重建脊柱内外平衡治疗颈椎间盘突出症的临床研究  

Treatment of cervical disc herniation by restoring internal-external spinal balance

作　　者：冯伟 冯子鹤 刘洪波 安建鹏 王雅蓉 FENG Wei;FENG Zihe;LIU Hongbo;AN Jianpeng;WANG Yarong(Department of TCM Manipulative Orthopedic,Air Force Medical Center,Air Force Medical University,PLA,Beijing 100142;Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]空军军医大学空军特色医学中心中西医结合正骨科,北京100142 [2]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《空军航空医学》2024年第5期417-422,共6页AVIATION MEDICINE OF AIR FORCE

摘　　要：目的初步研究脊柱内外平衡失稳理论指导下接受治疗的颈椎间盘突出症患者临床资料,总结该疾病临床特点及以脊柱定点旋转复位法纠正椎体位移为主治疗该疾病的临床经过及结局并对其机理进行探讨。方法回顾性分析2021年12月—2022年12月在空军特色医学中心中西医结合正骨科治疗的21例颈椎间盘突出症患者,按临床症状分为神经根型组14例和脊髓型组7例。采用脊柱定点旋转复位法作为主要治疗手段,重建脊柱内外平衡。观察2组治疗前、出院时及远期随访的临床疗效[疼痛视觉模拟评分(Visual Analogue Scale,VAS)、颈椎功能障碍指数(Neck Disability Index,NDI)及改良日本骨科协会评分(Modified Japanese Orthopaedic Association,mJOA)]、体型变化(基于深度学习的人体关键点检测技术评估)、关节囊压痛变化[疼痛强度数字评级量表(Numerical Rating Scale,NRS)和Wong-Baker面部表情疼痛量表(Wong Baker Faces Pain Scale Revision,FPS-R)]、以及影像学评估(C2~C7 Cobb角、颈椎质心线角、腰椎前凸、胸椎后凸、巴浦洛夫比值和颈椎核磁轴位矢状径指数)。结果与治疗前比较,2组出院时和远期随访VAS评分(P=0.001~0.017)、NDI评分均降低(P均<0.001),mJOA评分升高(P=0.001~0.005)。神经根型组患者治疗前后肩平衡角变化差异有统计学意义(F=8.589,P=0.001);2组治疗远段椎体位移后关节囊压痛NRS及FPS-R评分均降低(t=13.015~39.782,P均≤0.001);神经根型组治疗后巴浦洛夫比值增大、颈椎核磁轴位矢状径指数减小(t=3.404、4.474,P=0.005、0.001)。结论颈椎间盘突出症的临床表现是全脊柱整体内外平衡失衡的结果,治疗上利用脊柱定点旋转复位法优先纠正远段椎体位移并最终恢复脊柱内外平衡达临床治愈。Objective This study endeavors to undertake a comprehensive investigation into the clinical data of patients with cervical disc herniation who are receiving treatment informed by the principles of Feng's manipulation(FSM)therapy.Methods A retrospective cohort analysis was performed on 21 patients diagnosed with cervical disc herniation who underwent Feng's spinal manipulation(FSM)therapy at the Air Force Medical Center from December 2021 to December 2022,14 cases were radiculopathy type and 7 cases were myelopathy type.Outcome measures included clinical efficacy(VAS,NDI,and mJOA scores),body posture changes(assessed using deep learning-based human key point detection technology),joint capsule tenderness(evaluated using NRS and Wong-Baker scales),and radiographic parameters(C2-C7 Cobb angle,cervical centroid line angle,CCL,lumbar lordosis,LL,thoracic kyphosis,TK,Pavlov ratio,and sagittal index,SI).Results Compared with before treatment,both groups showed a decrease in VAS scores(P=0.001~0.017)and NDI scores(all P<0.001)at discharge and long-term follow-up,and an increase in mJOA scores(P=0.001~0.005).The radiculopathy group demonstrated significant changes in shoulder balance angle pre-and post-treatment(F=8.589,P=0.001).Both groups exhibited a sharp reduction in NRS and W-B scores for joint capsule tenderness after treatment of distal vertebral displacement(t=13.015~39.782,all P≤0.001).The radiculopathy group showed increased Pavlov ratio and decreased SI after treatment(t=3.404,4.474,P=0.005,0.001).Conclusion Cervical disc herniation is attributable to a comprehensive internal-external spinal imbalance.Intervention utilizing Feng's Spinal Manipulation(FSM)therapy addresses the subluxation of single or multiple vertebrae,with the ultimate goal of reinstating spinal balance and achieving clinical cure.

关 键 词：脊柱内外平衡 椎体位移 颈椎间盘突出症 新医正骨 

分 类 号：R681.5[医药卫生—骨科学]