八段锦锻炼联合常规康复疗法在老年神经根型颈椎病患者康复治疗中的应用

Application of BADUANJIN(八段锦) exercises combined with conventional rehabilitation therapy to the rehabilitation of cervical spondylotic radiculopathy in aged patients

目的:探讨八段锦锻炼联合常规康复疗法在老年神经根型颈椎病患者康复治疗中的应用价值。方法:将符合要求的60例老年神经根型颈椎病患者随机分为常规康复组(30例)和八段锦组(30例)。常规康复组采用口服甲钴胺片、颈椎牵引、电针联合远红外线疗法、推拿和关节松动手法、中频电疗法以及超短波疗法治疗,2周为1个疗程,共1个疗程;八段锦组在常规康复疗法的基础上配合八段锦锻炼,共12周。分别于治疗前及治疗开始后2周、12周比较2组患者颈部疼痛视觉模拟量表(visual analogue scale,VAS)评分、焦虑自评量表(self-rating anxiety scale,SAS)评分、抑郁自评量表(self-rating depression scale,SDS)评分及颈椎病治疗成绩评定表评分。结果:①颈部疼痛VAS评分。时间因素与分组因素存在交互效应(F=27.722,P=0.000);2组患者颈部疼痛VAS评分比较,组间差异有统计学意义,即存在分组效应(F=8.031,P=0.006);治疗前后不同时间点之间颈部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=97.739,P=0.000);2组患者颈部疼痛VAS评分随时间均呈下降趋势,但2组的下降趋势不完全一致[(4.07±1.14)分,(2.13±0.90)分,(0.93±0.58)分,F=91.616,P=0.000;(4.13±1.07)分,(2.10±0.76)分,(2.50±0.86)分,F=42.259,P=0.000];治疗前和治疗开始后2周,2组患者颈部疼痛VAS评分比较,差异均无统计学意义(t=-0.233,P=0.807;t=0.155,P=0.877);治疗开始后12周,八段锦组颈部疼痛VAS评分低于常规康复组(t=-8.251,P=0.000)。②SAS评分。时间因素与分组因素存在交互效应(F=8.948,P=0.000);2组患者SAS评分比较,组间差异有统计学意义,即存在分组效应(F=5.428,P=0.023);治疗前后不同时间点之间SAS评分的差异有统计学意义,即存在时间效应(F=22.020,P=0.000);八段锦组患者SAS评分随时间呈下降趋势,但常规康复组患者SAS评分不随时间发生明显变化[(47.03±6.38)分,(40.14±6.48)分,(33.48±6.00)分,F=34.807,P=0.000;(45.65±7.21)分,(42.21±8.13)分,(42.59±11.50)分,F=1.283,P=0.283];治疗前和治疗开始后2周,2组患者SAS评分比较,差异均无统计学意义(t=0.782,P=0.437;t=-1.089,P=0.281);治疗开始后12周,八段锦组SAS评分低于常规康复组(t=-3.850,P=0.000)。③SDS评分。时间因素与分组因素存在交互效应(F=4.796,P=0.013);2组患者SDS评分比较,组间差异无统计学意义,即不存在分组效应(F=0.964,P=0.330);治疗前后不同时间点之间SDS评分的差异有统计学意义,即存在时间效应(F=54.989,P=0.000);2组患者SDS评分随时间均呈下降趋势,但2组的下降趋势不完全一致[(49.49±10.25)分,(43.67±8.97)分,(37.00±8.98)分,F=13.212,P=0.000;(50.03±10.23)分,(43.83±8.87)分,(42.50±7.80)分,F=5.938,P=0.004];治疗前和治疗开始后2周,2组患者SDS评分比较,差异均无统计学意义(t=-0.205,P=0.838;t=-0.072,P=0.943);治疗开始后12周,八段锦组SDS评分低于常规康复组(t=-2.534,P=0.014)。④颈椎病治疗成绩评定表评分。时间因素与分组因素存在交互效应(F=29.730,P=0.000);2组患者颈椎病治疗成绩评定表评分比较,组间差异有统计学意义,即存在分组效应(F=25.235,P=0.000);治疗前后不同时间点之间颈椎病治疗成绩评定表评分的差异有统计学意义,即存在时间效应(F=155.061,P=0.000);2组患者颈椎病治疗成绩评定表评分随时间均呈上升趋势,但2组的上升趋势不完全一致[(16.67±2.58)分,(22.03±2.16)分,(23.93±1.74)分,F=89.215,P=0.000;(16.23±2.47)分,(21.93±1.84)分,(19.03±1.54)分,F=61.598,P=0.000];治疗前和治疗开始后2周,2组患者颈椎病治疗成绩评定表评分比较,差异均无统计学意义(t=0.664,P=0.509;t=0.193,P=0.847);治疗开始后12周,八段锦组颈椎病治疗成绩评定表评分高于常规康复组(t=11.541,P=0.000)。结论:在常规康复疗法的基础上进行八段锦锻炼,有助于缓解老年神经根型颈椎病患者颈部疼痛、减轻患者焦虑和抑郁、促进颈椎功能恢复,其疗效优于单纯的常规康复疗法。

