颈椎定点引伸手法治疗神经根型颈椎病的随机对照研究

Efficacy of cervical fixed-point traction manipulation for cervical spondylotic radiculopathy: a randomized controlled trial

背景:神经根型颈椎病是临床常见病、多发病,颈椎定点引伸手法是治疗神经根型颈椎病的方法之一。目的:评价颈椎定点引伸手法治疗神经根型颈椎病的临床疗效。设计、场所、对象和干预措施:采用前瞻性随机对照设计,84例神经根型颈椎病患者均为解放军总医院康复医学科门诊患者,随机分为治疗组和对照组,每组42例。治疗组采用颈椎定点引伸手法治疗,隔日1次,共7次;对照组单纯使用颈椎电脑牵引治疗,1次/d,每次30min,治疗14d。主要结局指标:采用视觉模拟量表(visual analogue scale,VAS)评估疼痛强度,应用红外热成像仪采集健肢与患肢皮肤温度,并计算健、患侧上肢温度差值。结果:治疗中脱落5例,其中治疗组1例,对照组4例。治疗组治疗后VAS评分和健、患侧上肢皮肤温度差值低于治疗前(t=28.652,P<0.01;t=64.214,P<0.01);对照组治疗后VAS评分和健、患侧上肢皮肤温度差值亦低于治疗前(t=14.484,P<0.05;t=84.425,P<0.05);治疗组VAS评分和上肢温度差值治疗前后的差异较对照组明显(t=7.494,P<0.01;t=5.321,P<0.01)。结论:颈椎定点引伸手法治疗神经根型颈椎病疗效优于颈椎牵引法,主要表现为缓解患者疼痛和减轻神经根压迫等。

BACKGROUND： Cervical spondylotic radiculopathy is a commonly encountered and frequently occurring disease. Traditional Chinese osteopathic manipulations may have better therapeutic efficacy than that of other methods in treating patients with cervical spondylotic radiculopathy. OBJECTIVE： To evaluate the clinical therapeutic effects of cervical fixed-point traction manipulation in treating patients with cervical spondylotic radiculopathy. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A prospective, randomized controlled trial was adopted. Eighty-four patients with cervical spondylotic radiculopathy were randomly divided into treatment group （n=42） and control group （n=42）. All patients were enrolled from the outpatient service of Department of Rehabilitation of Chinese PLA General Hospital of China. Patients received oral and written information about clinical procedures before giving their written informed consent. The patients were treated with cervical fixed-point traction manipulation （treatment group） or cervical computer traction （control group）. Cervical fixed-point traction was performed once every other day for a total of seven treatment periods and cervical computer traction was performed 30 min, once per day for 14 d. MAIN OUTCOME MEASURES： Before and after treatment, visual analogue scale （VAS） score and temperature of upper limb skin （normal limb and abnormal limb） detected by infrared thermal imaging system were contrastively analyzed. RESULTS： Five patients were lost to follow-up, one patient in the treatment group and four patients in the control group. There were significant differences in VAS score and temperature difference between the normal and abnormal upper limbs of infrared thermal imaging in the treatment group （t=28.652, P〈0.01; t=64.214, P〈0.01） or in the control group （t=14.484, P0.05; t=84.425, P0.05） compared between before and after treatment. After treatment, the changes in VAS score and temperature difference of normal and abnormal upper limbs in the treatment group were more obvious compared with the control group （t=7.494, P〈0.01; t=5.321, P〈0.01）. CONCLUSION： Cervical fixed-point traction manipulation has better efficacy than cervical computer traction in treating patients with cervical spondylotic radiculopathy.