[1]田俊松,应晓明,李晓,等.“分节段式”脊柱推拿手法对青少年特发性脊柱侧凸患者脊柱三维结构的影响[J].中医正骨,2022,34(07):15-21.
　TIAN Junsong,YING Xiaoming,LI Xiao,et al.Effects of segmental spinal manipulation on three-dimensional spinal structure in patients with adolescent idiopathic scoliosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(07):15-21.
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“分节段式”脊柱推拿手法对青少年特发性脊柱侧凸患者脊柱三维结构的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年07期
页码:
15-21
栏目:
临床研究
出版日期:
2022-07-20

文章信息/Info

Title:
Effects of segmental spinal manipulation on three-dimensional spinal structure in patients with adolescent idiopathic scoliosis
作者:
田俊松1; 应晓明2; 李晓2; 叶鑫2; 李帅林2; 周建忠1; 杨志峰1; 李立柯1
(1.余姚市中医医院,浙江 余姚 315499; 2.浙江中医药大学附属第三医院,浙江 杭州 310005)
Author(s):
TIAN Junsong1; YING Xiaoming2; LI Xiao2; YE Xin2; LI Shuailin2; ZHOU Jianzhong1; YANG Zhifeng1; LI Like1
1.Yuyao Hospital of TCM,Yuyao 315499,Zhejiang,China 2.The Third Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang,China
关键词:
脊柱侧凸;  推拿; 脊柱;  青少年;  临床试验
Keywords:
scoliosis;  manipulation; spinal;  adolescent;  clinical trial
摘要:
目的:探讨“分节段式”脊柱推拿手法对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱三维结构的影响。方法:将符合要求的90例AIS患者随机分为2组,每组45例。常规推拿组采用《推拿治疗学》中的脊柱病证推拿手法治疗,每周治疗2次,共治疗24周; 联合推拿组在常规推拿基础上联合“分节段式”脊柱推拿手法治疗,每周治疗1次,共治疗24周。分别于治疗前及治疗结束时记录并比较2组患者的脊柱矢状位垂直轴(sagittal vertical axis,SVA)距离、胸椎后凸角(thoracic kyphosis,TK)、胸腰段后凸角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)、C7铅垂线(C7 plumb line,C7PL)与骶骨中垂线(center sacral vertical line,CSVL)的距离、顶椎偏距(apical vertebral translation,AVT)、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)及骨盆倾斜角(pelvic tilt,PT)。结果:①脊柱矢状位参数。治疗前,2组患者的脊柱SVA距离、TK、TLK、LL比较,组间差异均无统计学意义[(5.100±1.125)cm,(5.250±0.920)cm,t=-0.326,P=0.748; 20.900°±3.143°,20.400°±2.674°,t=0.383,P=0.706; 5.300°±1.767°,4.900°±1.523°,t=0.542,P=0.594; 32.800°±3.393°,32.900°±2.378°,t=-0.076,P=0.940]; 治疗结束后,联合推拿组的脊柱SVA距离、TLK均小于常规推拿组[(2.400±0.843)cm,(3.900±0.614)cm,t=-4.546,P=0.000; 2.100°±0.994°,3.200°±1.033°,t=-2.426,P=0.026],联合推拿组的TK、LL均大于常规推拿组(28.500°±3.472°,25.100°±3.281°,t=2.251,P=0.037; 41.300°±3.301°,37.700°±2.584°,t=2.715,P=0.014),2组患者的脊柱SVA距离、TLK均小于治疗前(t=5.939,P=0.000; t=6.384,P=0.000; t=5.400,P=0.000; t=5.075,P=0.000),2组患者的TK、LL均大于治疗前(t=-5.919,P=0.000; t=-8.728,P=0.000; t=-15.105,P=0.000; t=-10.854,P=0.000)。②脊柱冠状位参数。治疗前,2组患者的C7PL与CSVL的距离、AVT比较,组间差异均无统计学意义[(3.350±0.668)cm,(3.100±0.843)cm,t=0.735,P=0.472;(5.650±1.001)cm,(5.200±1.206)cm,t=0.908,P=0.376]; 治疗结束后,联合推拿组患者的C7PL与CSVL的距离、AVT均小于常规推拿组[(1.150±0.474)cm,(2.050±0.643)cm,t=-3.561,P=0.002;(2.200±0.537)cm,(3.700±0.675)cm,t=-5.498,P=0.000],2组患者的C7PL与CSVL的距离、AVT均小于治疗前(t=11.000,P=0.000; t=7.584,P=0.000; t=8.835,P=0.000; t=4.881,P=0.000)。③骨盆参数。治疗前,2组患者的PI、SS、PT比较,组间差异均无统计学意义(43.150°±2.249°,43.100°±1.983°,t=0.053,P=0.959; 35.950°±4.699°,38.750°±1.438°,t=0.011,P=0.088; 6.900°±1.074°,6.800°±0.856°,t=0.230,P=0.821); 治疗结束后,联合推拿组患者的PI、SS均小于常规推拿组(33.390°±3.415°,37.300°±2.474°,t=-2.932,P=0.009; 28.000°±4.384°,33.850°±1.732°,t=-3.924,P=0.001),联合推拿组患者的PT大于常规推拿组(10.650°±1.029°,9.000°±1.202°,t=3.298,P=0.004),2组患者的PI、SS均小于治疗前(t=7.271,P=0.000; t=5.163,P=0.000; t=23.468,P=0.000; t=12.468,P=0.000)、PT均大于治疗前(t=-7.169,P=0.000; t=-4.714,P=0.000)。结论:对于AIS患者,在常规推拿手法基础上联合“分节段式”脊柱推拿手法治疗,可从整体上调整脊柱三维结构,重建及稳定脊柱三维平衡状态,其疗效优于单纯常规推拿手法治疗。
Abstract:
