针灸联合推拿手法对椎动脉型颈椎病患者的疗效及其对血流动力学和颈椎活动度的影响

Effect of Acupuncture Combined With Massage on Hemodynamics and Cervical Activity in the Patients with Cervical Spondylosis of Vertebral Artery Type

目的:探讨针灸联合推拿手法对椎动脉型颈椎病(CSA)患者的疗效及其对血流动力学和颈椎活动度的影响。方法:选取2015年9月-2017年9月期间山东省医学科学院颈肩腰腿痛医院收治的CSA患者900例为研究对象。根据随机数字表法将患者分为对照组(n=450)与研究组(n=450)。对照组给予针灸治疗,研究组则在对照组的基础上联合推拿手法治疗,两组患者均治疗14d,同时进行为期3个月的随访。观察两组患者临床疗效、症状评分、血流动力学以及颈椎活动度等变化情况。结果:治疗后研究组患者临床总有效率为96.44%(434/450),显著高于对照组的83.78%(377/450)(P<0.05)。两组患者治疗后眩晕、恶心或呕吐、头痛、肩颈痛、旋颈试验、生活及工作评分均较治疗前升高,且研究组高于对照组(P<0.05)。两组治疗后平均血流速度(TMFV)、收缩期峰值血流速度(PSV)均较治疗前升高,搏动指数(PI)、阻力指数(RI)均较治疗前降低,且研究组治疗后TMFV、PSV高于对照组,PI、RI低于对照组(P<0.05)。两组患者治疗3个月后前屈、后伸、左侧屈、右侧屈、左侧旋以及右侧旋活动度均较治疗前升高,且研究组后伸、左侧屈、右侧屈、左侧旋以及右侧旋活动度高于对照组(P<0.05)。结论:针灸联合推拿手法治疗CSA效果优于单用针灸治疗,对患者症状评分、血流动力学以及颈椎活动度均有改善作用,可进一步推广应用。

Objective： To investigate the effect of acupuncture combined with massage on hemodynamics and cervical activity in the patients with cervical spondylosis of vertebral artery type（CSA）. Methods： 900 cases of CSA patients who were treated in Neck and Shoulder Pain Hospital of Shandong Academy of Medical Sciences from September 2015 to September 2017 were selected as the research object. The patients were randomly divided into control group（n=450） and study group（n=450） according to the number table method. The control group was treated with acupuncture, and the study group was combined with massage on the basis of the control group. The patients were treated with 14 d, followed-up for 3 months.The changes of clinical efficacy, symptom score, hemodynamics and cervical activity in the two groups were observed. Results： The total clinical effective rate of the study group was 96.44%（434/450）,which was significantly higher than 83.78%（377/450） of the control group（P〈0.05）. Vertigo, nausea and vomiting, headache, shoulder neck pain, neck rotation test, life and work scores of the two groups after treatment were all higher than those before treatment, and the study group was higher than that of the control group（P〈0.05）. The average velocity of blood flow（TMFV）, peak systolic blood velocity（PSV） after treatment in the two groups were all higher than those before treatment, the pulsation index（PI）, the resistance index（RI）were lower than those before treatment, the TMFV and PSV in the study group were higher than those of the control group, PI and RI were lower than those of the control group（P〈0.05）. The flexion, extension, left flexion, right flexion, left rotation and right rotation of the two groups 3 months after treatment were all higher than those before treatment, the extension, left flexion, right flexion, left rotation and right rotation activity of the study group were higher than those of the control group（P〈0.05）. Conclusion： The effect of acupuncture combined with massage in the treatment of CSA is better than that of acupuncture alone, can improve the patient＇s symptom score,hemodynamics, and cervical spine activity, it can be further popularized and applied.