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[1]郭偉,趙頎,龔成,等.頸椎力學(xué)評價指標(biāo)在非手術(shù)療法治療神經(jīng)根型頸椎病療效評價中的應(yīng)用[J].中醫(yī)正骨,2018,30(03):22-26.
　GUO Wei,ZHAO Qi,GONG Cheng,et al.Application of cervical mechanical evaluation indexes to curative effect evaluation of nonoperative therapy in the treatment of cervical spondylotic radiculopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(03):22-26.
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頸椎力學(xué)評價指標(biāo)在非手術(shù)療法治療神經(jīng)根型頸椎病療效評價中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年03期
頁碼:
22-26
欄目:
頸椎疾患
出版日期:
2018-03-20

文章信息/Info

Title:
Application of cervical mechanical evaluation indexes to curative effect evaluation of nonoperative therapy in the treatment of cervical spondylotic radiculopathy
作者:
郭偉; 趙頎; 龔成; 趙平
中國人民解放軍空軍總醫(yī)院,北京 100142
Author(s):
GUO Wei; ZHAO Qi; GONG Cheng; ZHAO Ping
Airforce General Hospital of PLA,Beijing 100142,China
關(guān)鍵詞:
頸椎病;  非手術(shù)療法;  療效評價;  生物力學(xué)
Keywords:
Keywords cervical spondylosis;  nonoperative therapy;  curative effect evaluation;  biomechanics
摘要:
目的:探討頸椎力學(xué)評價指標(biāo)在非手術(shù)療法治療神經(jīng)根型頸椎病療效評價中的應(yīng)用價值。方法:2016年10月至2017年6月,采用手法等非手術(shù)療法治療神經(jīng)根型頸椎病患者46例。男26例、女20例,年齡(48.91±9.77)歲,體質(zhì)量指數(shù)(24.57±2.99)kg·m-2,病程(2.32±1.97)月。病變節(jié)段,單節(jié)段11例、2節(jié)段16例、3節(jié)段10例、4節(jié)段7例、5節(jié)段2例。分別在治療前和治療結(jié)束后,采用頸椎功能障礙指數(shù)(neck disability index,NDI)評分量表對患者頸椎功能進行臨床評價; 采用DAVID脊柱智能康復(fù)系統(tǒng)測定患者頸椎關(guān)節(jié)活動度、頸椎關(guān)節(jié)活動協(xié)調(diào)性、頸部肌群最大等長肌力矩和頸部肌群協(xié)調(diào)性,對患者頸椎進行力學(xué)評價。計算NDI及頸椎力學(xué)評價各項指標(biāo)治療前后的差值(治療后-治療前),分析臨床評價指標(biāo)變化與頸椎力學(xué)評價指標(biāo)變化之間的相關(guān)性。結(jié)果:①臨床評價與頸椎力學(xué)評價結(jié)果。46例患者均順利完成治療。治療結(jié)束后,患者頸椎NDI較治療前降低[(34.32±13.11)%,(18.21±10.65)%,t=-11.041,P=0.000]; 頸椎前屈、后伸、左右側(cè)屈、左右旋6個方向的關(guān)節(jié)活動度均較治療前增加[(39.67°±14.04°),(48.11°±10.76°),t=4.362,P=0.000;(46.76°±12.71°),(57.48°±11.22°),t=5.523,P=0.000;(33.13°±10.58°),(40.00°±11.68°),t=4.428,P=0.000;(35.70°±8.32°),(42.80°±39.55°),t=4.356,P=0.000;(51.17°±12.93°),(56.54°±11.11°),t=3.304,P=0.002;(51.28°±11.25°),(55.63°±10.95°),t=2.715,P=0.009]; 頸椎關(guān)節(jié)屈伸活動協(xié)調(diào)性較治療前改善,但側(cè)屈和旋轉(zhuǎn)活動協(xié)調(diào)性與治療前相比,差異無統(tǒng)計學(xué)意義[(1.37±0.87),(0.85±0.20),t=-3.775,P=0.000;(1.15±0.36),(1.10±0.17),t=-1.074,P=0.291;(1.05±0.33),(0.99±0.14),t=-1.202,P=0.211]; 頸部肌群后伸、前屈及左右側(cè)屈最大等長肌力矩均較治療前增加[(1.00±0.00)N·m-1,(1.00±1.00)N·m-1,Z=-2.312,P=0.021;(2.00±6.25)N·m-1,(5.00±11.00)N·m-1,Z=-3.545,P=0.000;(1.00±1.25)N·m-1,(2.00±5.00)N·m-1,Z=-3.903,P=0.000;(1.00±2.00)N·m-1,(2.00±5.00)N·m-1,Z=-2.465,P=0.014]; 頸部肌群屈伸力量協(xié)調(diào)性較治療前改善,而側(cè)屈力量協(xié)調(diào)性與治療前相比,差異無統(tǒng)計學(xué)意義[(2.00±5.00),(3.50±5.00),Z=-2.043,P=0.041;(1.00±0.62),(1.00±0.04),Z=-1.725,P=0.085]。②臨床評價指標(biāo)變化與頸椎力學(xué)評價指標(biāo)變化的相關(guān)性分析結(jié)果。治療前后患者NDI的差值與治療前后頸部肌群前屈、后伸最大等長肌力矩的差值呈負相關(guān)(r=-0.455,P=0.002; r=-0.334,P=0.024),即頸部肌群前屈、后伸最大等長肌力矩增加越多,NDI降低越多; 與治療前后頸部肌群屈伸力量協(xié)調(diào)性的差值呈正相關(guān)(r=0.344,P=0.020),即頸部肌群屈伸力量協(xié)調(diào)性改善越多,NDI降低越多; 與其他頸椎力學(xué)評價指標(biāo)治療前后的差值均無相關(guān)性。結(jié)論:在非手術(shù)療法治療神經(jīng)根型頸椎病的療效評價中應(yīng)用頸椎力學(xué)評價指標(biāo),有利于療效評價的客觀化和精確化。
Abstract:
ABSTRACT Objective:To explore the applied value of cervical mechanical evaluation indexes in curative effect evaluation of nonoperative therapy in the treatment of cervical spondylotic radiculopathy.Methods:Forty-six patients with cervical spondylotic radiculopathy received nonoperative treatment from October 2016 to June 2017.The patients consisted of 26 males and 20 females.Their ages were 48.91+/-9.77 years,and body mass indexes(BMI)were 24.57+/-2.99,and disease courses were 2.32+/-1.97 months.The pathological changes located at single segment(11),two segments(16),three segments(10),four segments(7)and five segments(2)respectively.The clinical evaluation of cervical vertebra function of patients was conducted by using neck disability