四天穴针刺法治疗神经根型颈椎病临床观察

Clinical Observations on the Efficacy of Acupuncture at Four Tian Points in Treating Cervical Spondylosis of Nerve Root Type

目的评价四天穴针刺法治疗神经根型颈椎病的临床疗效,探讨其作用机制。方法选用症状量表法、疼痛视觉模拟标尺法作为临床观察及疗效评定标准。与传统的针刺颈夹脊穴方法进行对照比较,并进行红外热像学的客观评价,同时通过测定针刺前后血清内皮素(ET)、6-酮-前列腺素F1(6-Keto-PGF1)、血栓素B2(TXB2)、白细胞介素1(IL-1)、丙二醛(MDA)、超氧化物歧化酶(SOD)的变化,初步探讨四天穴针刺法治疗神经根型颈椎病的疗效作用机理。结果四天穴针刺法治疗神经根型颈椎病,可以明显减轻疼痛,缓解临床症状和体征,评分比较明显优于颈夹脊穴针刺法。治疗后两组患者项背部皮肤温度与治疗前相比均明显降低,但四天穴治疗组的改善幅度优于颈夹脊穴对照组,肯定了四天穴针刺法对神经根型颈椎病患者项背部病理高温的改善作用优于传统颈夹脊穴。针刺后患者血清IL-1、ET、TXB2、MDA含量降低(P<0.05),6-Keto-PGF1含量及SOD的活性升高(P<0.05)。结论四天穴针刺法对神经根型颈椎病有肯定的临床疗效,优于传统颈夹脊穴。该针法可减低或抑制炎性介质释放,具有抗炎、镇痛作用,对神经根痛有明显干预作用;可舒张颈部神经根周围微小血管,减轻血液凝聚状态,调节微循环;可干预自由基代谢紊乱,提高机体抗氧化与清除自由基能力,从而对颈椎病动力失衡状态发挥综合调整作用。

Objective To investigate the clinical efficacy of acupuncture at four Tian points in treating cervical spondylosis of nerve root type and explore the mechanism of its action. Methods A symptom scale and a visual pain analog scale were used as criteria for clinical observation and evaluation of therapeutic effects. Acupuncture at four Tian points was compared with conventional acupuncture at cervical jiaji（ExB2） points. Infrared thermography was performed for an objective evaluation. Serum endothelin （ET）, 6-keto prostaglandin F1α （6-keto-PGF1α）, thromboxane B2 （TXB2）, interleukin 1 （IL-1）, malondialdehyde （MDA） and superoxide dismutase （SOD） were measured before and after treatment to preliminarily explore the mechanism of the therapeutic action of acupuncture at four Tian points on cervical spondylosis of nerve root type. Results Acupuncture at four Tian points obviously alleviated pain and relieved the clinical symptoms and signs in treating cervical spondylosis of nerve root type. It decreased the score significantly more than acupuncture at cervical jiaji points. Nape skin temperature decreased significantly in the two groups of patients after treatment compared with before, but it did significantly more in the four Tian points group than in the cervical jiaji points group, indicating that the improving effect of acupuncture at four Tian points on pathological nape high temperature was better than that of conventional acupuncture at cervical jiaji points. Serum IL-1, ET, TXB2 and MDA contents decreased significantly （P〈0.05） and 6-keto-PGF1α content and SOD activity increased significantly （P〈0.05） in the patients after treatment. Conclusion Acupuncture at four Tian points has an exact therapeutic effect on cervical spondylosis of nerve root type and is better than conventional acupuncture at cervical jiaji points. This acupuncture treatment can reduce or inhibit the release of inflammatory transmitters, produces antiinflammatory and analgesic effects and has an obvious intervening effect on radiculalgia. It can dilate cervical micro small blood vessels around the nerve root, reduce blood agglutination, regulate microcirculation, intervene in the disturbance of free radical metabolism and improve the abilities of the body to inhibit oxidation and eliminate free radicals. All this produce an integrated regulative effect on dynamic imbalance in cervical spondylosis.