Haynes Michael J
The Department of Anatomy and Human Biology, The University of Western Australia.
J Manipulative Physiol Ther. 2002 Nov-Dec;25(9):556-67. doi: 10.1067/mmt.2002.127077.
It has been proposed that Doppler velocimetry, which is noninvasive, quick, and relatively inexpensive, should be used when the screening vertebral arteries before manipulation to reduce the risk of cervical manipulation-related injury to these vessels. The objective of this analysis of the literature is to study the evidence of the suitability of Doppler velocimetry for this purpose.
Studies were examined that dealt with the incidence of stroke after manipulation, the proposed mechanisms for this clinical entity, the validity of the provocational tests that have been used in screening before manipulation, the validity and reliability of Doppler velocimetry of vertebral arteries, and the biomechanics of vertebral arteries.
There is a suspicion of increased risk for vertebrobasilar stroke for vertebral arteries that have markedly reduced patency in the neutral position and/or stenosis during cervical rotation. There is evidence that provocational tests lack validity and that Doppler velocimetry is valid in assessing the patency of vertebral arteries in the neutral position and during cervical rotation. Interexaminer reliability of the Doppler technique has been shown to be high. Doppler ultrasound screening also seems to be able to provide an indirect assessment of the mechanical stresses to the artery during cervical movements.
There is strong evidence to suggest that Doppler velocimetry should be included in the screening of vertebral arteries before manipulation.
有人提出，在对椎动脉进行手法操作前进行筛查时，应使用多普勒测速法，该方法无创、快速且相对便宜，可降低与颈椎手法操作相关的这些血管损伤风险。本文献分析的目的是研究多普勒测速法用于此目的的适用性证据。
审查了涉及手法操作后中风发生率、该临床实体的推测机制、手法操作前筛查中使用的激发试验的有效性、椎动脉多普勒测速法的有效性和可靠性以及椎动脉生物力学的研究。
怀疑对于在中立位通畅性明显降低和/或在颈椎旋转时出现狭窄的椎动脉，椎基底动脉中风风险增加。有证据表明激发试验缺乏有效性，且多普勒测速法在评估中立位和颈椎旋转时椎动脉的通畅性方面是有效的。已证明多普勒技术在检查者之间的可靠性很高。多普勒超声筛查似乎也能够间接评估颈椎运动期间动脉所受的机械应力。
有强有力的证据表明，在手法操作前对椎动脉进行筛查时应采用多普勒测速法。
