Needle-knife and traction with the orthopedic treatment of cervicogenic

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To explore the needle-knife and traction with the orthopedic treatment of cervicogenic headache clinical efficacy and mechanism. Methods 36 cases of cervicogenic headache patients after the use of needle knife loosen the soft tissue and then with the occipital bone-setting governance practices and cervical spinal traction to relieve the oppression and cervical nerve stimulation. Results of 36 cases of cervicogenic headache patients cured 32 cases (88.89%), improved in 3 cases (8.33%), ineffective in 1 (2.78%), the total effective rate 97.22%. Conclusion needle-knife and traction with the orthopedic treatment of cervicogenic headache effect is significant.
Keywords: needle-knife; orthopedic; traction; cervicogenic headache
The cause of many headaches for clinical multiple common diseases. Most patients have neck tenderness, this with the cervical nerve irritation related to their headaches for a long time the high incidence, clinical manifestations complex, more difficult to treat. Most scholars believe that the majority of degenerative changes with cervical spine and cervical dislocation, and muscle spasms related to named cervicogenic headache, I used needle knife after lysis pillow soft tissue tenderness point, and with the bone-setting rule and cervical traction to treat cervical spinal source headache, 36 cases of significant effect.
1 Data and methods
1.1 General Information of this group of 36 patients, male 12 cases, female 24 cases; age of 12 to 63 years, mean 37.2 years old; duration of the longest 23 years and the shortest half a month, an average of 6 years.
1.2 Clinical manifestations and diagnosis of
 1.2.1 In early clinical manifestations of occipital, suboccipital Department, ears back, the lower part there is ear discomfort. After the gradual expansion into nausea and acid pain, pain location can be expanded to the neck, top of the forehead, temporal region. Some can be accompanied by ipsilateral shoulder, back, upper limb pain. Pain can have remission. As the illness progresses, and slowly increase the persistence, remission shortened episodes increased. Fatigue, agitation, coughing, drinking, cold and weather changes can trigger the pain increased.
1.2.2 Diagnostic criteria based on pain location and performance, eliminate swelling
Tumor, traumatic brain injury sequelae, tuberculosis, chronic subdural hematoma, paranasal sinuses and periodontal diseases such as organic, and meet the following four characteristics:
(1) from head and neck movements or posture problems, headache, excitation;
(2) push aggravate or cause headache and neck with "comfortable pain";
(3) headache radiation to the neck and the ipsilateral shoulder and upper extremity.
(4), headache, occipital, suboccipital discomfort, as well as the performance of cervical spondylosis.
1.3 Treatment
1.3.1 Needle-knife lysis in the treatment of patients treated with prone position in bed, in patients with chest pad a thin pillow, and placed in the treatment of bed, bedside treatment of patients with head out, so that the head forward 45 ° ~ 60 ° or so. In the upper and lower entry line, C2 spinous process and transverse ligament items to find tender points, marking with gentian violet, sterile surgical field prepared skin under local anesthesia, shop towel, after hole No. 4 with the Han Zhang needle-knife, the knife-edge lines and points vertical axis parallel to the spine, straight into the direct bone surface, slightly raised needle-knife, longitudinal cutting, there is no breakthrough feel-stop, to pine for the degrees, so you can cut Mito can be vertical and horizontal swing. After swinging shovels should be affixed to bone surface transverse cut, left and right click, and then press out the pin. 3 ~ 6 points each so a week, an times, three times for a course of treatment.
1.3.2 Bone-setting rule whether there is cervical spinal dislocation according to the patients and, if misplaced persons, OK needle knife to loosen after cervical spinal orthopedic reset rule.
Based methods in patients with cervical dislocation for the corresponding ridge of bone-setting rule tactics. Such as the occipital ring, atlantoaxial joint dislocation who make upward, and shaking Dhamma: The patient supine, low pillow, a Satisfy their lower jaw, another Satisfy occipital, will be on his head Yang, tilt, slowly shaking a ~ 2, the relaxation in patients with head, it will first go to the most significant time, with limited wrist quick moment "flash power" to the cephalic Dayton pull.
