Rivett D A, Sharples K J, Milburn P D
School of Physiotherapy, University of Otago, Dunedin, New Zealand.
J Manipulative Physiol Ther. 1999 Jul-Aug;22(6):368-75. doi: 10.1016/s0161-4754(99)70081-3.
Neck manipulation occasionally causes stroke after trauma to the vertebral or internal carotid artery. Premanipulativ e tests involving cervical spine rotation or extension have been recommended to detect patients at risk of neurovascular ischemia. However, the effect of these procedures on extracranial blood flow is not well established, and their validity is thus controversial.
To determine the effect of premanipulative tests involving cervical spine rotation or extension on vertebral artery and internal carotid artery blood flow parameters.
Two-group experimental study.
Twenty subjects consisting of 16 patients treated with physiotherapy and four volunteers.
Subjects were tested with a recommended premanipulative protocol by both an independent physiotherapist and an investigator. One group consisted of 10 subjects with signs or symptoms indicative of neurovascular ischemia on premanipulative testing, with 10 subjects with no signs or symptoms indicative of neurovascular ischemia on premanipulative testing comprising the second group. Hemodynamic measurements for both vertebral and both internal carotid arteries were taken by use of duplex Doppler ultrasonography with color-flow imaging with the subjects in the following positions: neutral, end-range extension, 45 degrees contralateral rotation, end-range contralateral rotation, and combined end-range contralateral rotation/extension.
The reliability of premanipulative testing was supported. Significant changes in flow velocity of the vertebral artery (and to a lesser extent of the internal carotid artery) were shown in end-range positions involving rotation and extension. No meaningful significant differences were found between the two groups.
Screening procedures that use rotation and extension may be useful tests of the adequacy of collateral circulation. A larger study is needed to determine whether subjects testing positive significantly differ from those testing negative.
颈部手法操作偶尔会在椎动脉或颈内动脉受到创伤后导致中风。有人建议进行涉及颈椎旋转或伸展的手法前测试，以检测有神经血管缺血风险的患者。然而，这些操作对颅外血流的影响尚未完全明确，因此其有效性存在争议。
确定涉及颈椎旋转或伸展的手法前测试对椎动脉和颈内动脉血流参数的影响。
两组实验研究。
20名受试者，包括16名接受物理治疗的患者和4名志愿者。
由一名独立的物理治疗师和一名研究人员按照推荐的手法前方案对受试者进行测试。一组由10名在手法前测试中有神经血管缺血体征或症状的受试者组成，另一组由10名在手法前测试中无神经血管缺血体征或症状的受试者组成。使用双功多普勒超声结合彩色血流成像，在受试者处于以下位置时测量双侧椎动脉和双侧颈内动脉的血流动力学：中立位、终末伸展位、45度对侧旋转位、终末对侧旋转位以及终末对侧旋转/伸展联合位。
手法前测试的可靠性得到了支持。在涉及旋转和伸展的终末位置，椎动脉（以及在较小程度上颈内动脉）的流速出现了显著变化。两组之间未发现有意义的显著差异。
使用旋转和伸展的筛查程序可能是评估侧支循环是否充足的有用测试。需要进行更大规模的研究来确定测试阳性的受试者与测试阴性的受试者是否存在显著差异。
