颈椎牵引联合针刺放血疗法治疗神经根型颈椎病临床效果观察

目的探讨颈椎牵引联合针刺放血疗法治疗神经根型颈椎病的临床效果。方法选取四川省骨科医院自2019年1月至2022年1月收治的148例神经根型颈椎病患者为研究对象。采用随机数字表法将患者分为A组与B组,每组各74例。两组患者均给予基础治疗。A组患者给予颈椎牵引治疗,B组患者在A组基础上联合针刺放血疗法。两组患者均治疗2周。记录两组患者的临床疗效。记录并比较两组患者治疗前后中医症候积分、视觉模拟评分(VAS)、日本骨科学会评分标准(JOA)评分、椎功能障碍指数(NDI)评分。结果B组患者的总有效率为95.95%(71/74),高于A组的86.49%(64/74),差异有统计学意义(P<0.05)。治疗后,两组患者颈肩窜通、上肢麻木、颈部僵硬与头部沉重证候积分均低于治疗前,且B组上述证候积分均低于A组,差异均有统计学意义(P<0.05)。治疗后,两组患者的VAS、NDI评分均低于治疗前,JOA评分均高于治疗前,且B组的VAS、NDI评分均低于A组,JOA评分高于A组,差异均有统计学意义(P<0.05)。结论颈椎牵引联合针刺放血疗法治疗神经根型颈椎病疗效显著,可以改善患者临床症状与颈椎功能,缓解疼痛,并提高患者生活质量。     

独刺大椎穴配合冰麝散外用治疗神经根型颈椎病的临床观察

目的探讨独刺大椎穴配合冰麝散外用治疗神经根型颈椎病的疗效。方法将72例患者随机分为治疗组和对照组,治疗组给予大椎穴针刺,并行冰麝散局部外敷,每3 d治疗1次,5次为一疗程;对照组口服颈痛颗粒,每次4 g,3次/d,连用15 d为1个疗程。治疗前后对两组患者按照视觉模拟评定法（VAS）和20分法量表进行评分,并对两组疗效作对比分析。结果治疗后,两组VAS评分和20分法量表评分均明显优于治疗前（P〈0.01）。治疗组VAS评分明显低于对照组,20分法量表评分较对照组明显提高,差异均有统计学意义（P〈0.05）。治疗组总有效率为94.29%,对照组总有效率为82.33%,治疗组高于对照组（P〈0.05）。结论独刺大椎穴配合冰麝散外用可以有效减轻神经根型颈椎病的症状、体征。     

脊柱牵引整复机治疗神经根型颈椎病疗效观察

目的观察脊柱牵引整复机治疗神经根型颈椎病的临床疗效。方法2002年6月至今采用脊柱牵引整复机治疗神经根型颈椎病患者175例,同时设立颈椎牵引对照组,治疗1疗程后判定疗效。结果治疗组:临床治愈37例,显效98例,有效36例,无效4例;对照组:临床治愈9例,显效67例,有效56例,无效15例。两组之间疗效差异有统计学意义。结论脊柱牵引整复机是治疗神经根型颈椎病的一种有效手段,具有一定的推广价值。     

颈椎操对飞行人员颈型颈椎病疗效观察

目的探讨颈椎操对飞行人员颈型颈椎病的治疗效果。方法将102名患颈型颈椎病飞行人员随机分为颈椎操组(52例)和常规组(50例),常规组予以药物、物理疗法等常规治疗,颈椎操组在常规治疗基础上加前俯后仰、左顾右盼、耸肩颈、回环摇头等颈椎操治疗,两组均治疗21 d后,比较两组患者椎动脉平均血流速度、疼痛评分和临床疗效。结果治疗前两组患者椎动脉平均血流速度和疼痛评分无统计学差异(P>0.05),治疗后颈椎操组椎动脉平均血流速度、疼痛评分与同期常规组比较差异有统计学意义(P<0.05),颈椎操组临床疗效优于常规组(P<0.05)。结论颈椎操可改善飞行人员颈型颈椎病患者疼痛症状,并有很好疗效。     

