椎动脉型颈椎病“五步法”治疗前后血管结构和血液动力学的变化

VASCULAR STRUCTURE AND HEMODYNAMIC CHANGES IN PATIENTS WITH CERVICAL SPONDYLOTIC ARTERIOPATHY BEFORE AND AFTER “FIVE STEP THERAPY”

目的分析椎动脉型颈椎病经"五步法"(牵、按、熏、灸、电)治疗后其血管解剖结构和血液动力学的变化,为探讨椎动脉型颈椎病的病因及评价"五步法"治疗的效果提供依据。方法椎动脉型颈椎病127例及正常对照组40例,采用彩色多普勒超声诊断仪及转颈试验观察病例组经"五步法"治疗后血管结构及血流动力学指标的改变。结果 (1)在127例椎动脉型颈椎病患者中,有78例椎动脉内径偏细,其血流速度低于而阻力指数高于对照组,差异有显著性(P<0.05);另有49例椎动脉走形异常,其血流速度、阻力指数在转颈试验后也分别低于和高于对照组,差异有显著性(P<0.05)。(2)采用"五步法"治疗后,这些患者椎动脉血流速度都恢复到正常范围;血流阻力指数也较治疗前明显降低(P<0.05),但仍高于对照组(P<0.05)。(3)所有患者经治疗后,其血管内径及走形异常等解剖结构未见改变。结论椎动脉型颈椎病是椎动脉内径偏细、走形异常原因引起,导致血供不足、阻力增高血流动力学改变;"五步法"治疗后,血流速度恢复正常,阻力指数降低,但结构无变化。

Objective To observe the vasculo-anatomical and hemodynamic changes in patients with cervical spondylotic arteriopathy before and after＂ five step therapy＂（ cervival tracion, acupoint massage, Chinese medicine fumigation, acupuncture and moxibustion, and electro-physiotherapy）, so as to provide the basis for stud- ying the etiology of this disease and the curative effect of ＂five step therapy＂. Methods One hundred and twenty- seven cases of cervical spondylotic arteriopathy and 40 healthy volunteers as controls were observed in this study using color Doppler uhrasonography, and neck rotation test. Results （1）Among 127 patients,78 patients showed narrower vertebral artery（VA）. The inner diameter of their VA was smaller, blood flow velocity lower, and resist- ance index higher than that in the control （P〈0.05） ; the other 49 patients showed abnormal course of VA. The blood flow velocity, and resistance index in these patients was also lower, and higher respectively than that in the control after neck rotation test（P〈0.05 ）. （2）After treatment with＂five step therapy＂, the blood flow velocity in all patients recovered to normal level, and was not significantly different from that in the control（ P〉0.05 ） ;the resistance index was also lower than that before treatmen（P〈0.05） ,but still higher than that in the control（ P〈 0.05 ）. （ 3 ） The change of vascular anatomical structure in all patients was not found after treatment. Conclusions Decrease in inner diameter, and abnormal course of VA which lead to insufficient blood supply and changes of he- modynamic parameters, are the main cause of cervical spondylotic arteriopathy. Blood flow velocity was recovered to the normal level and resistance index was decreased after ＂five step therapy＂. However, anatomical structure had no change after treatment.