对颈椎病推拿的“筋骨评估”推广模式的探讨
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摘要
中医推拿"筋骨评估"指医者通过系统的方法评估患者的机体状态,以选择适宜的推拿疗法和达到安全高效的目的。通过总结现代中医推拿主要流派的筋骨评估特色,包括对骨性标志、软组织、疼痛的评估,及西方手法治疗脊柱疾病时对脊柱的触诊、姿势(体位)、疼痛、周围软组织的评估,提出了中医推拿治疗颈椎病的筋骨评估推广模式的核心要素,即对肌肉组织形态、头颈姿势体位、压痛点及颈椎关节活动的评估,以期为建立科学规范、切实可行的中医推拿筋骨评估模式的研究提供参考。
The evaluation on sinews and bones in tuina of traditional Chinese medicine(TCM)re-fersto a systematic approach to evaluate the patient's physical state,so as to select appropriate tuina therapies and achieve safe and efficient goals.Through summarizing the characteristics of evaluation on sinews and bones in main schools of modern TCMtuinaincluding assessments of bone landmarks,soft tissues and pain,and Western manual therapies including assessments of palpation of spine,postures(positions),pain and surrounding soft tissues,the key elements of promotion mode of evaluation on sinews and bones in TCM tuina are proposed,namely the ev alu-ation on muscle tissue morphology,postures,tenderness points and joint motions.The purpose is to provide a reference for establishing a scientific,standard and feasible mode of evaluation on sinews and bones.
The evaluation on sinews and bones in tuina of traditional Chinese medicine(TCM)re-fersto a systematic approach to evaluate the patient's physical state,so as to select appropriate tuina therapies and achieve safe and efficient goals.Through summarizing the characteristics of evaluation on sinews and bones in main schools of modern TCMtuinaincluding assessments of bone landmarks,soft tissues and pain,and Western manual therapies including assessments of palpation of spine,postures(positions),pain and surrounding soft tissues,the key elements of promotion mode of evaluation on sinews and bones in TCM tuina are proposed,namely the ev alu-ation on muscle tissue morphology,postures,tenderness points and joint motions.The purpose is to provide a reference for establishing a scientific,standard and feasible mode of evaluation on sinews and bones.
引文
[1]沈国权.脊柱推拿的理论与实践[M].北京:人民卫生出版社,2015:335-351.Shen GQ.Theory and Practice of Spinal Manipulation[M].Beijing:People's Medical Publishing House,2015:335-351.
[2]叶衍庆.魏指薪医师的伤科手法的应用指征及疗效机制[M].上海:上海科学技术出版社,1964:58.Ye YQ.Application indicators and therapeutic mechanisms of traumatology techniques of Wei Zhixin[M].Shanghai:Shanghai Scientific and Technical Publishers,1964:58.
[3]李沛,李江.运用李氏家传合缝手法治疗椎动脉型颈椎病58例[J].广西中医药,1998,21(6):9-11.Li P,Li J.Treatment of 58 cases of vertebral arterial cervical spondylosis by Li's family suture method[J].Guangxi Journal of Traditional Chinese Medicine,1998,21(6):9-11.
[4]冯天有.损伤性脊柱疾病诊治的中西医结合临床研究[J].空军总医院学报,1997,13(2):4-7.Feng TY.A clinical study on the diagnosis and treatment of spinal joint impairment disorder based on integration of traditional Chinese and Western medicien[J].Journal of Air Force General Hospital,1997,13(2):4-7.
[5]冯天有,刘世杰,银舜德.单(多)个椎体移位的机制探讨[J].陕西新医药,1981,10(7):16-18.Feng TY,Liu SJ,Yin SD.Mechanism study on single(multiple)vertebral body displacement[J].Shanxi New Medicine,1981,10(7):16-18.
[6]张济时.压痛点推拿结合压痛点阻滞治疗肩关节周围炎67例[J].中国中医急症,2011,20(3):493-494.Zhang JS.Treatment of periarthritis of shoulder joint with massage and block on tenderness pointin 67 cases[J].JEmerg Tradit Chin,2011,20(3):493-494.
