旋提手法对神经根型颈椎病患者颈部肌张力的效应分析^*

Effectiveness Analysis of Cervical Rotation-Traction Manipulation on Cervical and Dorsal Muscle Tone in Patients With Cervical Spondylotic Radiculopathy

摘要

目的 通过剪切波弹性成像技术明确中医颈椎旋提手法治疗神经根型颈椎病的效应机制。方法 纳入神经根型颈椎病患者30例及30例近3个月内颈部无异常疾患的志愿者。对患者每周进行1次手法治疗，每次15～20 min，持续2周，患者全疗程进行3次治疗。对志愿者不进行任何治疗。以剪切波弹性成像技术为主要研究手段（主要结局指标为杨氏模量），探究旋提手法对神经根型颈椎病患者颈背部软组织的干预效应。在治疗前，首次手法治疗后及手法治疗两周后，对患者共进行3次剪切波弹性成像技术检测。志愿者全程进行1次剪切波弹性成像技术检测作为基线对照。次要结局指标为患者治疗前、治疗后及治疗两周后的视觉模拟评分（visual analogue scale, VAS）与颈椎功能障碍指数（neck disabilitv index, NDI）等临床疗效评价指标。结果 患者治疗前的颈部肌肉杨氏模量值高于志愿者（P<0.001），而在疗程结束后与志愿者相比差异无统计学意义；患者治疗前后及疗程结束前后肌群杨氏模量差异均有统计学意义（P<0.001）；患侧颈部肌群杨氏模量值高于健侧（P=0.001），而经治疗后两者间差异无统计学意义；杨氏模量中位数与神经根型颈椎病患者的VAS评分（r=0.741, P<0.001）、NDI评分（r=0.591, P<0.001）均存在正相关性。结论 旋提手法治疗能够降低神经根型颈椎病患者VAS评分与NDI评分，降低患者颈部肌肉张力，并能够在降低颈部肌群张力的同时平衡其分布；杨氏模量值是反映手法疗效的潜在指标。

Abstract

Objective To clarify the mechanism of action of the Cervical Rotation-Traction Manipulation in treating cervical spondylotic radiculopathy using shear wave elastography. Methods Thirty patients with cervical spondylotic radiculopathy and 30 volunteers without abnormal cervical conditions in the past three months were included. Patients received manipulation therapy once a week for 15 to 20 minutes, totaling three sessions over two weeks. Volunteers received no treatment. Shear wave elastography was the primary research method (with Young's modulus as the primary outcome measure) to assess the effect of the Cervical Rotation-Traction Manipulation on the neck and back soft tissues in patients with cervical spondylotic radiculopathy. Shear wave elastography was performed on patients three times: before treatment, after the first manipulation session, and after two weeks of treatment. Volunteers underwent one shear wave elastography test as a baseline control. Secondary outcome measures were the visual analogue scale (VAS) and neck disability index (NDI) scores of patients before treatment, after treatment, and two weeks after treatment. Results The Young's modulus values of the cervical muscles in patients before treatment were higher than those in volunteers (P < 0.001), but there was no statistically significant difference after the treatment course. There were statistically significant differences in the Young's modulus of the muscle before and after treatment and before and after the treatment course in patients ( P < 0.001). The Young's modulus values of the affected side cervical muscles were higher than those of the healthy side ( P = 0.001), but there was no statistically significant difference after treatment. The median Young's modulus was positively correlated with the VAS score ( r = 0.741, P < 0.001) and the NDI score ( r = 0.591, P < 0.001) in patients with cervical spondylotic radiculopathy. Conclusion The Cervical Rotation-Traction Manipulation can reduce the VAS and NDI scores of patients with cervical spondylotic radiculopathy, lower neck muscle tension, and balance the distribution of cervical muscle tension while reducing it. Young's modulus is a potential indicator reflecting the therapeutic effect of the spinal manipulation.

关键词

中医正骨疗法 / 神经根型颈椎病 / 颈椎旋提手法 / 剪切波弹性成像

Key words

Traditional Chinese spinal manipulative therapy / Cervical spondylotic radiculopathy / Cervical rotation-traction manipulation / Shear wave elastography

参考文献

[1] COHEN S P, HOOTEN W M. Advances in the diagnosis and management of neck pain. BMJ, 2017, 358: j3221. doi: 10.1136/bmj.j3221.

