颈椎关节突退变临床特征与康复治疗对策

Study on clinical characteristics and rehabilitative treatment for degeneration of cervical articular process

目的:探讨颈椎关节突退变的发病机制以及康复治疗对策。方法:抽查颈椎病200例有颈椎斜位X线片的资料,有轻重不同的关节突退变90例,年龄在31～76岁,以中老年居多,占80%,男女无明显差异。结果:发现颈椎关节突退变有3种原因。①关节突生理性退行性病变;②急慢性外伤,尤其挥鞭性损伤;③医源性损伤。当椎间关节不稳定时,慢性劳损或急性损伤将不可避免地产生症状,临床表现出神经根型、椎动脉型、乃至二者混合型颈椎病的症状。结论:X线斜位片可见上关节突刺入椎间孔,致该椎间孔缩小,其缩小程度与仰头伸颈成正比。科学的辨证治疗是关键,屈颈位扩孔手法整复有明显的针对性,起到了标本兼治之功,特殊病例应摄过伸、过屈位X线片。

Objective ：To investigate the pathogenesis and rehabilitative treatment for degeneration of cervical articular process. Methods：Among 200 case of cervical disease with oblique radiography,90 （45%） have different levels of facet degeneration, aged from 31 to 76 years, mostly in the elderly （accounting for 80% ）. There are no significant differences between men and women. Results：There are three reasons for cervical facet degeneration. ①Physiological degeneration of the articular process;②Acute and chronic injuries, especially whiplash injury;③Iatrogenic injury. Among these causes,iatrogenic injury is very common and has been neglected for a long time. When the intervertebral joint is instable ,chronic fatigue or acute injury will certainly produce symptoms, including symptoms of nerve root type, or vertebral artery type, or both types of cervical disease. Conclusion： Oblique X-ray films show that superior articular process protrudes into the intervertebral foramen ,which causes intervertebral foramen narrow, and the narrow degree is in proportion to rising and extending range of head and neck. Scientific and dialectical therapy is the key to treat this disease, and manipulative reduction to enlarging intervertebral foramen with the neck at flexing position is a targeted treatment,which can treat symptoms and causes of the disease at the same time. If the case is special, cervical dynamic extension and flexion X-ray film should be taken.