选择性颈神经根阻滞联合牵引疗法对老年神经根型颈椎病疗效的临床研究

Clinical research of selective nerve block combined with traction therapy in elderly patients with cervical spondylotic radiculopathy

目的探讨超声引导下选择性颈神经根阻滞联合颈椎牵引疗法治疗老年患者神经根型颈椎病(CSR)的临床疗效。方法选取2018年1月~2019年1月联勤保障部队第967医院软伤科收治的CSR老年患者100例,按随机数表法随机分为两组:对照组50例,采用超声引导下选择性颈神经根阻滞治疗;联合组50例,采用超声引导下选择性颈神经根阻滞治疗联合颈椎牵引疗法治疗。于治疗前、治疗后1周、4周、6个月采用视觉模拟评分量表(VAS)和颈椎功能障碍指数(NDI)评分。治疗后6个月依据改良Macnab疗效评定标准进行疗效评定,计算治疗优良率和总有效率,并记录不良事件及并发症发生情况。测定两组患者血清肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)的水平变化情况。结果纳入病例脱落13例,脱落率13%,最终共87例纳入研究,联合组45例,对照组42例。治疗后两组各时点VAS评分、NDI评分较治疗前均降低,且联合组较对照组下降程度更为显著,差异有统计学意义(P<0.05)。治疗后4周,两组TNF-α和IL-1β水平较治疗前均降低,且联合组降低更为显著,差异有统计学意义(P<0.05)。Pearson相关性分析显示,联合组治疗前后TNF-α与VAS评分均呈正相关(r=0.581、0.557,P<0.05),治疗前后IL-1β与VAS评分均呈正相关(r=0.592、0.564,P<0.05)。联合组临床疗效优良率为84.4%,高于对照组的61.9%,差异有统计学意义(P<0.05);总有效率为95.6%,高于对照组的85.7%,差异无统计学意义(P>0.05)。所有患者未见眩晕、骨折脱位及心脑血管不良事件等不良反应,未发生误穿入血管、胸腔、内脏,未发生神经损伤等并发症。结论超声引导下选择性颈神经根阻滞治疗联合颈椎牵引疗法治疗老年患者CSR疗效确切,安全性高,可有效降低患者血清炎症因子水平。

Objective To evaluate the effect of selective nerve block combined with traction therapy in elderly patients with cervical spondylotic radiculopathy(CSR).Methods 100 elderly patients with CSR were enrolled.They were randomly divided into two groups.Combined therapy group:Ultrasound-guided selective nerve block combined with traction therapy.Control group:Ultrasound-guided selective nerve block.Prior to,and then one week,four weeks,and six months after treatment,the severity of radical pain were assessed by VAS and NDI.Six months after treatment,the efficacy evaluation was performed according to the modified Macnab efficacy evaluation standard,and the excellent rate and effective rate were calculated,and any complications were recorded.The levels of TNF-αand IL-1βwere measured in the two groups.Results A total of 87 cases were included in the statistics,45 cases in the combined therapy group,42 cases in the control group,13 cases dropped-out,and the drop-out rate was 13%.After treatment,the VAS scores and NDI scores of the two groups were lower than those before treatment(P<0.05).At four weeks after treatment,the levels of TNF-αand IL-1βin both groups were lower than those before treatment(P<0.05).Compared with the control group,the degree reduction of the combined therapy group were more significant than that of the control group(P<0.05).Pearson correlation analysis showed that there was a positive correlation between TNF-αand VAS scores before and after treatment in the combined therapy group(r=0.581,0.557,P<0.05).There was a positive correlation between IL-1βand VAS scores before and after treatment in the combined therapy group too(r=0.592,0.564,P<0.05).The excellent rate of the combined therapy group was 84.4%,which was higher than the 61.9%of the control group,and the difference was statistically significant(P<0.05);the effective rate of the combined group was 95.6%,which was higher than the control therapy group of 85.7%,but the difference was not statistically significant(P=0.120).None of the patients had any adverse reactions such as dizziness,fracture or dislocation,or cardiovascular/cerebrovascular events.There were no complications such as accidental penetration into the blood vessels,chest cavity,internal organs,or nerve damage.Conclusion Ultrasound-guided selective nerve block combined with traction therapy is effective,safe in the treatment of elderly patients with CSR,which can effectively reduce the level of serum inflammatory factors in patients.