颈椎旁神经阻滞联合Mulligan手法及针刺治疗颈源性头痛对颈椎活动度、TCD指标及炎性细胞因子水平的影响

Effect of cervical paravertebral nerve block combined with Mulligan manipulation and acupuncture treatment of cervical headache on cervical spine bobility,TCD index and inflammatory cytokine level

目的探究颈椎旁神经阻滞联合Mulligan手法及针刺治疗颈源性头痛对颈椎活动度、经颅多普勒超声(TCD)指标及炎性细胞因子水平的影响。方法选取2018年3月—2019年11月在首都医科大学附属北京安贞医院疼痛科、胜利油田中心医院疼痛科确诊为颈源性头痛的患者90例,按照随机数字表法分为对照组与观察组,每组45例,对照组给予传统针刺治疗,观察组在此基础上使用颈椎旁神经阻滞联合Mulligan手法治疗。比较2组患者治疗总有效率,治疗前后的颈椎活动度、TCD指标及炎性细胞因子水平,以及不良反应发生情况。结果观察组总有效率为88.89%,明显高于对照组的66.67%(χ^(2)=6.429,P=0.011)。2组患者治疗后的主动关节活动度(AROM)均高于治疗前,且观察组的前屈、后伸、左侧屈、右侧屈、左旋转、右旋转AROM均高于对照组(t=8.076、8.317、8.533、9.544、8.455、8.472,P均<0.01);2组患者治疗后的椎动脉和基底动脉血流速度均优于治疗前,且观察组椎动脉左右侧Vp、Vm、Vd及基底动脉Vp、Vm、Vd均优于对照组(t=3.060、2.509、2.402、2.195、2.193、2.694,2.054、2.276、2.229,P均<0.05);2组患者治疗后的血清IL-1、IL-6、IL-8和TNF-α水平均优于治疗前,且观察组优于对照组(t=27.577、36.062、29.346、43.656,P均<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)结论颈椎旁神经阻滞联合Mulligan手法及针刺治疗颈源性头痛可有效提升患者的颈椎活动度,改善患者的TCD指标及炎性细胞因子水平。

Objective To explore the effects of cervical paravertebral nerve block combined with Mulligan manipulation and acupuncture treatment of cervical headache on cervical spine range of motion,transcranial Doppler ultrasound(TCD)indicators and inflammatory cytokine levels.Methods From March 2018 to November 2019,90 patients diagnosed with cervicogenic headache in the Pain Department of Beijing Anzhen Hospital and Shengli Oilfield Central Hospital,Capital Medical University Affiliated to the Department of Pain,Shengli Oilfield Central Hospital were selected and divided into observation group and control group according to random number table,45 cases in each group,the control group was given traditional acupuncture treatment,and the observation group was treated with cervical paravertebral nerve block combined with Mulligan manipulation on this basis.The total effective rate of treatment,cervical spine mobility,TCD index and inflammatory cytokine levels before and after treatment were compared between the two groups,as well as the occurrence of adverse reactions.Results The total effective rate in the observation group was 88.89%,which was significantly higher than the 66.67%in the control group(χ^(2)=6.429,P0.011).The active joint range of motion(AROM)of the two groups of patients after treatment was higher than that before treatment,and the AROM of the observation group's flexion and extension,left flexion,right flexion,left rotation,and right rotation were all higher than those of the control group(t=8.076,8.317,8.533,9.544,8.455,8.472,P<0.01);the blood flow velocity of the vertebral artery and basilar artery after treatment in the two groups were better than before treatment,and the left and right sides of the vertebral artery Vp,Vm,Vd in the observation group And basilar artery Vp,Vm,Vd are better than the control group(t=3.060,2.509,2.402,2.195,2.193,2.694,2.054,2.276,2.229,P<0.05);The levels of IL-6,IL-8 and TNF-αwere better than before treatment,and the observation group was better than the control group(t=27.577,36.062,29.346,43.656,all P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Cervical paravertebral nerve block combined with Mulligan technique and acupuncture treatment of cervical headache can effectively improve the cervical spine mobility of the patient and improve the patient's TCD index and inflammatory cytokine level.