牵引及推拿的力学作用对颈椎病的疗效

背景非手术疗法治疗颈椎病是目前常用的治疗方法.这些方法都涉及到力学作用,尤其是颈椎牵引及推拿按摩的力学性质更加显著.目的通过比较牵引和推拿按摩与单一牵引对颈椎病患者的干预效果,对不同康复方法中力的依从性进行探讨.设计病例对比观察.单位四川大学华西医院康复中心.对象选择2002-10/2003-07在四川大学华西医院康复中心门诊就诊的符合非手术治疗的颈椎病患者52例,均自愿参加观察.随机分为2组,实验组和对照组各26例.方法①实验组采用牵引和推拿按摩术相结合的方法.牵引1次/d,30 min/次,5次为1个疗程,治疗一两个疗程.推拿按摩8～10 min/次,1次/d,5次为1个疗程,治疗一两个疗程.②对照组则采用单纯的牵引方法.采用颈椎疾患治疗成绩评分表,选用表中临床症状、临床检查、日常生活3大项目作为评分标准.根据治疗前后评分计算改善指数改善指数=(治疗后评分-治疗前评分)/治疗后评分.治疗后由医师进行评定改善指数.显效临床症状、体症明显改善,对工作、学习和日常生活影响小;有效临床症状、体症有改善,工作、学习部分受影响;无效临床症状、体症无改善,工作、学习和日常生活同治疗前.主要观察指标①两组患者治疗前后的颈椎疾患治疗成绩评分.②两组患者治疗后的干预效果.结果颈椎病患者52例全部进入结果分析,无脱落.①两组患者治疗前后的颈椎疾患治疗成绩评分比较治疗后实验组患者的颈椎治疗评分明显高于对照组16.431 ±3.212,13.147±3.036(t=4.676,P＜0.01)],且实验组患者颈椎功能改善指数也明显高于对照组0.505±0.163,0.368±0.145(t=3.860,P＜0.01)].②两组患者治疗后的干预效果比较实验组的显效率高于对照组(80.8%,46.2%).结论牵引和推拿按摩术相结合对颈椎病患者的干预效果优于单纯牵引疗法.不同的康复方法,其力学特性不同,干预效果也有较大的差异,表明力的变化对康复效果有明显影响.

Mechanical effects of traction and massage therapy on cervical spondylopathy

BACKGROUND:Non-operation therapies are commonly used in the treatment of cervical spondylopathy. All of these therapies involve biological mechanics; especially for traction and massage of the cervical vertebrae, they have an obvious property of biological mechanics in rehabilitation of the cervical vertebrae. OBJECTIVE: To probe into the biological mechanics of different rehabilitation methods through comparing the intervention effects between traction and traction combined with massage on cervical spondylopathy.DESIGN: A case-controlled observation. SETTING: Rehabilitation Center of West China Hospital of Sichuan University. PARTICIPANTS: Among the patients who came to the Rehabilitation Center of West China Hospital of Sichuan University between October 2002 and July 2003 for the treatment of spondylopathy, totally 52 patientsmet the criteria for non-operation therapy. They participated in the experiment voluntarily and were randomly divided into 2 groups: the experimental group and the control group, with 26 patients for each. METHODS: ①The patients in the experimental group were treated by traction in combination with massage. Traction was performed once a day,30 minutes each time, 5 times as a course of treatment, and one or two courses of treatment in total. Massage was performed for 8 to 10 minutes each time, once a day, 5 times as a course of treatment, and one or two courses in total. ② The patients in the control group were treated with traction only. Cervical Spondylopathy Therapeutic Effect Rating Scale was adopted to evaluate the effects, three items were selected to set as our scoring criterion, which included clinical symptoms, physical examinations and activities of the daily life (ADL). The improvement index was figured out on the basis of the pre-treatment score and post-treatment score. The improvement index is worked out by the following equation: improvement index = (The post-treatment score-pre-treatment score) / the post-treatment score. The improvement index was evaluated by physicians after the treat ment. Effectual: Clinical symptoms and body symptoms were obviously improved; work, learning, and daily life are not affected. Effective: Clinical symptoms and body symptoms have improved , and work, learning, and the daily life are partially affected. In-effective: There was no improvement in clinical symptoms and body symptoms and showed no effect on the work ,learning, and the daily life. MAIN OUTCOME MEASURES: ① Score of the treatment of cervical spondylopathy of the patients before and after the treatment. ② Intervention effect on the patients after the treatment RESULTS: Totally 52 patients with cervical spondylopathy entered the stage of result analysis with none missing in the midway. ① Comparison of the scores of the treatment of cervical spondylopathy of the patients before and after the treatment: After the treatment, the score in the experimental group was significantly higher than that in the control group 16.431 ±3.212,13.147 ±3.036 ( t =4.676, P ＜ 0.01 )], and the improvement index of the patients in the experimental group was significantly higher than that in the control group 0.505±0.163,0.368±0.145 (t=3.860, P ＜ 0.01 )]. ② Comparison of the intervention effects on the patients after the treatment: The effectual rate of the experimental group was higher than that of the control group (80.8%,46.2%).CONCLUSION: The approach of traction combined with massage is superior to simple traction. Different rehabilitation approaches have different properties in biological mechanics. It has showed that the force change is important to therapeutic effectiveness on cervical spondylopathy.