基于“骨脉筋肉”理论的四联方案治疗椎动脉型颈椎病疗效观察

Curative Observation of Applying Quadruple Regimen Based on the Theory of “Bone and Veins,Muscles and Flesh” in Treating Patients with Vertebral Artery Type Cervical Spondylopathy

目的:观察基于“骨脉筋肉”理论的四联方案治疗椎动脉型颈椎病患者的临床疗效。方法:选择2017年2月~2019年8月在彭州市人民医院收治的CSA患者共计123例,随机分为联合组、中药组和对照组各41例。对照组采用牵引常规治疗,中药组在对照组的基础上增加中药内服,联合组在中药组的基础上,增加加入理筋手法,并配合核心肌群肌力训练,3组均治疗2周。观察治疗前后的VAS疼痛评分、颈性眩晕症状与功能评估量表、颈椎功能障碍指数(NDI)、实验室指标(IL-6、全血黏度、血浆黏度)、椎-基底动脉血流速度(LVA、RVA、BA)、肌电图肌电积分(斜方肌、胸锁乳突肌)。结果:症状和功能方面,联合组在颈性眩晕症状与功能评分、VAS评分、NDI评分优于中药组和对照组,差异有统计学意义(P<0.05);在实验室检查方面,联合组在IL-6优于中药组和对照组,差异有统计学意义(P<0.05),而在全血黏度(低切)、血浆黏度,联合组在治疗后仅优于对照组,与中药组差异均无统计学意义(P>0.05)。在血流速度方面,联合组在LVA、RVA、BA血流速度均优于其余2组,差异有统计学意义(P<0.05)。在肌电图方面,联合组在斜方肌和胸锁乳突肌表面肌电图肌电积分优于其余2组,差异有统计学意义(P<0.05)。结论:基于“骨脉筋肉”理论的四联方案能有效缓椎动脉型颈椎病患者的疼痛和眩晕,改善功能障碍,提高血流速度以及核心肌群的肌肉力量与稳定性,对今后慢性老年性康复疾病可带来较大的社会效益,值得继续研究。

Objective:To observe the clinical efficacy of applying quadruple regimen based on the theory of“bone and veins,muscles and flesh”in the treatment of patients with vertebral artery type cervical spondylosis.Methods:A total of 123 CSA patients admitted to the People’s Hospital Pengzhou City from February 2017 to August 2019 were selected and randomly divided into 41 cases each in a combination group,a traditional Chinese medicine group and a controlled group.The controlled group was treated with conventional traction,the traditional Chinese medicine group added traditional Chinese medicine to the controlled group,and the combination group was added to the traditional Chinese medicine group by adding tendon manipulation and core muscle strength training.The three groups were treated for 2 weeks.Observed the VAS pain score,cervical vertigo symptom and function assessment scale,cervical spine dysfunction index(NDI),laboratory indicators(IL-6,whole blood viscosity,plasma viscosity),vertebral-basal artery blood flow velocity before and after treatment(LVA,RVA,BA),EMG EMG score(trapezius muscle,sternocleidomastoid muscle).Results:In terms of symptoms and functions,the combined group was superior to the traditional Chinese medicine group and the controlled group in cervical vertigo symptoms and function scores,VAS scores,and NDI scores,and the difference was statistically significant(P<0.05).In laboratory tests,the IL-6 level of the combined group was better than the traditional Chinese medicine group and the controlled group,the difference was statistically significant(P<0.05).In the whole blood viscosity(low-cut)and plasma viscosity,the combination group was only better than the controlled group after treatment.There was no statistically significant difference in the Chinese medicine group(P>0.05).In terms of blood flow velocity,the blood flow velocity of the combined group was better than the other two groups in LVA,RVA,BA,and the difference was statistically significant(P<0.05).In terms of electromyography,the combined group was better than the other two groups in the surface electromyography of the trapezius and sternocleidomastoid muscles,and the differencewas statistically significant(P<0.05).Conclusion:The quadruple program based on the theory of“bone and veins,muscles and flesh”can effectively relieve the pain and dizziness of patients with vertebral artery type cervical spondylosis,improve dysfunction,increase blood flow speed,and the muscle strength and stability of core muscles,which is useful for future chronic senile rehabilitation diseases can bring greater social benefits and are worth continuing research.