基于颈肌MRI探讨手法治疗椎动脉型颈椎病的起效机制  

The Efficacy Mechanism of Manipulation in Treating Vertebral Artery Type Cervical Spondylopathy Based on Cervical Muscles MRI

作　　者：罗凛[1] 王振辉 郭鸿基 张玲[2] LUO Lin;WANG Zhenhui;GUO Hongji;ZHANG Lin(Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510095,China;Guangzhou University of Chinese Medicine,Guangzhou 510006,China)

机构地区：[1]广东省第二中医院,广州510095 [2]广州中医药大学

出　　处：《中国中医骨伤科杂志》2020年第5期14-17,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金(81574093)。

摘　　要：目的:对比椎动脉型颈椎病患者接受手法治疗前后颈肌MRI的变化以明确其起效机制。方法:运用推拿手法对30例椎动脉型颈椎病患者进行手法治疗,经过3周的治疗,记录患者治疗前后FS-CSA评分,评估临床疗效,同时采用MRI测量颈部双侧斜方肌及胸锁乳突肌横截面图长短径变化,评估两组肌肉形态学变化。结果:经推拿手法治疗后,患者FS-CSA评分较治疗前显著提高,差异有统计学意义(P<0.05),测量双侧胸锁乳突肌长径、短径均较治疗前短,与治疗前比较差异均有统计学意义(P<0.01)。左右侧胸锁乳突肌治疗前后比较差异均有统计学意义,而治疗后的双侧斜方肌的长短径则较治疗前长(P<0.01)。结论:手法治疗椎动脉型颈椎病的起效机制可能与调节颈部肌肉,尤其是胸锁乳突肌以及斜方肌形态变化(长短径)从而维持颈椎的动力平衡有关,提示临床治疗颈椎病除了关注骨性结构的变化外,更应该注意纠正肌源性导致的力学失衡。Objective:To clarify the efficacy mechanism of manipulation in treating vertebral artery type cervical spondylopathy based on cervical muscles MRI.Methods:30 patients with vertebral artery type cervical spondylopathy(VRTCS)were treated by manipulation.The FS-CSA scores of these patients before and after treatment were recorded to evaluate the clinical effect.At the same time,the length and diameter of the cross-section of bilateral trapezius and sternocleidomastoid muscles were measured by MRI to evaluate the morphological changes of the muscles.Results:The FS-CSA scores of patients after manipulation were significantly higher than before(P<0.05).The bilateral sternocleidomastoid muscles were significantly shorter than before,while the length of bilateral trapezius muscles after treatment were longer than before(P<0.01).Conclusion:The mechanism of effectiveness of manipulation in the treatment of VRTCS may be related to the regulation of the sternocleidomastoid muscle and trapezius muscle morphology for the dynamic balance of the cervical spine.It is suggested that muscle resource disorder,besides the skeleton structure issue,needs to be corrected during the treatment of VRTCS.

关 键 词：手法 影像学 椎动脉型颈椎病 

分 类 号：R681.5[医药卫生—骨科学]