C2及C3脊神经后支阻滞联合斜方肌上束伸拉训练治疗颈源性头痛的疗效观察

Observation on the therapeutic effect of nerve block of posterior branches of C2 and C3 spinal nerve combined with stretch training of upper bundle of trapezius muscle for treatment of cervical headache

目的观察实施C2及C3脊神经后支阻滞联合斜方肌上束伸拉训练治疗颈源性头痛的临床疗效。方法前瞻性研究选择2016年5月至2017年9月在京东中美医院疼痛门诊收治的单侧或/和双侧颈源性头痛(18~50岁)患者40例,随机分为两组:C2及C3脊神经后支阻滞(B组,n=20)和C2及C3脊神经后支阻滞+斜方肌上束伸拉训练(T组,n=20)。治疗方法:(1)C2及C3脊神经后支阻滞:选择患侧C2及C3椎板(棘突旁开1 cm),垂直穿刺至针尖抵于C2或C3椎板骨质;分别注射药物:0.3%利多卡因+甲强龙注射剂20 mg+腺苷钴胺0.5 mg+生理盐水至3 ml(每周1次,共2次)。(2)C2及C3脊神经后支阻滞(方法同前)+斜方肌上束伸拉训练(治疗后的第3周和第4周)。观察比较治疗前与治疗后4周两组患者颈枕部症状评分(COSS分值)、颈枕部压痛点评分(COTS分值)、颈椎屈曲-旋转试验(CFRT)评分。结果治疗前,两组患者COSS分值、COTS分值及CFRT试验评分均无显著差异(P>0.05)。治疗后,(1)COSS分值:组内比较,两组治疗后4周COSS分值均明显低于治疗前,差异有显著性(P<0.05);组间比较,治疗后4周,T组的COSS分值明显低于B组,差异有显著性(P<0.05)。(2)COTS分值。组内比较:两组治疗后4周COTS分值均明显低于治疗前,差异有显著性(P<0.05);组间比较:治疗后4周,T组的COTS分值明显低于B组,差异有显著性(P<0.05)。(3)CFRT试验评分:组内比较,两组治疗后4周CFRT试验评分值均明显低于治疗前,差异有显著性(P<0.05);组间比较,治疗后4周,T组的CFRT试验评分值明显低于B组,差异有显著性(P<0.05)。结论与单纯C2及C3脊神经后支阻滞相比,C2及C3脊神经后支阻滞联合斜方肌上束伸拉训练方法治疗颈源性头痛,疗效更确切、更稳定。

Objective To observe the therapeutic effect of nerve block of posterior branches of C2 and C3 spinal nerve(NBPBSN)combined with stretch training of upper bundle of trapezial muscle(STUPTM)for treatment of cervical headache.Methods In this prospective study,forty patients with unilateral or bilateral cervical headache,aged from 18 to 50 years old,were randomly assigned to group B(n=20)in which NBPBSN was performed and group T(n=20)in which NBPBSN combined with STUPTM was performed.Patients in group B received NBPBSN and the procedure was firstly to choose the puncture site 1 cm lateral to spinous process of C2 or C3 and then vertically proceed to reach the lamina.The solution of lidocaine(0.3%),methylprednisolone(20 mg)and cobamamide(0.5 mg)in 0.9%sodium chloride solution diluted to 3ml was injected once a week and twice in total.Patients in group T received NBPBSN combined with STUPTM,and it was to do stretch training of upper bundle of trapezius muscle and it was performed in third and fourth weeks after the finish of NBPBSN.Cervical occipital symptom scores(COSS),cervical occipital tenderness scores(COTS),and cervical flexion-rotation test(CFRT)were compared between these two groups before treatment and four weeks after treatment.Results There was no significant difference in COSS scores,COTS scores and CFRT test scores between these two groups before treatment(P>0.05).After treatment:①In comparison with COSS scores:among groups,COSS scores of these two groups after treatment for 4 weeks were significantly lower than those before treatment,and the difference was statistically significant(P<0.05).After 4 weeks of treatment,the COSS scores of T group were significantly lower than those of group B,with significant difference(P<0.05).②In comparison with groups,the COTS scores of these two groups after treatment for 4 weeks were significantly lower than those before treatment,and the difference was significant(P<0.05).In compaison between these two groups:after 4 weeks of treatment,COTS scores in T group were significantly lower than those of B group,and the difference was significant(P<0.05).③The comparison in CFRT test scores:among groups,the scores of CFRT test in these two groups after treatment for 4 weeks were significantly lower than those before treatment(P<0.05).After treastment for 4 weeks,the scores of CFRT test in group T were significantly lower than those of group B,with significant difference(P<0.05).Conclusion In compareison with NBPBSN block,NBPBSN combined with STUPTM have more definite and stable therapeutic effect for treatment of cervical headache.