[7]李义凯.脊柱推拿的基础与临床[M].2版.北京:军事医学科学出版社,2015:589.Li YK.Foundation and clinic of spinal manipulation[M].Second Edition.Beijing:Press of Military Medical Sciences,2015:589.
[8]刘强,李君,张军.“筋出槽、骨错缝”理论在脊柱源性疾病中的认识[J].中国中医骨伤科杂志,2012,20(10):72-73.Liu Q,Li J,Zhang J.Understanding of theory of“sinew groove-out and bone dislocation”in spinal diseases[J].Chinese Journal of Traditional Medical Traumatology&Orthopedics,2012,20(10):72-73.
[9]周楠,房敏,朱清广,等.脊柱微调手法治疗腰椎间盘突出症的腰背肌生物力学性能评价[J].中国康复医学杂志,2012,27(2):115-119.Zhou N,Fang M,Zhu QG,et al.The biomechanical evaluation of lumbodorsal muscle in spine micro-adjusting manipulation treating lumbar intervertebral disc protrusion[J].Chinese Journal of Rehabilitation Medicine,2012,27(2):115-119.
[10]朱清广,房敏,沈国权,等.微调手法对颈椎病患者颈肌力学性能影响研究[J].北京中医药,2011,30(3):180-182.Zhu QG,Fang M,Shen GQ,et al.Effect of micro-adjusting manipulation on mechanical properties of cervical muscle in patients with cervical spondylosis[J].Beijing Journal of Traditional Chinese Medicine,2011,30(3):180-182.
[11]吕强,朱清广,房敏,等.微调手法对颈椎病患者颈肌疲劳程度影响研究[J].时珍国医国药,2011,22(10):2406-2407.Lyu Q,Zhu QG,Fang M,et al.Effect of micro-adjusting manipulation on fatigue of neck muscles treating in patients with cervical spondylosis[J].Lishizhen Medicine and Materia Medica Research,2011,22(10):2406-2407.
[12]李典翰,房敏,朱清广,等.推拿手法对颈椎病患者颈肌疲劳程度影响研究[J].北京中医药,2012,31(1):10-12.Li DH,Fang M,Zhu QG,et al.Effect of tuina manipulations on cervical muscle fatigue in patients with cervical spondylosis[J].Beijing Journal of Traditional Chinese Medicine,2012,31(1):10-12.
[13]King SW,Stephenson G.The motion palpation institute:25 years and counting[J].Dynamic Chiropractic,2006,24(5):86-90.
[14]Fligg DB.The art of motion palpation[J].Journal of the Canadian Chiropractic Association,1984,28(3):331-334.
[15]Fligg B.Lower cervical spine motion palpation(C2-7)[J].Journal of the Canadian Chiropractic Association,1984,28(1):219-221.
[16]Shin YJ,Kim WH,Kim SG.Correlations among visual analogue scale,neck disability index,shoulder joint range of motion,and muscle strength in young women with forward head posture[J].Journal of Exercise Rehabilitation,2017,13(4):413-417.
[17]Oliveira AC,Silva AG.Neck muscle endurance and head posture:A comparison between adolescents with and without neck pain[J].Manual Therapy,2016,22:62-67.
[18]Knight JF,Baber C.Neck muscle activity and perceived pain and discomfort due to variations of head load and posture[J].Aviation Space&Environmental Medicine,2004,75(2):123-131.
[19]Schneider M,Erhard R,Brach J,et al.Spinal palpation for lumbar segmental mobility and pain provocation:an interexaminer reliability study[J].J Manipulative Physiol Ther,2008,31(6):465-473.
[20]Jonsson A,Rasmussen-Barr E.Intra-and interrater reliability of movement and palpation tests in patients with neck pain:A systematic review[J].Physiother Theory Pract,2017,34(3):1-16.
[21]Seffinger MA,Najm WI,Mishra SI,et al.Reliability of spinal palpation for diagnosis of back and neck pain:a systematic review of the literature[J].Spine,2004,29(19):413-425.
