三维平衡正脊手法辅助治疗强直性脊柱炎近期疗效△

Short-term outcome of three-dimensional balanced chiropractic manipulation for ankylosing spondylitis

摘要:

[目的]探讨三维平衡正脊手法辅助治疗强直性脊柱炎（ankylosing spondylitis, AS）的近期疗效。[方法]选择 2021 年 1 月—2023 年 6 月收治的 AS 患者 102 例，随机数字表法分为正脊组 51 例，采用常规西医治疗+三维平衡正脊手法干预；常规组 51 例，采用常规西医治疗。对比两组临床、检验及影像学资料。[结果]与治疗前相比，两组治疗后 3 个月疼痛 VAS、巴氏 AS 疾病活动指数 （Bath ankylosing spondylitis disease activity index, BASDAI)、巴氏 AS 功能指数 （Bath ankylosing spondylitis functional index, BASFI）、指地距、墙枕距均显著减少（P＜0.05），胸廓活动度与 Schober 试验均显著增加（P＜0.05）。治疗后 3 个月，正脊组疼痛 VAS [(2.6±0.8) vs (3.8±1.0), P＜0.001]、BASDAI 指数 [(1.7±0.5) vs (2.8±0.6), P＜0.001]、BASFI 评分 [(14.8±5.5) vs (35.4±8.6), P＜0.001]、指地距 [(15.4±5.0) cm vs (19.3±6.2) cm, P＜0.001]、墙枕距 [(1.7±0.5) cm vs (2.5±0.6) cm, P＜0.001]、胸廓活动度 [(3.6±0.9) cm vs (2.9±0.7) cm, P＜0.001] 及 Schober 试验 [(4.9±1.0) cm vs (3.4±0.8) cm, P＜0.001] 均显著优于常规组。检验方面，治疗后 3 个月，正脊组在 ESR、CRP、IL-6、IL-17、IL-23 水平均显著优于常规组（P＜0.05)。影像方面，治疗后 3 个月，正脊组矢状面偏移（sagittal vertical axis, SVA）、腰椎后凸角（thoracic kyphosis, TK）、腰椎前凸角（lumbar lordosis, LL）、骨盆入射角（pelvic in- cidence, PI）、骨盆倾斜角（pelvic tilt, PT）、骶骨倾斜角（sacral slope, SS）显著优于常规组（P＜0.05)。[结论]三维平衡正脊手法治疗 AS 安全有效，能明显缓解其疼痛，改善脊柱功能及检验和影像参数。

Abstract:

[Objective] To investigate the short-term efficacy of three-dimensional balanced chiropractic manipulation in the treatment of ankylosing spondylitis (AS). [Methods] A total of 102 patients visited our hospital from January 2021 to June 2023 for AS were selected, and divided into two cohorts with 51 cases in each cohor by random number table method. Of them, the patients who received routine western medicine combined with three-dimensional balanced chiropractic manipulation were termed as CM group, while those who received routine western medicine only were named as RT group. The clinical, laboratory test and imaging data of the two groups were compared. [Results] Compared with those before treatment, VAS for pain, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), finger-ground distance and occipit-wall distance significantly decreased (P＜0.05), while thoracic cage motion and Schober test significantly increased in both groups 3 months after treatment (P＜0.05). The CM cohort proved significantly superior to the RT cohort in terms of pain VAS [(2.6±0.8) vs (3.8±1.0), P＜0.001], BASDAI [(1.7±0.5) vs (2.8±0.6), P＜0.001], BASFI [(14.8±5.5) vs (35.4± 8.6), P＜0.001] and finger-ground distance [(15.4±5.0) cm vs (19.3±6.2) cm, P＜0.001], occipit-wall distance [(1.7±0.5) cm vs (2.5±0.6) cm, P＜0.001], thoracic cage mobility [(3.6±0.9) cm vs (2.9±0.7) cm, P＜0.001] and Schober test [(4.9±1.0) cm vs (3.4±0.8) cm, P＜0.001] 3 months after treatment. In addition, the CM group also was significantly better than the RT group in terms of ESR, CRP, IL-6, IL-17 and IL-23 assayed in blood tests 3 months after treatment (P＜0.05). Furthermore, the CM was significantly better than the RT group regarding sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) measured on images months after treatment (P<0.05). [Conclusion] The three-dimensional balanced chiropractic manipulation is safe and effective in the treatment of AS, which can significantly relieve pain, improve spinal function and blood test and imaging parameters.