三维平衡正脊手法配合针刺治疗神经根型颈椎病临床研究

Clinical Study of Three-dimensional Balanced Spine Manipulation Combined withAcupuncture in Treatment of Cervical Spondylotic Radiculopathy

目的:观察三维平衡正脊手法配合针刺治疗神经根型颈椎病(CSR)的临床疗效。方法:将90例CSR患者运用随机数字表法分观察组、对照1组、对照2组,每组各30例。由于治疗过程中三组均有病例脱落,最终观察组、对照1组、对照2组参与疗效评价者分别为28例、29例、28例。三组患者均口服双氯芬酸钠缓释片,在此基础上,观察组采用三维平衡正脊手法配合针刺治疗,针刺穴位选取颈夹脊、天柱、后溪、申脉、悬钟、手三里、少海;对照1组采用常规推拿手法配合针刺治疗,针刺选穴与操作手法同观察组;对照2组单纯采用针刺治疗,针刺选穴与操作手法同以上两组。三组患者均每日治疗1次,10次为1个疗程,共治疗3个疗程。比较三组患者颈肩部视觉模拟评分法(VAS)评分、颈椎功能障碍指数(NDI)、颈椎病治疗成绩评分,评价临床疗效。结果:三组患者治疗后的VAS评分、NDI评分、颈椎病治疗成绩评分较治疗前均改善,差异有统计学意义(P<0.05)。三组患者治疗后的颈肩部VAS评分比较,差异有统计学意义(P=0.001);观察组治疗后的颈肩部VAS评分低于对照1组(P<0.001)和对照2组(P=0.042)。三组患者治疗后的NDI评分比较,差异有统计学意义(P<0.001);观察组治疗后的NDI评分低于对照1组和对照2组(P=0.036,P<0.001);对照1组治疗后的NDI评分低于对照2组(P=0.010)。三组患者治疗后的颈椎病治疗成绩评分比较,差异有统计学意义(P=0.002);观察组治疗后的颈椎病治疗成绩评分高于对照1组和对照2组(P=0.047,P<0.001)。观察组痊愈率、显效率均明显高于对照1组和对照2组,差异有统计学意义(P<0.05)。结论:三维平衡正脊手法配合针刺治疗CSR能有效缓解患者疼痛症状,改善患者NDI,临床疗效优于常规推拿手法结合针刺治疗及单纯针刺治疗。

Objective:To observe the clinical efficacy of three-dimensional balanced spine manipulation combined with acupuncture in the treatment of cervical spondylotic radiculopathy(CSR).Methods:A total of 90 patient with CSR were randomly divided into observation group,control group 1 and control group 2,with 30 cases in each group.Due to the existence of uncompleted invalid cases in the three groups during the treatment,there were 28 cases in the observation group,29 cases in the control group 1 and 28 cases in the control group 2 who finally completed the efficacy evaluation respectively.Patients in the three groups were all treated with diclofenac sodium sustained-release tablets.On this basis,the observation group adopted three-dimensional balanced spine manipulation combined with acupuncture treatment.The acupuncture points included Jiaji(EX-B2),Tianzhu(BL10),Houxi(SL3),Shenmai(BL62),Xuanzhong(GB39),ShouSanli(LI10)and Shaohai(HT3).The control group 1 was treated with conventional tuina manipulation combined with acupuncture,and the acupuncture points selection and manipulation were the same as those in the observation group.The control group 2 was simply treated with acupuncture,and the acupuncture points selection and manipulation were the same as the above two groups.All the patients in the three groups were treated once a day,10 times for a course of treatment,with a total of 3 courses.The visual analogue scale(VAS)score of the pain in the neck and shoulder,neck disability index(NDI)score,and treatment score of cervical spondylosis were compared among the three groups.The clinical efficacy of the three groups were evaluated.Results:After treatment,the VAS,NDI and cervical spondylosis treatment scores of the three groups were all improved compared with those before treatment,and the difference was statistically significant(P<0.05).The difference among the VAS scores of the three groups were statistically significant(P<0.001).The VAS score of the observation group was lower than that of the other two groups(P<0.001,P=0.042).The difference among the NDI scores of the three groups were statistically significant(P<0.001).The VAS score of the observation group was lower than that of the other two groups(P=0.036,P<0.001).The difference among the treatment score of cervical spondylosis of the three groups were statistically significant(P=0.002).The treatment score of cervical spondylosis of the observation group was higher than that of the other two groups(P=0.047,P<0.001).The cure rate and significant effect rate of the observation group were higher than those of the control group 1 and control group 2,and the the differences were statistically significant(P<0.05).Conclusions:Three-dimensional balanced spine manipulation combined with acupuncture can effectively relieve the pain symptoms and improve the NDI of the patients with CSR,and the clinical efficacy is better than that of conventional tuina manipulation combined with acupuncture treatment and only acupuncture treatment.