寰枢椎脱位的外科治疗与通调三焦的相关性研究

  本文关键词：寰枢椎脱位的外科治疗与通调三焦的相关性研究，由笔耕文化传播整理发布。

        目的：探讨寰枢椎脱位外科治疗与通调三焦的相关性。寰枢椎脱位常常伴有四肢肌力减弱,皮肤感觉障碍,膀胱功能异常。从中医学角度分析这些症候群,我们发现,皮肤感觉障碍与上焦肺主皮毛以及营卫运行有关；四肢的肌力减退与中焦脾主四肢以及气血生化有关；二便不调与下焦肾司二便以及膀胱气化有关。至于眩晕耳鸣、视物模糊、心慌汗出,舌蹇语塞、腹胀便溏等症状,均可以通过中医的脏腑五行理论——对号入座,并且分列于三焦的症候群中。例如心慌汗出一症,可归于上焦症状中,因为心慌为心失所养的表现,而汗为心之液,故汗出也多从心论治；再如腹胀便溏一症,多为脾虚所致,脾胃位居中焦,故腹胀便溏多从中焦论治。诸如以上列举的三焦不通的症状,能够按照中医四诊八纲进行辩证施治,但是有些患者通过中医传统的方法,例如中药、针灸、推拿、导引等,并不能收到满意的效果,有些可以说是毫无起色。在骨科门诊中我们会发现有很多人是以上述三焦不通的症状为主诉前来就诊的,西医给予的是寰枢椎脱位的诊断,收入院并进行手术治疗后,脊髓压迫得以解除。此时我们会发现,在经过寰枢椎脱位的外科治疗后,患者原来的三焦不通的症状也得到了不同程度的改善,所以我们考虑寰枢椎脱位的外科治疗与通调三焦之间是否有着某些相关性,基于上述分析,本文的目的就在于探讨寰枢椎脱位外科治疗与通调三焦的相关性,并希望能对中医临床工作者有一定的启迪与帮助。方法：作者从2005年9月至2011年9月就诊于北京中日友好医院治疗的寰枢椎脱位的患者中,对110例(男65例,女45例；年龄8～65岁,平均41.6岁)寰枢椎脱位患者按T0I分型分为T1、T2、0、I一共4组,并且给予寰枢椎脱位的外科治疗,其中包括牵引、手术复位、融合固定等。分别对比治疗前后寰椎平面SAC(脊髓有效空间),三焦气化不利评分(结合我对寰枢椎脱位症状的理解制定),JOA评分(17分法),DNI(颈椎功能障碍指数)的差异。重点观察治疗前后患者的三焦气化不利症状是否有所变化,如果患者经过寰枢椎脱位的外科治疗后症状有所改善,我们就认为寰枢椎脱位外科治疗与通调三焦有着一定的相关性。结果：T1、T2、0、I这4组患者寰椎平面SAC术前分别为(13.35±3.22)mm、(10.44±2.23)mm、(7.97±3.13)mm、(10.51±0.72)mm,末次随访分别为(16.03±1.43)mm、(15.35±1.88)mm、(14.48±1.57)mm、(12.51±0.72)mm；三焦气化不利评分术前分别为(12.36±1.86)、(8.86±1.34)、(6.78±1.14)、(10.31±1.23)；末次随访分别为(13.89±1.23)、(11.34±1.56)、(8.12±1.45)、(11.96±1.52)。JOA、DNI评分较术前明显改善。随着寰枢椎脱位患者脊髓压迫不同程度的解除,患者的神经功能同时也有了不同程度的改善,三焦气化不利的主要症状以及伴随症状均较外科治疗前有所缓解。结论：采用TO1分型对寰枢椎脱位患者进行外科治疗,在明显改善神经功能,解除脊髓压迫的同时,也有效地缓解了三焦气化不利的症状,这表明寰枢椎脱位的外科治疗与通调三焦有密切的相关性。这同时也提醒了广大的中医医生,在临床诊疗过程中,如果遇到主诉以三焦不通症状前来就诊的患者,在基于针灸、中药等治疗不见好转的情况下,应该建议患者进行颈椎核磁共振的检查,看是否有颈椎脊髓以及神经根压迫等影像学表现,如果确诊是由于脊髓、神经根压迫引起的症状,应该给予相应的外科治疗,及时解除压迫,恢复神经功能,以免耽误患者最佳治疗时机。

    Objective:To research the correlation between surgical treatment for atlantoaxial dislocation and adjusting San jiao. Atlantoaxial dislocation can lead to limb weakness, sensory disturbance of skin, functional abnormalities of bladder. From the point of Traditional Chinese Medicine,we can see that,there are some correlation between sensory disturbance of skin and lungs,Ying and Wei moving. There are some correlation between limb weakness and spleen and stomach,production of Qi and blood. There are some correlation between defalcation urine and kidney,gasifying abnormalities of bladder. Dizzy tinnitus,blurred vision,palpitation,sudation,language barrier,abdominal distension,having diarrhea and so on,we all can find the correlation according to the five elements and viscera,and put these into the syndrome of San jiao. For example,we can put the palpitation and sudation into the syndrome of Shang jiao. Because the blood can not nourish the heart. The sweat come from the heart,so we can treat the sudation from heart.Pi xu can lead to the abdominal distension and having diarrhea.So we can treat the abdominal distension and having diarrhea from spleen and stomach. From the methods of the four methods of diagnosis and the eight principal syndromes,we can treat these symptoms. But we count not gain the satisfied curative effects. During working in the clinic,some patients.witch have unsmooth of San jiao,feel better after the surgical treatment for atlantoaxial dislocation.We think that,there are some correlation between surgical treatment for atlantoaxial dislocation and adjusting San jiao,and we hope this article can bring the doctors some helps and enlightenmentsMethods:From September2005to September2010,110patients were reviewed, including65males and45females, with the mean age of41.6years (ranged,8to65years). All the patients were classified and treated by TOI clinical classification which included traction and decompression and reduction, and inter fixation fusion by surgery. The SAC (space available for the cord), San jiao Qi hua score, JOA score(seventeen scores), NDI score (cervical spine dysfunction index) before treatment were compared with those of after treatment.Results:The SAC in each group before treatment were (13.35±3.22) mm、(10.44±2.23) mm、(7.97±3.13) mm、(10.51±0.72) mm respectively, the last follow up of (16.03±1.43)、(15.35±1.88)、(14.48±1.57)、(12.51±0.72) mm; San jiao Qi hua score before treatment were (12.36±1.86)、(8.86±1.34)、(6.78±1.14)、(10.31±1.23) respectively, the last follow up of (13.89+1.23)、(11.34+1.56)、(8.12+1.45)、(11.96+1.52); JOA, NDI score significantly improved compared with that of before treatment.Conclusion:Atlantoaxial dislocation confirmed and treated by T0I clinical classification can effectively relieve the nerve function and unsmooth San jiao Qi hua syndrome, and show that surgical treatment is closely related with adjusting San jiao

寰枢椎脱位的外科治疗与通调三焦的相关性研究

中文摘要4-6Abstract6-7英文缩略词8-9第一部分 综述9-15    综述一、寰枢椎脱位外科治疗研究进展9-12    综述二、三焦气化不利的中医认识与治疗12-15第二部分 寰枢椎脱位的外科治疗与通调三焦的相关性研究15-25    前言15    1. 研究对象15    2. 研究方法15-18    3. 研究结果18-22    4. 讨论22-25参考文献25-28致谢28-29个人简历29

  本文关键词：寰枢椎脱位的外科治疗与通调三焦的相关性研究，由笔耕文化传播整理发布。