手法治疗椎动脉型颈椎病的TCD和BAEP观察

目的 观察手法治疗椎动脉型颈椎病的经颅多普勒超声（TCD）和脑干听觉诱发电位（BAEP）变化，从血流速度及神经电生理角度探讨手法治疗的作用机理。方法 将60例椎动脉型颈椎病患者分为手法治疗组30例和常规治疗组30例，治疗前及治疗2周后检查TCD和BAEP，观察手法治疗对椎动脉型颈椎病患者血流速度及脑电生理的影响。结果 （1）2组治疗后总有效率分别为96．6％和90％，其中手法组临床治愈率为46．6％，常规组临床治愈率为33．3％，2组间疗效及平均治疗时间无统计学差异。（2）治疗前疾病组椎基底动脉（VBA）流速明显低于对照组（P＜0．05）。TCD异常率为76．7％（46／60例），以VBA流速降低为主要特点。BAEP异常率为80％（48／60例），以脑干型异常为主。（3）治疗后2组VBA血流速度均有改善，手法治疗组比常规治疗组椎动脉流速改善更显著（P＜0．05）。治疗后2组神经传导功能均有改善，与常规治疗组相比，手法治疗组V波PL，Ⅲ-Ⅴ和Ⅰ-ⅤIPL改善更显著（P＜0．05）。结论 手法治疗可改善椎动脉型颈椎病椎基循环的血流速度及脑干神经传导功能。

The study of TCD and BAEP for patients with vertebral-artery-type cervical spondylosis after manual reduction

Objective To observe the effect of manual reduction on patients with vertebral-artery-type cervical spondylosis with transcranial Doppler sonography (TCD) and brainstem auditory evoked potentials (BAEP) studies. Methods Sixty cases with vertebral-artery-type cervical spondylosis were divided into manual reduction treatment group (30 cases) and routine treatment group (25 cases). The effect of manual reduction on the blood velocity and cerebral electrophysiology was analyzed, based on the changes revealed by TCD and BAEP studies. Results (1) The total efficiency rates in the two treatment groups were 96.6% and 90%, respectively. The clinical cure rate was 46.6% in the former group and 33.3% in the later group. (2)Decreased blood velocity of vertebrobasilar artery (VBA) was found with TCD (46/60,76.7%). The abnormal BAEP rate was 80% (46/60 cases). (3) The blood velocity increased in both groups after treatment, but it was more marked in the manual reduction group( P <0.05). The nerve conduction in both groups was improved, and it was still more significant in the manual reduction group( P <0.05). Conclusion Manual reduction can improve the blood velocity of VBA and the function of brainstem nerve conduction in patients with vertebral artery type cervical spondylosis.