颈椎扳法引导颈椎运动节段后伸纠正异常颈椎矢状位参数的临床观察

目的：观察颈椎扳法治疗青年人颈型颈椎病的影像学变化及疗效。方法：将2018年1月至2019年9月就诊的65例（脱落5例，最终符合方案60例）颈型颈椎病患者按照数字表法随机分为治疗组和对照组。治疗组30例，男14例，女16例，年龄20~44（29.83±6.99）岁，行颈椎扳法治疗（每周1次，共4次）。对照组30例，男12例，女18例，年龄18~43（31.77±5.93）岁，行坐位牵引治疗（每周1次，共4次）。分别记录治疗前，治疗后1个月两组患者C₂-C₇ Cobb角，弧弦距，T₁倾斜角（T₁ slope，T₁S）的变化，比较两组患者治疗前和治疗后1、3个月的疼痛数字评分（numerical rating scale，NRS）。结果：60例均获得随访，时间（3.2±0.3）个月。治疗前两组患者的NRS、C₂-C₇ Cobb角、弧弦距、T₁S差异无统计学意义（P>0.05）。治疗后1个月治疗组NRS、C₂-C₇ Cobb角、弧弦距、T₁S分别为（1.67±0.76）分、（16.55±6.01）°、（10.95±4.04） mm、（18.95±4.19）°，对照组分别为（1.40±0.86）分、（10.23±5.94）°、（6.11±4.17） mm、（13.34±4.25）°；治疗组患者的C₂-C₇ Cobb角、弧弦距、T₁S优于对照组（P<0.05）；NRS两组间比较差异无统计学意义（P>0.05）。治疗组C₂-C₇ Cobb角、弧弦距、T₁S较治疗前差异有统计学意义（P<0.05），对照组较治疗前差异无统计学意义（P>0.05）。术后3个月治疗组NRS为（1.60±0.62）分，对照组为（4.17±0.70）分，治疗组优于对照组（P<0.05）；治疗组评分小于治疗前（P<0.05），对照组较治疗前差异无统计学意义（P>0.05）。结论：颈椎扳法、颈椎坐位牵引可以缓解颈型颈椎病患者的疼痛症状，但颈椎扳法效果更加持久；颈椎扳法可以纠正异常的颈椎矢状位参数。

Clinical observation on correction of abnormal cervical sagittal parameters by cervical pulling method guided by cervical motion segment extension

Objective: To observe the radiological change and curative effect of cervical spondylosis treated with cervical vertebra pulling therapy in young people.Methods: A total of 65 patients(shedding in 5 patients and final inclusion in 60 patients) with cervical spondylosis who were treated from January 2018 to September 2019 were randomly divided into treatment group and control group according to the digital table method. There were 30 patients in treatment group, including 14 males and 18 females, aged from 20 to 44 years old with an average of(29.83±6.99) years, who were treated with cervical vertebra pulling therapy(once a week, 4 times in total). The control group consisted of 30 cases, 12 males and 18 females, aged from 18 to 43 years old with an average of (31.77±5.93) years, who received sitting traction therapy(once a week, 4 times in total). The changes of C₂-C₇ Cobb angle, arc-chord distance and T₁ slope (T₁S) in two groups were observed before treatment and 1 month after treatment, for intra-group and inter-group comparison;and the changes of numerical rating scale(NRS) in two groups were observed before treatment and 1, 3 months after treatment, for intra-group and inter-group comparison.Results: Sixty patients were followed up for (3.2±0.3) months. There were no significant differences in NRS, C₂-C₇ Cobb angle, arc-chord distance and T₁S between two groups before treatment (P>0.05). One month after treatment, the NRS, C₂-C₇ Cobb angle, arc-chord distance and T₁S were(1.67±0.76) scores, (16.55±6.01)°, (10.95±4.04)mm, (18.95±4.19)° in treatment group and(1.40±0.86) scores, (10.23±5.94) °, (6.11±4.17) mm, (13.34±4.25)° in control group respectively. C₂-C₇ Cobb angle, arc-chord distance and T₁S in treatment group were better than those in control group (P<0.05); there was no significant difference in NRS between two groups (P>0.05). Compared with before treatment, there were statistically significant differences in C₂-C₇ Cobb angle, arc-chord distance and T₁S in treatment group(P<0.05), but no statistically significant differences in control group(P>0.05). Three months after operation, NRS of treatment group was (1.60±0.62) scores and that of control group was (4.17±0.70) scores. The treatment group was better than the control group(P<0.05). The scores of treatment group after treatment were lower than those before treatment(P<0.05), and there was no significant difference in control group before and after treatment(P>0.05).Conclusion: Cervical vertebra pulling method and cervical vertebra sitting traction can relieve the pain symptoms of patients with cervical spondylosis, but the effect of cervical vertebra pulling method is more durable;cervical vertebra pulling method can correct abnormal cervical sagittal parameters.