【目的】 观察颈椎旋提手法治疗颈型颈椎病（neck type cerivical spondylopathy，NTCS）后颈椎正侧双斜位数字化X线摄影 （digital radiography，DR）上的矢状位参数的变化，结合疼痛程度视觉模拟量表（visual analogue scale，VAS）评分探究颈椎矢状 位参数在评估 NTCS疗效方面的临床意义。【方法】 采用回顾性研究方法，选取 2020年 11月至 2021年 5月佛山市中医院推拿 科门诊收治的36例NTCS患者为研究对象，根据治疗方法的不同，将36例患者分为试验组和对照组，每组各18例。试验组 采用旋提手法治疗，对照组采用颈椎牵引治疗，均隔日治疗1次，持续治疗2周。观察2组患者治疗前后疼痛程度VAS评分 及颈椎正侧双斜位 DR 上的矢状位参数[颈椎 2-7 矢状位偏移（C2-7 SVA）、胸 1 倾斜角（T1S）、颈倾斜角（NT）、胸廓入口角 （TIA）]的变化情况，并采用Spearman相关性检验分析疼痛程度VAS评分与颈椎矢状位参数值之间的相关性。【结果】（1）治疗 前，2组患者的疼痛程度VAS评分比较，差异无统计学意义（P＞0.05）。治疗后，2组患者的疼痛程度VAS评分均较治疗前明 显降低（P＜0.05），且试验组的降低作用明显优于对照组（P＜0.01）。（2）治疗前，2组患者的 C2-7 SVA、T1S、NT、TIA等颈 椎矢状位参数值比较，差异均无统计学意义（P＞0.05）。治疗后，试验组的 C2-7 SVA、T1S、TIA均较治疗前明显改善（P＜ 0.05），NT改善不明显（P＞0.05）；对照组的各项颈椎矢状位参数值均较治疗前无明显改善（P＞0.05）；组间比较，试验组对 C2-7 SVA、T1S、TIA等颈椎矢状位参数值的改善作用均明显优于对照组（P＜0.05或P＜0.01），而2组患者治疗后的NT值比 较，差异无统计学意义（P＞0.05）。（3）Spearman相关性检验结果显示：治疗前，疼痛程度 VAS 评分与 C2-7 SVA、T1S、NT、 TIA无相关性（P＞0.05）；C2-7 SVA与NT呈负相关（r = -0.502，P＜0.05）；T1S 与 NT 呈正相关（r = 0.601，P＜0.05）。治 疗后，疼痛程度 VAS 评分与 C2-7 SVA 呈负相关（r = -0.362，P＜0.05），与TIA呈正相关（r = 0.476，P＜0.05）；C2-7 SVA 与NT呈正相关（r = 0.928，P＜0.05）；T1S与TIA呈正相关（r = 0.623，P＜0.05）。【结论】（1）颈椎旋提手法、颈椎牵引均可以 缓解 NTCS患者的疼痛程度和调整颈椎矢状位参数，但相比较而言，颈椎旋提手法治疗 NTCS的疗效更加显著；（2）NTCS患 者疼痛程度VAS 评分与颈椎矢状位参数可能存在一定相关性。

Objective To observe the changes of cervical sagittal parameters of digital radiography （DR） at bilateral oblique position of cervical spine in patients with neck type cervical spondylopathy（NTCS）after cervical rotation and lifting manipulations， and to evaluate the clinical significance of cervical sagittal parameters in assessing the efficacy of NTCS by combining the pain score of visual analogue scale（VAS）. Methods A retrospective analysis was carried out in 36 NTCS patients admitted to the outpatient clinic of the Tuina Department of Foshan Hospital of Traditional Chinese Medicine from November 2020 to May 2021. According to the treatment method，the patients were divided into the trial group and the control group，with 18 patients in each group. The trial group was treated with cervical rotation and lifting manipulations， and the control group was treated with cervical vertebra traction. The two groups were treated once every other day for 2 continuous weeks. The changes of VAS pain score and sagittal parameters of DR such as sagittal vertical axis of cervical vertebra 2-7（C2-7 SVA）， the T1 slope（T1S），neck tilt（NT），and thoracic inlet angle（TIA）in the two groups were observed before and after treatment. Spearman correlation analysis was used to explore the correlation between VAS scores of pain level and cervical sagittal parameters. Results（1）Before treatment，there was no statistically significant difference in the VAS pain scores between the two groups（P＞0.05）. After treatment，the VAS pain scores in the two groups were significantly decreased compared with those before treatment（P＜0.05），and the decrease of the scores in the trial group was significantly superior to that in the control group（P＜0.01）.（2）Before treatment，there was no statistically significant difference in the values of cervical sagittal parameters of C2-7 SVA，T1S，NT，and TIA between the two groups（P＞0.05）. After treatment， the C2-7 SVA， T1S， and TIA of the trial group were significantly improved compared with those before treatment（P＜0.05）， but the improvement of NT was not obvious（P＞0.05）；the cervical sagittal parameters of the control group were not significantly improved compared with those before treatment（P＞0.05）. The intergroup comparison showed that the improvement of C2-7 SVA， T1S，and TIA in the trial group was significantly superior to that in the control group（P＜0.05 or P＜0.01），while the difference in NT between the two groups after treatment was not statistically significant（P＞0.05）.（3）The results of Spearman correlation analysis showed that before treatment，VAS pain score had no correlation with C2- 7 SVA，T1S，NT，and TIA（P＞0.05），C2-7 SVA was negatively correlated with NT（r = -0.502，P＜0.05）， and T1S was positively correlated with NT（r = 0.601，P＜0.05）. After treatment，VAS pain score was negatively correlated with C2-7 SVA（r = -0.362，P＜0.05）and positively correlated with TIA（r = 0.476，P＜0.05），C2-7 SVA was positively correlated with NT（r = 0.928，P＜0.05），and T1S was positively correlated with TIA（r = 0.623，P＜0.05）. Conclusion Both cervical rotation and lifting manipulations and cervical traction can relieve the pain and adjust cervical sagittal parameters in the patients with NTCS， but cervical rotation and lifting manipulations are more effective in treating NTCS. And there may be a correlation between the VAS scores of pain level and cervical sagittal parameters in patients with NTCS.

R244.15

国家中医药循证能力建设项目（编号：2019XZZX-GK006）