[1]滕红林,王靖,张纯武,等.椎动脉超声对动脉硬化患者 颈椎旋转手法治疗的安全性评价[J].中医正骨,2011,23(02):20-23.
　Teng Hong-lin*,Wang Jing,Zhang Chun-wu,et al.Safety evaluation during rotational manipulation of the cervical spine in the patients with arteriosclerosis by sonography on the vertebral arteries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2011,23(02):20-23.
点击复制

椎动脉超声对动脉硬化患者 颈椎旋转手法治疗的安全性评价()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第23卷
期数:
2011年02期
页码:
20-23
栏目:
临床研究
出版日期:
2011-02-25

文章信息/Info

Title:
Safety evaluation during rotational manipulation of the cervical spine in the patients with arteriosclerosis by sonography on the vertebral arteries
作者:
滕红林; 王靖; 张纯武; 吴春雷; 朱旻宇; 赵亮; 吕超
温州医学院附属第一医院,浙江 温州 325000
Author(s):
Teng Hong-lin*; Wang Jing; Zhang Chun-wu; et al.*
The first affiliated hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China
关键词:
椎动脉 超声检查 动脉硬化 颈椎旋转手法
Keywords:
Vertebral Artery; ultrasongraphy;  arteriosclerosis; manipulation of the cervical rotation
摘要:
目的:通过对伴有动脉硬化中老年患者进行模拟旋颈状态下颈椎椎动脉超声检查,权衡手法的好处和潜在的风险,为临床医师对颈椎采取手法治疗前提供参考。方法:对208例动脉硬化患者进行彩色多普勒超声检查,观察椎动脉的狭窄程度以及血流充盈程度,血流频谱形态等。测量血流参数[收缩期峰值血流速度(VMAX)、舒张末期流速(VMIN)、平均血流速度(VTAMX)]、反映血管舒缩和阻力状况的阻力指数(RI)、反映血管顺应性和血管弹性的搏动指数(PI)。结果:超声显示在旋颈状态下VA血流变细,血管迂曲及局部受压狭窄; 伴有动脉粥样硬化者,可见血管内膜粗糙,管壁增厚,回声增强,有动脉粥样硬化小斑块形成及管腔狭窄,椎骨段VA走形迂曲,VA平均内径<3 mm。在过屈位旋颈后血流减少甚至部分患者彩色血流中断而不显像。在正常仰卧位时所测得的血流参数与对照组相比差异无统计学意义,经左右旋颈45°后,检测所得两组血流动力学参数与对照组相比开始出现差异,当过屈位旋颈45°后,两组血流动力学参数呈现显著性差异。结论:彩色多谱勒超声可以观察椎动脉形态的变化并对血流进行定量测定,其检查操作便捷,敏感性高,可以作为颈椎手法前筛查潜在VA损伤的动脉硬化患者的方法之一。
Abstract:
Objective:To weight the pros and cons before rotatory manipulation of the cervical spine in the patients with arteriosclerosis.Methods:208 cases with arteriosclerosis underwent sonography to explore the course and stenosis of the vertebral arteries. The VMAX, VMIN, VTMAX and RI were also measured.Results:The results showed the decreased blood stream and local compression of the VA during the rotatory manipulation of the cervical spine. In cases with arteriosclerosis, coarse inner membrane, thickening of the arterial wall and increased echogenicity were found. The blood stream decreased or even totally blocked during rotation and flexion of the cervical spine. In the prone position, there was no hemodynamics difference between the two groups, while difference was found between the two groups after 45° rotation of the cervical spine. Significant difference was found between the two groups after 45° rotation and flexion of the cervical spine.Conclusion:Sonography could observe the morphological changes of the vertebral arteries and measure the hemodynamics parameters. It could be one of the routines to exclude the potential injuries to the VA in the patients with arteriosclerosis before the rotatory manipulation of the cervical spine.

参考文献/References:

[1] Haldeman S,Carey P,Townsend M,et al.Arterial dissections following cervical manipulation:the chiropractic experience[J].CMAJ,2001,165(7):905-906.
[2] Haldeman S,Kohlbeck FJ,McGregor M.Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation[J].Spine,1999,24(8):785-794.
[3] Miley ML,Wellik KE,Wingerchuk DM,et al.Does cervical manipulative therapy cause vertebral artery dissection and stroke[J].Neurologist,2008,14(1):66-73.
[4] Young YH,Chen CH.Acute vertigo following cervical manipulation[J].Laryngoscope,2003,113(4):659-662.
[5] Heikkila H,Johansson M,Wenngren BI.Effects of acupuncture,cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin:a pilot study[J].Man Ther,2000,5(3):151-157.
[6] Di Fabio RP.Manipulation of the cervical spine:risks and benefits[J].Phys Ther,1999,79(1):50-65.
[7] Haldeman S,Kohlbeck FJ,McGregor M.Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy:a review of sixty-four cases after cervical spine manipulation[J].Spine,2002,27(1):49-55.
[8] Haldeman S,Kohlbeck FJ,McGregor M.Stroke,cerebral artery dissection,and cervical spine manipulation therapy[J].J Neurol,2002,249(8):1098-1104.
[9] Cagnie B,Barbaix E,Vinck E,et al.Atherosclerosis in the vertebral artery:an intrinsic risk factor in the use of spinal manipulation[J]? Surg Radiol Anat,2006,28(2):129-134.
[10] 李义凯,钟世镇.旋转手法对椎管内结构和容积影响的研究[J].中国中医骨伤科,1997,5(6):4-7.

备注/Memo

备注/Memo:
基金项目:浙江省中医药管理局科技项目(2009CA078)
更新日期/Last Update: 2011-02-25