计学意义（P>0.05）；椎体间稳定性无明显改变（P>0.05）。结论：整骨手法联合PECD方案治疗难治性神经根型颈椎病，不但能快速改善神经根性症状，而且可以安全有效缓解PECD术后残余症状，且短期内不会使颈椎邻近节段出现加速失稳的征象。

Manual therapy combined with posterior percutaneous endoscopic cervical decompression for the treatment of cervical spondylotic radiculopathy

Objective: To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy.Methods: From May 2016 to May 2018,23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly,the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up,including 14 males and 9 females,the age ranged from 29 to 78 years old with an average of (50.30±12.28) years,the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C_4,5 in 4 cases,C_5,6 in 13 cases,C_6,7 in 6 cases. The visual analogue scale (VAS),neck disability index (NDI),changes of cervical physiological curvature and interbody stability,adverse events were observed before and after operation. The follow-up time points were before operation,1 day after operation and 1,3 and 6 months after operation.Results: All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases,23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI,VAS of neck,shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05),while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy,NDI significantly decreased (P<0.05),however,there was no significant difference in VAS of neck,shoulder and arm,physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05).Conclusion: Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms,but also alleviate the residual symptoms after PECD safely and effectively,and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.