手法治疗寰枢关节半脱位研究述评

手法治疗寰枢关节半脱位具有行气止痛、活血祛瘀、解痉除痹、疏通经络、分解粘连的功效,可促进炎症吸收,从而缓解颈部疼痛。手法治疗还可纠正关节紊乱,具体表现为可缩小寰齿前间隙,减少齿状突与寰枢椎两者轴线之间的偏移距离。临床常用于治疗寰枢关节半脱位的手法有:壮医经筋手法结合改良小角度矢状位扳法、颈椎微调手法、整脊调曲结合寰枢端转法、定点三项仰正法及枢椎短杠杆推法等。也有学者将手法与针刺疗法、综合疗法相结合治疗寰枢关节半脱位,取得满意疗效。但也存在一些问题:一方面手法治疗的安全性缺乏统一规范,如手法操作角度、力量的控制,手法治疗寰枢关节半脱位的适用范围和禁忌证的研究等。另一方面对各种手法力学原理的研究相对较少,同时对手法治疗的基础研究较为匮乏,一定程度上缺乏客观大数据、大样本的支撑等。今后,在开展手法治疗寰枢关节半脱位的临床研究时,应规范各类手法的操作要点,加强不同手法治疗的基础研究,力图为临床医师提供更为有效的、规范的诊疗方案,减少因手法操作不当而带来的不良反应。

Review on the Study of Manipulation for Atlanto-axial Subluxation

Manual treatment of atlantoaxial subluxation has the effects of promoting qi,relieving pain,promoting blood circulation and removing stasis,relieving spasm and arthralgia,dredging channels and collaterals,and resolving adhesion,which can promote the absorption of inflammation and relieve neck pain.Manual treatment can also correct the joint disorder,which can reduce the anterior space of atlanto odontoid and the offset distance between the axis of odontoid process and atlantoaxial.The methods commonly used in the treatment of atlantoaxial subluxation are as follows:The method of strengthening the meridian and tendons of Zhuang traditional medicine combined with the improved small angle sagittal pull,cervical fine adjustment,adjusting the spine and curve,atlantoaxial end rotation,fixed-point three point upward alignment and axis short lever push,etc.Some scholars have combined manipulation with acupuncture and comprehensive therapy to treat atlanto-axial subluxation,and achieved satisfactory results.At present,there are some problems in the study:on the one hand,the safety of manual treatment is lack of unified norms,such as the angle of manipulation,the control of strength,the scope of application of manual treatment of atlanto-axial subluxation and the study of contraindications.On the other hand,there are relatively few researches on the mechanical principles of various manipulations.At the same time,there is a lack of basic research on manipulative therapy,and a lack of support from objective big data and large samples to some degree.In the future,in the clinical study of manual treatment of atlanto-axial subluxation,we should standardize the operation points of various manipulations,strengthen the basic research of different manipulations,and try to provide more effective and standardized diagnosis and treatment programs for clinicians,so as to reduce the adverse reactions caused by improper manipulation.