美式整脊手法结合脊柱脉冲诊疗仪治疗小儿寰枢椎旋转半脱位

Treatment of atlantoaxial rotatory subluxation with chiropractic manipulation and spinal adjusting instrument in children

目的探讨美式整脊手法（Chiropractic）配合脊柱脉冲诊疗仪治疗小儿寰枢椎旋转半脱位的有效性。方法回顾性分析2004年7月至2014年8月,于我院门诊骨科就诊的37例寰枢椎旋转半脱位患儿,其中男27例,女10例,年龄3.5-12岁,平均7.9岁。发病前有明确上呼吸道感染病史的患儿占21.6%（8/37）,有明确头颈部外伤史的占35.1%（13/37）。就诊时间为发病后当天至3个月不等。所有患儿均接受颈部活动范围检查,部分（年龄较大的患儿）接受视觉模拟评分（visual analogue scale,VAS）测量;同时接受颈椎正、侧、张口位X线检查,部分患儿加做寰枢椎螺旋CT扫描及图像三维重建检查。三维CT检查重点测量寰枢椎在纵轴和矢状轴上旋转畸形的角度。所有患儿均接受本研究第一作者给予的Chiropractic治疗和脊柱脉冲诊疗仪（Sigma公司,Neuromechinical Innovation公司,美国）的治疗。患儿在伤后2-3天内连续接受1次/天的治疗,随后改为2-3次/周,并佩戴颈托2周。治疗结束后给予影像学复查,治疗前后的VAS值进行统计学比较。结果治疗后多数患儿的疼痛症状获得明显改善。本组11例在治疗前后接受VAS测试,治疗前VAS评分7.2-10分,平均8.68分,治疗后VAS评分0-3分,平均1.75分,差异有统计学意义（P〈0.01）。本组在治疗后接受影像学复查的病例共13例,但接受影像学复查的时间相差甚远（1.5小时至7年）。绝大多数患者影像学有明显好转,仅2例在复查X线片时对位不佳,尚需继续治疗和观察。结论Chiropractic是治疗小儿寰枢椎旋转半脱位有效方法之一,脊柱脉冲诊疗仪对小儿而言更具有依从性和安全性,两者配合使用可以增加疗效。三维螺旋CT能对寰枢椎在纵轴和矢状轴上旋转畸形的角度进行精确的测量,并对治疗有指导意义。

Objective To investigate the effectiveness of chiropractic manipulation with spinal adjusting instrument in treating children with atlantoaxial rotary subluxation. Methods This was a retrospective analysis for the cases from July 2004 to August 2014 in our hospital. There were 37 cases（ 27 males and 10 females）, and the age ranged from 3.5 to 12 years（ mean 7.9 years）. Clear history of upper respiratory tract infection before the onset was found in 8 children（ 21.6%）; while a clear history of head and neck trauma accounted for 13（ 35.1%）. Treatment time was ranging from the day of the onset to 3 months after the onset. All patients underwent neck examination for the range of motion, and visual analog scale（ VAS） was performed on some elder children. All patients received cervical spinal X ray, including PA lateral and open mouth position; some of the children also received an atlantoaxial spiral CT scanning and 3 D reconstruction. Three-dimensional CT examination focused on measuring atlantoaxial rotation angle in both vertical and sagittal axes of deformities. All patients underwent chiropractic manipulation. The treatment protocol included the children receiving continuous treatment for 2 to 3 days, 1 time / day, followed by 2 to 3 times /week, 2 weeks with a cervical collar. Each patient received spiral CT after the treatment for reviewing. VAS scores prior and post to the treatment were statistically analyzed. Results After the treatment, most children had significant improvement in pain symptoms. Eleven patients received VAS evaluation before（ 7.2- 10 points, mean 8.68 points） and after the treatment（ 0- 3 points, mean 1.75 points）, showing significant improvement with statistical significance（ P〈 0.01）. Thirteen patients had imaging review and most of them improved significantly, but with different intervals（ 1.5 hours-7 years）. Only 2 cases showed slightly worsening in the review of X-ray, and further treatment and observation were needed. Conclusions Chiropractic manipulation is an effective way for young patients with atlantoaxial rotary subluxation; Spinal adjusting instrument is safer for patients with better compliance. Both of them can promote therapeutic efficacy. Three-dimensional helical CT scan can show atlantoaxial in the vertical and sagittal axes of rotational angle of deformities with accuracy, guiding the treatment in clinic.