| Cervical spondylosis is a currently common disease in orthopaedic with high incidence rate, it refers to the serial symptoms caused by the degeneration of cervical intervertebral disk and cervical vertebrae hyperostosis. Cervical spondylotic radiculopathy is the most common type of the cervical spondylosis, which refers the changes of movement and sensation and nervous reflex following relevant spinal nerves caused by root compression. There are many treatments for cervical spondylosis in clinic and manipulation is regarded as one of the main treatments. At present, there are a large number of clinical researches about treating cervical radiculopathy by various kinds manipulation technique, but these researches lack standardization on methods and the evaluation, which affected the conclusion's authenticity and repeatability, and the result is hard to be recognized at home and abroad. So we need to evaluate the advantage and development potential of manipulation to treating cervical radiculopathy using the methods of evidence-based medicine because EBM is accepted gradually by international medical and health decision-making department. We also care about the specific manipulation technique, so the approach to laws of manual treatment will be discussed. This dissertation consists of two parts:systematic review and approach to laws of manual treatment.Systematic reviewObjective:To systematically evaluate the effectiveness and safety of manipulation therapy for cervical radiculopathy using the methods of evidence-based medicine.Methods:A specified literature search was performed on PUBMED, The Cochrane Library, CNKI, CBM, VIP and Wanfang database. Supplemented by hand searches of selected journals, and consultation with experts in the research field of prediabetes.All randomized controlled trials about manipulation for primary cervical radiculopathy were included. Two independent reviewers were responsible for data extraction and assessment., they assessed the qualities of trials according to PEDro scale. The original data of each trial were analyzed with software Revman 5.0.The result:Twenty nine randomized controlled trails (RCTs) were identifed with 3396 patients. The general methodological quality of all the trials were relatively poor, only three trails award above 5 points. The results of meta-analysis show that: manipulation was more effective than anti-inflammatory analgesics for cervical radiculopathy (RR 1.18; 95%CI 1.03～1.36), manipulation was more effective than mechanical traction (RR 1.13; 95%CI 1.02～1.26), manipulation combined with mechanical traction was more effective than mechanical traction (RR 1.21; 95%CI 1.11～1.30);compared with mechanical traction, manipulation decrease VAS score more(WMD-1.04; 95%CI-1.34～-0.74); manipulation and mechanical traction have same effectiveness on horizontal displacement of the vertebrae (WMD-0.03; 95%CI-0.15～-0.08) and cervical physiological curvature(WMD 0.36; 95%CI-1.11～1.82); compared with mechanical traction, manipulation can improve symptom score of headache (WMD 0.54; 95%CI 0.39～0.69)and viability (WMD 0.43; 95%CI 0.28～0.58) better.Conclusions:Compared with anti-inflammatory analgesics and mechanical traction, manipulation was more effective, manipulation can improve VAS score, symptom score of headacheand and viability. Manipulation and mechanical traction have same effectiveness on horizontal displacement of the vertebrae and cervical physiological curvature. But because of low methodological quality, there was no fully convincing evidence for manipulation on cervical radiculopathy, there is an urgent need for randomized, blinded, placebo controlled trials to assess the conclusion.Approach to laws of manual treatmentObjective:To summarize the approach to laws of manual treatment for cervical radiculopathy by analysing RCTs and Quasi-RCTs, and provide assistance reference in clinic.Methods:Laws were discussed mainly from the aspects of manipulation techniques, meridians and acupoints, course of treatment and time of the therapy etc.The result:An-pressing is frequently used in relaxed technique, finger twisting and tapping is rarely used. Dian-pressing is frequently used in warm stimulation technique, vibrating is rarely used. Rotation is frequently used in enhancing joints movement mobilizations, flex-extending is rarely used. Cervical traction in sitting position is frequently used in reducing dislocated joints manipulations, ban-manipulation is rarely used. Stationary circular pressing is frequently used in preparation, traction and rotation in sitting position is frequently used in treatment, and grasping is frequently used in recovery.Acupoints in Gallbladder meridian and Du meridian are frequently used in clinic, and the most frequently used acupoints are:Fengchi(GB20), Quchi(LI11), Hegu(LI4). Supraspinatus muscle is most commonly treated. Manipulation for cervical radiculopathy commonly integrate mechanical traction, anti-inflammatory analgesics and medium frequency medical apparatus. Treatment duration generally is 20 minutes and 10 times for one course of treatment, total treatment frequencies is 20 times.Conclusions:In clinic, an-pressing is frequently used in relaxed technique, dian-pressing is frequently used in warm stimulation technique, rotation is frequently used in enhancing joints movement mobilizations, cervical traction in sitting position is frequently used in reducing dislocated joints manipulations; stationary circular pressing is frequently used in preparation, traction and rotation in sitting position is frequently used in treatment, and grasping is frequently used in recovery; acupoints in Gallbladder meridian and Du meridian are frequently used in clinic, Fengchi(GB20) and supraspinatus muscle is most commonly treated; manipulation commonly integrate other treatments; treatment duration generally is 20 minutes and total treatment frequencies is 20 times. |
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