手法治疗高流速型颈性眩晕的随机对照试验

Randomized controlled trial on manipulation for the treatment of cervical vertigo of high flow velocity type

目的:比较手法和牵引加尼莫地平片对高流速型颈性眩晕患者椎基底动脉血流速度的影响及疗效。方法:2008年3月至2009年2月,按随机数字表方法将70例经颅多普勒(TCD)表现为高流速状态的颈性眩晕患者分成治疗组(35例)和对照组(35例),男32例,女38例;年龄21～45岁,平均37.6岁;病程1d～2年,平均12.6d。治疗组采用手法治疗,每周3次,共治疗3周;对照组采用牵引(牵引重量5～6kg,每次20min,隔日1次)+尼莫地平片(每日3次,每次40mg)口服,共治疗3周。3周后应用TCD和眩晕评估量表记录观察治疗前后椎基底动脉血流速改变和眩晕分值变化,6个月后对疗效进行随访。结果:两组左侧椎动脉、右侧椎动脉和椎基底动脉血流速度均较治疗前有明显下降(P<0.01),治疗后治疗组左右椎动脉、椎基底动脉血流速度下降更明显,差异有统计学意义(P<0.01);两组间治疗后的眩晕量化分值变化比较有统计学意义(P<0.01)。X线"双边征"改善率及临床疗效治疗组优于对照组(P<0.01)。结论:对高流速型颈性眩晕患者,采用手法治疗对椎基底动脉血流速的影响较牵引加尼莫地平片口服明显,并有很好疗效,但对手法有较高的要求。

Objective：To explore the effects of manipulation and traction combined with Nimodipine on the blood flow velocity of vertebrobasilar artey （VBA） in cervical vertigo of high flow velocity,and to evaluate clinical therapeutic effects between two methods. Methods：From March 2008 to Feburary 2009,70 patients who were diagnosed as high flow velocity of cervical vertigo were randomly divided into treatment group（35 cases） and control group（35 cases）. Among 70 patients, 32 were male and 38 were female. The age ranged from 21 to 45 years with an average of 37.6 years. The disease course ranged from one day to two years with an average of 12.6 days. Patients of the treatment group were treated with manipula- tion for total three weeks,three times once week. The patients in the control group were treated with traction （weight ranged from 5 to 6 kg,20 minutes each time,once every other day） and Nimodipine for total three weeks（three times each day,and with a dose of 40 mg each time）. After three weeks,the changes of flow velacity of VBI and score before and after treatment were observed using transcranil Doppler （TCD） and Evaluation Scale for Cervical Vertigo. After six weeks,the therapeutic effects were assessed. Results：The mean velocity in left vertebral artery （LVA）,right vertebral artery （RVA） and basilar artery（BA） were obviously lower than those before treatment in two groups（P〈0.01）. The LVA,RVA and BA of the treatment group was lower than those of control group after 3 weeks （P〈0.01）. There was significant difference in vertigo score after treatment between the two groups. The improvement rate of double sides sign in X ray image and the therapeutic effects of treatment group was superior to that of control group （P〈0.01）. Conclusion：The effect of manipulation on flow velocity of VBA is superior to that of traction combined with Nimodipine,and there are better therapeutic effects in treating cervical vertigo of high flow velocity in comparison with traction combined with Nimodipine. But there are more higher demands for manipulation＇s application.