活血化瘀汤治疗神经根型颈椎病的临床研究

目的观察活血化瘀汤治疗神经根型颈椎病的临床疗效。方法将152例神经根型颈椎病,随机分为活血化瘀汤治疗组(87例)和颈复康颗粒对照组(65例),分别观察两组患者治疗前后主要症状疼痛程度(VAS法)、血液流变学指标、血清细胞因子IL-10和血黏附因子的变化,并比较两组疗效。结果治疗组和对照组治疗后疼痛积分较治疗前均明显减少(P<0.01),两组间治疗前后疼痛积分的差值比较,有显著性差异(P<0.05);血液流变学指标、血清细胞因子IL-10和血黏附因子,治疗后两组均有显著性差异(P<0.05);治疗组的治愈率、有效率与对照组比较有显著性差异(P<0.05)。结论活血化瘀汤治疗神经根型颈椎病有明显的疗效。     

低温等离子髓核成形术联合盘内臭氧注射治疗神经根型颈椎病的临床对照研究北大核心CSCD

目的 探讨低温等离子髓核成形术联合盘内臭氧注射治疗神经根型颈椎病的临床疗效。方法 选择2018年5月至2021年9月合肥市第二人民医院介入血管疼痛科治疗的神经根型颈椎病患者25例,其中行单纯低温等离子髓核成形术11例(A组),行等离子联合盘内臭氧注射治疗14例(B组)。记录两组术前、术后1周和1、3、6个月的疼痛视觉模拟(VAS)评分和田中靖久颈椎病症状量表评分;术后6个月依据Macnab标准评价临床疗效;记录不良反应发生情况。结果 A组患者术前VAS评分为(6.36±0.92)分,B组患者术前VAS评分为(6.57±0.85)分,差异无统计学意义(P>0.05)。治疗后,两组患者VAS评分均较术前显著降低(P<0.01)。B组术后1周和1、3、6个月的VAS评分分别为(2.43±0.51)、(1.71±0.61)、(1.36±0.49)、(1.29±0.47),均低于A组的(2.91±0.54)、(2.45±0.52)、(2.09±0.3)、(1.82±0.6)分(均P<0.05)。术前,A组患者症状评分(8.91±0.94)分,B组(8.57±1.22)分,差异无统计学意义(P>0.05)。治疗后,两组患者症状评分均较术前显著降低(P<0.01)。B组术后1周和1、3、6个月的症状评分分别为(14.07±1.07)、(14.93±0.73)、(15.5±1.09)、(15.93±0.61)分,均高于A组的(13.18±0.75)、(14.09±0.94)、(14.54±1.08)、(15.36±0.67)分,差异均有统计学意义(均P<0.05)。末次随访时B组整体优良率为92.9%,A组为81.8%。两组均未发生术后并发症。结论 低温等离子髓核成形术联合盘内臭氧注射治疗神经根型颈椎病疗效更佳,且简便安全。     

