| 手法治疗青年颈椎失稳症临床疗效及复发危险因素分析 |
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投稿时间：2023-06-05
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| 作者 | Author | 单位 | Address | E-Mail |
| 路广琦 |
LU Guang-qi |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 庄明辉 |
ZHUANG Ming-hui |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 李路广 |
LI Lu-guang |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 常晓娟 |
CHANG Xiao-juan |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 朱立国 |
ZHU Li-guo |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 于杰 |
YU Jie |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
doctoryujie@aliyun.com |
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| 期刊信息：《中国骨伤》2023年，第36卷，第10期，第959-964页 |
| DOI：10.12200/j.issn.1003-0034.2023.10.010 |
| 基金项目:国家自然科学基金面上项目(编号:82074455);北京市科技计划首都临床诊疗技术研究及转化应用项目(编号:Z211100002921023);中国中医科学院科技创新工程重大攻关项目(编号:CI2021A02002) |
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中文摘要:
目的:明确不同手法治疗青年颈椎失稳症的临床疗效,分析青年颈椎失稳症复发的危险因素。
方法:自2021年3月至2022年6月,回顾性分析收治的120例青年颈椎失稳症患者的临床资料,按照治疗方法不同分为旋提组(60例,脱落3例)和理筋组(60例,脱落5例)。旋提组男25例,女32例;年龄22~44岁,中位数28岁;病程0.17~120个月,中位数22个月;采用旋提手法进行治疗。理筋组男22例,女33例;年龄21~42岁,中位数27岁;病程0.23~180个月,中位数24个月;采用理筋手法进行治疗。两组患者均治疗2周,隔日1次,共7次。观察并比较治疗前后两组患者视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)。疗程结束后1年,对治疗有效的患者进行随访,统计复发情况,复发者纳入复发组,未复发者则纳入未复发组,统计可能影响症状复发的因素,进行单因素和多因素回归分析。
结果:对经治疗无效的13例(旋提组4例,理筋组9例)不进行随访,99例经治疗有效的患者均获得随访,时间303~406 d,中位数359 d,所有患者无并发症发生。两组治疗后VAS、NDI与治疗前比较,差异有统计学意义(P<0.05);两组治疗后VAS、NDI组间比较,差异有统计学意义(P<0.05)。获得随访的99例患者中,56例(56.57%)复发,43例(43.43%)未复发。单因素相关性分析显示,复发组和未复发组治疗前NDI、每天伏案时长、每天使用电子产品时长、治疗前前屈位角度位移组间比较,差异有统计学意义(P<0.05)。多因素回归分析显示,患者每天伏案时长[OR=2.447,95%CI(1.255,4.771)]、每天使用电子产品时长[OR=1.892,95%CI(1.066,3.358)]、治疗前前屈位角度位移[OR=1.246,95%CI(1.045,1.485)]是其复发的危险因素。
结论:旋提手法和理筋手法均能够有效治疗青年颈椎失稳症,旋提手法在改善患者颈痛和颈椎功能障碍方面较理筋手法更有优势;每天伏案时长、每天使用电子产品时长、颈椎前屈位角度位移的增大会使患者的复发风险增高。 |
| 【关键词】手法 颈椎失稳症 临床疗效 复发 危险因素 |
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| Analysis of clinical efficacy and risk factors of relapse in young patients with cervical instability treated by manipulation |
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ABSTRACT
Objective To determine the clinical efficacy of different manipulation in the treatment of cervical instability in young people,and to analyze the risk factors of relapse of cervical instability in young people.
Methods From March 2021 to June 2022,the clinical data of 120 young patients with cervical instability were retrospectively analyzed. According to the different treatment methods,they were divided into rotation group (60 cases,3 cases of loss) and tendon group (60 cases,5 cases of loss). There were 25 males and 32 females in rotation-traction manipulation group;age ranged from 22 to 44 years old with a median of 28 years old;course of disease ranged from 0.17 to 120 months with amedian of 22 months. There were 22 males and 33 females in tendon-regulating manipulation group;age ranged from 21 to 42 years old with a median of 27 years old;course of disease ranged from 0.23 to 180 months with a median of 24 months. Both groups were treated for 2 weeks,once every other day for 7 times,and were followed up for 1 year. The clinical efficacy of the two groups was evaluated,and the visual analogue scale (VAS),neck disability index (NDI) were observed before and after treatment. One year after the course of treatment,patients with effective treatment were followed up to make statistics on recurrence. Patients with recurrence were included in the recurrence group,while those without recurrence were included in the non-recurrence group. Factors that may affect symptom recurrence were analyzed,and univariate and multivariate Logistic regression analysis were performed.
Results The 13 patients who failed the treatment (4 cases in the rotation-traction manipulation group and 9 cases in the tendon-regulating manipulation group) were not followed up. All the 99 patients who were effective in treatment were followed up ranged from 303 to 406 days with a median of 359 days. No complications occurred in all patients. There were significant differences in VAS and NDI between the two groups after treatment and before treatment (P<0.05),and there were significant differences in VAS and NDI between the two groups after treatment (P<0.05). Ninety-nine patients achieved follow-up,56 (56.57%) relapsed and 43 (43.43%) did not. Univariate correlation analysis showed that NDI index,the time spent at the desk every day,the time spent using electronic products every day and angular displacement of anterior flexion before treatment in the relapse group were significantly higher than those in the non-relapse group (P<0.05). Logistic regression analysis showed that the time spent at the desk every day[OR=2.447,95%CI(1.255,4.771)],the time spent using electronic products every day[OR=1.892,95%CI(1.066,3.358)] and the angular displacement of anterior flexion of the cervical before treatment[OR=1.246,95%CI(1.045,1.485)]were the risk factors for relapse.
Conclusion Both rotation-traction manipulation and tendon-regulating manipulation can effectively treat cervical instability in young people,and rotation-traction manipulation has more advantages than tendon-regulating manipulation in improving cervical pain and cervical dysfunction in patients. The time spent at the desk every day,the time spent using electronic products every day,and the increase of cervical flexion angle displacement will increase the risk of relapse in patients. |
| KEY WORDS Manipulation Cervical instability Clinical curative effect Relapse Risk factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 路广琦,庄明辉,李路广,常晓娟,朱立国,于杰.手法治疗青年颈椎失稳症临床疗效及复发危险因素分析[J].中国骨伤,2023,36(10):959~964 |
| 英文格式: | LU Guang-qi,ZHUANG Ming-hui,LI Lu-guang,CHANG Xiao-juan,ZHU Li-guo,YU Jie.Analysis of clinical efficacy and risk factors of relapse in young patients with cervical instability treated by manipulation[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(10):959~964 |
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