LAUSR

ObjectiveTo compare the risk angle and safety angle of needling Yamen (GV 15) between the atlanto-axial dislocation (AAD) patients and healthy subjects.MethodsA total of 177 AAD patients diagnosed and treated at the Center of Upper Cervical Vertebra of Beijing China-Japan Friendship Hospital between January 2010 and January 2018 were included in the AAD group. Another 207 healthy subjects were included in the normal group. There were totally 191 males and 193 females. The MRI scan was performed for the cervical vertebrae to measure the risk angle and safety angle of acupuncture at Yamen (GV 15) on the sagittal image.ResultsIn the AAD group, the risk angle was (13.14±3.99)° and the relative safety angle was (10.31±3.23)° for the perpendicular needling, while the oblique needling risk angle was (9.09±3.09)° for the male; the risk angle was (12.12±2.74)° and the relative safety angle was (10.56±2.09)° for the perpendicular needling, while the oblique needling risk angle was (9.70±2.95)° for the female. In the normal group, the risk angle was (7.89±1.59)° and the relative safety angle was (10.21±3.55)° for the perpendicular needling, while the oblique needling risk angle was (16.07±1.77)° for the male; the risk angle was (6.93±1.45)° and the relative safety angle was (10.70±2.94)° for the perpendicular needling, while the oblique needling risk angle was (14.89±2.18)° for the female. The perpendicular needling risk angles for the males and females in the AAD group were larger than those in the normal group, and the differences were statistically significant (both P<0.01); for the inner-group comparison, there was no significant difference in the perpendicular needling risk angle between the male and the female in the AAD group (P>0.05); however, the perpendicular needling risk angle for the male was larger than the female, and the difference was statistically significant in the normal group (P<0.01). There were no significant differences in the relative safety angle for both the male and the female between the AAD group and the normal group (both P>0.05). For the inner-group comparison, there was no significant difference in the relative safety angle between the male and the female (P>0.05). The oblique needling risk angles for both the males and females were smaller in the AAD group than those in the normal group, and the differences were statistically significant (both P<0.01); the oblique needling risk angle for the male was not significantly different from that for the female in the AAD group (P>0.05); in the normal group, the oblique needling risk angle for the male was larger than that for the female, and the difference was statistically significant (P<0.01).ConclusionUnder the AAD condition, the risk angle and safety angle of acupuncture at Yamen (GV 15) change significantly, perpendicular needling should be better if performed slightly lower than the horizontal direction, and the oblique needling should be safer across the occipital foramen toward the occipital bone.摘要目的比较寰枢椎脱位(AAD)患者与正常人哑门针刺的危险角度和安全角度。方法选取2010年1月至2018 年1月在北京中日友好医院上颈椎中心诊断并治疗的177例AAD患者为AAD组, 另选取207例正常人为正常组, 其 中男性191例, 在矢状位像上测量哑门穴针刺的危险角度和安全角度。结果在AAD组中, 男性直刺危险角度(13.14±3.99)°, 相对安全角度(10.31±3.23)°, 斜刺危险角度(9.09±3.09)°; 女性直刺 危险角度(12.12±2.74)°, 相对安全角度(10.56±2.09)°, 斜刺危险角度(9.70±2.95)°。正常组中, 男性直刺危险角度(7.89±1.59)°, 相对安全角度(10.21±3.55)°, 斜刺危险角度(16.07±1.77)°; 女性直刺危险角度(6.93±1.45)°, 相对安全角度(10.70±2.94)°, 斜刺危险角度(14.89±2.18)°。AAD组男性和女性的直刺危险角度均大于正常组, AAD组中男性直刺危险角度与女性无统计学差异(P>0.05), 但正常组中男性大于女性, 且差异有统计学意义(P<0.01)。AAD组男性和女性的相对安全角度与正常组均无统计学差异(均P>0.05); 两组相对安全角度的组内比较, 且差异均有统计学意义(均P<0.01); AAD组中, 男性的斜刺危险角度与女性无统计学差异(P>0.05); 正常组中, 男性的斜刺危险角度大于女性, 且差异有统计学意义(P<0.01)。结论AAD状态下, 哑门穴针刺危险角度和安全角度发生了明显的改变, 针刺时直刺以水平方向略偏下为宜, 斜刺应越过枕骨大孔向枕骨方向针刺最为安全。