经皮激光椎间盘减压术治疗神经根型颈椎病的长期疗效观察与分析

目的:探讨经皮激光椎间盘减压术(percutaneous laser disc decompression,PLDD)治疗神经根型颈椎病的长期疗效。方法:通过对2003年10月至2010年12月收治的62例行PLDD(Nd∶YAG激光治疗仪治疗,波长1 064 nm)治疗神经根型颈椎病的患者进行长期随访,应用视觉模拟评分法(visual analogue score,VAS)评价入组患者术前、术后神经根型颈椎病症状情况,采用日本整形外科学会(Japanese Orthopedic Association,JOA)神经根型颈椎病疗效评定标准(20分法)对术后疗效进行评估,应用改良Macnab评价标准对其术后优良率和有效率进行评估。并比较不同性别、年龄亚组患者术后的优良率及有效率。结果:患者术中及术后均未见神经损伤、感染等并发症发生。最终选取了资料完整的32例入组,男性组25例,女性组7例,平均年龄59.09岁,入组患者获得了62～148个月随访,平均随访(112.53±23.81)个月。至末次随访时,32例患者的颈痛、肩痛、上肢麻木、上肢疼痛等症状的VAS评分较术前降低(P0.01)。术前与末次随访时的神经根型颈椎病疗效评定的总分分别为(11.60±3.80)和(15.33±3.43),总体改善率为45.06%(P0.01)。患者总体疗效依据改良Mac Nab评价标准,优7例,良11例,可6例,差8例,总体优良率为56.25%,总体有效率为75.00%;60岁组和≥60岁组患者比较,优良率分别为68.75%和43.75%,有效率分别为87.5%和62.50%,两组比较差异无统计学意义(P0.05)。男性组和女性组患者比较,优良率分别为52.00%和71.43%,有效率分别为76.00%和71.43%,两组比较差异无统计学意义(P0.05)。结论:经皮激光椎间盘减压术治疗神经根型颈椎病9.38年以上的长期疗效确切,且不同年龄组及性别组患者的长期临床疗效均无明显差异。     

卧位微调手法治疗椎动脉型颈椎病的临床疗效分析

目的:评价卧位微调手法治疗椎动脉型颈椎病(CSA)的临床疗效。方法:将111例CSA患者按就诊顺序随机分为卧位整复手法治疗组56例,微电脑颈椎牵引对照组55例,进行临床治疗对比分析。结果:两组治愈率和总有效率比较,卧位整复手法治疗组明显优于颈椎牵引对照组(P<0.05)。     

上颈段颈椎退变性颈肩痛临床诊治探讨

目的:探讨上颈段(C1～C4)颈椎退变性颈肩痛的临床特点并比较不同康复治疗方案的临床疗效.方法:将52例临床诊断为颈肩部肌肉筋膜炎的患者分为三组:上颈段颈椎退变1组(A组,16例),上颈段颈椎退变2组(B组,15例)和非上颈段颈椎退变组(C组,21例).三组均采用相同的推拿和中频电治疗.不同的是A组增加了颈椎牵引和针对根型颈椎病的手法治疗.3组的治疗时间均为2周,治疗次数均不超过10次.治疗前后进行VAS疼痛评分,并对各组疗效进行Odom评定.结果:三组之间性别、年龄和病程均无显著差异性.上颈段颈椎退变性颈肩痛的主要临床特点是伴随斜方肌张力升高和压痛的锁骨水平以上部位的颈肩部肌肉筋膜炎表现.治疗后A组和C组V.AS评分明显改善,均好于B组(P=0.000).Odom评定结果显示:A组治疗优良率(93.8%)和C组(95.2%)相比无显著性差异(P=0.692),均优于B组(P=0.001).结果提示:对于伴有斜方肌张力升高和压痛的颈肩部肌肉筋膜炎患者应常规摄颈椎X线片了解上颈段颈椎退变情况.对于伴随上颈段颈椎退变和上颈段椎间孔狭窄的患者,建议按神经根型颈椎病而不是单纯颈肩部肌肉筋膜炎的康复治疗方法进行治疗,可以取得良好的治疗效果.     

半导体激光照射星状神经节联合牵引治疗椎动脉型颈椎病

目的观察半导体激光星状神经节照射结合牵引治疗椎动脉型颈椎病的临床疗效。方法60例椎动脉型颈椎病患者随机分为3组,每组20例。A组行半导体激光星状神经节照射,B组行牵引治疗,C组半导体激光星状神经节照射联合牵引。治疗前后采用颈性眩晕评估量表(ESCV)及经颅多普勒超声(TCD)进行测评。结果治疗后3组患者ESCV评分均有显著提高(P0.01),左、右椎动脉和基底动脉的平均血流速度(Vm)均较治疗前有提高(P0.05);但C组优于A、B组(P0.05)。结论半导体激光星状神经节照射联合牵引治疗椎动脉型颈椎病临床疗效显著,两种方法具有协同作用。     

