上颈段颈椎退变性颈肩痛临床诊治探讨

Treatment of Shoulder and Neck Pain in Patients with and without Upper Cervical Degeneration

目的:探讨上颈段(C1～C4)颈椎退变性颈肩痛的临床特点并比较不同康复治疗方案的临床疗效。方法:将52例临床诊断为颈肩部肌肉筋膜炎的患者分为三组:上颈段颈椎退变1组(A组,16例),上颈段颈椎退变2组(B组,15例)和非上颈段颈椎退变组(C组,21例)。三组均采用相同的推拿和中频电治疗。不同的是A组增加了颈椎牵引和针对根型颈椎病的手法治疗。3组的治疗时间均为2周,治疗次数均不超过10次。治疗前后进行VAS疼痛评分,并对各组疗效进行Odom评定。结果:三组之间性别、年龄和病程均无显著差异性。上颈段颈椎退变性颈肩痛的主要临床特点是伴随斜方肌张力升高和压痛的锁骨水平以上部位的颈肩部肌肉筋膜炎表现。治疗后A组和C组VAS评分明显改善,均好于B组(P=0.000)。Odom评定结果显示:A组治疗优良率(93.8%)和C组(95.2%)相比无显著性差异(P=0.692),均优于B组(P=0.001)。结果提示:对于伴有斜方肌张力升高和压痛的颈肩部肌肉筋膜炎患者应常规摄颈椎X线片了解上颈段颈椎退变情况。对于伴随上颈段颈椎退变和上颈段椎间孔狭窄的患者,建议按神经根型颈椎病而不是单纯颈肩部肌肉筋膜炎的康复治疗方法进行治疗,可以取得良好的治疗效果。

Objective To compare the results of clinical treatment of shoulder and neck pain in patients with and without upper cervical degeneration. Methods Fifty two patients with diagnosed shoulder and neck muscular fasciitis （with high tension and tenderness on the trapezius） were divided into 3 groups： group A, with upper cervical degeneration （16 cases） ; group B, with upper cervical degeneration （15 cases）, and group C, without cervical degeneration （21 cases）. There were no significant difference in gender, age and course of disease among the 3 groups. Patients in 3 groups were regularly treated by naprapathy and electric therapy （intermediate frequency）. Cervical traction and manipulation was added to the patients in group A. Treatment for 3 groups lasted for 2 weeks. The Visual Analog Scale （VAS） scores and Odom criteria before and after treatment were used for determining the results of clinical treatment. Results The VAS scores after treatment were significantly improved in group A and group C as compared with that in group B （P：0. 000）. Odom criteria of group A （93.8%） and group C （95.2 % ） were excellent and good without significant difference （P = 0.692）, but they were significantly higher than that of group C （P = 0.001）. Conclusions Patients with shoulder and neck pain accompanied by upper cervical degeneration （narrowing of intervertebral foramen） should be treated with cervical traction and manipulation beside the routine therapy.