脊骨神经医学颈椎矫正技术治疗椎动脉型颈椎病临床观察

Clinical observation on cervical chiropractic for cervical spondylosis of vertebral artery type

目的：观察脊骨神经医学颈椎矫正技术治疗椎动脉型颈椎病（CSA）的疗效并探讨其可能的作用机制.方法：将60例CSA患者随机分为2组,治疗组30例采用脊骨神经医学颈椎矫正技术治疗,隔日1次,共7次;对照组30例口服扩管药物盐酸氟桂利嗪胶囊10 mg,每晚睡前1次,共14 d.治疗前及治疗后7d进行颈性眩晕症状与功能评估量表评分及经颅多普勒（TCD）检测.结果：治疗组总有效率为96.7％,对照组为83.3％;治疗组治愈率为66.7％,对照组为20％,组间总有效率及治愈率差异均有统计学意义（均P＜0.05）.两组患者治疗后的颈性眩晕症状与功能评估量表评分均较治疗前明显增加（均P＜0.01）,组间差异有统计学意义（P＜0.05）.两组患者治疗后椎动脉、基底动脉的收缩期最大血流速度（Vs）、舒张末期最大血流速度（Vd）、平均血流速度（Vm）、血管搏动指数（PI）及阻力指数（RI）均较治疗前明显改善（均P＜0.01）,组间差异均有统计学意义（均P＜0.05）.结论：采用脊骨神经医学颈椎矫正技术治疗CSA的疗效确切,且其疗效优于单纯服用氟桂利嗪胶囊,其作用机制可能是纠正“颈椎失稳”.

Objective：To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type （CSA） and to explore its possible mechanism.Methods：Sixty CSA patients were randomly divided into two groups.Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae,once every other day,7 treatments in total.The other 30 patients in the control group received oral administration of flunarizine hydrochloride,10 mg per night,for 14 d.Cervical vertigo and functional assessment scale and transcranial cerebral Doppler （TCD） were measured before treatment and 7 days after treatment.Results：The total effective rate was 96.7% in the treatment group and 83.3% in the control group.The curative rate was 66.7% in the treatment group and 20% in the control group.The differences between the two groups in the total effective rate and the curative rate were statistically significant （both P〈0.05）.The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment （both P〈0.01）;the difference between the two groups was statistically significant （P〈0.05）.After treatment,the maximum systolic velocity （Vs）,the maximum diastolic velocity （Vd）,the mean velocity （Vm）,the pulsatility index （PI） and the vascular resistance index （RI） in both groups were significantly improved compared with those before the treatment （all P〈0.01）;there were significant differences between the two groups （all P〈0.05）.Conclusion：Cervical chiropractic is an effective method for CSA,and its curative effect is better than that of flunarizine hydrochloride alone.Its mechanism may relate to correcting cervical instability.