三维平衡正脊手法治疗椎动脉型颈椎病的临床研究

目的观察三维平衡正脊手法治疗椎动脉型颈椎病的疗效及对椎基底动脉血流速的影响。方法使用随机数字表将67例椎动脉型颈椎病患者分为2组,对照组33例采用针灸、拔罐、推拿、牵引、盐酸氟桂利嗪胶囊口服治疗,治疗组34例在对照组治疗基础上给予三维平衡正脊手法治疗。针灸、拔罐、推拿、牵引每周治疗5次为1个疗程,2个疗程间休息2 d,药物持续口服,2组均连续治疗4个疗程。比较2组治疗前后及随访3个月时颈性眩晕症状与功能积分,观察2组治疗前后阳性症状及体征、椎动脉和基底动脉的平均流速(Vm)及收缩峰值流速(Vs)变化情况,统计2组近期疗效。结果2组疗程结束时颈性眩晕症状和功能积分均明显高于治疗前(P均<0.05),疗程结束3个月时均明显高于治疗结束时(P均<0.05),治疗组各时间点颈性眩晕症状和功能积分明显高于同期对照组(P均<0.05)。疗程结束后,2组椎动脉扭曲试验、颈肩部疼痛、肌肉紧张痉挛和颈后压痛阳性率均比治疗前明显降低(P均<0.05),其中治疗组肌肉紧张痉挛和颈后压痛的阳性率均明显低于对照组(P均<0.05)。疗程结束后,2组椎动脉和基底动脉的Vm均明显高于治疗前(P均<0.05),但Vs均未见明显改变(P均>0.05);2组疗程结束后椎动脉和基底动脉的Vm及Vs比较差异均无统计学意义(P均>0.05)。治疗组的显效率明显高于对照组(P<0.05),2组总有效率比较差异无统计学意义(P>0.05)。结论在针灸、拔罐、推拿、牵引、药物治疗基础上辅以三维平衡正脊手法治疗,可通过调整椎动脉型颈椎病患者颈椎小关节紊乱,恢复颈椎的内外力学平衡,缓解肌痉挛,减少对交感神经和椎动脉的刺激或压迫,提高显效率,且远期效果更稳定。

Clinical research on the treatment of vertebral artery type of cervical spondylosis with three-dimensional balance regulating spinal manipulation

Objective It is to observe the effect of three-dimensional balance regulating spinal manipulation on vertebral artery type of cervical spondylosis and it’s effect on vertebrobasilar blood flow. Methods 67 cases of patients with vertebral artery type of cervical spondylosis were divided into 2 groups by random number table. The control group of 33 cases were treated with acupuncture, cupping, massage, traction, flunarizine hydrochloride capsules orally. The treatment group of 34 cases was treated with three-dimensional balance regulating spinal manipulation based on the control group. Acupuncture, cupping, massage, and traction were treated 5 times a week as a course of treatment, with a rest period of 2 days between the two courses. The drug was continuously taken orally. Both groups were treated continuously for 4 courses.The symptoms and functional scores of cervical vertigo before and after treatment and follow-up for 3 months were compared between the two groups. The changes of positive symptoms and signs, mean flow velocity and peak systolic flow velocity of vertebral artery and basilar artery were observed before and after treatment in the two groups. The short-term effects of the two groups were evaluated. Results The scores of cervical vertigo symptoms and function at the end of treatment were significantly higher than those before the treatment(P<0.05),and the scores in months after treatment were significantly higher than those at the end of the treatment in the two groups(P<0.05), the scores at every time point in the treatment group were significantly higher than those in the control group over(P<0.05). After treatment, the positive rates of vertebral artery torsion test, neck and shoulder pain, muscle tension and spasm, and posterior neck tenderness in the two groups were significantly lower than those before treatment(P<0.05), the positive rates of muscle spasm and posterior neck tenderness in the treatment group were significantly lower than those in the control group(P<0.05). At the end of treatment, the flow velocity of vertebral artery and basilar artery were significantly higher than those before treatment in both groups(P<0.05), but peak systolic flow velocity did not change significantly(P>0.05). There were no significant differences in mean flow velocity and peak systolic flow velocity of vertebral artery and basilar artery between the two groups at the end of treatment(P>0.05). The effective rate of the treatment group was significantly higher than that of the control group(P<0.05). There was no significant difference in the total effective rate between the two groups(P>0.05). Conclusion Based on acupuncture, cupping, massage, traction, and medication,the therapy supplemented with three-dimensional balance regulating spinal manipulation can adjust cervical facet joint disorders, restore internal and external mechanical balance of cervical spine, relieve muscle spasm, and reduce stimulation or compression of sympathetic nerves and vertebral arteries, improves the apparent efficiency and the long-term effect is more stable in the treatment of patients with vertebral artery type of cervical spondylosis.