颈神经后支源性颈肩痛神经阻滞与手法治疗的效果比较(英文)

A comparative study on the effects of nerve block and manipulation therapy for cervical dorsal rami neck shoulder pain

背景颈神经后支源性颈肩痛(cervicaldorsalramineck-shoulderpain,CDRNSP)因缺乏特征性体征,目前认识不足。极容易同具有相似症状而不同病因的疾病相混淆,发生误诊误治。目的分析CDRNSP的病理特点,对照比较神经阻滞和手法松解的治疗效果。设计以诊断为依据,设立对照的回顾性研究。地点和对象在本院门诊和住院部完成,实验对象为130例CDRNSP患者,男45例,女85例;平均年龄(40±4)岁。干预分为颈神经后支阻滞组63例,行颈神经后支阻滞治疗,1次/周;定点旋转手法组67例,行定点旋转手法治疗,2次/周。4次为1疗程。主要观察指标观察比较两组颈肩痛症状缓解情况。结果颈神经后支阻滞组显效20例,有效26例,无效17例,总有效率73%(46/63);定点旋转手法组显效40例,有效21例,无效6例,总有效率90.3%(61/67)。两组疗效比较差异有显著性意义(χ2=7.04,P<0.01)。结论手法治疗颈神经后支源性颈肩痛疗效优于颈神经后支阻滞疗效。

BACKGROUND:Still not completely understood due to lack of characteristic physical signs,cervical dorsal rami neck shoulder pain(CDRNSP) is often confused with other diseases with similar symptoms but different causes.Misdiagnosis and wrong treatment are frequent.OBJECTIVE:To analyze the pathological characters of CDRNSP,and compare the therapeutic effects of nerve block and manipulation therapy.DESIGN:A retrospective controlled study was conducted on the basis of diagnosis.SETTING and PARTICIPANTS:Totally 130 CDRNSP patients,45 males and 85 females,aged (40±4) years old,were selected from the Outpatient or Inpatient Departments,the Fifth Affilated Hospital of Sun Yat sen University.INTERVENTIONS:Sixty three patients in the nerve block group underwent nerve block at the cervical dorsal rami once a week.Sixty seven patients in the manipulation group were treated with manipulation of rotation at fixed points twice a week,4 times making up a course of treatment.MAIN OUTCOME MEASURES:To observe and compare the improvement of the sign of neck shoulder pain in these two groups.RESULTS:In the nerve block group,the treatment was markedly effective in 20 cases,effective in 26 cases,and ineffective in 17 cases,with a general effective rate of 73%(46/63).In the manipulation group,the treatment was markedly effective in 40 cases,effective in 22 cases,and ineffective in 6 cases with a general effective rate of 90.3%(61/67).The difference in curative effect between these two groups was significant(χ2=7.04,P< 0.01).CONCLUSION:Manipulation therapy for CDRNSP is more effective than nerve block therapy.