[22]黄祠辉.浅谈中医的手摸心会[J].天津中医药,2010,27(3):257-258.Huang CH.Brief talk on palpation and realization of traditional Chinese medicine[J].Tianjin Journal of Traditional Chinese Medicine,2010,27(3):257-258.
[23]孙宇.颈椎病诊断与治疗中的若干问题[C]//中国康复医学会.中国康复医学会第八次全国颈椎病学术会议论文集.北京:中国知网,2004.Sun Y.Some problems in diagnosis and treatment of cervical spondylosis[C]//Chinese Rehabilitation Medical Association.Proceedings of the Eighth National Con-ference on Cervical Spondylosis of the Chinese Rehabilitation Medical Association.Beijing:CNKI,2004.
[24]黄湧,顾非,王峻良.腰椎间盘突出症手法治疗后腰部软组织张力变化研究[J].颈腰痛杂志,2013,34(4):273-276.Huang Y,Gu F,Wang JL.Effect of manipulation maneuver on the waist soft tissue tension in patietns with lumbar disc herniation[J].The Journal of Cervicodynia and Lumbodynia,2013,34(4):273-276.
[25]李玉斌.屈颈正骨手法治疗神经根型颈椎病的临床研究[D].武汉:湖北中医药大学,2010.Li YB.The clinical research of buckling neck and zhenggu gimmick to treat cervical spondylotic radiculopathy[D].Wuhan:Hubei University of Chinese Medicine,2010.
[26]Enwemeka CS,Bonet IM,Ingle JA,et al.Postural correction in persons with neck pain(integrated electromyography of the upper trapezius in three simulated neck positions)[J].Journal of Orthopaedic&Sports Physical Therapy,1986,8(5):240-242.
[27]Ruhe A,Fejer R,Walker B.Pain relief is associated with decreasing postural sway in patients with non-specific low back pain[J].Bmc Musculoskeletal Disorders,2012,13(1):1-12.
[28]Sohn MK,Lee SS,Song HT.Effects of acute low back pain on postural control[J].Annals of Rehabilitation Medicine,2013,37(1):17-25.
[29]曾衍钧,杜春娟,黄曹,等.利用软组织力-位移测试系统诊断颈痛[J].中国生物医学工程学报,2005,24(5):583-586.Zeng YJ,Du CJ,Huang C,et al.Diagnosis of cervical spine pain by using load-displacement measurement system of soft tissue[J].Chinese Journal of Biomedical Engineering,2005,24(5):583-586.
[30]闻鑫高,严樱菊,吴有鲁,等.压痛点强刺激推拿配合药物治疗颈椎间盘突出症[J].针灸推拿医学(英文版),2015,13(6):377-380.Wen XG,Yan YJ,Wu YL,et al.Intensive stimulation tuina at tender points plus medication for cervical intervertebral disc herniation[J].J Acupunct Tuina Sci(English Version)2015,13(6):377-380.
[31]李锦恒.压痛点强刺激推拿治疗颈性眩晕疗效观察[J].实用中医药杂志,2015,31(10):942-943.Li JH.Observation on curative effect of point hyperstimulation tuina on cervical vertigo[J].Journal of Practical Chinese Medicine,2015,31(10):942-943.
[32]Humphreys BK,Delahaye M,Peterson CK.An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a‘gold standard'[J].BMC Musculoskeletal Disorders,2004,5(1):19-28.
[2]叶衍庆.魏指薪医师的伤科手法的应用指征及疗效机制[M].上海:上海科学技术出版社,1964:58.Ye YQ.Application indicators and therapeutic mechanisms of traumatology techniques of Wei Zhixin[M].Shanghai:Shanghai Scientific and Technical Publishers,1964:58.
[3]李沛,李江.运用李氏家传合缝手法治疗椎动脉型颈椎病58例[J].广西中医药,1998,21(6):9-11.Li P,Li J.Treatment of 58 cases of vertebral arterial cervical spondylosis by Li's family suture method[J].Guangxi Journal of Traditional Chinese Medicine,1998,21(6):9-11.
