1、基金项目:国家自然科学基金项目(82074455);北京市中国中医科学院“十三五”第二批重点领域科研项目(ZZ10-022);国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-C-202003)作者简介:陈焯贤(1995.08)，男，硕士研究生在读，研究方向:脊柱相关疾病的临床研究，E-mail:通信作者:冯敏山(1979.04)，男，博士，主任医师，研究方向:脊柱相关疾病的临床与基础研究，E-mail:fengminshan 500 例旋提手法治疗颈椎病的影像学特点与疗效研究陈焯贤1，2冯敏山2，3朱立国2尹逊路2张威2温聪聪2，4赵文龙1，2(1 北京中医药大学，北京，10
2、0029;2 中国中医科学院望京医院，北京，100102;3 中医正骨技术北京市重点实验室，北京，100007;4 贵州中医药大学，贵阳，550002)摘要目的:回顾性总结旋提手法治疗颈椎病的影像学特点及疗效。方法:选取2016 年4 月至2021 年4 月就诊于中国中医科学院望京医院脊柱二科，诊断为颈椎病(除外脊髓型颈椎病)且经旋提手法治疗的 500 例患者作为研究对象，对其一般情况、影像学特点(X 线平片、CT 及 MI)及手法治疗的疗效、疗程、安全性进行回顾性分析。结果:500 例患者中男 171例，女 329 例;年龄 17 82 岁，平均年龄(52.17 12.84)岁;颈型、神经根
3、型、椎动脉型、混合型颈椎病比例分别为 5.60%、62.60%、10.40%、21.40%;X 线诊断生理曲度异常及颈椎失稳比例分别为 96.00%和 47.00%;CT 诊断颈椎间盘突出、颈椎管狭窄及后纵韧带骨化比例分别为 86.12%、48.98%、22.86%;MI 诊断颈椎间盘突出、颈椎管狭窄比例分别为96.18%、54.60%;旋提手法治疗颈型、神经根型、椎动脉型、混合型颈椎病的有效率分别为 96.43%、96.17%、98.08%、96.26%，治愈率分别为 17.86%、15.65%、17.31%、14.95%;疗程 7 23 d，平均疗程(13.553.06)d;500 例患者
4、接受旋提手法治疗均无不良反应发生。结论:颈椎曲度异常和颈椎间盘突出是颈椎病的主要影像学表现;旋提手法治疗颈椎病疗效确切，安全性高，其中颈型与椎动脉型颈椎病患者见效较快;该手法可应用于无脊髓型颈椎病症状体征但存在颈椎间盘突出、颈椎管狭窄及后纵韧带骨化患者，但应重视询问病史与体格检查，排除手法禁忌。关键词旋提手法;颈椎病;影像学特点;疗效;疗程;安全性;数据分析;回顾性研究Imaging Features and Curative Effect of Cervical Spondylosis Treated by Cervicalotation-traction Manipulation:A et
5、rospective Analysis of 500 CasesCHEN Zhuoxian1，2，FENG Minshan2，3，ZHU Liguo2，YIN Xunlu2，ZHANG Wei2，WEN Congcong2，4，ZHAO Wenlong1，2(1 Beijing University of Chinese Medicine，Beijing 100029，China;2 Wangjing Hospital of China Academy of Chinese MedicalSciences，Beijing 100102，China;3 Beijing Key Laborator
6、y of Orthopedics of Traditional Chinese Medicine，Beijing 100007，China;4 Guizhou University of Traditional Chinese Medicine，Guiyang 550002，China)AbstractObjective:To retrospectively summarize the imaging features and curative effect of patients with cervical spondylosistreated by cervical rotation-tr
7、action manipulation Methods:A total of 500 patients who were diagnosed with cervical spondylosis(except cervical spondylotic myelopathy)and treated with cervical rotation-traction manipulation in the Second Department of Spi-nal Surgery of Wangjing Hospital of China Academy of Chinese Medical Scienc
8、es from April 2016 to April 2021 were collected Thegeneral data，imaging features(X-rays，CT or MI)，as well as the curative effect，course of treatment and safety of the patients wereretrospectively analyzed esults:Among the 500 patients，there were 171 males and 329 females aged 17 82 years，with an ave
