基于“筋骨并重”探讨针药并用、理筋整复手法治疗神经根型颈椎病(气滞血瘀证)的效果及机制

Based on the Principle of“Equal Emphasis on Muscles and Bones”to Explore the Effect and Mechanism of Acupuncture and Medicine Combined with Reconditioning and Reconditioning in the Treatment of Cervical Spondylotic Radiculopathy(Qi Stagnation and Blood Stasis Syndrome)

目的:观察针药并用、理筋整复手法治疗神经根型颈椎病(气滞血瘀证)的临床效果,初步对可能的起效机制进行探究。方法:将就诊于我院的118例神经根型颈椎病患者,按照随机数字表法分为对照组(n=59)和观察组(n=59)。对照组患者给予理筋整复手法;观察组患者在对照组基础上加用针灸、中药汤剂进行内外合治。比较两组有效率,测定颈椎活动度,评估颈肩疼痛程度、强度、分级指数,监测血清中肿瘤坏死因子-α(TNF-α)、降钙素基因相关肽(CGRP)、内皮素-1(ET-1)、一氧化氮(NO)水平变化。结果:观察组的有效率高达93.22%(55/59),明显高于对照组的77.97%(46/59),差异有统计学意义(χ^(2)=0.018,P<0.05);与对照组相比,观察组患者治疗后的颈椎活动度改善更明显,颈椎活动相关的右旋、左旋、后伸、前屈、左屈、右屈度明显高于对照组(P<0.05);观察组患者治疗后的颈椎疼痛减轻更明显,VAS、PPI、PRI评分显著降低(P<0.05);观察组患者炎症状态、血管内皮功能改善优于对照组,血清中TNF-α、CGRP、ET-1水平低于对照组,NO水平高于对照组(P<0.05)。结论:针药并用、理筋整复手法利于提高神经根型颈椎病患者的颈椎活动度,缓解颈椎痛感,其机制可能与干预血清中TNF-α、CGRP、ET-1、NO水平以减轻炎症反应、改善血管内皮功能有关,值得进行临床推广。

Objective To observe the clinical effect of acupuncture and medicine combined with reconditioning and reconditioning in the treatment of cervical spondylotic radiculopathy(qi stagnation and blood stasis syndrome),and to preliminarily explore the possible mechanism of the study.Methods A total of 118 patients with cervical spondylotic radiculopathy admitted to our hospital were divided into control group(n=59)and observation group(n=59)according to random number table method.Patients in the control group were given the reconditioning technique.The patients in observation groupwere given acupuncture,moxibustion and Chinese medicine decoction on the basis of control group.The clinical efficacy of the two groups were compared,the degree of cervical activity was measured.The degree,intensity and grading index of neck and the shoulder pain were evaluated and the serum changes in TNF-α,CGRP,ET-1 and NO levels were monitored.Results The effective rate of the observation group was as high as 93.22%(55/59),which was significantly higher than that of the control group of 77.97%(46/59),which the difference was statistically significant(χ^(2)=0.018,P<0.05).Compared with the control group,the patients in the observation group showed more significant improvement in the range of motion of cervical vertebra after treatment,and the degree of extension related to cervical vertebra activity was significantly higher than that of the control group(P<0.05).In the observation group,the cervical pain was significantly reduced after treatment,and VAS,PPI and PRI scores were significantly reduced(P<0.05).The inflammatory status and vascular endothelial function of the observation group were better than those of the control group,and the serum levels of TNF-α,CGRP and ET-1 were lower than those of the control group,and the levels of NO were higher than those of the control group(P<0.05).Conclusion The combination of acupuncture and medicine and rearrangement of muscles and tendons is beneficial to improve cervical mobility and relieve cervical pain in the early stage of juvenile radiculopathy.Its mechanism may be related to the intervention of serum TNF-α,CGRP,ET-1 and NO levels so as to reduce inflammation and improve vascular endothelial function,which is worthy of clinical promotion.