[2] CASTELLINI G, PILLASTRINI P, VANTI C, et al. Some conservative interventions are more effective than others for people with chronic non-specific neck pain: a systematic review and network meta-analysis. J Physiother, 2022, 68(4): 244-254. doi: 10.1016/j.jphys.2022.09.007.

[3] LIU R, KURIHARA C, TSAI H T, et al. Classification and treatment of chronic neck pain: a longitudinal cohort study. Reg Anesth Pain Med, 2017, 42(1): 52-61. doi: 10.1097/AAP.0000000000000505.

[4] WEI X, WANG S, LI L, et al. Clinical evidence of Chinese massage therapy (Tui Na) for cervical radiculopathy: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2017, 2017: 9519285. doi: 10.1155/2017/9519285.

[5] KAZEMINASAB S, NEJADGHADERI S A, AMIRI P, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 2022, 23(1): 26. doi: 10.1186/s12891-021-04957-4.

[6] SLEIJSER-KOEHORST M L S, COPPIETERS M W, EPPING R, et al. Diagnostic accuracy of patient interview items and clinical tests for cervical radiculopathy. Physiotherapy, 2021, 111: 74-82. doi: 10.1016/j.physio.2020.07.007.

[7] TIANXIAO F, XIAOKUAN Q, KAI S, et al. Clinical practice guideline for Traditional Chinese Medicine: cervical radiculopathy. J Tradit Chin Med, 2025, 45(6): 1423-1434. doi: 10.19852/j.cnki.jtcm.2025.06.020.

[8] 王旭, 魏戌, 朱立国, 等. 医工结合的中医手法治疗脊柱退行性疾病疗效机制研究: 思路与前. 中国全科医学, 2023, 26(33): 4118-4124. doi: 10.12114/j.issn.1007-9572.2023.0182.

[9] WANG X, WEI S, ZHU L G, et al. Research Ideas of the efficacy mechanism and prospect analysis of traditional Chinese manipulative therapy on treating spinal degenerative diseases with combination of medicine and industry. Chinese General Practice, 2023, 26(33): 4118-4124. doi: 10.12114/j.issn.1007-9572.2023.0182.

[10] SUAREZ-RODRIGUEZ V, FEDE C, PIRRI C, et al. Fascial innervation: a systematic review of the literature. Int J Mol Sci, 2022, 23(10): 5674. doi: 10.3390/ijms23105674.

[11] ALJANOVIC M S, GIMBER L H, BECKER G W, et al. Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics, 2017, 37(3): 855-870. doi: 10.1148/rg.2017160116.

[12] NAKAMURA M, AKAGI R. Ultrasonic shear-wave elastography: a novel method for assessing musculoskeletal soft tissue and nerves. Clin Neurophysiol, 2022, 140: 163-164. doi: 10.1016/j.clinph.2022.05.006.

[13] WANG X, JIN Z, FENG T, et al. The immediate effect of cervical rotation-traction manipulation on cervical paravertebral soft tissue: a study using soft tissue tension cloud chart technology. BMC Musculoskelet Disord, 2024, 25(1): 184. doi: 10.1186/s12891-024-07277-5.

[14] 冯天笑, 肖想玉, 秦晓宽, 等. 以手法为主要干预措施的随机对照试验在样本量估计方面的常见问题分析. 中医正骨, 2024, 36(10): 39-43. doi: 10.3969/j.issn.1001-6015.2024.10.006.

[15] FENG T X, XIAO X Y, QING X K, et al. Common problems in sample size estimation of randomized controlled trials with manipulation as the primary intervention measure. The Journal of Traditional Chinese Orthopedics and Traumatology, 2024, 36(10): 39-43. doi: 10.3969/j.issn.1001-6015.2024.10.006.

[16] HUANG Y, LI S, FENG M, ZHU L. Cervical spine mechanism for reproduction of the biomechanical behaviours of the human neck during rotation-traction manipulation. Appl Bionics Biomech, 2017, 2017: 5829048. doi: 10.1155/2017/5829048.

[17] PENG B, YANG L, LI Y, et al. Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review. Pain Ther, 2021, 10(1): 143-164. doi: 10.1007/s40122-020-00230-z.

[18] VATOVEC R, VOGLAR M. Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord, 2024, 25(1): 155. doi: 10.1186/s12891-024-07241-3.

