Hurwitz E L, Aker P D, Adams A H, Meeker W C, Shekelle P G
RAND, Santa Monica, CA, USA.
Spine (Phila Pa 1976). 1996 Aug 1;21(15):1746-59; discussion 1759-60. doi: 10.1097/00007632-199608010-00007.
Cervical spine manipulation and mobilization were reviewed in an analysis of the literature from 1966 to the present.
To assess the evidence for the efficacy and complications of cervical spine manipulation and mobilization for the treatment of neck pain and headache.
Although recent research has demonstrated the efficacy of spinal manipulation for some patients with low back pain, little is known about its efficacy for neck pain and headache.
A structured search of four computerized bibliographic data bases was performed to identify articles on the efficacy and complications of cervical spine manual therapy. Data were summarized, and randomized controlled trials were critically appraised for study quality. The confidence profile method of meta-analysis was used to estimate the effect of spinal manipulation on patients' pain status.
Two of three randomized controlled trials showed a short-term benefit for cervical mobilization for acute neck pain. The combination of three of the randomized controlled trials comparing spinal manipulation with other therapies for patients with subacute or chronic neck pain showed an improvement on a 100-mm visual analogue scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15, 25.5) for manipulation compared with muscle relaxants or usual medical care. The highest quality randomized controlled trial demonstrated that spinal manipulation provided short-term relief for patients with tension-type headache. The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations.
Cervical spine manipulation and mobilization probably provide at least short-term benefits for some patients with neck pain and headaches. Although the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of permanent impairment or death.
对1966年至今的文献进行分析，回顾颈椎推拿和松动术。
评估颈椎推拿和松动术治疗颈部疼痛和头痛的疗效及并发症的证据。
尽管近期研究已证明脊柱推拿对一些腰痛患者有效，但对其治疗颈部疼痛和头痛的疗效知之甚少。
对四个计算机化文献数据库进行结构化检索，以识别有关颈椎手法治疗疗效和并发症的文章。对数据进行总结，并对随机对照试验的研究质量进行严格评估。采用荟萃分析的置信轮廓法估计脊柱推拿对患者疼痛状况的影响。
三项随机对照试验中的两项显示，颈椎松动术对急性颈部疼痛有短期益处。三项随机对照试验将脊柱推拿与亚急性或慢性颈部疼痛患者的其他疗法进行比较，结果显示，与肌肉松弛剂或常规医疗护理相比，推拿组在3周时100毫米视觉模拟疼痛量表上的疼痛改善了12.6毫米（95%置信区间，-0.15，25.5）。质量最高的随机对照试验表明，脊柱推拿能为紧张型头痛患者提供短期缓解。颈椎推拿的并发症发生率估计为每1000万次推拿中有5至10例。
颈椎推拿和松动术可能至少为一些颈部疼痛和头痛患者提供短期益处。尽管推拿的并发症发生率较低，但由于存在永久性损伤或死亡的可能性，必须考虑不良后果的潜在风险。
