通督强脊“三步五法”推拿对颈型颈椎病肌肉功能影响的临床研究

Randomized controlled study on muscle function of neck type cervical spondylosis treated with Tongluo Qiangji tuina with ’three steps and five methods’

目的:观察通督强脊"三步五法"推拿对颈型颈椎病患者颈椎活动度、颈肌肌力和耐疲劳能力的影响。方法:采用多中心、单盲、随机对照的设计方法。试验分3个中心进行,将符合纳入标准的颈型颈椎病病例820例,按照1∶1的比例随机分为对照组和治疗组,分别采用间歇性颈椎牵引和通督强脊"三步五法"推拿的治疗方案。两组病例治疗周期均为2周,每天治疗1次,每周治疗5次。于治疗前后评估两组患者的颈椎活动度、颈肌最大肌力、颈肌表面肌电信号(sEMG)。结果:最终有效病例共799例,其中对照组401例,治疗组398例。两组在治疗后颈椎各方向活动度和颈肌最大肌力较本组治疗前均有不同程度增加(P<0.05),治疗组治疗后颈椎各方向活动度及颈椎前屈、后伸、右侧屈方向的最大肌力均优于对照组(P<0.05)。对照组患者除前屈外各肌肉的sEMG在治疗后与本组治疗前相比较均无显著差异,治疗组患者各肌肉的sEMG在治疗后与治疗前比较在前屈、后伸、右侧屈方向有不同程度提高(P<0.05),与对照组相比在前屈、后伸、左右侧屈方向有不同程度改善(P<0.05)。结论:通督强脊"三步五法"推拿可显著改善颈型颈椎病患者的颈椎活动功能,增强颈椎周围肌群的肌力,提高其肌肉的抗疲劳能力,从而增强颈椎的稳定性,其疗效优于颈椎间歇牵引法。

Objective: To observe the effects of Tongluo Qiangji tuina with ‘three steps and five methods’ on cervical mobility, cervical muscle strength and fatigue resistance of patients with neck type cervical spondylosis, and to provide evidence for its clinical promotion. Methods: A multi-center, single-blind, randomized controlled study were used. The study was conducted in three centers. A total of 700 cervical spondylosis patients who met the inclusion criteria were randomly divided into the control group and the treatment group according to the ratio of 1:1. The control group were treated with intermittent traction for cervical spondylosis, while the treatment group were treated with Tongluo Qiangji tuina with ‘three steps and five methods’. Patients of two groups were treated once a day and 5 times a week, and the treatment period was 2 weeks. Cervical mobility, maximal cervical muscle strength and cervical surface electromyography(sEMG) were evaluated in both groups before and after treatment. Results: There were 672 effective cases, 337 in the control group and 335 in the treatment group. The degree of cervical mobility and the maximal strength of cervical muscles in the control group and the treatment group increased in different degrees after treatment(P<0.05). The degree of cervical mobility in all directions and the maximum muscle strength of cervical spine flexion, extension and right flexion in the treatment group were better than those in the control group after treatment(P<0.05). The sEMG of each cervical muscles except spine flexion had no significant difference in the control group before and after treatment. The sEMG of each cervical muscle in the treatment group was higher in flexion, extens on and right flexion direction than before treatment(P<0.05). Compared with the control group, the sEMG of the treatment group was improved in flexion, extension and left and right flexion direction(P<0.05). Conclusion: Tongluo Qiangji tuina with ‘three steps and five methods’ can significantly improve the cervical movement function of patients with neck type cervical spondylosis, enhance the muscle strength around the cervical spine, improve the anti-fatigue ability of its muscles, thereby enhancing the stability of the cervical spine, and its efficacy is better than that of cervical intermittent traction.