[19] HVEDSTRUP J, KOLDING L T, ASHINA M, et al. Increased neck muscle stiffness in migraine patients with ictal neck pain: a shear wave elastography study. Cephalalgia, 2020, 40(6): 565-574. doi: 10.1177/0333102420919998.

[20] HAUEISE A, LE SANT G, EISELE-METZGER A, et al. Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography. Clin Physiol Funct Imaging, 2024, 44(3): 187-204. doi: 10.1111/cpf.12870.

[21] DIETERICH A V, YAVUZ U Ş, PETZKE F, et al. Neck muscle stiffness measured with shear wave elastography in women with chronic nonspecific neck pain. J Orthop Sports Phys Ther, 2020, 50(4): 179-188. doi: 10.2519/jospt.2020.8821.

[22] TORELL F, DIMITRIOU M. Local muscle pressure stimulates the principal receptors for proprioception. Cell Rep, 2024, 43(9): 114699. doi: 10.1016/j.celrep.2024.114699.

[23] BARAL P, UDIT S, CHIU I M. Pain and immunity: implications for host defence. Nat Rev Immunol, 2019, 19(7): 433-447. doi: 10.1038/s41577-019-0147-2.

[24] PARTANEN J V, LAJUNEN H R, LILJANDER S K. Muscle spindles as pain receptors. BMJ Neurol Open, 2023, 5(1): e000420. doi: 10.1136/bmjno-2023-000420.

[25] MAAS H, NOORT W, SMILDE H A, et al. Detection of epimuscular myofascial forces by Golgi tendon organs. Exp Brain Res, 2022, 240(1): 147-158. doi: 10.1007/s00221-021-06242-1.

[26] PAPAIOANNOU S, DIMITRIOU M. Goal-dependent tuning of muscle spindle receptors during movement preparation. Sci Adv, 2021, 7(9): eabe0401. doi: 10.1126/sciadv.abe0401.

[27] BLUM K P, CAMPBELL K S, HORSLEN B C, et al. Diverse and complex muscle spindle afferent firing properties emerge from multiscale muscle mechanics. Elife, 2020, 9: e55177. doi: 10.7554/eLife.55177.

[28] SAS D, GAUDEL F, VERDIER D, et al. Hyperexcitability of muscle spindle afferents in jaw-closing muscles in experimental myalgia: evidence for large primary afferents involvement in chronic pain. Exp Physiol, 2024, 109(1): 100-111. doi: 10.1113/EP090769.

[29] GEVERS-MONTORO C, PROVENCHER B, DESCARREAUX M, et al. Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Eur J Pain, 2021, 25(7): 1429-1448. doi: 10.1002/ejp.1773.

[30] NIU K, LI Y, GUAN H, et al. Optimization of traditional Chinese medicine rolling manipulation and pressure attenuation. Am J Transl Res, 2021, 13(7): 7654-7666.

[31] BUTTAGAT V, NARKTRO T, ONSRIRA K, et al. Short-term effects of traditional Thai massage on electromyogram, muscle tension and pain among patients with upper back pain associated with myofascial trigger points. Complement Ther Med, 2016, 28: 8-12. doi: 10.1016/j.ctim.2016.07.004.

[32] NOGUEIRA N, OLIVEIRA-CAMPELO N, LOPES Â, et al. The acute effects of manual and instrument-assisted cervical spine manipulation on pressure pain threshold, pressure pain perception, and muscle-related variables in asymptomatic subjects: a randomized controlled trial. J Manipulative Physiol Ther, 2020, 43(3): 179-188. doi: 10.1016/j.jmpt.2019.05.007.

[33] YOUNG K J, LEBOEUF-YDE C, GORRELL L, et al. Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation. Chiropr Man Therap, 2024, 32(1): 28. doi: 10.1186/s12998-024-00549-w.

[34] DICE J L, BRISMÉE J M, FROMENT F P, et al. Spinal manipulation and mobilisation among infants, children, and adolescents: an international Delphi survey of expert physiotherapists. J Man Manip Ther, 2024, 32(3): 284-294. doi: 10.1080/10669817.2024.2327782.

基金资助

*2025年度北京市科技新星交叉合作课题(20250484972)

国家级非物质文化遗产代表性项目(102160242020130000006)

中国中医科学院望京医院高水平中医医院建设项目(WJYY-XZKT-2023-05)