基于MCU和3D-FEA对改善颈椎病疗效的前瞻性研究

Efficacy of MCU-based and 3D-FEA for Improving Cervical Spondylosis

目的:基于颈椎多功能训练评估系统(MCU)和三维有限元分析(3D-FEA),探索南少林易筋经“托天桩”功法练习是否改善电针治疗颈型颈椎病的疗效。方法:符合入选标准颈型颈椎病患者按年龄分层随机化,分为对照组和试验组。最终有效病例共156例,2组各78例。2组均采用电针治疗4周,试验组在电针治疗基础上结合南少林易筋经“托天桩”练习12周。治疗前后采用有限元模型、疼痛视觉模拟评分(VAS)、MCU对2组不同年龄段患者治疗前后疼痛情况、颈椎各方向活动度、前屈活动时C4-C7之间椎间盘应力及钩突关节囊应力变化进行比较。结果:治疗4周后,2组VAS评分均较治疗前有明显改善(P<0.05),组内各年龄组及组间各亚组差异均无统计学意义(P>0.05)。治疗12周后,试验组和各亚组VAS评分均低于对照组(P<0.05和P<0.017);且各年龄亚组疼痛评分缓解程度差异有统计学意义(P<0.05),提示青年患者疼痛缓解优于中、老年患者。治疗12周后,2组颈椎各方向活动度、各方向肌力均有不同程度增加(P<0.05),2组间以及各亚组间比较差异均有统计学意义(P<0.05和P<0.017);各年龄亚组间C4-C7椎间盘应力、C4-C7钩突关节囊应力较本组治疗前均有不同程度减少(P<0.05),试验组与对照组相比应力减少程度更为显著(P<0.05)。结论:电针结合南少林易筋经“托天桩”在缓解疼痛、改善颈椎活动度、改善肌力、减少颈椎应力方面优于单纯电针治疗,青年组患者功法治疗效果最优。

Objective:Based on the Muli-Cervical Unit(MCU)and three-dimensional finite element analysis(3D-FEA),this study explored whether the"Tuo tian zhuang"exercise in the Southern Shaolin Yi Jin Jing can improve the efficacy of electroacupuncture in the treatment of cervical spondylosis.Methods:Patients who met the inclusion criteria for cervical spondylosis of cervical type were randomized assigned by age stratification into control group and experimental group.A total of effective cases were 156 with 78 cases in each group.Both the control group and the experimental group were treated with electroacupuncture for 4 weeks,and the experimental group was continued to practise the Southern Shaolin Yi Jin Jing"Tuo tian zhuang"exercise for 12 weeks.A finite element model,the visual and analogue scale(VAS)of pain and MCU were used to compare the pain changes,including cervical spine mobility in all directions,disc stress between C4-C7 during forward flexion and joint capsule stress in the hooks of the two groups before and after treatment.Results:After 4 weeks of electroacupuncture treatment,the VAS scores of both groups were improved significantly compared with scores before treatment(P<0.05),with no significant differences between the ages groups within the group and the subgroups between the groups(all P>0.05).After 12 weeks of treatment,VAS scores were lower in the experimental group and in all subgroups than in the control group(P<0.05 and P<0.017,respectively);and there was a statistical difference in the degree of pain relief in each age subgroup(P<0.05),suggesting that young patients had better pain relief than middle-aged and elderly patients.Patients in both groups showed varying degrees of increase in cervical mobility and muscle strength in all directions(P<0.05),12 weeks of treatment with significant differences between the experimental and control groups and between subgroups(P<0.05 and P<0.017,respectively);the C4-C7 disc stress and C4-C7 crotal joint capsule stress were reduced to varying degrees between age subgroups compared to the pre-treatment period in this group.The stresses in the C4-C7 disc and C4-C7 capsular joint were reduced to varying degrees between the ages subgroups compared with those before treatment(P<0.05).Conclusion:The combination of electroacupun-cture with the Southern Shaolin Yi Jin Jing"Tuo tian zhuang"is more effective than electroacupuncture alone in relieving pain,impro-ving the mobility of the cervical spine,improving muscle strength and reducing stress in the cervical.The young group of patients have the best therapeutic effect.