阻滞联合手法复位治疗颈源性头痛的疗效分析

A clinical study for the treatment of cervicogenic headache via upper cervical paravertebral block combined with manipulative reduction

目的:探讨高位颈椎旁阻滞联合手法复位对颈源性头痛的治疗效果。方法:40例颈源性头痛患者随机分为两组(A,n=20例;B,n=20例),A组接受颈2椎旁阻滞治疗,B组接受手法复位联合颈2椎旁阻滞治疗。比较治疗前后及不同治疗方法治疗后不同时间段,患者的轻、中度头痛天数、剧烈头痛的发作次数及服药剂量。结果:A组接受治疗后1—2个月、3—4个月,患者的每月轻、中度头痛天数、剧烈头痛发作次数及口服非甾体类抗炎药物(NSAID)的剂量分别为:2.5±1.1d、1.0±0.30次、200±50mg/d和7.6±3.5d、1.6±0.4次、860±80mg/d均较治疗前2个月明显减少,差异有极显著意义(P<0.01);B组治疗后1—2个月、3—4个月的数据分别为:2.3±1.0d、1.2±0.45次、300±75mg/d和3.7±2.3d、1.0±0.33次、350±100mg/d,较治疗前2个月明显减少,差异有极显著意义(P<0.01);B组治疗后3—4个月,患者每月头痛天数、剧烈头痛发作次数及口服NSAID的剂量均较A组:7.6±3.5d、1.6±0.4次和860±80mg/d明显减少,差异有显著意义(P<0.05)。结论:高位颈椎旁阻滞联合手法复位治疗颈源性头痛疗效优于单纯高位颈椎旁阻滞,但其远期疗效尚待探讨。

Objective： To study the effect of upper cervical paravertebral block combined with manipulative reduction for the treatment of cervicogenic headache. Method： Forty patients suffered from cervicogenic headache, aged between 25 and 48 years were randomly di- vided into A and B groups （20 patients in each group）. Group A received C2 paravertebral block treatment, group B received manual reduction combined with C2 paravertebral block. The pain score, severity of pain epi- sode and the amount of medication before and after treatment were compared. Result： For group A, posttreatment 1--2 months and 3--4 months, the monthly days of mild and moderate headache, the number of severe headache episode, and the amount of oral non-steroidal anti-inflammatory drugs （NSAID） were 2.5 ± 1.1d, 1.0 ± 0.30times,200 ± 50mg/d and 7.6± 3.5d, 1.6 ± 0.4times,860 ± 80mg/d respectively;com- pared with 2 months pretreatment all reduced significantly（P〈0.01）. For group B, posttreatment 1-2 months and 3--4 months, the monthly days of mild and moderate headache, the number of severe headache episode, and the amount of oral NSAID were 2.3 ± 1.0d, 1.2± 0,45times, 300 ± 75mg/d and 3.7 ±2.3d, 1.0 ± 0.33times, 350 ± 100mg/d respectively; compared with 2 months pretreatment all also reduced significantly（P〈0.01）. In group A posttreatment 3--4 months, the monthly days of mild and moderate headache, the number of severe headache episode, and the amount of oral NSAID were 7.6 ± 3.5d, 1.6 ± 0.4times and 860± 80mg/d respectively. There were signifi-cant difference between group B and group A posttreatment 3--4 months（P〈0.05）. Conclusion： For effects of the treatment of cervicogenic headache, upper cervical paravertebral block combined with manipulative reduction was better than the upper cervical paravertebral block alone, but its long-term effect needed to be further explore.