9、r-age of(52.17 12.84)years Neck type cervical spondylosis，cervical spondylotic radiculopathy，vertebral artery type of cervicalspondylosis，and mixed type of cervical spondylosis accounted for 5.60%，62.60%，10.40%，and 21.40%，respectively The pro-portions of abnormal curvature and cervical spine instabi
10、lity by X-ray diagnosis were 96.00%and 47.00%，respectively;the pro-portions of cervical disc herniation，cervical spinal stenosis and posterior longitudinal ligament ossification by CT diagnosis were86.12%，48.98%，and 22.86%，respectively;cervical disc herniation and cervical spinal stenosis by MI diag
11、nosis accounted for96.18%and 54.60%，respectively The effective rate of cervical rotation-traction manipulation on neck type cervical spondylosis，cervical spondylotic radiculopathy，vertebral artery type of cervical spondylosis，and mixed type of cervical spondylosis was96.43%，96.17%，98.08%，and 96.26%，
12、respectively，and the cure rate was 17.86%，15.65%，17.31%，and 14.95%，respec-tively The course of treatment was 7 23 days，with an average of(13.553.06)days No adverse reaction occurred in the 500 pa-tients Conclusion:Abnormal curvature and cervical disc herniation are the main imaging manifestations of
13、 cervical spondylosisCervical rotation-traction manipulation is effective and safe in treating cervical spondylosis;especially neck type and vertebral ar-tery type of cervical spondylosis This method can be applied to patients without symptoms and signs of cervical spondylotic myelop-athy but with c
14、ervical disc herniation，cervical spinal stenosis，and posterior longitudinal ligament ossification，and attention shouldbe paid to patients medical history as well as physical examination to rule out contraindicationsKeywordsCervical rotation-traction manipulation;Cervical spondylosis;Imaging features
15、;Curative effect;Course of treatment;825WOLD CHINESE MEDICINEFebruary 2023，Vol 18，No 4Safety;Data analysis;etrospective study中图分类号:259;245文献标识码:Adoi:10 3969/j issn 1673 7202 2023 04 015颈椎病是由于椎间盘的退行性病变和椎体骨质的增生性病变，压迫颈神经根和(或)脊髓引起的临床综合征，病变主要累及颈椎骨、椎间盘和周围韧带及纤维结构，又称颈椎退行性骨关节病、颈椎综合征1。根据不同组织结构受累而出现的不同临床表现一般分为
16、颈型颈椎病、神经根型颈椎病、椎动脉型颈椎病、脊髓型颈椎病及混合型颈椎病等2。根据流行病学调查显示，该病发病率为 3.8%17.5%，其中神经根型颈椎病占 60%70%，且发病呈年轻化的趋势3-4。颈椎病的治疗方法主要分为手术治疗和非手术治疗(包括牵引、药物、手法和运动疗法等)两大类，而非手术治疗是颈型、神经根型以及椎动脉型颈椎病的首选和基本疗法2，5。研究证实，手法治疗颈椎病具有侵入性少、治疗手段更为保守、降低医疗成本等独特优势6。现回顾中国中医科学院望京医院脊柱二科近 5 年来经颈椎旋提手法治疗颈椎病的影像学特点及疗效并报道如下。1资料与方法1.1一般资料选取 2016 年 4 月至 2021 年 4 月期间在中国中医科学院望京医院脊柱二科门诊或住院，诊断为颈椎病(除外脊髓型颈椎病)且以旋提手法作为主要治疗手段的 500 例患者作为研究对象。男 171 例，女 329 例;年龄 17 82 岁，平均年龄(52.17 12.84)岁，其中颈型颈椎病 28 例(占5.60%)，神经根型颈椎病 313 例(占 62.60%)，椎动脉型颈椎病 52 例(占 10.40%)，混合型颈椎病107
