颈后肌群等长收缩锻炼治疗颈型颈椎病的临床观察

Clinical Research of Neck-type Cervical Syndrome Treated with Isometric Neck Strength Training

【目的】评价颈后肌群等长收缩锻炼治疗颈型颈椎病的有效性和安全性。【方法】以手法组为平行对照，选择95例符合颈型颈椎病诊断标准的受试者，采用分层随机方法将其分配至治疗组（55例）和对照组（40例），分别接受颈后肌群等长收缩锻炼或颈椎手法治疗。2周为1个疗程。采用视觉模拟量表（VAS评分）和Vernon颈椎废用指数对两组治疗前后的相关症状和体征进行评分，并对其安全性进行评价。【结果】全部病例均获3-11．4个月的随访，治疗组无病情进展病例，对照组1例进展为神经根型颈椎病、1例转化为交感型颈椎病。在3个月内发作次数方面，治疗组为（2．27±1．50）次，对照组为（6．65±2．62）次，两组比较差异有显著性意义（P〈0．05）。治疗后两组VAS评分与治疗前比较均明显降低（P〈0．05），且治疗组的降低作用更为显著（P〈0．05）；3个月后随访，两组VAS评分比较差异仍有显著性意义（P〈0．05）。治疗后两组颈椎废用指数与治疗前比较，差异有显著性意义（P〈0．05），但两组间比较，差异无显著性意义（P〉0．05）；3个月后随访，两组间颈椎废用指数比较，差异有显著性意义（P〈0．05）。在安全性评价方面，治疗组有4例出现颈项及上肢酸痛加重、红色痕迹，停止锻炼后即自行消失，后均可恢复正常训练；对照组无不适。两组均未见骨折、脱位、晕厥等其他不良反应。【结论】颈后肌群等长收缩锻炼治疗颈型颈椎病是安全、有效的，具有较好的远期效果，且具有简、便、廉的特点。

Objective To evaluate the effectiveness and safety of isometric neck strength training for the treatment of neck-type cervical syndrome. Methods The qualified patients with neck-type cervical syndrome were divided into two groups by stratified randomization： the treatment group （N = 55 ） received isometric neck strength training, and the control group （N = 40 ） received manipulation treatment. Two weeks constituted one treatmeat course. Visual Analog Scale （VAS） and Vernon Cervical Disability Index （VCDI） were used to evaluate the efficacy, and the safety was also monitored. Results All of the 95 enrolled patients were followed up for 3 - 11.4 months. No aggravation was found in the treatment group, but in the control group one patient developed into cervical spondylotic radiculopathy and one patient developed into sympathetic cervical spondylosis. The frequency of serious neck pain attack within 3 months was 6. 65 ± 2.62 times in the control group and 2.27 ± 1.50 times in the treatment group, the difference being significant （P 〈 0. 05 ）. After treatment for 2 weeks, VAS score was decreased in the two groups （P 〈0. 05 compared with that before treatment）, and the decrease was obvious in the treatment group （ P 〈 0. 05 ） ; the result of follow-up on the 3^rd month after treatment showed that the difference of VAS score was significant between the two groups （ P 〈 0.05 ）. After treatment for 2 weeks, VCDI score in the two groups differed from that before treatment （P 〈 0. 05 ）, but the difference was insignificant between the two groups （P 〉0. 05 ） ; the result of follow-up on the 3^rd month after treatment showed that the difference of VCDI score was significant between the two groups （P 〈 0. 05 ）. The results of safe evaluation showed that aching pain in the neck and nape and upper limb became severe, and red scratch occurred in g patients of the treatment group, but the above manifestations vanished after suspension of training. There were no any complaints in the control group. Bone fracture, dislocation and syncope as well as other adverse reaction did not show in both groups. Conclusion Isometric neck strength training is effective and safe for the treatment of neck-type cervical syndrome, with the advantages of being simple, convenient and cheap.