旋转手法治疗神经根型颈椎病的机制及特点

Mechanism and characteristics of the rotary manipulation in the treatment of cervical spondylotic radiculopathy

目的:分析旋转手法治疗神经根型颈椎病的机制和特点。资料来源:应用计算机检索Medline数据库1994-01/2006-05有关神经根型颈椎病方面的文献,检索词“cervicalspondyloticradiculopathy,rotarymanipulation”,限定文章语言种类为English。同时计算机检索清华同方CNKI中国期刊全文数据库1994-01/2006-05有关神经根型颈椎病方面的文献,检索词“神经根型颈椎病,旋转手法”,限定文章语言种类为中文。资料选择:对资料进行初审,选取包括神经根型颈椎病基础和临床研究的相关文献,开始查找全文。纳入标准:①神经根型颈椎病基础和临床研究。②旋转手法治疗。排除标准:①颈椎骨折及良恶性肿瘤。②综述类文献,重复的同一研究,Meta分析类文章。资料提炼:共检索到关于神经根型颈椎病基础和临床研究及旋转手法治疗的文献32篇,24篇文献符合纳入标准。资料综合:神经根型颈椎病是临床常见病,因颈椎间盘退行性变致椎间盘高度降低、前位钩椎关节及后位关节突关节退行性变等合并因素所致脊神经根管狭窄并压迫神经根是其最常见的原因。旋转手法是治疗神经根型颈椎病的独特疗法,其主要治疗机制是松解神经根及其周围软组织粘连;改变椎间孔大小,调整钩椎关节位置关系;缓解肌肉痉挛,解除滑膜嵌顿;调整颈椎各组织应力分布,增强颈椎稳定性;重建颈曲,恢复颈椎正常的生理弧度。结论:旋转手法是治疗神经根型颈椎病独特的方法,是安全有效的,但手法的操作需要进一步规范和统一。

OBJECTIVE： To analyze mechanism and characteristics of the rotary manipulation in the treatment of cervical spondylotic radiculopathy. DATA SOURCES： The literatures of cervical spondylotic radiculopathy were collected from the Medline database published between January 1994 and May 2006 with the key words of “cervical spondylotic radiculopathy, rotary manipulation” in English. Moreover, the literatures of of cervical spondylotic radiculopathy were collected from the China Natignal Knowledge Infrastructure （CNKI） database published between January 1994 and May 2006 with the key words of “cervical spondylotic radiculopathy, rotary manipulation”in Chinese. STUDY SELECTION： The data were selected firstly, and the literatures about base and clinical research of cervical spondylotic radiculopathy were sdlected and the complete papers were found. Inclusive criteria： ①base and clinical research of cervical spondylotic radiculopathy, ② rotary manipulation. Exclusive criteria： ③the papers about the cervical spine fracture, benign tumor and malignant tumor, ④reviews, repeated study and Meta analytical papers. DATA EXTRACTION： The literatures of base and clinical research of cervical spondylotic radiculopathy and rotary manipulation were 32, and totally 24 papers were accorded with inclusive criteria. DATA SYNTHESIS： Cervical spondylotic radiculopathy was a common disease in clinic. The most common cause of cervical spondylotic radiculopathy was stenosis of spinal nerve root tube which compressed the nerve root due to complicated factors, including decreased height of intervertebral disc, degenerative changes of the uncovertebral joints anteriorly and zygapophyseal joints posteriorly caused by degenerative changes of the cervical intervertebral disc. As a specific treatment for cervical spondylotic radiculopathy, the main therapeutic mechanism of rotary manipulation included solution of the adherence in nerve root and it＇s surrounding soft tissue, changing the size of intervertebral foramina, adjusting uncovertebral joint position, relieving muscle spasm, removing synovialinterposing, regulating stress distribution, strengthening stability of cervical vertebra, rebuilding cervical curvature and recovering normal physiologic curve of cervical vertebra. CONCLUSION： Rotary manipulation is a specific, safe and effective treatment for cervical spondylotic radiculopathy, but its manipulation needs uniform standards.