颈椎不同节段手法正骨治疗椎动脉型颈椎病的临床研究

目的:观察颈椎不同节段手法正骨对椎动脉型颈椎病患者的疗效和椎-基底动脉血流的影响,并评价椎动脉型颈椎病手法正骨治疗的优选节段。方法:将90例具有寰椎轴线分离的椎动脉型颈椎病患者随机分为A、B、C共3组,3组病例均以颈部的分理揉按为基础治疗,其中A组加用定点复位法调整C1～2;B组加用角度复位法调整C3～5;C组加用侧旋提推法调整C6～7,以症状、体征、X线片及TCD检测为观察指标,评价各组治疗效果。结果:颈椎三节段手法正骨均能减少椎动脉型颈椎病患者的临床症状,A、B、C3组的临床疗效分别为90.00%、66.67%、60.00%,A组与B组、C组比较有显著差异(P0.01);A组较B组、C组更能改善寰枢椎轴线分离程度(P0.01);A组较B组、C组更能减少患者眩晕症状积分(P0.01)及改善患者椎-基底动脉血流状况(P0.05或P0.01)。结论:本组椎动脉型颈椎病患者的椎-基底动脉的供血不足与寰枢椎的错动移位关系密切,提示椎动脉型颈椎病患者在合并有寰枢椎的错动移位时,颈椎寰枢节段应作为手法正骨的优选节段,针对性地纠正寰椎或枢椎的错动移位可提高临床疗效。

Clinical Research of Vertebral Artery Type of Cervical Spondylosis Treated by Different Manipulation on Different Segments of Cervical Vertebra

Objective：To observe the effect on vertebral-basilar artery blood flow in patient with vertebral artery type of cervical spondylosis treated by different manipu lation on different segments,to evaluate and ascertain the optimality segment of vertebral artery type cervical spondylosis when treated by Orthopedics manipulation.Methods：90 patients with Axis separation of atlantoaxial in vertebral artery type of cervical spondylosis were randomly divided into A,B,C three groups,Rubbing and pressing separately for three group patients were accepted as basic treatment,group A were adjusted by Fixed-Reset method as a plus manipulation on C1～2,group B were adjusted by Angle-reposition method as a plus manipulation on C3～5,group C were adjusted with lateral twisting and pushing method as a plus manipulation on C6～,the symptoms,signs,X-ray and TCD testing were observed as index to evaluate the group treatment efficacy.Results：Orthopedics and Traumatology manipulation on three different cervical sections can reduce the clinical symptoms of patients.the clinical efficacy of the A,B and C group were respectively 90.00%,66.67% and 60.00%,the clinical efficacy of group A was significant difference compare with group B and group C（P0.01）;manipulation in group A can enhance cure efficacy and reduce degree of Axis separation of atlantoaxial significantly than in group B and group C（P 0.01）;manipulation in group A can reduce patient＇s vertigo symptom score（P0.01）and improve patient vertebral-basilar artery blood flow than group B and group C（P0.05 or P0.01）.Conclusion：The vertebral-basilar artery insufficiency is closely related to atlantoaxial dislocation or displacement in patients with vertebral artery type of cervical spondylosis,it suggest that cervical atlantoaxial segments should be the optimality treating segment in patient with vertebral artery type of cervical spondylosis associated with atlantoaxial dislocation and displacement.Targeted to correct the atlas and axis dislocation or movement can enhance the treatment efficacy.