[4]冯天有.损伤性脊柱疾病诊治的中西医结合临床研究[J].空军总医院学报,1997,13(2):4-7.Feng TY.A clinical study on the diagnosis and treatment of spinal joint impairment disorder based on integration of traditional Chinese and Western medicien[J].Journal of Air Force General Hospital,1997,13(2):4-7.
[5]冯天有,刘世杰,银舜德.单(多)个椎体移位的机制探讨[J].陕西新医药,1981,10(7):16-18.Feng TY,Liu SJ,Yin SD.Mechanism study on single(multiple)vertebral body displacement[J].Shanxi New Medicine,1981,10(7):16-18.
[6]张济时.压痛点推拿结合压痛点阻滞治疗肩关节周围炎67例[J].中国中医急症,2011,20(3):493-494.Zhang JS.Treatment of periarthritis of shoulder joint with massage and block on tenderness pointin 67 cases[J].JEmerg Tradit Chin,2011,20(3):493-494.
[7]李义凯.脊柱推拿的基础与临床[M].2版.北京:军事医学科学出版社,2015:589.Li YK.Foundation and clinic of spinal manipulation[M].Second Edition.Beijing:Press of Military Medical Sciences,2015:589.
[8]刘强,李君,张军.“筋出槽、骨错缝”理论在脊柱源性疾病中的认识[J].中国中医骨伤科杂志,2012,20(10):72-73.Liu Q,Li J,Zhang J.Understanding of theory of“sinew groove-out and bone dislocation”in spinal diseases[J].Chinese Journal of Traditional Medical Traumatology&Orthopedics,2012,20(10):72-73.
[9]周楠,房敏,朱清广,等.脊柱微调手法治疗腰椎间盘突出症的腰背肌生物力学性能评价[J].中国康复医学杂志,2012,27(2):115-119.Zhou N,Fang M,Zhu QG,et al.The biomechanical evaluation of lumbodorsal muscle in spine micro-adjusting manipulation treating lumbar intervertebral disc protrusion[J].Chinese Journal of Rehabilitation Medicine,2012,27(2):115-119.
[10]朱清广,房敏,沈国权,等.微调手法对颈椎病患者颈肌力学性能影响研究[J].北京中医药,2011,30(3):180-182.Zhu QG,Fang M,Shen GQ,et al.Effect of micro-adjusting manipulation on mechanical properties of cervical muscle in patients with cervical spondylosis[J].Beijing Journal of Traditional Chinese Medicine,2011,30(3):180-182.
[11]吕强,朱清广,房敏,等.微调手法对颈椎病患者颈肌疲劳程度影响研究[J].时珍国医国药,2011,22(10):2406-2407.Lyu Q,Zhu QG,Fang M,et al.Effect of micro-adjusting manipulation on fatigue of neck muscles treating in patients with cervical spondylosis[J].Lishizhen Medicine and Materia Medica Research,2011,22(10):2406-2407.
[12]李典翰,房敏,朱清广,等.推拿手法对颈椎病患者颈肌疲劳程度影响研究[J].北京中医药,2012,31(1):10-12.Li DH,Fang M,Zhu QG,et al.Effect of tuina manipulations on cervical muscle fatigue in patients with cervical spondylosis[J].Beijing Journal of Traditional Chinese Medicine,2012,31(1):10-12.
[13]King SW,Stephenson G.The motion palpation institute:25 years and counting[J].Dynamic Chiropractic,2006,24(5):86-90.
[14]Fligg DB.The art of motion palpation[J].Journal of the Canadian Chiropractic Association,1984,28(3):331-334.
[15]Fligg B.Lower cervical spine motion palpation(C2-7)[J].Journal of the Canadian Chiropractic Association,1984,28(1):219-221.
[16]Shin YJ,Kim WH,Kim SG.Correlations among visual analogue scale,neck disability index,shoulder joint range of motion,and muscle strength in young women with forward head posture[J].Journal of Exercise Rehabilitation,2017,13(4):413-417.
[17]Oliveira AC,Silva AG.Neck muscle endurance and head posture:A comparison between adolescents with and without neck pain[J].Manual Therapy,2016,22:62-67.
[18]Knight JF,Baber C.Neck muscle activity and perceived pain and discomfort due to variations of head load and posture[J].Aviation Space&Environmental Medicine,2004,75(2):123-131.
