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脊柱手法为主治疗腰椎间盘突出症:受累椎体X射线量化分析 被引量:20

Spinal manipulative-oriented therapy for lumbar disc herniation:quantitative X-ray analysis on the involved vertebral segment
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摘要 背景:腰椎功能性侧凸是腰椎间盘突出症的重要体征之一,其发生原因除外神经根性刺激,还与病变节段结构生物力学紊乱密切相关。目的:分析脊柱手法等保守治疗对腰椎间盘突出症引发脊柱功能性侧凸畸形的力学影响。方法:选择腰椎间盘突出症伴功能性侧凸患者56例,使用冯氏脊柱关节手法配合常规方法治疗,1个疗程结束后,通过美国Logan脊柱X射线软件系统量化分析椎体的旋转值和侧弯角,同时记录采用日本骨科协会腰痛疾患评分及腰腿痛目测类比评分变化。结果与结论:Logan测量中发现,受累椎体恰为力学耦合反常的椎体,即"失代偿椎体"或"椎体位移",且与脊柱手法触诊定位发现的问题移位椎体一致性很高;经手法治疗后"失代偿椎体"旋转值发生明显逆向改变,转化为力学耦合正常的"代偿椎体",全腰椎侧弯角亦出现明显的改善,这两个指标的变化情况与日本骨科协会腰痛疾患评分评分、目测类比评分改善程度均显著相关。结果表明腰椎间盘突出症患者受累椎体的力学代偿恢复与症状学改变显著相关。提示脊柱手法以纠正"失代偿椎体"(所谓"椎体位移"征象)为原则、以恢复脊柱代偿平衡为目的的基本认识具有重要的临床意义。 BACKGROUND:Functional lumbar scoliosis is a major symptom of lumbar disc herniation. The reason for its occurrence was strongly associated with the disorder of biomechanics of affected segment structure besides nerve root stimulus. OBJECTIVE:To analyze the mechanical impact of spinal manipulative therapy and other conservative treatment on functional scoliosis caused by lumbar disc herniation. METHODS:A total of 56 cases of lumbar disc herniation with functional scoliosis were consecutively selected in the study. The samples were mainly treated by spinal manipulation and conventional conservative therapy. After one course of treatment, the rotation and tilting angle of the involved vertebrae were quantitatively analyzed by Logan Spine X-Ray Software System. Simultaneously, the alterations in scores of Japanese Orthopaedic Association and Visual Analogue Scale were recorded. RESULTS AND CONCLUSION:The involved segment was proved abnormal y coupled with the mechanical tendency of spine list by Logan Spine X-ray analysis, i.e.,“uncompensated vertebrae”or“vertebral subluxation”. Moreover, there is a significant consistency with the troubled vertebra by palpation. After spinal manipulative therapy, the“uncompensated vertebrae”rotation reversed significantly and the segment was coupled normal y with the mechanical tendency of functional scoliosis of lumbar spine. It could be an evidence of a rebuilt of“compensated vertebral segment”. The entire lumbar spine list was also noticeably reduced. These changes were significantly associated with the changes of Japanese Orthopaedic Association score and Visual Analogue Scale score. Results suggested that compensatory rebalance of the involved vertebral segment is significantly associated with symptomatology improvement in the patients with lumbar disc herniation. These indicated that it is of great clinical significance of correcting“uncompensated vertebrae”or“vertebral subluxation”to recover compensatory spinal balance as principle of spinal manipulation.
出处 《中国组织工程研究》 CAS CSCD 2014年第17期2740-2745,共6页 Chinese Journal of Tissue Engineering Research
基金 首都医学科技发展基金(SF-2009-2-17) 北京市科技计划课题(Z121107001012078)~~
关键词 植入物 数字化骨科 腰椎间盘突出症 脊柱侧凸 X射线测量 手法 椎体位移 intervertebral disk displacement scoliosis manipulation,osteopathic
作者简介 韩磊,男,1984年生,山东省聊城市人,汉族,2012年中国中医科学院毕业,博士,主治医师,主要从事损伤退变性脊柱疾病的临床与基础研究。 通讯作者:赵平,硕士,主任医师,解放军空军总医院正骨治疗中心,北京市100142
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