Manual therapy combined with posterior percutaneous endoscopic cervical decompression for the treatment of cervical spondylotic radiculopathy / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy.@*METHODS@#From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C4,5 in 4 cases, C5,6 in 13 cases, C6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation.@*RESULTS@#All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05).@*CONCLUSION@#Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.

Therapeutic effect of exercise acupuncture and osteopathy on traumatic knee arthritis / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of exercise acupuncture and osteopathy in the treatment of traumatic knee arthritis.@*METHODS@#Fifty-one patients with traumatic knee arthritis were divided into three groups:routine group, exercise acupuncture group and osteopathy group. In the routine group, there were 17 cases, 12 males and 5 females, with a mean age of (49.4±8.9) years old; the averaged course of disease was (4.89±1.52) years; total WOMAC score before treatment was 100.77±15.48. Seventeen patients (11 males and 6 females) in the exercise acupuncture group were aged (48.6±10.1) years old; the course of disease was (4.21±1.37) years; and the total WOMAC score before treatment was 106.16±14.95. In the osteopathy group, there were 17 cases, 8 males and 9 females, with a mean age of (52.3±8.4) years old; the average course of disease was (4.79±1.50) years; total WOMAC score before treatment was 103.87±10.14. The patients in the routine group were treated with routine rehabilitation; the patients in the exercise acupuncture group were treated with routine rehabilitation combined with exercise acupuncture, and the patients in the osteopathy group were treated with osteopathy combined with routine rehabilitation. The changes of WOMAC score and ROM in three groups were compared before treatment and 4 weeks after treatment.@*RESULTS@#The overall effect of osteopathy group was better than that of routine group (=3.151, =0.005). The scores of WOMAC before and after treatment:pain of 23.84±4.66, 11.98±2.66, stiffness of 10.44±1.71, 6.42±0.74, daily life of 66.49±11.85, 35.80±4.44 in the routine group; pain of 22.64±3.22, 8.90±2.19, stiffness of 11.82±2.57 , 6.03±1.06, daily life of 71.72±13.59, 32.94±4.73 in the exercise acupuncture group; pain of 22.38±3.68, 10.66±2.75, stiffness of 11.81±2.08, 5.63±1.69, daily life of 69.69±8.96, 28.84±5.76 in the osteopathy group. Compared with the other two groups after treatment, the improvement of pain score in the exercise acupuncture group was better than those in the other two groups. There were no significant differences in stiffness score among the three groups. The degree of difficulty in daily life in the osteopathy group was better than that in the other two groups. The total score of WOMAC in the exercise acupuncture group and the osteopathy group were better than that in the conventional group, but there was no significant difference between the two groups.@*CONCLUSIONS@#On the basis of routine rehabilitation treatment, exercise needling and osteopathy have positive significance for the improvement of joint pain and dysfunction of joint movement in patients with traumatic knee arthritis, with certain popularlized value in the treatment of traumatic knee arthritis.