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[1]田俊松,應(yīng)曉明,李曉,等.“分節(jié)段式”脊柱推拿手法對青少年特發(fā)性脊柱側(cè)凸患者脊柱三維結(jié)構(gòu)的影響[J].中醫(yī)正骨,2022,34(07):15-21.
　TIAN Junsong,YING Xiaoming,LI Xiao,et al.Effects of segmental spinal manipulation on three-dimensional spinal structure in patients with adolescent idiopathic scoliosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(07):15-21.
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“分節(jié)段式”脊柱推拿手法對青少年特發(fā)性脊柱側(cè)凸患者脊柱三維結(jié)構(gòu)的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年07期
頁碼:
15-21
欄目:
臨床研究
出版日期:
2022-07-20

文章信息/Info

Title:
Effects of segmental spinal manipulation on three-dimensional spinal structure in patients with adolescent idiopathic scoliosis
作者:
田俊松1; 應(yīng)曉明2; 李曉2; 葉鑫2; 李帥林2; 周建忠1; 楊志峰1; 李立柯1
(1.余姚市中醫(yī)醫(yī)院,浙江 余姚 315499; 2.浙江中醫(yī)藥大學(xué)附屬第三醫(yī)院,浙江 杭州 310005)
Author(s):
TIAN Junsong1; YING Xiaoming2; LI Xiao2; YE Xin2; LI Shuailin2; ZHOU Jianzhong1; YANG Zhifeng1; LI Like1
1.Yuyao Hospital of TCM,Yuyao 315499,Zhejiang,China 2.The Third Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang,China
關(guān)鍵詞:
脊柱側(cè)凸;  推拿; 脊柱;  青少年;  臨床試驗(yàn)
Keywords:
scoliosis;  manipulation; spinal;  adolescent;  clinical trial
摘要:
目的:探討“分節(jié)段式”脊柱推拿手法對青少年特發(fā)性脊柱側(cè)凸(adolescent idiopathic scoliosis,AIS)患者脊柱三維結(jié)構(gòu)的影響。方法:將符合要求的90例AIS患者隨機(jī)分為2組,每組45例。常規(guī)推拿組采用《推拿治療學(xué)》中的脊柱病證推拿手法治療,每周治療2次,共治療24周; 聯(lián)合推拿組在常規(guī)推拿基礎(chǔ)上聯(lián)合“分節(jié)段式”脊柱推拿手法治療,每周治療1次,共治療24周。分別于治療前及治療結(jié)束時(shí)記錄并比較2組患者的脊柱矢狀位垂直軸(sagittal vertical axis,SVA)距離、胸椎后凸角(thoracic kyphosis,TK)、胸腰段后凸角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)、C7鉛垂線(C7 plumb line,C7PL)與骶骨中垂線(center sacral vertical line,CSVL)的距離、頂椎偏距(apical vertebral translation,AVT)、骨盆入射角(pelvic incidence,PI)、骶骨傾斜角(sacral slope,SS)及骨盆傾斜角(pelvic tilt,PT)。結(jié)果:①脊柱矢狀位參數(shù)。治療前,2組患者的脊柱SVA距離、TK、TLK、LL比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(5.100±1.125)cm,(5.250±0.920)cm,t=-0.326,P=0.748; 20.900°±3.143°,20.400°±2.674°,t=0.383,P=0.706; 5.300°±1.767°,4.900°±1.523°,t=0.542,P=0.594; 32.800°±3.393°,32.900°±2.378°,t=-0.076,P=0.940]; 治療結(jié)束后,聯(lián)合推拿組的脊柱SVA距離、TLK均小于常規(guī)推拿組[(2.400±0.843)cm,(3.900±0.614)cm,t=-4.546,P=0.000; 2.100°±0.994°,3.200°±1.033°,t=-2.426,P=0.026],聯(lián)合推拿組的TK、LL均大于常規(guī)推拿組(28.500°±3.472°,25.100°±3.281°,t=2.251,P=0.037; 41.300°±3.301°,37.700°±2.584°,t=2.715,P=0.014),2組患者的脊柱SVA距離、TLK均小于治療前(t=5.939,P=0.000; t=6.384,P=0.000; t=5.400,P=0.000; t=5.075,P=0.000),2組患者的TK、LL均大于治療前(t=-5.919,P=0.000; t=-8.728,P=0.000; t=-15.105,P=0.000; t=-10.854,P=0.000)。②脊柱冠狀位參數(shù)。治療前,2組患者的C7PL與CSVL的距離、AVT比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(3.350±0.668)cm,(3.100±0.843)cm,t=0.735,P=0.472;(5.650±1.001)cm,(5.200±1.206)cm,t=0.908,P=0.376]; 治療結(jié)束后,聯(lián)合推拿組患者的C7PL與CSVL的距離、AVT均小于常規(guī)推拿組[(1.150±0.474)cm,(2.050±0.643)cm,t=-3.561,P=0.002;(2.200±0.537)cm,(3.700±0.675)cm,t=-5.498,P=0.000],2組患者的C7PL與CSVL的距離、AVT均小于治療前(t=11.000,P=0.000; t=7.584,P=0.000; t=8.835,P=0.000; t=4.881,P=0.000)。③骨盆參數(shù)。治療前,2組患者的PI、SS、PT比較,組間差異均無統(tǒng)計(jì)學(xué)意義(43.150°±2.249°,43.100°±1.983°,t=0.053,P=0.959; 35.950°±4.699°,38.750°±1.438°,t=0.011,P=0.088; 6.900°±1.074°,6.800°±0.856°,t=0.230,P=0.821); 治療結(jié)束后,聯(lián)合推拿組患者的PI、SS均小于常規(guī)推拿組(33.390°±3.415°,37.300°±2.474°,t=-2.932,P=0.009; 28.000°±4.384°,33.850°±1.732°,t=-3.924,P=0.001),聯(lián)合推拿組患者的PT大于常規(guī)推拿組(10.650°±1.029°,9.000°±1.202°,t=3.298,P=0.004),2組患者的PI、SS均小于治療前(t=7.271,P=0.000; t=5.163,P=0.000; t=23.468,P=0.000; t=12.468,P=0.000)、PT均大于治療前(t=-7.169,P=0.000; t=-4.714,P=0.000)。結(jié)論:對于AIS患者,在常規(guī)推拿手法基礎(chǔ)上聯(lián)合“分節(jié)段式”脊柱推拿手法治療,可從整體上調(diào)整脊柱三維結(jié)構(gòu),重建及穩(wěn)定脊柱三維平衡狀態(tài),其療效優(yōu)于單純常規(guī)推拿手法治療。
Abstract:
