活血通络汤联合针灸、推拿手法治疗椎动脉型颈椎病

Treatment of Vertebral Artery Cervical Spondylopathy with Huoxue Tongluo Decoction as Well as Acupuncture and Massage

目的:观察采用活血通络汤联合针灸、推拿手法治疗椎动脉型颈椎病(cervical spondylosis of vertebral artery type,CSA)的临床疗效和安全性。方法:120例经临床确诊的CSA患者采用随机抽签方法分为两组,对照组60例采用活血通络汤治疗4周,研究组60例采用活血通络汤联合针灸推拿治疗4周。对比两组患者临床疗效、椎-基底动脉血流参数、颈椎活动度的变化,采用颈性眩晕症状与功能评估量表(cervical vertigo symptoms and functional assessment scales,ESCV)评价两组治疗前后临床症状和颈椎功能的差异,并对两组治疗期间的安全性进行评估。结果:研究组临床有效率为93.33%,对照组有效率为78.33%,两组比较,差异有统计学意义(P<0.05)。两组患者治疗后椎动脉血流动力学参数、颈椎活动度、临床症状和颈椎功能均较治疗前显著改善(P<0.05)。与对照组相比,研究组治疗后左右椎动脉、基底动脉舒张期血流速度(diastolic velocity,Vd)、收缩期血流速度(systolic velocity,Vs)、平均血流速度(mean velocity,Vm)增加明显(P<0.05)、血管搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)降低幅度更大(P<0.05),ESCV积分提高幅度更显著(P<0.05),颈椎前屈、后伸、左侧屈、右侧屈、左侧旋、右侧旋角度改善程度更大(P<0.05),两组均无严重不良反应。结论:活血通络汤联合针灸、推拿手法对CSA患者临床症状、椎-基底动脉血流供应、颈椎功能改善更加显著,效果优于单纯中药治疗。

Objective:To observe the clinical efficacy and safety of Huoxue Tongluo Decoction combined with acupuncture and massage for the treatment of cervical spondylosis of vertebral artery type(CSA).Methods:120 patients with clinically diagnosed CSA were randomly divided into two groups,60 cases in the control group were treated with Huoxue Tongluo Decoction for 4 weeks,and 60 cases in the study group were treated with Huoxue Tongluo Decoction combined with acupuncture and massage for 4 weeks.The clinical efficacy,vertebral-basal artery blood flow parameters,and cervical spine mobility of the two groups were compared.The cervical vertigo symptoms and functional assessment scales(ESCV)were used to evaluate the clinical symptoms and the treatment of the two groups before and after treatment.Differences in cervical spine function,and the safety of the two groups during treatment was evaluated.Results:The clinical effective rate of the research group was 93.33%,and the effective rate of the control group was 78.33%.The difference between the two groups was statistically significant(P<0.05).The vertebral artery hemodynamic parameters,cervical spine mobility,clinical symptoms and cervical spine function were significantly improved after treatment in both groups(P<0.05).Compared with the control group,the diastolic velocity(Vd),systolic velocity(Vs),and mean velocity(Vm)of the left and right vertebral arteries and basilar arteries in the study group after treatment were compared.Significant increase(P<0.05),pulsatility index(PI),resistance index(resistance index,RI)decreased more(P<0.05),ESCV score increased more significantly(P<0.05).The degree of cervical anterior flexion,rear extension,left flexion,right flexion,left-hand rotation,and right-hand rotation improved sinificantly(P<0.05).There were no serious adverse reactions in both groups.Conclusion:Huoxue Tongluo decoction combined with acupuncture and massage manipulation has more significant improvement in clinical symptoms,vertebral-basal artery blood supply and cervical spine function in CSA patients and the effect is better than that of simple Chinese medicine treatment.