手法矫正寰椎偏移治疗颈性眩晕

Correction of atlas drift by chiropractic treatment for the vertigo of the cervical syndrome

目的:通过颈性眩晕的临床表现及放射学检查,确立诊断标准,以期为采用矫正寰枢椎移位治疗颈性眩晕提供临床选择。方法:于1999-07/2003-08选择武装警察部队总医院骨科收治颈性眩晕患者78例。病程至少1年,治疗前后详细查体,所有患者均摄颈椎前后位、侧位及颈椎张口位,部分患者行颈椎MRI椎动脉造影。根据颈椎放射检查寰椎偏移将其分为寰椎前弓上右移7例;寰椎前弓上左移10例;寰椎前弓上右移向前旋转4例;寰椎前弓上右移向后旋转8例;寰椎前弓上左移向前旋转6例;寰椎前弓上左移向后旋转9例;寰椎前弓下右移5例;寰椎前弓下左移4例;寰椎前弓下右移向前旋转5例;寰椎前弓下右移向后旋转7例;寰椎前弓下左移向前旋转5例;寰椎前弓下左移向后旋转8例。按照临床分型进行手法寰椎矫正治疗。取仰卧位,寰椎的横突前外、外侧及后外侧为接触点,用示指远节指间关节接触寰椎横突矫正向左或右的侧移和向前或后的旋转。治疗评估效果依据颈椎功能恢复情况及放射学检查结果进行分级。①优:眩晕完全缓解,无失眠、头痛等症状,恢复工作,X射线复查显示颈椎生理曲度正常或接近正常,两侧块与枢椎齿状突距离基本相等。②良:眩晕基本缓解,失眠、头痛等症状明显减轻,不影响日常工作和生活,X射线复查显示颈椎生理曲度正常或接近正常,两侧块与枢椎齿状突距离基本相等。③一般:眩晕有所缓解,失眠、头痛等症状减轻,日常工作和生活需口服药物治疗,X射线复查显示颈椎生理曲度异常,两侧块与枢椎齿状突距离不等。④差:眩晕无缓解或加重,失眠、头痛等症状无明显减轻,影响日常工作和生活,X射线复查显示颈椎生理曲度异常,两侧块与枢椎齿状突距离不等。结果:78例患者均获矫正治疗,平均随访3年,随访率100%。所有的患者均眩晕缓解,失眠、头痛减轻,颈椎的功能改善;X射线显示颈椎生理曲度正常或接近正常,两侧块与枢椎齿状突间距离不等好转。其中优47例(61%);良22例(28%);一般9例(11%);差0例。优良率为89%。结论:通过手法治疗矫正寰椎的侧移和旋转,能消除对椎动脉的影响,改善颈性眩晕症状。

AIM： To establish diagnostic criteria by the clinical manifestation and radiological examination of the vertigo of cervical syndrome, and provide clinical choice for the correction of atlas drift in the treatment of the vertigo of cervical syndrome. METHODS： Seventy-eight patients with the vertigo of cervical syndrome, who were treated at Department of Orthopaedics, General Hospital of Chinese Army Police Force from July 1999 to August 2003, were selected. The progress was one year at least. These patients were thoroughly checked, and take photograph of cervical vertebrae of A-P position, lateral position and mouth open position, and some patients were checked by the cervical MRI vertical arteriography before and after the treatment. According to the radioscopy of cervical vertebra, the atlas drift was checked and divided into： anterior arch of atlas towards up and right （7 patients）; anterior arch of atlas towards up and left （10 patients）; anterior arch of atlas towards up and right, forward conbolution （4 patients）; anterior arch of atlas towards up and right, back conbolution （8 patients）; anterior arch of atlas towards up and left, forward conbolution （6 patients）; anterior arch of atlas towards up and left, back conbolution （9 patients）; anterior arch of atlas towards down and right （5 patients）; anterior arch of atlas towards down and left （4 patients）; anterior arch of atlas towards down and right, forward conbolution （5 patients）; anterior arch of atlas towards down and right, back conbolution（7 patients）; anterior arch of atlas towards down and left, forward conbolution （5 patients）; anterior arch of atlas towards down and left, back conbolution （8 patients）. The correction of atlas by chiropractic treatments was performed according to the clinical classifications. The supine position, anterior, lateral and back lateral of transverse process of atloid were gained as contact point. The sideway drift toward left or right and the conbolution toward forward or back of transverse pr^ess correction of atlas were contacted by the distal interphalangeal joint of index finger. The effects after therapy and evaluation were classified according to the restoration condition of cervical vertebra function and the radiological examination. ① Excellent： The vertigo was released completely, without agrypnia and headache etc., and recovery to work. The review of X ray showed that the physical curvature of cervical vertebra was normal or was close to normal, the distance of the two lateral masses and odontoid process of axis was nearly the same. ② Good The vertigo was released more or less; the symptom of agrypnia and ache etc. was reduced significantly, and did not have effects on the routine work and living. The review of X ray indicated that the physical curvature of cervical vertebra was normal or was close to normal, the distance of the two lateral masses and odontoid process of axis was nearly the same. ③ Common： The vertigo was released a little, and the symptom of agrypnia and ache etc. was reduced. The orally took drug was needed to maintain the routine work and living. The review of X ray showed that physical curvature of cervical vertebra was abnormal, and the distance of the two lateral masses and odontoid process of axis was not the same. ④ Bad： . There was no release of the vertigo or became severe, and there was no reduction of the sy/nptom of agrypnia and headache etc., and had effects on the routine work and living. The review of X ray showed that physical curvature of cervical vertebra was abnormal, and the distance of the two lateral masses and odontoid process of axis was not equal. RESULTS： All the 78 patients were gained the correction treatment, and averagely followed up 3 years; the follow-up rate was 100%. The vertigo was released, the agrypnia and headache were reduced, and the function of cervical vertebra was ameliorated in all the patients. The review of X ray showed that physical curvature of cervical vertebra was normal or was near to normal, and the distance of the two lateral mass and odontoid process of axis took a turn for the better differently. Among them, there were 47 ex-cellent cases （61% ）; 22 good cases （28%） ; 9 common cases （ 11% ）; Zero bad cases. The excellent and good rate was 89%. CONCLUSION： The correction of the sideway drift and conbolution of atloid by the chiropractic treatment can remove the effects on vertebral artery, and improve the symptom of cervical vertigo.