推拿手法对颈椎病患者颈椎节段三维空间位置的影响

目的 通过观察推拿手法对颈椎病患者颈椎三维空间角度的影响，探讨推拿手法治疗颈椎病“骨错缝”的机制。方法 自2009年8—12月，选取20例颈椎病患者，分为松解手法组（简称理筋组）10例和松解手法联合调整关节手法组（简称理调组）10例，另选取健康志愿者（简称健康组，采用松解手法）10名。手法干预前后在同等条件下采用Philips 64排螺旋CT从颅底扫描至胸1椎骨水平的长度范围, 获得容积数据，重建层厚0.625 mm，由上海交通大学软件学院数字医疗实验室提供的ITK重建软件，根据CT数据完成干预前后每一节段颈椎骨骼的重建，比较3组手法干预前后颈椎结构三维空间角度的变化。结果 C2椎骨的三维空间的调整：理调组在X、Y、Z轴显著大于健康组（P<0.05），在X、Z轴上显著大于理筋组（P<0.05），理筋组在Z轴上显著大于健康组（P<0.05）。C3椎骨的三维空间的调整：理调组在X、Y轴显著大于健康组（P<0.05），在X轴上显著大于理筋组（P<005），理筋组在X轴上显著大于健康组（P<0.05）。C4椎骨的三维空间的调整：理调组在X、Y轴显著大于健康组（P<0.05），在X、Z轴上显著大于理筋组（P<0.05）。手法干预后C1、C5、C6、C7三维空间位置的调整3组之间比较，差异无统计学意义，但理调组有大于健康组和理筋组的趋势。结论 松解手法联合调整关节手法对颈椎病患者C2、C3、C4颈椎的三维空间角度有显著改变作用，推拿手法治疗颈椎病的“骨错缝”的机制有可能是调整了颈椎的三维空间位置，改善了颈椎的功能。

Effects of Tuina Manipulation on the Three-dimensional Space of Cervical Vertebral Segments of Cervical Spondylosis Patients

Objective To study the mechanisms of tuina manipulation for treating the dislocation of bone in cervical spondylosis(CS) patients by observing the effects of tuina manipulation on the three-dimensional(3D) angles.Methods From August to December 2009 20 CS patients were assigned to Group 1(10 cases,treated with relaxing manipulation) and Group 2(10 cases,treated with relaxing manipulation and joint regulation).Besides,10 healthy subjects were recruited as the normal group(treated with relaxing manipulation).Before and after manipulation intervention,all of them were scanned from the base of the skull to the first thoracic vertebra using Philips 64 spiral CT under equal conditions,thus obtaining the volume data.The 0.625 mm thickness was reconstructed using ITK reconstruction software provided by the digital medical laboratory,Software College of Shanghai Jiaotong University.The reconstruction of each cervical skeleton was finished referring to CT data.Changes of the 3D angles were compared among the three groups.Results The regulation of the 3D C2 vertebra:Results of Group 2 were significantly larger than those of the normal group at X-,Y-,and Z-axis(P<0.05).Results of Group 2 were significantly larger than those of Group 1 at X-and Z-axis(P<0.05).But results of Group 1 were significantly larger than those of the normal group at Z-axis(P<0.05).The regulation of the 3D C3 vertebra:Results of Group 2 were significantly larger than those of the normal group at X-and Y-axis(P<0.05).Results of Group 2 were significantly larger than those of Group 1 at X-axis(P<0.05).But results of Group 1 were significantly larger than those of the normal group at X-axis(P<0.05).The regulation of the 3D C4 vertebra:Results of Group 2 were significantly larger than those of the normal group at X-and Y-axis(P<0.05).Results of Group 2 were significantly larger than those of Group 1 at X-and Z-axis(P<0.05).There were no significant difference among the three groups in the 3D spaces of C1,C5,C6,and C7.The larger 3D space was shown in Group 2 than in Group 1 and the normal group.Conclusions The relaxing manipulation combined with joint regulation significantly improved the 3D angles of C2,C3,and C4 in CS patients.The mechanism of tuina manipulation for treating the dislocation of bone in CS patients might lie in adjusting the 3D space of the cervical spine,and improving its functions.