index(NDI)scoring scale before treatment and after the end of the treatment respectively.Meanwhile,the mechanical evaluation indexes,including joint range of motion(ROM)of cervical vertebrae,coordination of cervical joint motion,maximal isometric torque of cervical muscle group and coordination of cervical muscle group,were measured by using DAVID intelligent spine rehabilitation system.The differences of NDI and cervical mechanical evaluation indexes between pretreatment and posttreatment were calculated,and the correlation between the change of clinical evaluation indexes and the change of cervical mechanical evaluation indexes were analyzed.Results:The treatment were finished successfully in all patients.The NDI of cervical vertebrae decreased(34.32+/-13.11% vs 18.21+/-10.65%,t=-11.041,P=0.000),while the joint ROM of cervical vertebrae in 6 kinds of states of motion,including anteflexion,backward extension,left-right lateral flexion and left-right rotation increased(39.67+/-14.04 vs 48.11+/-10.76 degrees,t=4.362,P=0.000; 46.76+/-12.71 vs 57.48+/-11.22 degrees,t=5.523,P=0.000; 33.13+/-10.58 vs 40.00+/-11.68 degrees,t=4.428,P=0.000; 35.70+/-8.32 vs 42.80+/-39.55 degrees,t=4.356,P=0.000; 51.17+/-12.93 vs 56.54+/-11.11 degrees,t=3.304,P=0.002; 51.28+/-11.25 vs 55.63+/-10.95 degrees,t=2.715,P=0.009)after the end of the treatment.The flexion-extension coordination of cervical vertebrae was improved after the end of the treatment,while there was no statistical difference in the coordination of cervical lateral flexion and rotation between pre-treatment and posttreatment(1.37+/-0.87 vs 0.85+/-0.20,t=-3.775,P=0.000; 1.15+/-0.36 vs 1.10+/-0.17,t=-1.074,P=0.291; 1.05+/-0.33 vs 0.99+/-0.14,t=-1.202,P=0.211).The maximal isometric torque of cervical muscle group increased after the end of the treatment in the states of backward extension,anteflexion and left-right lateral flexion(1.00+/-0.00 vs 1.00+/-1.00 N/m,Z=-2.312,P=0.021; 2.00+/-6.25 vs 5.00+/-11.00 N/m,Z=-3.545,P=0.000; 1.00+/-1.25 vs 2.00+/-5.00 N/m,Z=-3.903,P=0.000; 1.00+/-2.00 vs 2.00+/-5.00 N/m,Z=-2.465,P=0.014).The flexion-extension coordination of cervical muscle group was improved after the end of the treatment,while there was no statistical difference in the coordination of lateral flexion of cervical muscle group between pre-treatment and posttreatment(2.00+/-5.00 vs 3.50+/-5.00,Z=-2.043,P=0.041; 1.00+/-0.62 vs 1.00+/-0.04,Z=-1.725,P=0.085).The analytic results of correlation between changes of clinical evaluation indexes and changes of cervical mechanical evaluation indexes showed that the differences of NDI between pretreatment and posttreatment were negatively correlated with the differences of maximal isometric torque of cervical muscle group between pretreatment and posttreatment in states of anteflexion and backward extension(r=-0.455,P=0.002; r=-0.334,P=0.024),in other words,the more the maximal isometric torque of cervical muscle group in states of anteflexion and backward extension increased,the more the NDI decreased.The differences of NDI between pretreatment and posttreatment were positively correlated with the differences of flexion-extension coordination of cervical muscle group between pretreatment and posttreatment(r=0.344,P=0.020),in other words,the more the flexion-extension coordination of cervical muscle group was improved,the more the NDI decreased.The differences of NDI between pretreatment and posttreatment had no correlations with the differences of other cervical mechanical evaluation indexes between pretreatment and posttreatment.Conclusion:It is helpful to objective and accurate curative effect evaluation of nonoperative treatment of cervical spondylotic radiculopathy to apply cervical mechanical evaluation indexes.

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備注/Memo

備注/Memo:
通訊作者:趙平 E-mail:[email protected]
更新日期/Last Update: 2018-08-02