摘要
目的:探讨颈椎力学评价指标在非手术疗法治疗神经根型颈椎病疗效评价中的应用价值。方法:2016年10月至2017年6月,采用手法等非手术疗法治疗神经根型颈椎病患者46例。男26例、女20例,年龄(48.91±9.77)岁,体质量指数(24.57±2.99)kg·m^(-2),病程(2.32±1.97)月。病变节段,单节段11例、2节段16例、3节段10例、4节段7例、5节段2例。分别在治疗前和治疗结束后,采用颈椎功能障碍指数(neck disability index,NDI)评分量表对患者颈椎功能进行临床评价;采用DAVID脊柱智能康复系统测定患者颈椎关节活动度、颈椎关节活动协调性、颈部肌群最大等长肌力矩和颈部肌群协调性,对患者颈椎进行力学评价。计算NDI及颈椎力学评价各项指标治疗前后的差值(治疗后-治疗前),分析临床评价指标变化与颈椎力学评价指标变化之间的相关性。结果:(1)临床评价与颈椎力学评价结果。46例患者均顺利完成治疗。治疗结束后,患者颈椎NDI较治疗前降低[(34.32±13.11)%,(18.21±10.65)%,t=-11.041,P=0.000];颈椎前屈、后伸、左右侧屈、左右旋6个方向的关节活动度均较治疗前增加[(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];颈椎关节屈伸活动协调性较治疗前改善,但侧屈和旋转活动协调性与治疗前相比,差异无统计学意义[(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];颈部肌群后伸、前屈及左右侧屈最大等长肌力矩均较治疗前增加[(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];颈部肌群屈伸力量协调性较治疗前改善,而侧屈力量协调性与治疗前相比,差异无统计学意义[(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)临床评价指标变化与颈椎力学评价指标变化的相关性分析结果。治疗前后患者NDI的差值与治疗前后颈部肌群前屈、后伸最大等长肌力矩的差值呈负相关(r=-0.455,P=0.002;r=-0.334,P=0.024),即颈部肌群前屈、后伸最大等长肌力矩增加越多,NDI降低越多;与治疗前后颈部肌群屈伸力量协调性的差值呈正相关(r=0.344,P=0.020),即颈部肌群屈伸力量协调性改善越多,NDI降低越多;与其他颈椎力学评价指标治疗前后的差值均无相关性。结论:在非手术疗法治疗神经根型颈椎病的疗效评价中应用颈椎力学评价指标,有利于疗效评价的客观化和精确化。
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(l l),two segments(16),three segments(lO),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 clinicalevaluation 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%=-11.041=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,^=4.362,P=0.0 00;46.76+/-12.71 vs 57.48+/-11.22 degrees^=5.523=0.0 00;33.13+/-1 0.5 8 vs 4 0.00+/-1 1.6 8 degrees^=4.42 8=0.0 00;35.70+/-8.32 vs 42.80+/-3 9.55 degrees^=4.356=0.0 00;51.1 7+/-1 2.9 3 vs 56.54+/-1 1.11 degrees^=3.3 0 4,P=0.0 0 2;5 1.28+/-11.25 vs 55.63+/-1 0.9 5 degrees,^-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 treatm ent,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,^=-3.775=0.000;1.15+/-0.36 vs 1.1 0+/-0.1 7,^=-1.0 7 4,P=0.291;1.05+/-0.3 3 vs 0.99+/-Q.14,t=-1.202,P=0.2 1 1).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=-2.3 1 2,P=0.0 2 1;2.0 0+/-6.2 5 vs 5.0 0+/-1 1.0 0 N/m,Z=-3.545,P=0.0 0 0;1.0 0+/-1.2 5 vs 2.0 0+/-5.0 0 N/m,Z=-3.903=0.0 00;1.00+/-2.00 vs 2.00+/-5.00 N/m,Z=-2.465=0.014).The flexion-extension coordination of cervical muscle group was improved after the end of the treatm ent,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.QQ,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=-Q.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 w ords,the more the flexion-extension coordination of cervical muscle group was im proved,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.
作者
郭伟
赵颀
龚成
赵平
GUO Wei;ZHAO Qi;G0NG Cheng;ZHAO Ping(Airforce General Hospital of PLA,Beijing 100142,China)
出处
《中医正骨》
2018年第3期22-26,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
关键词
颈椎病
非手术疗法
疗效评价
生物力学
cervical spondylosis
nonoperative therapy
curative effect evaluation
biomechanics
作者简介
通讯作者:赵平E-mail:kzzp@sina.com
