医源性颈部过度旋转性损伤

Iatrogenic Over rotatory Injury of Neck

目的：报道１３例颈部推拿治疗患者，因采用“拧头”手法操作，旋转暴力过大而致寰齿关节脱位及神经功能障碍属医源性损害。方法：通过对１３例患者系统神经检查、ＣＴ和ＭＲＩ的比较和相关研究进行分类，结果：根据寰齿关节变位情况不同区分为：１寰齿关节旋转性半脱位，（１）齿突尖移位型；（２）齿突基底部移位型；（３）全齿突移位型。２寰椎前脱位。根据临床特征又区分为：１神经根型；２神经根—脊髓型；３神经根—脊髓—延髓型的临床分型。结论：对于环齿关节因旋转暴力过大而引起医源性损害尚存在一定的规律性分型，提供了对该类医源性损害的依据，提出在颈椎病推拿中应避免“拧头”这一手法操作。

Objective:To demonstrate the iatrogenic injury in the massage of neck we reported 13 patients who massaged by over rotatory violence for the neck of patients with cervical spondylosis.Method:The patients examinated by regular examination of nerve system.CT and MRI were gone further into comparison,relative research and classification.Result:According to alteration of atlanta alial joint position,we distinguish them into:1 Atlanta axial joint rotatory subluxation (1)Displacement of top of odontoid process;(2)Displacement of base of odontoid process;(3)Displacement of all odontoid process.2 Atlas forward dislocation.On the basis of clinic features we divide them into:(1)Nerve root type;(2)Nerve root spinal cord type;(3)Nerve root spinal cord medulla oblongata type.Conclusion:We believe that manipulator should give up the rotatory manipulation when they try to practive it.