手法治疗青年颈椎病疗效以及抑郁状况评价的临床对照研究

Analysis on clinical characteristics and pathogenic factors of cervical spondylopathy in youth and evaluation of it's depression state

目的:探讨青年颈椎病的临床特点、手法疗效、发病因素以及抑郁发病率、与抑郁相关的危险因素。方法:将46例30岁(平均24.4±5.6岁)以下青年颈椎病患者作为研究组,40～55岁的患者作为对照组。两组均施以手法治疗为主。采用Zung抑郁自量表(SDS)进行抑郁评分,抑郁指数≥0.5者为抑郁,计算患病率,对影响抑郁状态的危险因素,进行调查。结果:与对照组比较平均病程(t=3.62,P<0.01)、临床分型(χ2=26.461,P<0.01)、抑郁发病率(χ2=6.298,P<0.05)、平均治疗次数(t=5.38,P<0.01)差异有统计学意义;疗效优良率差异无统计学意义(P>0.05);与抑郁相关的危险因素依次为学习工作效率下降、睡眠障碍、记忆力下降、社会不支持、疼痛、很难治愈。结论:①青年颈椎病具有体征与影像学改变严重、症状不典型、以颈型和椎动脉-交感型为主的特点。②抑郁的发生率较高,要重视对青年颈椎病患者抑郁状态的评价。③过量剧烈运动和长期颈椎屈曲状态可能是导致椎间盘提前退变的主要因素,软组织的条索状物形成和椎间关节移位是颈椎病的主要病理改变;要重视对青年颈椎病患者抑郁状态的评价。

Objective： To approach clinical characteristics, curative effect by manipulation, pathogenic factor as well as depression disease incidence and dangerous factors correlated with cervical spondylopathy in youth. Method ： 46 cases of patients with cervical spon- dylosis, below 30 years old, were selected as study group for the experiment, male 27 cases and female 19 cases, the average age was 24. 4± 5.6 years, and 50 cases of patients, ranging in age from 40 - 55 years, were choosed for control group. All patients were mainly treated with manipulation. Zung self-rating depression scale （SDS） was used to score depression. Depression was defined when depression index was more than 0. 5. Meanwhile the morbidity rates were marked and dangerous factors effccted on depressive state of cervical spondylopathy were designed with tables for investigation. Results： There had statistical significance in two groups on average duration （ t = 3.62, P 〈 0. 01 ）, clinical manifestations （ χ^2 = 26. 461 ,P 〈 0. 01 ） , depression disease incidence （ χ^2 = 6. 298, P 〈 0. 05 ） , average numbers of treat- ment （ t = 5.38, P 〈 0. 01 ）. There had no significant difference on excellent-good rate in two groups （ P 〉 0. 05 ）. The dangerous factors correlated with depression wereby turns low efficiency in studies and working, somnipathy, decline in memory, no social support,pain and worry to cure it. Conclusion： There are some characteristics in patients with cervical spondylopathy of youth, such as paroxysm, short duration and atypical sympotoms. Physical signs and radiograghic presentation were more serious than sympotoms, lateral curvature and reverse of the physiological curve often were seen, while injury and function flaw of nerves were rare. The clinical manifestation was mainly the neck type and the vertebral artery-sympathetic nerve type, while the incidence of the nerve root type was not high. The curative effect was unstable including symptoms relapsing easily and healing time longer. Compared with control group, incidence of depression was apparently higher. In aspect of pathogenic factors, the excessive strenuous exercise and the long-term cervical vertebra flexure condition possibly led to degeneration of disc ahead for youth, the formation of adhesion in soft tissues and malposition of the cervical intervertebral joints were main pathology, changes. It is essential to evaluate depression state on patients with cervical spondylopathy of youth.