Objective:To explore the applied values of BADUANJIN(八段锦,BDJ)exercises combined with conventional rehabilita-tion therapy in the rehabilitation of cervical spondylotic radiculopathy(CSR)in aged patients.Methods:Sixty patients with CSR were en-rolled in the study and were randomly divided into conventional rehabilitation group and BDJ group,30 cases in each group.All patients in the 2 groups were treated with oral application of mecobalamin tablets,cervical traction,electroacupuncture therapy combined with far-in-frared therapy,TUINA and joint mobilization,medium frequency electrotherapy and ultrashort wave therapy for one course of treatment,2 weeks for each course.Moreover,the patients in BDJ group were treated with BDJ exercises for consecutive 12 weeks.The neck pain visual analogue scale(VAS)score,self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score and treatment outcome score of cervical spondylosis were recorded and compared between the 2 groups before treatment and at 2 and 12 weeks after the beginning of the treatment respectively.Results:There was interaction between time factor and group factor in neck pain VAS scores(F=27.722,P=0.000).There was statistical difference in neck pain VAS scores between the 2 groups,in other words,there was group effect(F=8.031,P=0.006).There was statistical difference in neck pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=97.739,P=0.000).The neck pain VAS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing tendency(4.07+/-1.14,2.13+/-0.90,0.93+/-0.58 points,F=91.616,P=0.000;4.13+/-1.07,2.10+/-0.76,2.50+/-0.86 points,F=42.259,P=0.000).There was no statisti-cal difference in neck pain VAS scores between the 2 groups before the treatment and at 2 weeks after the beginning of the treatment(t=-0.233,P=0.807;t=0.155,P=0.877).The neck pain VAS scores were lower in BDJ group compared to conventional rehabilita-tion group at 12 weeks after the beginning of the treatment(t=-8.251,P=0.000).There was interaction between time factor and group factor in SAS scores(F=8.948,P=0.000).There was statistical difference in SAS scores between the 2 groups,in other words,there was group effect(F=5.428,P=0.023).There was statistical difference in SAS scores between different timepoints before and after the treat-ment,in other words,there was time effect(F=22.020,P=0.000).The SAS scores presented a time-dependent decreasing trend in BDJ group and remained substantially unchanged in conventional rehabilitation group(47.03+/-6.38,40.14+/-6.48,33.48+/-6.00 points,F=34.807,P=0.000;45.65+/-7.21,42.21+/-8.13,42.59+/-11.50 points,F=1.283,P=0.283).There was no statistical differ-ence in SAS scores between the 2 groups before the treatment and at 2 weeks after the beginning of the treatment(t=0.782,P=0.437;t=-1.089,P=0.281).The SAS scores were lower in BDJ group compared to conventional rehabilitation group at 12 weeks after the begin-ning of the treatment(t=-3.850,P=0.000).There was interaction between time factor and group factor in SDS scores(F=4.796,P=0.013).There was no statistical difference in SDS scores between the 2 groups,in other words,there was no group effect(F=0.964,P=0.330).There was statistical difference in SDS scores between different timepoints before and after the treatment,in other words,there was time effect(F=54.989,P=0.000).The SDS scores presented a time-dependent decreasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the decreasing tendency(49.49+/-10.25,43.67+/-8.97,37.00+/-8.98 points,F=13.212,P=0.000;50.03+/-10.23,43.83+/-8.87,42.50+/-7.80 points,F=5.938,P=0.004).There was no statistical difference in SDS scores between the 2 groups before the treatment and at 2 weeks after the beginning of the treatment(t=-0.205,P=0.838;t=-0.072,P=0.943).The SDS scores were lower in BDJ group compared to conventional rehabilitation group at 12 weeks after the be-ginning of the treatment(t=-2.534,P=0.014).There was interaction between time factor and group factor in treatment outcome scores of cervical spondylosis(F=29.730,P=0.000).There was statistical difference in treatment outcome scores of cervical spondylosis be-tween the 2 groups,in other words,there was group effect(F=25.235,P=0.000).There was statistical difference in treatment outcome scores of cervical spondylosis between different timepoints before and after the treatment,in other words,there was time effect(F=155.061,P=0.000).The treatment outcome scores of cervical spondylosis presented a time-dependent increasing trend in both of the 2 groups,while the 2 groups were inconsistent with each other in the increasing tendency(16.67+/-2.58,22.03+/-2.16,23.93+/-1.74 points,F=89.215,P=0.000;16.23+/-2.47,21.93+/-1.84,19.03+/-1.54 points,F=61.598,P=0.000).There was no statistical difference in treatment outcome scores of cervical spondylosis between the 2 groups before the treatment and at 2 weeks after the beginning of the treatment(t=0.664,P=0.509;t=0.193,P=0.847).The treatment outcome scores of cervical spondylosis were higher in BDJ group compared to conventional rehabilitation group at 12 weeks after the beginning of the treatment(t=11.541,P=0.000).Conclusion:On the basis of conventional rehabilitation therapy,BDJ exercises is helpful to relieving neck pain,alleviating anxiety and depression and promoting cervical functional recovery in aged patients with CSR.The combination therapy surpasses the monotherapy of conventional rehabilitation therapy in the clinical curative effect.