三部复位法治疗寰枢关节骨错缝疗效评价

Efficacy evaluation on three-part reduction method in the treatment of articulatio atlantoepistrophica semidislocation

目的:观察三部复位法治疗寰枢关节骨错缝的临床疗效。方法:纳入106例寰枢关节骨错缝患者,随机分为观察组和对照组,每组各53例。观察组患者给予三部复位法治疗,对照组患者给予颈椎斜扳法治疗,治疗周期为2周,治疗结束后随访4周。评价两组患者的临床疗效,比较两组患者治疗前后的颈椎疼痛视觉模拟评分(VAS);采用颈椎张口位X线片检测评价患者的寰枢关节骨错缝情况,包括寰枢关节偏歪程度、寰齿关节偏歪程度、齿突棘突不共线水平;采用经颅多普勒(TCD)检测所有患者的颈部椎-基底动脉血流收缩期速率,比较两组患者的异常率。结果:①治疗1周、2周后及随访时,观察组患者的临床总有效率分别为92.45%、98.11%、98.11%,对照组分别为49.06%、52.83%、50.94%,观察组患者的疗效均优于对照组(P<0.01)。②治疗后及随访时,两组患者的疼痛VAS评分较治疗前均降低(P<0.05),且观察组患者的评分均低于对照组(P<0.05)。③治疗后,观察组患者的寰枢关节偏歪程度、寰齿关节偏歪程度、齿突棘突不共线水平较治疗前均明显改善(P<0.05),对照组患者的寰齿关节偏歪程度、齿突棘突不共线水平较治疗前亦明显改善(P<0.05),且治疗后观察组患者寰枢关节偏歪程度、寰齿关节偏歪程度的改善均优于对照组(P<0.05)。④治疗后,观察组患者的TCD检测异常率较治疗前明显降低(P<0.05),且观察组患者的TCD检测异常率显著低于对照组(P<0.05)。结论:三部复位法可有效改善寰枢关节骨错缝患者的临床症状、体征及影像学检测指标,且其疗效优于颈椎斜扳法。

Objective: To observe the clinical efficacy of three-part reduction method in the treatment of articulatio atlantoepistrophica semidislocation. Methods: One hundred and six patients with articulatio atlantoepistrophica semidislocation were included and randomly divided into the observation group and control group, 53 cases in each group. The patients in the observation group were treated with three-part reduction method and the patients in the control group were treated with cervical vertebra oblique pulling method. The course of treatment was 2 weeks, and after treatment, the patients were followed-up for 4 weeks. The clinical efficacy of the two groups was evaluated, and the scores of visual analogue scale(VAS) of cervical vertebra pain in the two groups were compared before and after treatment. The articulatio atlantoepistrophica semidislocation was evaluated by X-ray film of cervical vertebra open mouth view, including the degree of atlantoaxial joint deviation, the degree of atlanto-odontoid joint deviation, and the non-collinear level of odontoid and spinous processes. The systolic blood flow velocity of cervical vertebra-basilar artery was detected by transcranial Doppler(TCD), and the abnormal rate was compared between the two groups. Results:①After one-week and two-week treatment and at follow-up, the total clinical effective rates of the observation group were 92.45%,98.11%and 98.11%respectively,and the total clinical effective rates of the control group were 49.06%,52.83%and 50.94%respectively.The efficacy of the observation group was better than that of the control group(P<0.01).②After treatment and at follow-up,the VAS scores of pain in the two groups were decreased compared with those before treatment(P<0.05),and the scores of the observation group were lower than those of the control group(P<0.05).③After treatment,the degree of atlantoaxial joint deviation,the degree of atlanto-odontoid joint deviation,and the non-collinear level of odontoid and spinous processes in the observation group were significantly improved compared with those before treatment (P<0.05),the degree of atlanto-odontoid joint deviation and the non-collinear level of odontoid and spinous processes in the control group were also obviously improved compared with those before treatment(P<0.05).After treatment,the improvements on the degree of atlantoaxial joint deviation and the degree of atlantoodontoid joint deviation in the observation group were superior to the control group(P<0.05).④After treatment,the abnormal rate of TCD detection in the observation group was significantly decreased compared with that before treatment(P<0.05),and the abnormal rate of TCD detection in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Three-part reduction method can effectively improve the clinical symptoms,signs and indexes of imaging examination in patients with articulatio atlantoepistrophica semidislocation,and its efficacy is better than that of cervical vertebra oblique pulling method.