自创定点坐位拔伸整复手法对椎动脉型颈椎病的诊治价值

The diagnosis and treatment value of vertebral artery type of cervical spondylosis with self-made fixed-point sitting extension and reduction technique

目的评价用定点坐位拔伸整复手法筛选和治疗椎动脉型颈椎病(CSA)的临床价值。方法将100例CSA患者经定点坐位拔伸整复手法筛选,按结果分为阳性组(50例)和阴性组(50例),按照随机数字表法将阳性组分为阳性药物组、阳性推拿组,阴性组分为阴性药物组、阴性推拿组,各25例。阳性药物组、阴性药物组予药物治疗;阳性推拿组、阴性推拿组予推拿结合颈部牵引治疗。4组均10 d为1个疗程,1个疗程后统计临床疗效,并观察阳性组、阴性组治疗前后颈性眩晕症状与功能评分、CSA功能评定量表评分。结果治疗后阳性药物组、阴性药物组眩晕(程度、频度、持续时间)、头痛、日常生活及工作评分和总分均较本组治疗前升高(P<0.05),阳性药物组与阴性药物组治疗后颈性眩晕症状与功能各项评分和总分比较差异均无统计学意义(P>0.05);治疗后阳性推拿组与阴性推拿组眩晕(程度、频度、持续时间)、颈肩痛、头痛、日常生活及工作、心理及社会适应评分和总分均较本组治疗前升高(P<0.05),且阳性推拿组眩晕(程度、频度、持续时间)、头痛、心理及社会适应评分和总分均高于阴性推拿组(P<0.05)。治疗后各组CSA功能评定量表评分均降低(P<0.05);阳性药物组治疗后CSA功能评定量表评分与阴性药物组比较差异无统计学意义(P>0.05);阳性推拿组治疗后CSA功能评定量表评分低于阴性推拿组(P<0.05)。阳性推拿组与阴性推拿组总有效率比较差异有统计学意义(P<0.05),阳性推拿组临床疗效优于阴性推拿组;阳性药物组与阴性药物组总有效率比较差异无统计学意义(P>0.05),阳性药物组与阴性药物组临床疗效相当。结论定点坐位拔伸整复手法可用于CSA手法治疗适应证的筛选,并能显著缓解患者的临床症状,改善日常生活和心理社会适应能力,提高临床疗效。

Objective To evaluate the clinical value of vertebral artery type of cervical spondylosis(CSA)with self-made fixed-point sitting extension and reduction technique.Methods 100 patients with CSA were selected by fixed-point sitting extension and reduction technique,and divided into positive group(50 cases)and negative group(50 cases).The positive group was divided into positive drug group and positive massage group according to the random number table method.The negative group was divided into negative drug group and negative massage group,with 25 cases in each group.The positive drug group and the negative drug group were treated by drugs.The positive massage group and the negative massage group were treated by massage combined with neck traction.All the four groups had a course of treatment for 10 days,and the clinical effect was counted after a course of treatment.The symptoms and function scores of cervical vertigo and CSA function evaluation scale were observed in the positive and negative groups before and after treatment.Results After treatment,the vertigo(degree,frequency,duration),headache,daily life and work scores and total scores of the positive drug group and the negative drug group were higher than those of the group before treatment(P<0.05).There was no significant difference between the positive drug group and the negative drug group in the scores and total scores of cervical vertigo symptoms and functions after treatment(P>0.05).After treatment,the vertigo(degree,frequency,duration),neck and shoulder pain,headache,daily life and work,psychological and social adaptation scores and total scores in the positive massage group and the negative massage group were higher than those in the group before treatment(P<0.05),and vertigo(degree,frequency,duration),headache,psychological and social adaptation scores and total scores in the positive massage group were higher than those in the negative massage group(P<0.05).After treatment,the score of CSA functional assessment scale in each group was decreased(P<0.05).There was no significant difference between the positive drug group and the negative drug group(P>0.05).The score of CSA in positive massage group was lower than that in negative massage group(P<0.05).The difference of total effective rate between positive and negative massage groups was statistically significant(P<0.05),the clinical effect of positive massage group is better than that of negative massage group.There was no significant difference in the total effective rate between the positive drug group and the negative drug group(P>0.05).The clinical efficacy of the positive drug group was comparable to that of the negative drug group.Conclusion The drugs of fixed-point sitting extension and reduction technique can be used to screen the indications of CSA manipulation.The treatment of CSA can significantly alleviate the clinical symptoms,improve the ability of daily life and psychosocial adaptation,and improve the clinical efficacy.