本文關(guān)鍵詞：寰樞椎脫位的外科治療與通調(diào)三焦的相關(guān)性研究，由筆耕文化傳播整理發(fā)布。

        目的：探討寰樞椎脫位外科治療與通調(diào)三焦的相關(guān)性。寰樞椎脫位常常伴有四肢肌力減弱,皮膚感覺障礙,膀胱功能異常。從中醫(yī)學(xué)角度分析這些癥候群,我們發(fā)現(xiàn),皮膚感覺障礙與上焦肺主皮毛以及營(yíng)衛(wèi)運(yùn)行有關(guān)；四肢的肌力減退與中焦脾主四肢以及氣血生化有關(guān)；二便不調(diào)與下焦腎司二便以及膀胱氣化有關(guān)。至于眩暈耳鳴、視物模糊、心慌汗出,舌蹇語塞、腹脹便溏等癥狀,均可以通過中醫(yī)的臟腑五行理論——對(duì)號(hào)入座,并且分列于三焦的癥候群中。例如心慌汗出一癥,可歸于上焦癥狀中,因?yàn)樾幕艦樾氖B(yǎng)的表現(xiàn),而汗為心之液,故汗出也多從心論治；再如腹脹便溏一癥,多為脾虛所致,脾胃位居中焦,故腹脹便溏多從中焦論治。諸如以上列舉的三焦不通的癥狀,能夠按照中醫(yī)四診八綱進(jìn)行辯證施治,但是有些患者通過中醫(yī)傳統(tǒng)的方法,例如中藥、針灸、推拿、導(dǎo)引等,并不能收到滿意的效果,有些可以說是毫無起色。在骨科門診中我們會(huì)發(fā)現(xiàn)有很多人是以上述三焦不通的癥狀為主訴前來就診的,西醫(yī)給予的是寰樞椎脫位的診斷,收入院并進(jìn)行手術(shù)治療后,脊髓壓迫得以解除。此時(shí)我們會(huì)發(fā)現(xiàn),在經(jīng)過寰樞椎脫位的外科治療后,患者原來的三焦不通的癥狀也得到了不同程度的改善,所以我們考慮寰樞椎脫位的外科治療與通調(diào)三焦之間是否有著某些相關(guān)性,基于上述分析,本文的目的就在于探討寰樞椎脫位外科治療與通調(diào)三焦的相關(guān)性,并希望能對(duì)中醫(yī)臨床工作者有一定的啟迪與幫助。方法：作者從2005年9月至2011年9月就診于北京中日友好醫(yī)院治療的寰樞椎脫位的患者中,對(duì)110例(男65例,女45例；年齡8～65歲,平均41.6歲)寰樞椎脫位患者按T0I分型分為T1、T2、0、I一共4組,并且給予寰樞椎脫位的外科治療,其中包括牽引、手術(shù)復(fù)位、融合固定等。分別對(duì)比治療前后寰椎平面SAC(脊髓有效空間),三焦氣化不利評(píng)分(結(jié)合我對(duì)寰樞椎脫位癥狀的理解制定),JOA評(píng)分(17分法),DNI(頸椎功能障礙指數(shù))的差異。重點(diǎn)觀察治療前后患者的三焦氣化不利癥狀是否有所變化,如果患者經(jīng)過寰樞椎脫位的外科治療后癥狀有所改善,我們就認(rèn)為寰樞椎脫位外科治療與通調(diào)三焦有著一定的相關(guān)性。結(jié)果：T1、T2、0、I這4組患者寰椎平面SAC術(shù)前分別為(13.35±3.22)mm、(10.44±2.23)mm、(7.97±3.13)mm、(10.51±0.72)mm,末次隨訪分別為(16.03±1.43)mm、(15.35±1.88)mm、(14.48±1.57)mm、(12.51±0.72)mm；三焦氣化不利評(píng)分術(shù)前分別為(12.36±1.86)、(8.86±1.34)、(6.78±1.14)、(10.31±1.23)；末次隨訪分別為(13.89±1.23)、(11.34±1.56)、(8.12±1.45)、(11.96±1.52)。JOA、DNI評(píng)分較術(shù)前明顯改善。隨著寰樞椎脫位患者脊髓壓迫不同程度的解除,患者的神經(jīng)功能同時(shí)也有了不同程度的改善,三焦氣化不利的主要癥狀以及伴隨癥狀均較外科治療前有所緩解。結(jié)論：采用TO1分型對(duì)寰樞椎脫位患者進(jìn)行外科治療,在明顯改善神經(jīng)功能,解除脊髓壓迫的同時(shí),也有效地緩解了三焦氣化不利的癥狀,這表明寰樞椎脫位的外科治療與通調(diào)三焦有密切的相關(guān)性。這同時(shí)也提醒了廣大的中醫(yī)醫(yī)生,在臨床診療過程中,如果遇到主訴以三焦不通癥狀前來就診的患者,在基于針灸、中藥等治療不見好轉(zhuǎn)的情況下,應(yīng)該建議患者進(jìn)行頸椎核磁共振的檢查,看是否有頸椎脊髓以及神經(jīng)根壓迫等影像學(xué)表現(xiàn),如果確診是由于脊髓、神經(jīng)根壓迫引起的癥狀,應(yīng)該給予相應(yīng)的外科治療,及時(shí)解除壓迫,恢復(fù)神經(jīng)功能,以免耽誤患者最佳治療時(shí)機(jī)。

    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

寰樞椎脫位的外科治療與通調(diào)三焦的相關(guān)性研究

中文摘要4-6Abstract6-7英文縮略詞8-9第一部分 綜述9-15    綜述一、寰樞椎脫位外科治療研究進(jìn)展9-12    綜述二、三焦氣化不利的中醫(yī)認(rèn)識(shí)與治療12-15第二部分 寰樞椎脫位的外科治療與通調(diào)三焦的相關(guān)性研究15-25    前言15    1. 研究對(duì)象15    2. 研究方法15-18    3. 研究結(jié)果18-22    4. 討論22-25參考文獻(xiàn)25-28致謝28-29個(gè)人簡(jiǎn)歷29

  本文關(guān)鍵詞：寰樞椎脫位的外科治療與通調(diào)三焦的相關(guān)性研究，由筆耕文化傳播整理發(fā)布。