枕部针刀松解治疗颈源性头痛的临床研究

Clinical study on acupotomy of occipitalia on the treatment of cervicogenic headache

目的:观察针刀治疗颈源性头痛的效果,探讨皮神经卡压因素在颈源性头痛发病中的作用。方法:自2008年10月至2009年6月,采用针刀松解术治疗颈源性头痛患者82例,治疗部位为枕部,左右两侧共8点:乳突后压痛点;乳突与C2棘突连线中点;枕骨粗隆与乳突连线内1/3交点;C2棘突水平后正中点旁开1.5～2cm处压痛点。男23例,女59例;年龄17～73岁,平均41.57岁;病程0.5～50年,平均10.4年。患者均以头痛为第一主诉,本文以头痛疼痛强度(PPI)评估分级为观察指标。结果:术后1个月总有效率为81.70%(67/82),术后3个月内复发现象明显。但17.07%(14/82)的患者在治疗后6个月未复发。结论:一次针刀松解治疗使17.07%的颈源性头痛患者获得临床痊愈,说明皮神经卡压因素是颈源性头痛的重要病因;针刀治疗后3个月内患者头痛复发现象明显,提示应在此期间增加治疗次数并扩大治疗范围。

Objective：To observe the effects of acupotomy on cervicogenic headache and explore the function of cutaneous nerve entrapment in the mechanism of cervicogenic headache. Methods：From October 2008 to June 2009,82 patients with cervicogenic headache were treated with acupotomy. There were 23 males and 59 females,ranging in age from 17 to 73 years（averaged 41.57 years）. The course of disease ranged from 0.5 to 50 years,with an average of 10.4 years. The location of treatment was occipitalia,both of left and right side：altogether were 8 points,including tenderness point of postmastoid;the midpoint between mastoid and C2 spinous process;the internal 1/3 attachment between occipital protuberance and mastoid process;the posterior midline of C2 spinous process open to 1.5～2 cm. The chief complaint of all patients was headache. PPI assessment rating was observed. Results：The total effective rate at 1 month after treatment was 81.70%（67/82）. Recurrence of headache within 3 months after treatment was obvious. However,17.07%（14/82） patients did not reoccur at 6 months after treatment. Conclusion：17.07% patients with cervicogenic headache recovered by acupotomy,so it shows cutaneous nerve entrapment plays an important role in the mechanism of cervicogenic headache. For the patients whose headache recurred at 3 months after treatment,increasing the treatment time and therapeutic range is suggested.