Belash V O, Mokhov D E, Tregubova E S
FGBOU VO 'I.I. Mechnikov North-Western State Medical University', Ministry of Health of the Russian Federation, Sankt-Peterburg, Russia.
FGBOU VO 'I.I. Mechnikov North-Western State Medical University', Ministry of Health of the Russian Federation, Sankt-Peterburg, Russia; FGBOU VO 'Sankt-Peterburg State University', Sankt-Peterburg, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2018;95(6):34-43. doi: 10.17116/kurort20189506134.
The pathological changes in the cervical spine frequently result in the disturbances of the blood supply in the vertebral-basiliar system. The degenerative-dystrophic processes in the cervical spine occupy the leading place in the pathogenesis of the vertebral artery syndrome (VAS) causing disorders of the microcirculation and innervation, as well as the restriction of mobility and the development of somatic dysfunctions. It can be assumed that the manual methods applied to manage this condition can be effective in the removal the functional abnormalities in the blood flow.
The objective of the present study was to evaluate the effectiveness of the osteopathic treatment as a component of combined therapy of the patients presenting with the vertebral artery syndrome.
This experimental prospective controlled randomized study was conducted during the period from January 2015 till January 2017. A total of 106 patients with VAS, aged from 20 to 60 (the average age was 43.1±1.0 years) took part in the study. The patients were divided into three groups. The experimental group was comprised of 40 patients who received the medicamentous and osteopathic treatment. The control group consisted of 40 patients given the medicamentous treatment alone. The group of comparison contained 26 patients treated with the use of pharmacotherapy and massage. The methods finding application in clinical neurology, clinical osteopathy, and ultrasonic diagnostics of the brachiocephalic vessels were employed to evaluate the health status of the patients and evaluate the effectiveness of their treatment.
The combined treatment of the patients comprising the experimental group with the use of osteopathic correction and pharmacotherapy produced the positive effect and resulted in the normalization of the neurological status of the patients; specifically, the incidence of both subjective and objective (neurological) symptoms was reduced. Simultaneously, the incidence of somatic dysfunctions at all levels of their manifestation decreased as compared with their frequency in the patients of the control and comparison groups. The results of the ultrasound examination of the great vessels of the neck and the brain in the experimental group made possible the evaluation of the dynamics in the incidence of the major pathological changes in the vessels of the vertebral-basiliar basin (VBB). It was shown that the occurrence of such serious changes as venous dishemia, reduction of the vasoconstriction and vasodilation reserves in VBB, in the patients of the experimental group vessels fell down by 32.1% (p<0.001), in comparison with only 12% (p<0.05), in the control group and 6,27% in the group of comparison (p>0.05).
The osteopathic manipulative treatment included in the combined therapy of patients with VAS based on the personified approach to the management of individual cases, detection and correction of each clinically significant functional disorder accompanying the pathological process greatly contributes to the regression of the neurological symptoms, elimination of somatic dysfunctions at different levels of the body, normalization of the blood flow in the vessels of the vertebral-basilar system. Taken together, these effects prolong the beneficial results of the combined rehabilitative treatment of the patients with the vertebral artery syndrome based on the application of standard pharmacotherapy and correction of the functional disorders with the use of the osteopathic methods.
颈椎的病理变化常导致椎基底动脉系统供血紊乱。颈椎的退行性营养不良过程在椎动脉综合征（VAS）的发病机制中占主导地位，可引起微循环和神经支配紊乱，以及活动受限和躯体功能障碍。可以推测，用于治疗这种情况的手法治疗可能对消除血流中的功能异常有效。
本研究的目的是评估整骨疗法作为椎动脉综合征患者综合治疗组成部分的有效性。
本实验性前瞻性对照随机研究于2015年1月至2017年1月进行。共有106例年龄在20至60岁（平均年龄为43.1±1.0岁）的VAS患者参与研究。患者分为三组。实验组由40例接受药物和整骨疗法的患者组成。对照组由40例仅接受药物治疗的患者组成。比较组包含26例接受药物治疗和按摩的患者。采用临床神经学、临床整骨疗法和头臂血管超声诊断中应用的方法来评估患者的健康状况并评估其治疗效果。
实验组患者采用整骨矫正和药物联合治疗产生了积极效果，使患者的神经状态恢复正常；具体而言，主观和客观（神经）症状的发生率均降低。同时，与对照组和比较组患者相比，其在各个表现水平的躯体功能障碍发生率均有所下降。实验组对颈部和脑部大血管的超声检查结果使得评估椎基底动脉供血区（VBB）血管主要病理变化发生率的动态变化成为可能。结果显示，实验组患者中出现静脉缺血、VBB血管收缩和舒张储备降低等严重变化情况的比例下降了32.1%（p<0.001）；相比之下，对照组仅下降了12%（p<0.05），比较组下降了6.27%（p >0.05）。
基于对个体病例的个性化管理方法，在VAS患者综合治疗中纳入的整骨手法治疗，检测并纠正伴随病理过程的每一种具有临床意义的功能障碍，极大地有助于神经症状的消退、消除身体不同水平的躯体功能障碍、使椎基底动脉系统血管的血流正常化。综上所述，这些效果延长了基于标准药物治疗和使用整骨方法纠正功能障碍的椎动脉综合征患者综合康复治疗的有益效果。
