Boyles Robert, Toy Patrick, Mellon James, Hayes Margaret, Hammer Bradley
Program of Physical Therapy, University of Puget Sound, Tacoma, WA, USA.
J Man Manip Ther. 2011 Aug;19(3):135-42. doi: 10.1179/2042618611Y.0000000011.
Systematic review of randomized clinical trials.
Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy.
Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83·2 per 100 000 and an increased prevalence in the fifth decade of life among the general population.
Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of ⩾5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising.
Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR.
随机临床试验的系统评价。
回顾当前关于手法治疗颈神经根病有效性的文献。
颈神经根病（CR）是物理治疗诊所中经常遇到的临床病症。颈神经根病是颈椎占位性病变的结果：颈椎间盘突出、脊柱关节病或骨赘形成。这些病变影响骨骼和韧带组织的疼痛产生源，产生在颈神经根病变患者上肢观察到的根性症状（即疼痛、麻木、无力、感觉异常）。据报道，颈神经根病的年发病率为每10万人83.2例，在普通人群中，50岁左右患病率增加。
通过EBSCO、Cochrane图书馆和谷歌学术搜索Medline和CINAHL，检索1995年至2011年2月间的随机临床试验研究用于本综述。四项研究符合纳入标准，被认为质量较高（PEDro评分⩾5）。手法治疗技术包括肌肉能量技术、颈椎和/或胸椎的非推力/推力手法操作/松动、软组织松动和神经松动。在每项研究中，手法治疗要么是单独的干预措施，要么是多模式方法的一部分，多模式方法包括治疗性运动，通常还包括某种形式的颈椎牵引。虽然在根性症状改善与手法治疗之间无法明确建立因果关系，但结果总体上很有前景。
虽然尚未制定出明确的治疗颈神经根病的方案，但文献中普遍达成共识，即手法治疗技术与治疗性运动相结合在增加功能以及主动活动度方面有效，同时可减轻疼痛和残疾程度。需要高质量的有对照组的随机对照试验来建立治疗颈神经根病的明确有效方案。
