Chiropractic Management of Patients with Neck Pain: Interpretation of Best Practice Guidelines

doi:10.12114/j.issn.1007-9572.2022.0618

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (11): 1305-1309.DOI: 10.12114/j.issn.1007-9572.2022.0618

Special Issue: 指南/共识最新文章合辑

• Guide·Consensus • Previous Articles Next Articles

Chiropractic Management of Patients with Neck Pain: Interpretation of Best Practice Guidelines

1. School of Acupuncture and Massotherapy, Anhui University of Traditional Chinese Medicine, Hefei 230038, China
2. School of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230038, China
3. Beijing University of Traditional Chinese Medicine, Beijing 100029, China
4. Wangjing Hospital of Chinese Academy of Chinese Medical Sciences, Beijing 100102, China
5. Beijing Key Laboratory of Traditional Chinese Medicine Bone-setting Technology, Beijing 100102, China
6. DepartmentⅠof Orthopedics and Traumatology, the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, China

Received:2022-04-28 Revised:2022-10-26 Published:2023-04-15 Online:2022-11-17
Contact: ZHANG Jianhua, LIANG Long
About author:
ZHANG S Y, LIU X L, HU Y Q, et al. Chiropractic management of patients with neck pain: interpretation of best practice guidelines [J]. Chinese General Practice, 2023, 26 (11): 1305-1309.

颈痛患者手法治疗：最佳实践指南解读

1．230038　安徽省合肥市，安徽中医药大学针灸推拿学院
2．230038　安徽省合肥市，安徽中医药大学中医学院
3．100029　北京市，北京中医药大学
4．100102　北京市，中国中医科学院望京医院
5．100102　北京市，中医正骨技术北京市重点实验室
6．230031　安徽省合肥市，安徽中医药大学第一附属医院骨伤一科

通讯作者: 张建华, 梁龙
作者简介:
张思雅，刘晓龙，胡滟琦，等.颈痛患者手法治疗：最佳实践指南解读[J].中国全科医学，2023，26（11）：1305-1309. [www.chinagp.net]
作者贡献：张思雅提出本文研究选题方向，负责对原指南内容进行归纳总结，整理出适用于我国颈痛患者治疗的适用方法，并撰写论文初稿；作者刘晓龙、胡滟琦进行国内颈痛治疗相关资料的收集和整理；何蕾、徐晓静负责国外颈痛治疗相关资料的收集和整理；金子开、尹逊路、王星宇负责文章的修订及参考文献的核对；张建华、梁龙负责文章的质量控制及审校，提出专业性意见，对文章整体负责；所有作者确认了论文的最终稿。
基金资助:
北京市自然科学基金资助项目（7214297）——补肾活血方调控髓核细胞坏死性凋亡延缓椎间盘退行性变的机制研究；横向课题：白脉软膏用于腰椎间盘突出症的多中心、随机、双盲、安慰剂平行对照临床研究

Abstract

Abstract:

Neck pain is often caused by cervical degenerative diseases, which is easy to cause adverse effects on neck function and quality of life of patients. To provide the best and effective diagnosis and treatment plan, the National University of Health Sciences published its evidence-based clinical practice guidelines for neck pain in 2019. The author in fully study the latest version guidelines on the basis of diagnosis and treatment content, from the diagnosis, treatment, matters needing attention in three aspects, and search the relevant literature research longitudinal contrast multiple high quality neck pain guidelines, from the biomechanics and neurobiological analysis of scientific treatment, and combined with the analysis of Chinese diagnosis and treatment status that the recommended treatment and treatment process is feasible in China, based on this that should through existing evidence-based medical evidence combined with Chinese Traditional Medicine guide clinical practice, hope to reference to domestic clinical treatment today.

Key words: Neck pain, Cervical vertebrae, Technique treatment, Guide interpretation, Diagnosis, Treatment, Practical advice

摘要：

颈痛在临床上常由颈椎退行性疾病引起，易对患者颈部功能及生活质量造成不良影响。为提供最佳、有效的诊断及治疗方案，2019年美国国家健康科学大学发表了《最佳实践建议：颈痛患者的整脊治疗管理》。课题组在充分研读最新版指南诊治内容的基础上，从诊断、治疗、注意事项3个方面进行解读，同时检索相关文献，纵向对比多个高质量颈痛相关指南，从生物力学及神经生物学方面分析手法治疗颈痛的科学性，并结合中国诊疗现状分析认为其推荐的手法治疗及诊疗流程在中国具有可行性，基于此认为将国内外现有的循证医学证据结合中国传统医学能指导临床实践。

关键词: 颈痛, 颈椎, 手法治疗, 指南解读, 诊断, 治疗, 实践建议

ZHANG Siya,LIU Xiaolong,HU Yanqi, et al. Chiropractic Management of Patients with Neck Pain: Interpretation of Best Practice Guidelines[J]. Chinese General Practice, 2023, 26(11): 1305-1309. DOI: 10.12114/j.issn.1007-9572.2022.0618.
张思雅,刘晓龙,胡滟琦等. 颈痛患者手法治疗：最佳实践指南解读[J]. 中国全科医学, 2023, 26(11): 1305-1309. DOI: 10.12114/j.issn.1007-9572.2022.0618.

