CAJ | 학술논문

背景:适宜方向、角度的牵引对于椎动脉型颈椎病疗效显著.选择性血管造影被公认为是确定血管疾病的"金标准",核磁共振血管造影虽为无创性检查,却存在检查时间较长、易受人为因素影响、具有一定侵袭性等不足.目的:通过彩色多普勒和经颅多普勒加转颈试验,对不同牵引方向和牵引角度治疗前后椎动脉型颈椎病患者血流参数变化进行比较分析.方法:选择椎动脉型颈椎病患者240例,根据解剖学角度按病变部位(上颈段病变、下颈段病变、混合型)和牵引方式、角度(坐位前倾分1°～10°、11°～20°、21°～30°组,坐位后伸1°～10°、11°～20.、21°～30°组,坐位中立位组)分组,以局部按摩为对照组.通过彩色多普勒加转颈试验检测治疗前后椎动脉最窄部位血管内径、收缩期峰值速度、平均血流速度.通过经颅多普勒加转颈试验测量治疗前后左、右椎动脉和基底动脉的收缩期峰值血流速度、平均血流速度等血流参数,并进行比较分析.结果与结论:①根据解剖部位确立了椎动脉型颈椎病的类型.椎动脉型颈椎病根据病变部位划分为上颈段(C1～C3)、下颈段(C4～C6)和混合型,这从椎骨形态和力学角度等方面为临床牵引治疗提供了指导.②确定了最佳牵引角度.即上颈段椎动脉型颈椎病患者坐位后伸11°～20°牵引疗效较好,下颈段椎动脉型颈椎病患者坐位前屈11°～20°牵引疗效较好,混合型椎动脉型颈椎病患者坐位前屈1°～10°疗效较好.③确立了彩色多普勒及经颅多普勒超声检测是指导椎动脉型颈椎病牵引治疗的简便、无创、安全可靠、重复性好的验证手段.
배경:괄의방향、각도적견인대우추동맥형경추병료효현저.선택성혈관조영피공인위시학정혈관질병적"금표준",핵자공진혈관조영수위무창성검사,각존재검사시간교장、역수인위인소영향、구유일정침습성등불족.목적:통과채색다보륵화경로다보륵가전경시험,대불동견인방향화견인각도치료전후추동맥형경추병환자혈류삼수변화진행비교분석.방법:선택추동맥형경추병환자240례,근거해부학각도안병변부위(상경단병변、하경단병변、혼합형)화견인방식、각도(좌위전경분1°～10°、11°～20°、21°～30°조,좌위후신1°～10°、11°～20.、21°～30°조,좌위중립위조)분조,이국부안마위대조조.통과채색다보륵가전경시험검측치료전후추동맥최착부위혈관내경、수축기봉치속도、평균혈류속도.통과경로다보륵가전경시험측량치료전후좌、우추동맥화기저동맥적수축기봉치혈류속도、평균혈류속도등혈류삼수,병진행비교분석.결과여결론:①근거해부부위학립료추동맥형경추병적류형.추동맥형경추병근거병변부위화분위상경단(C1～C3)、하경단(C4～C6)화혼합형,저종추골형태화역학각도등방면위림상견인치료제공료지도.②학정료최가견인각도.즉상경단추동맥형경추병환자좌위후신11°～20°견인료효교호,하경단추동맥형경추병환자좌위전굴11°～20°견인료효교호,혼합형추동맥형경추병환자좌위전굴1°～10°료효교호.③학립료채색다보륵급경로다보륵초성검측시지도추동맥형경추병견인치료적간편、무창、안전가고、중복성호적험증수단.
BACKGROUND: Appropriate direction and angle of traction for the vertebral artery type cervical spondylosis(CSA)make significant effect.Selective angiography is recognized as"gold standard"to diagnose the vascular disease.Although magnetic resonance angiography as a non-invasive examination,there exist shortcomings such as a longer time checking,vulnerable to man-made factors,a certain aggressive feature.OBJECTIVE: Through the use of color Doppler flow imaging(CDFI)and transcranial Doppler sonography(TCD)adding the test of turning neck,to analyze the change of blood current parameter before and after the tractions from different directions and angles.METHODS: 240 cases suffering CSA were selected and divided into groups according to anatomy angle of lesion parts(upper cervical segments,lower cervical segments,mixed type)and traction mode,angel(anteversion sitting position 1°-10°,11°-20°,21°-30° groups,posterior extension sitting position 1°-10°,11°-20°,21°-30° groups,neutral position sitting position group).Local massage served as control group.The indexes of vertebral artery of neck part including inner diameter(D)of narrowest location,peak systolic velocity and average velocity of blood were measured by CDFI adding the test of turning neck.The indexes of left vertebral artery,right vertebral artery and basiiar artery including peak velocity(Vp)of period of contraction and mean velocity(Vm)of blood were measured by TCD adding the test of turning neck.RESULTS AND CONCLUSION: ①We determined vertebral artery type of cervical spondylosis on the base of anatomic site. On the basis of diseased region,we divided cervical syndrome into 3 types.They were superior part(C1-C3),inferior part (C4-C6) and commixture.it offers clinical guidance for traction therapy from spondylous morphous and mechanics.② We determined the gbest angle of traction.The therapeutic efficacy in posterior extension sitting position occupying 11-20～was better in upper hind neck;the therapeutic efficacy in anteversion sitting position occupying 11-20° was better in inferior neck; the therapeutic efficacy in anteversion sitting position occupying 1-10° was better in neutral position sitting position.③ We knew that CDFI and TCD are the convenient,non-invasive,safe and reduplicative methods to guide traction therapy in vertebral artery type of cervical spondylosis.