 If the level of side tilting left cervical dislocation were for cervical lateral pull by the entire complex method: The patient supine, operator stand bedside, one hand Hold hold his neck and to the thumb side elevated risk of vertebral transverse Department, Another Satisfy his jaw and affixed his cheek with a forearm, both hands cooperation will be the first traction in patients with head and evolute to the contralateral to the affected side after the bend, when to impose the maximum angle of the affected side, the thumb "sentinel" not to relax, with the "fixed point "At the same time to make a move one hand by a slight joint" flash power ", the thumb can touch the whole sense of re-bounce, and multi-joint joint shells could be heard the sound. Such as the rotary cervical dislocation, the entire complex is being pushed for cervical spine: The patient supine, low pillow, to the left cervical correction, for example, the operator squat in patients with cephalic left-rear, two-handed thumb-index finger open, respectively, in patients placed on both sides of cheek, the index finger and the face parallel to the fixed index finger after the thumb, and the other three fingers to hold back the skull and facial Wang Youce patients to the appropriate angle so that patients in a non-neck muscle stiffness as a degree, this time, right below the left In the left hand thumb between the first 1,2 withhold suffering from intervertebral joints of the articular process, his right hand to his head on the patient care to the moderate point of view, and the hand-over, start with within the band way to move forward, upward 45 ° c. the implementation of the entire complex correction.
1.3.3 line needle knife loosen after cervical traction, no cervical dislocation, that is to make continuous supine cervical traction therapy; a cervical dislocation, he shall rule the way orthopedic spinal reset, before making the continuous supine cervical traction therapy, traction supine forward position angle of about 20 ° ~ 40 °, pulling the weight of the individual patient weight and the patient feels comfortable as the basis, ranging from 5 ~ 15kg force day one times, each 30min.
2 Results
2.1 The efficacy of the standard is not valid: patients with symptoms and signs with no change in pre-treatment; valid: to alleviate symptoms, there are clear incentives pillow when you still have pain and tenderness; healing: patient symptoms and signs disappeared completely.
 2.2 The results of 36 patients treated by 1 ~ 3 times after treatment, recovered 32 cases, accounting for 88.89%, effective in 3 cases, accounting for 8.33%; ineffective one cases, accounting for 2.78%. The total effective rate 97.22%. Recovered after 6 months follow-up cases, in addition to three cases of patients with occasional discomfort, the rest had no recurrence.
3 Discussion
1995 BOGDUK that cervicogenic headache is the direct cause of cervical degenerative changes, and muscle spasms. He believes that cervicogenic headache can be called cervical dorsal rami-derived pain. Its pathogenesis [1] may be involved according to the different parts of nerve root is divided into neuropathic pain and muscle-derived pain.
Sensory nerve root irritation caused by the root fibers of neuropathic pain, while the ventral motor nerve root irritation is caused when the muscle-derived pain. C1 ~ 3, after most of the nerves leaving the spinal canal through the soft muscle tissue. Degeneration in the cervical spine and cervical dislocation, based on the dynamic equilibrium of cervical disorders, foraminal stenosis and intervertebral disc space narrowing. If the pillow back of the soft tissue inflammation, ischemia, spasm and chronic injuries and so on, can be stimulating and (or) pressure caused cervical dorsal rami of cervical pain.
Needle knife loosen the upper and lower entry line, spinous process, transverse process, nuchal ligament attached to the soft tissue, etc., while to peel adhesion, scar curettage, loosen muscles, lifting spasm, blocking clear, the role of blood flow . Pillow soft tissue to restore the dynamic balance after the effective lifting of soft tissue spasm, ischemia and inflammation, can be lifted after cervical nerve branch stimulation and oppression, and ultimately achieving the purpose of lifting of cervical pain.
It should be noted in the needle-knife operation, familiar with the local anatomical structure, the operation should be careful, gentle, in the upper and lower lines between the items into the needle, needle-knife and the skull surface perpendicular to knife-edge parallel with the blood vessels and nerves.
Transverse process and spinous process in the Ministry of therapy, a knife could not leave the bone surface, carefully moving blade to prevent injury in the spinal cord, blood vessels and nerves. Governance practices with the correction of spinal bone-setting because of dislocation and bone mechanical Citation nerve pain, bone-setting reset mode when you need to distinguish between cervical dislocation, targeted the main ridge of the different methods, is the key to effective operation, aiming at steady, accurate, Qiao, way to avoid iatrogenic injury caused by improper. Needle-knife release and orthopedic Across The main purpose of cervical traction tension of skeletal muscle tension or spasm, and play a role in braking, and can increase the intervertebral space and expanded the role of the intervertebral foramen to relieve mechanical oppression, to restore cervical homeostasis.

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