许鸿智 林定坤 陈博来

[摘要] 目的 探討仰卧前屈拔伸牵引治疗伴退变性脊髓压迫神经根型颈椎病的效果及安全性。 方法 选取2014年 9月～2015年12月广东省中医院门诊诊断为伴退变性脊髓压迫神经根型颈椎病的中老年患者21例作为研究对象，应用仰卧前屈拔伸牵引法进行保守治疗，采用疼痛评分（VAS）及颈椎功能障碍指数（NDI）评价其疗效，体感诱发电位（CSEP）检测脊髓神经功能变化，多体位磁共振（MRI）技术探讨椎管矢状径的变化，所有患者均进行治疗后1年的随访观察。 结果 21例患者均完成多体位MRI、CSEP检查和10 d的治疗，并在治疗后1年均得到随访，有效随访率为100%。其中1例由于上肢麻木加重，在随访期间转为手术治疗。其余20例患者的治疗2、4、6、8、10 d后及随访1年的VAS评分均较治疗前降低（P < 0.01），治疗10 d后及随访1年的NDI评分也明显低于治疗前（P < 0.01）。前屈牵引时的CSEP潜伏期和波幅与正常体位时比较，差异无统计学意义（P > 0.05）。前屈位椎管有效矢状径明显大于中立位（t=3.56，P=0.00），而中立位则明显大于后伸位（t=4.22，P=0.00）。 结论 仰卧前屈拔伸牵引法治疗伴退变性脊髓压迫根型颈椎病是有效安全的，但由于病例样本量较小，随访时间尚短，仍需进行更大样本量及更长时间的随访观察，并开展相关适应证和禁忌证的研究，提高疗效和预后。此外，还应进一步研究脊髓受压与脊髓功能的变化、疾病预后的相互关系，为此类疾病的干预提供依据。

[关键词] 神经根型颈椎病；退变性脊髓压迫；牵引

[中图分类号] R681.55 [文献标识码] A [文章编号] 1673-7210（2018）04（c）-0053-05

Evaluation of the efficacy and safety of supine flexion traction in the treatment of cervical spondylotic radicular spondylosis with degenerative spinal cord compression

XU Hongzhi LIN Dingkun CHEN Bolai

Department of Orthopedics， Guangdong Province Hospital of Traditional Chinese Medicine， Guangdong Province， Guangzhou 510120， China

[Abstract] Objective To investigate the efficacy and safety of supine flexion traction in the treatment of cervical spondylotic radicular spondylosis with degenerative spinal cord compression. Methods From September 2014 to December 2015， 21 middle-aged and elderly patients with degenerative spinal cord compression type cervical spondylotic radicular in Guangdong Province Hospital of Traditional Chinese Medicine were selected as research objects. Supine flexion traction was used as conservative treatment. The visual analogue scale score （VAS） and neck dysfunction index （NDI） were used to evaluate the efficacy. The changes of spinal nerve function were detected with somatosensory evoked potential （CSEP）， and the changes of the sagittal diameter of the spinal canal were investigated with the combination of multi position magnetic resonance （MRI） technique. All patients were followed up for 1 year after treatment. Results All 21 patients completed the multiple body position MRI， CSEP examination and 10 days of treatment， and they were followed up for 1 years after treatment， the effective follow-up rate was 100%. One patient was turned into surgical treatment during the follow-up period due to the aggravation of the upper limb numbness. The VAS score of after 2， 4， 6， 8 d and 10 d of treatment and 1 year follow up of the remaining 20 patients were lower than those of before treatment （P < 0.01）. The NDI score of after10 days of treatment and 1 year follow up were also significantly lower than those of before treatment （P < 0.01）. The evoked potential latency of CSEP and amplitude between in the flexion traction and normal position were compared， the difference were not statistically significant （P > 0.05）. The valid sagittal diameter of the spinal canal of flexion position was significantly greater than that of neutral position （t=3.56， P=0.00）， while neutral position was significantly greater than that of the posterior extension （t=4.22， P=0.00）. Conclusion Supine flexion traction is effective and safe for cervical spondylotic radicular spondylosis with degenerative spinal cord compression. But due to small sample size and short follow-up time， a larger sample size and longer follow-up observation are still needed. The study of indications and contraindications is also needed to improve the curative effect and prognosis. In addition， should further study the relationship between the spinal cord compression and the changes of spinal cord function and the prognosis of the disease so as to provide the basis for the intervention of such diseases.

[Key words] Cervical spondylotic radiculopathy； Degenerative spinal cord compression； Traction

据相关报道，无症状颈椎退变性脊髓压迫作为一种亚临床现象，已较普遍地（7.9%～27.0%）存在于人群中[1]。经过在临床工作和文献查阅中也发现，有相当一部分中老年患者，临床上仅表现为神经根型颈椎病的症状和体征，并没有脊髓损害的表现，但影像学检查却发现有颈椎退行性改变引起的脊髓受压。……