Figures/Tables 2

References 23

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NP治疗相关循证医学指南	手法干预措施	推荐意见
退行性颈神经根病变的诊断和治疗（2011版）^[17]	手法/整脊疗法	须注重手法操作安全性，操作前应常规进行影像学检查，减少脑血管病变等不良事件的发生
WHO西太区传统医学治疗CR临床实践指南（2011版）^[18]	手法治疗	多项临床证据表明，手法操作可显著改善颈部疼痛、颈椎活动度、颈部压痛等症状体征；而手法操作的规范性、可控性和可重复性提示其具安全性
颈部疼痛和相关疾病的管理：来自安大略交通伤害管理部门合作的临床实践指南（2016版）^[19]	综合疗法（手法治疗结合功能锻炼）	推荐使用综合疗法治疗NAD（病程4~6个月）；不推荐使用放松类手法操作治疗Ⅰ~Ⅱ级NAD（病程0~6个月）
近期发病的CR患者非手术治疗的国家临床指南（2017版）^[20]	手法治疗	弱推荐使用手法治疗，且缺乏循证证据支撑
颈部疼痛（2017版）^[4]	颈椎手法操作	推荐用于慢性NP伴活动障碍、亚急性/慢性NP伴头痛（颈源性）、NP伴放射痛（神经根性）
		推荐用于急性、亚急性NP伴活动障碍
颈椎病的分型、诊断及非手术治疗专家共识（2018版）^[10]	中医手法治疗	推荐适度予以手法操作，但手法治疗颈椎病（特别是旋转手法）有造成脊髓损伤的风险，应谨慎应用
颈痛患者手法治疗：最佳实践指南解读（2019版）^[8]	手法治疗	推荐用于急性、亚急性NP，最佳治疗频率缺乏循证证据支撑；推荐慢性NP手法治疗60 min/次，3次/周，持续4周；推荐3次/周，持续4周手法治疗NAD、WAD；认为脊柱手法治疗存在引起患者椎动脉夹层和中风的风险

NP治疗相关循证医学指南	手法干预措施	推荐意见
退行性颈神经根病变的诊断和治疗（2011版）^[17]	手法/整脊疗法	须注重手法操作安全性，操作前应常规进行影像学检查，减少脑血管病变等不良事件的发生
WHO西太区传统医学治疗CR临床实践指南（2011版）^[18]	手法治疗	多项临床证据表明，手法操作可显著改善颈部疼痛、颈椎活动度、颈部压痛等症状体征；而手法操作的规范性、可控性和可重复性提示其具安全性
颈部疼痛和相关疾病的管理：来自安大略交通伤害管理部门合作的临床实践指南（2016版）^[19]	综合疗法（手法治疗结合功能锻炼）	推荐使用综合疗法治疗NAD（病程4~6个月）；不推荐使用放松类手法操作治疗Ⅰ~Ⅱ级NAD（病程0~6个月）
近期发病的CR患者非手术治疗的国家临床指南（2017版）^[20]	手法治疗	弱推荐使用手法治疗，且缺乏循证证据支撑
颈部疼痛（2017版）^[4]	颈椎手法操作	推荐用于慢性NP伴活动障碍、亚急性/慢性NP伴头痛（颈源性）、NP伴放射痛（神经根性）
		推荐用于急性、亚急性NP伴活动障碍
颈椎病的分型、诊断及非手术治疗专家共识（2018版）^[10]	中医手法治疗	推荐适度予以手法操作，但手法治疗颈椎病（特别是旋转手法）有造成脊髓损伤的风险，应谨慎应用
颈痛患者手法治疗：最佳实践指南解读（2019版）^[8]	手法治疗	推荐用于急性、亚急性NP，最佳治疗频率缺乏循证证据支撑；推荐慢性NP手法治疗60 min/次，3次/周，持续4周；推荐3次/周，持续4周手法治疗NAD、WAD；认为脊柱手法治疗存在引起患者椎动脉夹层和中风的风险

Chiropractic Management of Patients with Neck Pain: Interpretation of Best Practice Guidelines

颈痛患者手法治疗：最佳实践指南解读

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