循经走罐法改善颈椎病患者症状与病程及年龄的关系(英文)

Symptomatic improvement of cervical spondylosis by sliding cupping and its relation to disease course and age

背景:循经走罐法治疗颈椎病,主要是起到疏通经络,行气活血,消除瘀滞的目的。目的:探讨循经走罐法改善颈椎病患者症状,疗效与病程及年龄的关系。设计:患者自身前后对照观察。单位:解放军空军总医院理疗科。对象:2000-12/2003-12空军总医院理疗科门诊治疗的颈椎病患者100例。其中男39例,女61例;年龄≤30岁9例,31～40岁38例,41～50岁42例,>50岁11例。病程<1年36例,1～5年49例,>5年15例。颈型51例,椎动脉型25例,神经根型24例;其中有69例患者经过X射线检查显示颈椎生理曲度变直或反向,或有不同程度的退行性改变。有23例患者脑血流图显示椎动脉供血不足。干预:患者俯伏坐位,暴露颈肩部和上背部,用负压罐吸拔于颈部,使颈肩部和背部疼痛部位的皮肤出现瘀斑,每周治疗一两次,治疗1个月后,根据患者治疗前后的自觉症状和体征以及X射线片、脑血流图的检查结果进行治疗效果评定。症状消失:疼痛0级;颈椎的生理弯曲恢复10°～15°;脑血流图显示椎动脉收缩峰速度恢复正常范围。明显好转:疼痛降低2级以上;颈椎的生理弯曲恢复6°～9°;脑血流图椎动脉收缩峰速度恢复正常范围的80%。好转:疼痛降低1级;颈椎的生理弯曲恢复3°～5°;脑血流图椎动脉收缩峰速度恢复正常范围的40%～80%。无效:疼痛无变化;颈椎的生理弯曲恢复3°以下;脑血流图椎动脉收缩峰速度在正常范围的40%以下。主要观察指标:①各型患者治疗后症状改善情况。②病程与治疗效果的关系。③年龄与治疗效果的关系结果:按意向处理分析,100例患者均进入结果分析。症状消失、明显好转、好转、无效,颈型分别为27,17,5,2例;椎动脉型分别为8,10,4,3例;神经根型分别为4,9,7,4例;病程<1年分别为19,12,3,2例;病程1～5年分别为18,19,7,5例;病程>5年分别为2,5,6,2例;年龄<30岁分别为5,3,1例;31～40岁分别为18,13,4,3例;41～50岁分别为15,18,5,4例;>50岁分别为1,2,6,2例。结论:循经走罐法对改善颈型颈椎病患者的效果较好,椎动脉型次之,神经根型治疗结果较差。病程越短,年龄越小,治疗效果越好。

BACKGROUND:Sliding cupping has been used for treating cervical spondylosis, with the effects of dredging the meridian system, activating qi and removing blood stasis. OBJECTIVE:To probe into symptomatic improvement of cervical spondylosis with sliding cupping and the relationship between curative effect and course of disease as well as age. DESIGN:Self controlled observation. SETTING:Department of Physiotherapy,General Hospital of Air Force of Chinese PLA. PARTICIPANTS:Totally 100 out-patients with cervical spondylosis receiving treatment in the Department of Physiotherapy,General Hospital of Air Force of Chinese PLA were involved from December 2000 to December 2003.Among them,39 cases were male and 61 cases were female;9 cases were under 30 years old,38 cases were 31 to 40 years old,42 cases were 41 to 50 years old and 11 cases were above 50 years old.There were 36 cases with less-than-one-year course of disease,49 with 1 to 5-year course and 15 with more-than-5-year course.Fifty-one cases were cervical type;25 cases vertebral artery type;24 cases nerve root type.X-ray examination revealed that there were 69 cases whose cervical vertebral physiological curvature became straight or reverse,or with certain degree of degenerative change.Vertebroarterial blood supply insufficiency was detected in 23 cases by rheoencephalogram. INTERVENTIONS:The patients were asked to be in prone sitting position, their nape and shoulder were fully exposed, and the negative pressure cupping was applied to patient's nape and shoulder until petechiae appeared on the skin.The treatment was given once or twice a week.After one-month treatment,the curative effect was calculated according to subjective symptoms,signs,and the results of X-ray and rheoencephalogram examination before and after treatment.Symptom disappearance: pain was 0 grade;the cervical vertebral physiological curvature restored by 10°-15°and rheoencephalogram showed that the contraction peak velocity of the vertebroarterial blood supply became normal.Marked improvement:the pain reduced by more than 2 grade,the cervical vertebral physiological curvature restored by 6°-9°and rheoencephalogram showed that the vertebroarterial blood supply restored to 80%of the normal range.Improvement:the pain reduced by 1 grade,the cervical vertebral physiological curvature restored by 3°-5°and rheoencephalogram showed that the vertebroarterial blood supply restored to 40%-80%of the normal range.Inefficacy:the pain did not reduce, the cervical vertebral physiological curvature restored by less than 3°and rheoencephalogram showed that the vertebroarterial blood supply became less than 40%. MAIN OUTCOME MEASURES: ①The condition of symptomatic improvement after treatment;②relationship between course of disease and curative effect;③relationship between age and curative effect. RESULTS: According to the intention-to-treat analysis, 100 patients entered the result analysis.For symptom disappearance,marked improvement, improvement,inefficacy there were 27,17,5 and 2 cases respectively in cervical type;8,10,4 and 3 cases respectively in the vertebral artery type;4,9,7 and 4 cases respectively in the nerve root type. There were 19, 12, 3 and 2 cases respectively with less-than-one-year course of disease;18,19,7 and 5 cases respectively with 1 to 5-year course;2,5,6 and 2 cases respectively with more-than-5-year course.And there were 5,3 and 1 cases respectively with age < 30 years;18,13,4 and 3 cases respectively with age of 31 to 40 years;15,18,5 and 4 cases respectively with age of 41 to 50 years;1,2,6 and 2 cases respectively with age >50 years. CONCLUSION:The effect of sliding cupping was good for patients with cervical spondylosis of vertical type, next of vertebroarterial type and bad of nerve root type. The shorter the course of disease is, the younger the patient is, and the better the curative effect is.