中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3094-3098.doi: 10.3969/j.issn.1673-8225.2010.17.014

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

彩色多普勒和经颅多普勒对椎动脉型颈椎病牵引治疗效果的评价

王  琳1，孙月芳1，陈宪福1，刘  敏2，宋军学3，李幼琼1   

  1. 1吉林大学基础医学院人体解剖学教研室，吉林省长春市 130021；   2长春中医药大学第一附属医院电诊科，吉林省长春市  130021；3吉林大学附属第一医院肝胆胰内科超声室，吉林省长春市  130021
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 作者简介:王 琳★，女，1971年生，辽宁省沈阳市人，汉族，2008年吉林大学毕业，硕士，沈阳医学院沈洲医院副主任医师，主要从事血管超声研究。 wlin101@163.com
  • 基金资助:

    卫生部科教司科研基金(20070831)“中国老年人关节的数字化研究”。

Evaluating the clinical efficacy of the traction therapy for cervical spondylosis by color Doppler flow imaging and transcranial Doppler sonography

Wang Lin1, Sun Yue-fang1, Chen Xian-fu1, Liu Min2, Song Jun-xue3, Li You-qiong1   

  1. 1 Department of Human Anatomy, School of Basic Medical Sciences, Jilin University, Changchun   130021, Jilin Province, China; 2 Department of Electrical Diagnosis, First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun   130021, Jilin Province, China; 3 Department of Ultrasound of Hepatobiliary and Pancreatic Medicine, First Affiliated Hospital, Jilin University, Changchun   130021, Jilin Province, China
  • Online:2010-04-23 Published:2010-04-23
  • About author:Wang Lin, Master, Associate chief physician, Department of Human Anatomy, School of Basic Medical Sciences, Jilin University, Changchun 130021, Jilin Province, China wlin101@163.com
  • Supported by:

    the Scientific Research Foundation of Department of Medical Science and Education of Health Ministry, No. 20070831 *

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845

被引次数

64

摘要：

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。

关键词: 彩色多普勒超声, 经颅多普勒, 椎动脉型颈椎病, 牵引, 数字化医学

Abstract:

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 basilar 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:  ① We 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 best 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.

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