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

作　　者：张开勇[1,2,3,4] 刘鹏 徐斯伟[1] 张必萌[1] 罗倩[1] 詹红生[2,3,4] ZHANG Kai-yong;LIU Peng;XU Si-wei;ZHANG Bi-meng;LUO Qian;ZHAN Hong-sheng(Shanghai First People’s Hospital,Shanghai 200080,China;SHIs’Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Traumatology&Orthopedics,Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203,China;ZHAN Hong-sheng Shanghai Famous Traditional Chinese Medicine Experience Research Studio,Shanghai 201203,China)

机构地区：[1]上海市第一人民医院,上海200080 [2]上海中医药大学附属曙光医院石氏伤科医学中心,上海201203 [3]上海市中医药研究院骨伤科研究所,上海201203 [4]詹红生上海市名中医学术经验研究工作室,上海201203

出　　处：《中华中医药杂志》2023年第6期2979-2982,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：上海市临床重点专科“中医骨伤科学”(No.shslczdzk03901);上海市慢性筋骨病临床医学研究中心(No.20MC1920600);促进市级医院临床技能与临床创新三年行动计划(2020—2022年)重大临床研究项目(No.SHDC2020CR1051B);上海市中西医临床协作试点项目[No.ZXYXZ-201703,No.ZY(2018-2020)-FWTX-1007];国家自然科学基金项目(No.81973871);2019年度松江区科技攻关项目(No.19SJKJGG29)。

摘　　要：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.

关 键 词：眩晕 三维伪连续脉冲动脉自旋标记 磁共振成像 灌注失衡 手法治疗 

分 类 号：R255.3[医药卫生—中医内科学]