宫颈环扎术治疗宫颈机能不全60例疗效观察

目的探讨宫颈环扎术治疗妊娠期宫颈机能不全的疗效。方法对60例孕妇合并宫颈机能不全者,36例施行宫颈环扎术治疗,观察妊娠结局。结果孕妇手术36例中,延长妊娠至足月28例,早产4例,流产4例,胎儿成活32例,与非手术组比较有显著性差异（P〈0．01）。结论宫颈机能不全行宫颈环扎术可以延长孕妇的孕周,改善妊娠结局。     

宫颈环扎术治疗宫颈机能不全60例疗效观察

目的探讨宫颈环扎术治疗妊娠期宫颈机能不全的疗效。方法对60例孕妇合并宫颈机能不全者,36例施行宫颈环扎术治疗,观察妊娠结局。结果孕妇手术36例中,延长妊娠至足月28例,早产4例,流产4例,胎儿成活32例,与非手术组比较有显著性差异（P〈0.01）。结论宫颈机能不全行宫颈环扎术可以延长孕妇的孕周,改善妊娠结局。     

Value of cervical myelography in lateral cervical root compression

The roentgenograms of preoperative cervical metrizamide myelography performed in 133 patients who had undergone surgery for a lateral cervical root compression (foraminotomy) were retrospectively re-evaluated without knowledge of the findings at surgery. Detailed criteria of the radiologic root cavity recess were compared with details of findings at surgery, in order to check the value of the information provided by the myelogram with regard to the morphological nature of the root compression. A review of the two main categories--"soft prolapse with or without primary sequestrum" and "hard protrusion" revealed different myelographic findings. It was not possible to establish an unequivocal diagnosis in individual cases and with regard to forms of root compression exhibiting a greater degree of differentiation.     

颈椎受力改变与颈椎退行性改变的关系

目的：探讨颈椎受力改变与颈椎退行性改变间的因果关系，旨在进一步提高对颈椎退行性改变的认识。方法：对248例颈椎退行性改变的CT检查，X线正、侧、双斜位及部分过屈、过伸位片检查结果进行分析。结果：颈椎受力改变与颈椎退行性改变有密切关系，C4-5、C5-6受力最大，发生在C4-6的颈椎退行性改变最多。结论：椎间盘是人体中最早发生退行性改变的组织，颈椎椎间盘变性引起的颈椎受力改变，可导致颈椎退行性改变的一系列病理改变，而这一系列改变又引起颈椎受力进一步改变，二者互为因果。     

两种锁定型钢板在颈椎前路固定术中的应用

目的 观察和分析两种锁定钢板（CSLP、ORION）在颈椎前路固定术中的应用价值及其适应证。方法 对18例颈椎伤病患者行前路减压、植骨融合,并采用CSLP和ORION内固定。结果 随访3－10个月,17例病人神经系统症状均有不同程度的恢复,植骨块也在术后3个月获骨性愈合,无一例发生钢板断裂、螺钉松动。结论 CSLP及ORION钢板能固定节段达到内在的稳定,有利于植骨块的愈合。同时,具有操作简单、安全,生物相容性好,不干扰CT、MRI等影像学检查,不需再次手术等优点。     

子宫颈癌及宫颈上皮内瘤变流行病学调查

目的了解湖北航天医院就诊患者中子宫颈癌及宫颈上皮内瘤变的发病年龄及其病理类型趋势的变化．为我院妇科体检提供相关科学依据。方法以湖北航天医院1991～2010年病理检查资料为材料，分别统计各年龄组的发病情况，并采用方差分析对数据进行流行病学调查。结果患者的年龄范围21～76岁，宫颈癌患病高峰年龄段为41～55岁：宫颈上皮内瘤变患病高峰年龄段为36～45岁。前十年和后十年患病高峰年龄段对比分析差异无显著性（P〉0．01）。结论我院未出现明显宫颈癌及宫颈上皮内瘤变患病年轻化趋势，应加大对36～55岁妇女的普查和健康教育的力度，做好1、2级预防工作。本资料可为我院宫颈癌及宫颈上皮内瘤变的防治提供基础资料和决策依据。     

