【作者】 熊爱民；

【导师】 詹红生；

【作者基本信息】 浙江中医学院 ， 针灸推拿学， 2003， 硕士

【摘要】 目的 本文分临床与实验两部分，临床拟对已建立的仰卧拔伸手法操作规范，进一步研究以明确其在治疗神经根型颈椎病中的临床地位和作用。实验通过观察长时间异常应力环境下兔颈椎间盘的生物力学性能变化，及不同时期推拿手法的影响，分析其与椎间盘组织形态和基质成分变化之间的关系，同时了解推拿防治颈椎病的原理、机制和效果。 方法 临床选择符合神经根型颈椎病诊断、纳入标准的，来自四个临床中心的118例患者。随机分为手法治疗组(A组)和牵引对照组(B组)；治疗组采用仰卧拔伸手法进行治疗，对照组使用常规放松治疗、理筋手法结合颌枕吊带牵引。记录治疗过程中患者症状、体征的变化，中医证型变化，病人依从性以及不良反应等。实验选取60只家兔，随机分为对照组、模型组、推拿预防组、推拿治疗组。后三组家兔颈椎处于低头屈曲45°位异常应力环境下，固定时间为5小时／次·天。推拿预防组于造模开始时即给予推拿手法治疗，推拿治疗组于造模2月后开始推拿手法治疗。动物处死后，取颈椎C3一4颈椎功能节段作生物力学性能测试，比较各组间可能存在的差异。 结果手法治疗组(A组)和牵引对照组(B组)疗效分别为93.7%、94.9%，两组总有效率比较无统计学差异护)0.05)，两组对临床症状和体征均有明显改善(尸<0.01)，两组比较无差别;患者年龄、病程、病情、中医证型与疗效无关护>0.05);治疗过程中未见骨折、脱位、晕厥等不良反应。实验发现对照组颈椎间盘生物力学性能无明显变化;模型组颈椎间盘生物力学性能测试则表现为明显下降，并随着异常应力作用时间的延长而表现更为显著。从颈椎生物力学性能看，推拿预防组要好于治疗组，而治疗组又要好于模型组(尸<0.05)。推拿预防组与对照组无明显差异(尸夕0 .05)。 结论临床得出仰卧拔伸手法治疗神经根型颈椎病有良好的疗效，可以明显改善颈项酸痛和上肢放射痛等临床症状和体征，恢复患者的日常工作、生活能力。手法治疗组和牵引对照组相比疗效无统计学差异，但手法组的满意度高，分析其操作更符合生物力学原理，易为患者接受。实验得出长时间处于异常应力环境下能使兔颈椎间盘生物力学性能发生明显退行性改变，这与兔颈椎间盘的组织形态、基质生化组 2中成退变相关;早期推拿手法能够有效改变异常应力环境下颈椎间盘的组织形态、基质生化组成和生物力学性能，一定程度延缓颈椎间盘退变的发生。晚期推拿手法则无法逆转异常应力环境下颈椎间盘退变的发生发展。更多还原

【Abstract】 Adjective To observe the effect and security of pulling manipulation in supine position to cervicalspondylotic radiculopathy. And to characterize the changes of cervical intervretebral disc biomechanics associated with disc degeneration ,and to evaluate the effect of Chinese massage on disc degeneration.Methods Clinic part 118 patients of cervicalspondylotic radiculopathy from four clinical center were randomly divided into test group with therapy and control group with mechanical traction. The amelioration of symptoms and signs after treating was observed. And Sixty Japanese white rabbit were randomly divided into control, model, massage prevention(mp), massage treatment(mt) groups.Rabbits in the latter three groups were kept at 45-degree flexion for 5 hours once every day. Respectively, rabbits in the mp were given massage at the initial stage,rabbits in the mt were treated two months later.After sacrificed, C3-4 function spinal unit was chosen to do the regular biomechanic test. All the results were compaired among the groups above.Results Total clinical efficiency ratio in the test group was 93.7%, while that was 94.9% in the control group; Symptoms and signs of the patients in the two group were evidently ameliorated before and after treatment (P<0.01).They didn’t differ greatly between test and control group. However, the amelioration of neck aching pain in the test group was evidently better than that in the control one (P<0.05). No patients did suffer from facture, dearticulatio, faintness and other sever ill effects during the treatment. It wad observed that Rabbits in the control group showed no biomechanical changes on cervical disc, Rabbits in the model group showed biomechanical change on cervical, and rapidly decline with time passing, According to biomechanical change on cervical, the rabbit in the mp and mt prior to the rabbit in the model group (P<0.05),and the rabbit in the mp were preceding those in the mt.Conclusion Pulling manipulation in supine position is an effective and secure therapy to cervicalspondylotic radiculopathy, which had the same curative effect as by mechanical traction, but the patients were readily receptive to the manipulation. Abnormal stress can induced discal degeneration; Manipulation intervention can retard the degenerative changes of biomechanical in the different degree; Manipulation may prevent the injurement of skeletonmuscle behind the cervical vertebra in the degenerative disc model in rabbit, which means that restoring dynamic equilibrium of cervical spine by the good effects of manipulation on soft tissue may be one of channels which manipulation retard cervical disc degeneration. The effect of manipulation lie on the time which manipulation were given.更多还原