Objective:To explore the effects of segmental spinal manipulation on three-dimensional(3D)spinal structure in patients with adolescent idiopathic scoliosis(AIS).Methods:Ninety AIS patients were enrolled in the study and were randomly divided into conventional manipulation group and combination manipulation group,45 cases in each group.All patients in the 2 groups were treated with manipulation for spinal diseases which was extracted from Manipulation Acology,twice a week for consecutive 24 weeks.Moreover,the patients in combination manipulation group were further treated with segmental spinal manipulation,once a week for consecutive 24 weeks.The parameters including sagittal vertical axis(SVA)distance,thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),distance between C7 plumb line(C7PL)and center sacral vertical line(CSVL),apical vertebral translation(AVT),pelvic incidence(PI),sacral slope(SS)and pelvic tilt(PT)were recorded and compared between the 2 groups before the treatment and at the end of treatment.Results:①There was no statistical difference in SVA distance,TK,TLK and LL between the 2 groups before the treatment(5.100±1.125 vs 5.250±0.920 cm,t=-0.326,P=0.748; 20.900±3.143 vs 20.400±2.674 degrees,t=0.383,P=0.706; 5.300±1.767 vs 4.900±1.523 degrees,t=0.542,P=0.594; 32.800±3.393 vs 32.900±2.378 degrees,t=-0.076,P=0.940).The SVA distance was shorter,the TLK was smaller,whereas the TK and LL were greater in combination manipulation group compared to conventional manipulation group after the end of the treatment(2.400±0.843 vs 3.900±0.614 cm,t=-4.546,P=0.000; 2.100±0.994 vs 3.200±1.033 degrees,t=-2.426,P=0.026; 28.500±3.472 vs 25.100±3.281 degrees,t=2.251,P=0.037; 41.300±3.301 vs 37.700±2.584 degrees,t=2.715,P=0.014).The SVA distance and TLK decreased,whereas the TK and LL increased after the end of the treatment compared to pretreatment in the 2 groups(t=5.939,P=0.000; t=6.384,P=0.000; t=5.400,P=0.000; t=5.075,P=0.000; t=-5.919,P=0.000; t=-8.728,P=0.000; t=-15.105,P=0.000; t=-10.854,P=0.000).②There was no statistical difference in AVT and the distance between C7PL and CSVL between the 2 groups before the treatment(5.650±1.001 vs 5.200±1.206 cm,t=0.908,P=0.376; 3.350±0.668 vs 3.100±0.843 cm,t=0.735,P=0.472).The AVT and the distance between C7PL and CSVL were shorter in combination manipulation group compared to conventional manipulation group after the end of the treatment(2.200±0.537 vs 3.700±0.675 cm,t=-5.498,P=0.000; 1.150±0.474 vs 2.050±0.643 cm,t=-3.561,P=0.002).The AVT and the distance between C7PL and CSVL decreased after the end of the treatment compared to pretreatment in the 2 groups(t=8.835,P=0.000; t=4.881,P=0.000; t=11.000,P=0.000; t=7.584,P=0.000).③There was no statistical difference in PI,SS and PT between the 2 groups before the treatment(43.150±2.249 vs 43.100±1.983 degrees,t=0.053,P=0.959; 35.950±4.699 vs 38.750±1.438 degrees,t=0.011,P=0.088; 6.900±1.074 vs 6.800±0.856 degrees,t=0.230,P=0.821).The PI and SS were smaller,whereas the PT was greater in combination manipulation group compared to conventional manipulation group after the end of the treatment(33.390±3.415 vs 37.300±2.474 degrees,t=-2.932,P=0.009; 28.000±4.384 vs 33.850±1.732 degrees,t=-3.924,P=0.001; 10.650±1.029 vs 9.000±1.202 degrees,t=3.298,P=0.004).The PI and SS decreased,while the PT increased after the end of the treatment compared to pretreatment in the 2 groups(t=7.271,P=0.000; t=5.163,P=0.000; t=23.468,P=0.000; t=12.468,P=0.000; t=-7.169,P=0.000; t=-4.714,P=0.000).Conclusion:The conventional manipulation combined with segmental spinal manipulation can adjust the 3D structure of the spine,reconstruct and stabilize the 3D balance state of the spine in AIS patients,and its curative effect is better than that of conventional manipulation alone.

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備注/Memo

備注/Memo:
基金項(xiàng)目:浙江省中青年臨床名中醫(yī)項(xiàng)目(sjzqn202106); 浙江中醫(yī)藥適宜技術(shù)培育項(xiàng)目(2018ZT003) 通訊作者:應(yīng)曉明 E-mail:[email protected]
更新日期/Last Update: 1900-01-01