颈椎定点伸引手法联合银质针导热疗法治疗颈椎管狭窄症的效果

Interventional effects of cervical local-point traction manipulation plus silver needle heat conductive treatment for cervical spinal canal stenosis

目的:观察颈椎定点伸引手法与银质针导热疗法治疗颈椎管狭窄症的作用。方法:于2002-02/2006-02选择解放军总医院康复医学科诊治的均由CT扫描或MRI检查确诊的颈椎管狭窄症患者150例。随机数字法分成3组:颈椎定点伸引手法组,银质针导热组,颈椎定点伸引手法及银质针导热联合组,每组50例。颈椎定点伸引手法组采用颈椎定点伸引疗法,对椎管狭窄节段施行该疗法,1次/周,共做2次;银质针导热组采用银质针导热疗法对颈背部和肩胛部软组织病变部位施行银质针导热疗法,1次/周,共2次;颈椎定点伸引手法及银质针导热联合组先后采用颈椎定点伸引手法和银质针导热疗法,各2次。比较各组患者治疗前、治疗后3个月和6个月疼痛数字评分及治疗后1个月的临床体征改善情况及疗效结果。结果:所有患者均完成治疗和指标评定,全部进入结果分析。①治疗后3个月颈椎定点伸引手法组、银质针导热组、颈椎定点伸引手法及银质针导热联合组疼痛数字评分值与治疗前相比均有降低,而颈椎定点伸引手法及银质针导热联合组更为明显(8.62±1.39,2.36±2.80,χ2=2.52,P<0.01)。治疗后6个月,各组病例的疼痛症状多数获得控制,以颈椎定点伸引手法及银质针导热联合组更为明显(1.12±2.78,χ2=4.02,P<0.01)。其中颈椎定点伸引手法组、颈椎定点伸引手法及银质针导热联合组与银质针导热组相比差异均有显著性意义(P<0.05)。②治疗后1个月各组临床体征均较治疗前明显改善,尤其是颈椎挤压试验阳性率,颈椎定点伸引手法及银质针导热联合组与银质针导热组、颈椎定点伸引手法组相比差异均有非常显著性意义(χ2=9.25,9.02,P<0.01),而银质针导热组与颈椎定点伸引手法组相比差异无显著性意义(P>0.05)。③颈椎定点伸引手法及银质针导热联合组与银质针导热组、颈椎定点伸引手法组有效率相比差异有非常显著性意义(88%,78%,78%,χ2=6.31,6.11,P<0.01)。结论:颈椎定点伸引手法具有解除肌肉痉挛、松解神经根粘连的作用;银质针导热疗法则有消除椎管内外软组织无菌性炎症、改善血供和松解肌肉的作用。两种疗法治疗颈椎管狭窄症具有互补性。

AIM： To explore the complementary action and mechanism of cervical local-point traction manipulation and silver needle heat conductive treatment for cervical spinal canal stenosis （CSCS）. METHODS： Totally 150 CSCS patients diagnosed with CT scanning or MRI examination were selected from the Department of Rehabilitation Medicine, Chinese PLA General Hospital between February 2002 and February 2006. They were randomly divided into three groups with 50 patients in each group, Cervical local-point traction manipulation group： Cervical local-point traction manipulation treatment was performed to the segment of canal stenosis once a week totally for 2 times. Silver needle heat conductive treatment group： Silver needle heat conductive treatment was conducted on patient＇s neck and shoulders once a week totally for 2 times. Successive group： Cervical local-point traction manipulation treatment and silver needle heat conductive treatment were successively done twice. The numeric rating scale （NRS） score and improvements of clinical signs as well as curative effects were compared in three groups before treatment and 3 months as well as 6 months after the treatment. RESULTS： All the patients accomplished the treatment and index assessment, thus entered the result analysis. ① The NRS scores decreased in three groups after 3-month treatment than those before treatment, especially in the successive group （8.62±1.39,2.36±2.80,x^2=2.52, P 〈 0.01）. And most of the painful symptoms were controlled after 6-month treatment, which was the most significant in the successive group （1.12±9.78, x^2=4.02, P 〈 0,01）, There were significant differences between cervical local-point traction manipulation group and silver needle heat conductive treatment group as well as those between silver needle heat conductive treatment group and successive group （P 〈 0.05）. ② After one-month treatment, the clinical signs of three groups were all improved notably, especially the positive rate of cervical squeeze press test. The differences were much more significant between the successive group and silver needle heat conductive treatment group, and between the successive group and cervical local-point traction mariipulation group （x^2=9.25, 9.02, P 〈 0.01）, whereas there was no remarkable difference between the cervical local-point traction manipulation group and silver needle heat conductive treatment group （P 〉 0.05）. ③ There were significant differences in the validity among the cervical local-point traction manipulation group, successive group and the silver needle heat conductive treatment group （which were respectively 88%, 78% and 78%, x^2=6.31, 6.11, P 〈 0.01）. CONCLUSION： Cervical local-point traction manipulation treatment is effective for relieving the muscle spasm and relaxing the nerve root adhesion, while silver needle heat conductive treatment has effects on eliminating the aseptic inflammation of the soft tissues in or out of vertebral canal as well as improving the blood supply and relaxing the muscles, So the two therapies are complementary for treating CSCS patients.