基于三维伪连续脉冲动脉自旋标记技术探讨脊柱手法治疗眩晕症的临床研究

Clinical study of spinal manipulation in the treatment of vertigo based on three-dimensional pseudo-continuous pulse arterial spin labeling technology

目的:筛选适合中医脊柱手法治疗的眩晕症患者。方法:收集存在脊柱“骨错缝、筋出槽”的眩晕患者78例,磁共振扫描并应用三维伪连续脉冲动脉自旋标记(3D-pcASL)技术进行筛选,双侧大脑半球存在灌注峰值不同步者列为观察组,灌注峰值同步者列为对照组,对两组患者应用脊柱手法治疗,应用眩晕障碍量表(DHI)评估眩晕改善状况,再次磁共振3D-pcASL成像扫描观察灌注情况。结果:78例眩晕症患者中观察组患者数为47例,占60.26%,眩晕症状改善有效率为85.11%(40/47);对照组患者数为31例,占39.74%,眩晕症状改善有效率为45.16%(14/31)。观察组总有效率显著高于对照组(P<0.01)。治疗后,观察组灌注峰值同步数为37例,对照组为29例。观察组和对照组治疗前后DHI评分差值分别为(37.53±13.96)、(10.65±8.33)分,差异有统计学意义(P<0.05)。结论:磁共振3D-pcASL成像是评估双侧大脑灌注是否均衡的有效手段;同时存在“骨错缝、筋出槽”和双侧大脑灌注失衡眩晕患者适宜脊柱手法治疗且疗效较好。

Objective:To screen patients with vertigo suitable for traditional Chinese medicine(TCM)spinal manipulation.Methods:To collect 78 patients with vertigo with spinal‘Gu Cuo Feng and Jin Chu Cao’,MRI scan and application of three-dimensional pseudo-continuous pulse arterial spin labeling(3D-pcASL)technique for screening.Patients with uneven perfusion in bilateral cerebral hemispheres were listed as the observation group,and patients with similar perfusion in bilateral cerebral hemispheres were listed as the control group.Vertigo improvement was assessed by dizziness handicap inventory(DHI)after spinal manipulations in both groups.MRI 3D-pcASL imaging scanning to observe perfusion.Results:Among 78 patients with vertigo,the observation group had 47 cases,accounting for 60.26%,and the effective rate of improving vertigo symptoms was 85.11%(40/47);the control group had 31 cases,accounting for 39.74%.The effective rate of improving vertigo symptoms was 45.16%(14/31).The total effective rate of the observation group was significantly higher than that of the control group(P<0.01).After the treatment,the synchronous number of perfusion peak curve in the observation group was 37 cases,29 cases in the control group.The difference of DHI scores before and after treatment in the observation group and the control group was(37.53±13.96)points and(10.65±8.33)points,respectively,and the difference was statistically significant(P<0.05).Conclusion:MRI 3D-pcASL imaging is an effective way to assess whether the bilateral cerebral perfusion is balanced.At the same time,patients with‘Gu Cuo Feng and Jin Chu Cao’and bilateral cerebral perfusion imbalance are suitable for spinal manipulation,which has good curative effects.