刃针闭合松解联合牵引下复位治疗神经根型颈椎病的临床研究

Clinical study on curing the cervical spondylotic radiculopathy with the methods of Blade needle closed loosing and reduction with traction at the same time

目的:探讨刃针闭合松解联合牵引下复位治疗神经根型颈椎病临床疗效。方法:2006年5月至2009年5月治疗神经根型颈椎病65例,采用简单随机法,根据SAS统计软件生成随机数字表,将65例神经根型颈椎病患者随机分为治疗组和对照组,治疗组35例,男18例,女17例,年龄42～73岁,平均(61.3±6.4)岁,病程8～42个月,平均(23.8±13.8)个月,治疗前颈椎功能评分4～17分,平均(11.45±3.31)分。对照组30例,男14例,女16例,年龄44～76岁,平均(62.4±8.8)岁;病程7～43个月,平均(24.4±16.8)个月,治疗前颈椎功能评分4～18分,平均(11.40±3.24)分。治疗组给予刃针闭合松解联合术后牵引复位治疗,对照组给予常规牵引治疗。分别于治疗后10、20、180d进行随访,根据中医病症诊断疗效标准对比两组颈椎功能评分,其中包括颈肩臂疼痛、颈部活动受限、颈部压痛、上肢麻木、上肢肌力下降等。结果:①治疗后10d,颈椎功能总评分治疗组为(15.43±3.46)分,对照组为(13.17±3.18)分,治疗组明显优于对照组(P<0.01);各项症状评分比较:颈部压痛治疗组优于对照组(P<0.05),活动受限、肌力下降改善更为明显(P<0.01)。②治疗后20d,颈椎功能总评分治疗组为(18.00±2.94)分,对照组为(15.90±2.89)分,治疗组明显优于对照组(P<0.01);各项症状评分比较:颈肩臂疼痛、肌力下降、上肢麻木治疗组优于对照组(P<0.05),尤以活动受限、颈部压痛改善更明显(P<0.01)。③治疗后180d,颈椎功能总评分治疗组为(16.63±3.32)分,对照组(12.67±3.42)分,治疗组明显优于对照组(P<0.01);各项症状评分比较:上肢麻木治疗组优于对照组(P<0.05),尤以颈肩臂疼痛、颈肩活动度受限,颈部压痛、颈肩上肢肌力下降改善更为明显(P<0.01)。结论:与传统牵引相比,刃针闭合松解联合牵引下复位治疗神经根型颈椎病可较快地获得颈椎功能的改善;能有效缓解颈肩臂疼痛、颈部活动受限及上肢麻木,且长期疗效稳定。

Objective：To observe the effects of curing the cervical spondylotic radiculopathy with the methods of Blade needle closed loosing and reduction with traction at the same time. Methods：From May 2006 to May 2009,65 patients with cervical spondylotic radiculopathy were divided into treatment group and control group according the random number table produced by SAS Software. There were 18 males and 17 females in the treatment group,age in range from 42 to 73 years old with an average of（61.3±6.4） years,course of disease was from 8 to 42 months with an average of（23.8±13.8） months,preoperatively cervical functional score was from 4 to 17 scores with the mean of （11.45±3.31） scores. And in the control group,including 14 males and 16 females,aged from 44 to 76 years old with an average of（62.4±8.8） years,course of disease was from 7 to 43 months with an average of（24.4±16.8） months,preoperatively cervical functional score was from 4 to 18 scores with the mean of （11.40±3.24） scores. The patients of treatment group were treated with Blade needle closed loosing the specific pain point on the neck and shoulder,then immediately underwent traction and reduction after operation. And the patients of control group were treated with traditional traction. The cervical functional score were compared between the two groups at 10,20,180 d after treatment,including pain of neck and shoulder,limitation of motion of neck,tenderness of neck,numbness and muscle weakness of upper limb. Results：①At the 10th day after treatment,the total score of treatment group was（15.43±3.46） scores,which was obviously higher than that of control group＇s（13.17±3.18） scores（P0.01）. In different symptoms,treatment group also was better than that of control grou（P0.05）,so as in the tenderness of neck,and especially in the limitation of motion of neck and muscle weakness of upper limb decreased obviously（P0.01）. ②At the 20th day after treatment,the total score of treatment group was（18.00±2.94） scores,which was obviously better than that of control group＇s （15.90±2.89） scores（P0.01）. In different symptoms,treatment group also was better than that of control group（P0.05）,so as in the pain of neck and shoulder,numbness and muscle weakness of upper limb（P0.05）,and especially in the limitation of motion of neck,tenderness of neck decreased obviously（P0.01）. ③At the 180th day after treatment,the total score of treatment group was （16.63±3.32） scores,which was obviously better than that of control group＇s （12.67±3.42） scores（P0.01）;In different symptoms,treatment group also was better than that of control group（P0.05）,so as in the numbness of upper limb（P0.05）,and especially in the pain of neck and shoulder,muscle weakness of upper limb,limitation of motion of neck,tenderness of neck decreased obviously（P0.01）.Conclusion：Compared with method of traditional traction,Blade needle closed loosing and traction in treating cervical spondylotic radiculopathy can significantly obtain clinical effects,which can quickly improve symptoms,relieve pain of neck and shoulder,limitation of motion of neck,tenderness of neck,numbness and muscle weakness of upper limb.