Objective:To explore the effects of segmental spinal manipulation on three-dimensional(3D)spinal structure in patients with adolescent idiopathic scoliosis(AIS).Methods:Ninety AIS patients were enrolled in the study and were randomly divided into conventional manipulation group and combination manipulation group,45 cases in each group.All patients in the 2 groups were treated with manipulation for spinal diseases which was extracted from Manipulation Acology,twice a week for consecutive 24 weeks.Moreover,the patients in combination manipulation group were further treated with segmental spinal manipulation,once a week for consecutive 24 weeks.The parameters including sagittal vertical axis(SVA)distance,thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),distance between C7 plumb line(C7PL)and center sacral vertical line(CSVL),apical vertebral translation(AVT),pelvic incidence(PI),sacral slope(SS)and pelvic tilt(PT)were recorded and compared between the 2 groups before the treatment and at the end of treatment.Results:①There was no statistical difference in SVA distance,TK,TLK and LL between the 2 groups before the treatment(5.100±1.125 vs 5.250±0.920 cm,t=-0.326,P=0.748; 20.900±3.143 vs 20.400±2.674 degrees,t=0.383,P=0.706; 5.300±1.767 vs 4.900±1.523 degrees,t=0.542,P=0.594; 32.800±3.393 vs 32.900±2.378 degrees,t=-0.076,P=0.940).The SVA distance was shorter,the TLK was smaller,whereas the TK and LL were greater in combination manipulation group compared to conventional manipulation group after the end of the treatment(2.400±0.843 vs 3.900±0.614 cm,t=-4.546,P=0.000; 2.100±0.994 vs 3.200±1.033 degrees,t=-2.426,P=0.026; 28.500±3.472 vs 25.100±3.281 degrees,t=2.251,P=0.037; 41.300±3.301 vs 37.700±2.584 degrees,t=2.715,P=0.014).The SVA distance and TLK decreased,whereas the TK and LL increased after the end of the treatment compared to pretreatment in the 2 groups(t=5.939,P=0.000; t=6.384,P=0.000; t=5.400,P=0.000; t=5.075,P=0.000; t=-5.919,P=0.000; t=-8.728,P=0.000; t=-15.105,P=0.000; t=-10.854,P=0.000).②There was no statistical difference in AVT and the distance between C7PL and CSVL between the 2 groups before the treatment(5.650±1.001 vs 5.200±1.206 cm,t=0.908,P=0.376; 3.350±0.668 vs 3.100±0.843 cm,t=0.735,P=0.472).The AVT and the distance between C7PL and CSVL were shorter in combination manipulation group compared to conventional manipulation group after the end of the treatment(2.200±0.537 vs 3.700±0.675 cm,t=-5.498,P=0.000; 1.150±0.474 vs 2.050±0.643 cm,t=-3.561,P=0.002).The AVT and the distance between C7PL and CSVL decreased after the end of the treatment compared to pretreatment in the 2 groups(t=8.835,P=0.000; t=4.881,P=0.000; t=11.000,P=0.000; t=7.584,P=0.000).③There was no statistical difference in PI,SS and PT between the 2 groups before the treatment(43.150±2.249 vs 43.100±1.983 degrees,t=0.053,P=0.959; 35.950±4.699 vs 38.750±1.438 degrees,t=0.011,P=0.088; 6.900±1.074 vs 6.800±0.856 degrees,t=0.230,P=0.821).The PI and SS were smaller,whereas the PT was greater in combination manipulation group compared to conventional manipulation group after the end of the treatment(33.390±3.415 vs 37.300±2.474 degrees,t=-2.932,P=0.009; 28.000±4.384 vs 33.850±1.732 degrees,t=-3.924,P=0.001; 10.650±1.029 vs 9.000±1.202 degrees,t=3.298,P=0.004).The PI and SS decreased,while the PT increased after the end of the treatment compared to pretreatment in the 2 groups(t=7.271,P=0.000; t=5.163,P=0.000; t=23.468,P=0.000; t=12.468,P=0.000; t=-7.169,P=0.000; t=-4.714,P=0.000).Conclusion:The conventional manipulation combined with segmental spinal manipulation can adjust the 3D structure of the spine,reconstruct and stabilize the 3D balance state of the spine in AIS patients,and its curative effect is better than that of conventional manipulation alone.

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备注/Memo

备注/Memo:
基金项目:浙江省中青年临床名中医项目(sjzqn202106); 浙江中医药适宜技术培育项目(2018ZT003) 通讯作者:应晓明 E-mail:whiteantgo@hotmail.com
更新日期/Last Update: 1900-01-01