Understanding the underutilization of cervical brachytherapy for locally advanced cervical cancer

PurposeTo understand the reasons behind current low utilization of brachytherapy for locally advanced cervical cancer in the United States.Methods and MaterialsA 17-item survey was e-mailed to the American Brachytherapy Society (ABS) listserv of active members in 2018. Responses of attending physicians in the United States were included in the analysis.ResultsAmong a total of 135 respondents, 81 completed the survey. Eighty-four percent agree/strongly agree that cervical brachytherapy is underutilized, and 46.9% disagree/strongly disagree that residents are receiving adequate training for brachytherapy; 75.3% agree/strongly agree that inadequate maintenance of brachytherapy skills is a major obstacle to brachytherapy use; and 71.6% agree/strongly agree that increased time requirement constitutes a major obstacle. Over 97% will recommend brachytherapy for most patients with cervical cancer if given access/time; 72.8% always perform their own brachytherapy, whereas 29.6% reported some type of barrier exists in performing brachytherapy themselves, with time required to perform brachytherapy (9.9%) being a leading factor. A quarter (24.7%) routinely refer to other radiation oncologists for brachytherapy. Even among ABS members, 37.0% reported that they would perform an intensity-modulated radiation therapy or stereotactic body radiation therapy boost in specific scenarios in potentially curable patients. The most common scenario is inability to place a uterine tandem (56.7%).ConclusionsThe underutilization of brachytherapy in cervical cancer is widely recognized by ABS members with inadequate training during residency and inadequate maintenance of skills being possible major contributing factors. Even among ABS members, there are identifiable barriers. Continued advocacy and future initiatives in enhancing access to brachytherapy training and efficiency are needed.     

CT引导硬膜外皮质激素注射治疗神经根型颈椎病

目的 评价CT引导硬膜外皮质激素注射治疗神经根型颈椎病的安全性和疗效.方法 回顾性分析2006年12月至2008年6月间一组32例保守治疗2周无效的神经根型颈椎病患者行CT引导下皮质激素注射治疗的临床及影像学资料.以视觉模拟评分(VAS)和Odom标准评估其治疗前后的症状.结果 32例术后3个月Odom有效率达87.5%(28/32),VAS评分平均缓解5.88±1.10.其中突出组与退变组间、病程大于半年组与小于半年组间、治疗1次组与重复治疗2次组间有效率和VAS评分差异均无统计学意义(P>0.05).结论 CT引导下细针穿刺硬膜外"靶点"注射非颗粒型皮质激素足治疗神经根型颈椎病的理想选择,适合在保守治疗无效的患者中应用.     

Radiotherapy of cervical carcinoma

Refering to the "Annual Report on the Results of Treatment in Gynecological Cancer" it is pointed out, that there is still no agreement concerning the kind of treatment of stage I and a part of stage II patients. In stage I patients most of the clinics use primarily operation. In stage II still an important number of the patients are operated, too. There is no certain difference in the 5-years figures between operation and radiation treatment. In stage III and IV patients mostly get radiation treatment. In the radiation treatment there is a trend to use afterloading instead of Radium. In external radiation more and more clinics use accelerators. Using these new application forms there is no evidence that the indication rather for primary operation or radiation treatment would have changed. There is still a slight increase of the 5-years figures but at the same time there is also a tendency for increase of the better stages.     

The rheumatoid cervical spine: signs of instability on plain cervical radiographs

The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the metacarpophalangeal joints. Joint, bone and ligament damage in the cervical spine leads to subluxations which can cause cervical cord compression resulting in paralysis and even sudden death. Because many patients with significant subluxations are asymptomatic, the radiologist plays a key role in recognizing the clinically important clues to instability on plain radiographs of the cervical spine-often difficult in rheumatoid arthritis when the bony landmarks are osteoporotic or eroded. This review focuses on the signs of instability on plain radiographs of the cervical spine, using diagrams and clinical examples to illustrate methods of identifying significant subluxations in rheumatoid arthritis.