[19]Schneider M,Erhard R,Brach J,et al.Spinal palpation for lumbar segmental mobility and pain provocation:an interexaminer reliability study[J].J Manipulative Physiol Ther,2008,31(6):465-473.
[20]Jonsson A,Rasmussen-Barr E.Intra-and interrater reliability of movement and palpation tests in patients with neck pain:A systematic review[J].Physiother Theory Pract,2017,34(3):1-16.
[21]Seffinger MA,Najm WI,Mishra SI,et al.Reliability of spinal palpation for diagnosis of back and neck pain:a systematic review of the literature[J].Spine,2004,29(19):413-425.
[22]黄祠辉.浅谈中医的手摸心会[J].天津中医药,2010,27(3):257-258.Huang CH.Brief talk on palpation and realization of traditional Chinese medicine[J].Tianjin Journal of Traditional Chinese Medicine,2010,27(3):257-258.
[23]孙宇.颈椎病诊断与治疗中的若干问题[C]//中国康复医学会.中国康复医学会第八次全国颈椎病学术会议论文集.北京:中国知网,2004.Sun Y.Some problems in diagnosis and treatment of cervical spondylosis[C]//Chinese Rehabilitation Medical Association.Proceedings of the Eighth National Con-ference on Cervical Spondylosis of the Chinese Rehabilitation Medical Association.Beijing:CNKI,2004.
[24]黄湧,顾非,王峻良.腰椎间盘突出症手法治疗后腰部软组织张力变化研究[J].颈腰痛杂志,2013,34(4):273-276.Huang Y,Gu F,Wang JL.Effect of manipulation maneuver on the waist soft tissue tension in patietns with lumbar disc herniation[J].The Journal of Cervicodynia and Lumbodynia,2013,34(4):273-276.
[25]李玉斌.屈颈正骨手法治疗神经根型颈椎病的临床研究[D].武汉:湖北中医药大学,2010.Li YB.The clinical research of buckling neck and zhenggu gimmick to treat cervical spondylotic radiculopathy[D].Wuhan:Hubei University of Chinese Medicine,2010.
[26]Enwemeka CS,Bonet IM,Ingle JA,et al.Postural correction in persons with neck pain(integrated electromyography of the upper trapezius in three simulated neck positions)[J].Journal of Orthopaedic&Sports Physical Therapy,1986,8(5):240-242.
[27]Ruhe A,Fejer R,Walker B.Pain relief is associated with decreasing postural sway in patients with non-specific low back pain[J].Bmc Musculoskeletal Disorders,2012,13(1):1-12.
[28]Sohn MK,Lee SS,Song HT.Effects of acute low back pain on postural control[J].Annals of Rehabilitation Medicine,2013,37(1):17-25.
[29]曾衍钧,杜春娟,黄曹,等.利用软组织力-位移测试系统诊断颈痛[J].中国生物医学工程学报,2005,24(5):583-586.Zeng YJ,Du CJ,Huang C,et al.Diagnosis of cervical spine pain by using load-displacement measurement system of soft tissue[J].Chinese Journal of Biomedical Engineering,2005,24(5):583-586.
[30]闻鑫高,严樱菊,吴有鲁,等.压痛点强刺激推拿配合药物治疗颈椎间盘突出症[J].针灸推拿医学(英文版),2015,13(6):377-380.Wen XG,Yan YJ,Wu YL,et al.Intensive stimulation tuina at tender points plus medication for cervical intervertebral disc herniation[J].J Acupunct Tuina Sci(English Version)2015,13(6):377-380.
[31]李锦恒.压痛点强刺激推拿治疗颈性眩晕疗效观察[J].实用中医药杂志,2015,31(10):942-943.Li JH.Observation on curative effect of point hyperstimulation tuina on cervical vertigo[J].Journal of Practical Chinese Medicine,2015,31(10):942-943.
[32]Humphreys BK,Delahaye M,Peterson CK.An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a‘gold standard'[J].BMC Musculoskeletal Disorders,2004,5(1):19-28.