针刺颈夹脊穴及颈三针联合正骨推拿治疗椎动脉型颈椎病的临床观察

Clinical Report on the Treatment of Needling Three Cervical Points and Crvical Jiaji Points Combined with Manipulation Therapy on Patients with Vertebral Artery Type Cervical Spondylopathy

目的:探究针刺颈夹脊穴及颈三针联合正骨推拿对椎动脉型颈椎病(VACS)患者的临床疗效及颈部血流速度的影响。方法:回顾性分析2015年6月至2019年6月收治的VACS患者187例,根据治疗方式不同分为两组:单一正骨推拿治疗组(A组,79例),针刺颈夹脊穴及颈三针联合正骨推拿治疗组(B组,108例),两组患者疗程均为1个月。采用改良颈性眩晕症状与功能评估量表(ESCV)评估患者临床症状的改善情况及治疗总有效率,并对两组患者的治疗进行安全性评估。经颅多普勒超声(TCD)检测治疗前后患者左椎动脉(LVA)、右椎动脉(RVA)以及椎-基底动脉(VBA)的血流速度变化;采用对应试剂盒检测治疗前后患者血清一氧化氮(NO)及血浆内皮素(ET-1)的水平变化。结果:与治疗前比较,两组患者治疗后临床症状均显著改善,ESCV评分均显著升高,差异有统计学意义(P<0.05),且B组ESCV评分高于同期A组,差异有统计学意义(P<0.05)。B组治疗总有效率为92.59%,显著高于A组的73.42%,差异有统计学意义(P<0.05),且两组患者均未出现不良反应情况。与同组治疗前比较,治疗后两组患者LVA,RVA及VBA的平均血流速度、血清NO水平均显著升高,差异有统计学意义(P<0.05);血浆ET-1水平显著降低,差异有统计学意义(P<0.05);且B组患者血清NO水平显著高于同期A组,差异有统计学意义(P<0.05);而血浆ET-1水平显著低于同期A组,差异有统计学意义(P<0.05)。结论:针刺颈夹脊穴及颈三针联合正骨推拿能够有效改善VACS患者颈部血流速度及临床症状,提高治疗总有效率,这可能与提升血清NO水平及降低血浆ET-1水平有关,值得临床推广应用。

Objective:To investigate the clinical effect and the influence of needling three cervical points and cervical Jiaji points combined with manipulation therapy on cervical blood flow velocity in patients with vertebral artery type cervical spondylopathy(VACS).Methods:A retrospective analysis was performed on 187 VACS patients admitted to Zhongshan Hospital of Traditional Chinese Medicine in Guangdong province from June 2015 to June 2019.According to the different treatment methods,it was divided into two groups:single manipulation therapy group(group A,79 cases);The treatment group(group B,108 cases)was treated by needling three cervical points and cervical Jiaji points combined with manipulation therapy.The duration of treatment was 1 month in both groups.The improved cervical vertigo symptom and function assessment scale(ESCV)was used to evaluate the improvement of clinical symptoms and the total effective rate of treatment,and the safety of treatment in both groups was assessed at the same time.The blood flow velocity changes of the left vertebral artery(LVA),right vertebral artery(RVA)and vertebrobasilar artery(VBA)before and after treatment were detected by transcranial doppler ultrasound(TCD).The changes of serum nitric oxide(NO)and plasma endothelin-1(ET-1)levels were detected before and after treatment with corresponding kits.Results:Compared with before treatment,the clinical symptoms of the two groups were significantly improved after treatment,and the ESCV score of the two groups was significantly increased(P<0.05),and the ESCV score of the B group was higher than that of the A group during the same period(P<0.05).The total effective rate of treatment in group B was 92.59%,significantly higher than that in group A(73.42%,P<0.05),and no adverse reactions occurred in both groups.Compared with the same group before treatment,after treatment,two groups of patients with LVA,RVA and mean blood flow velocity of VBA,serum NO level were significantly increased(P<0.05),plasma ET-1 level decreased significantly(P<0.05),and serum NO level in group B patients was significantly higher than the same period in group A(P<0.05),while the plasma ET-1 level was significantly lower(P<0.05).Conclusion:Needling three cervical points and cervical Jiaji points combined with manipulation therapy can effectively improve the cervical blood flow velocity and clinical symptoms of VACS patients and improve the total effective rate of treatment,which may be related to the increase of serum NO level and the decrease of plasma ET-1 level,and is worthy of clinical application.