针刺联合雷火灸治疗风寒湿型神经根型颈椎病的随机对照研究

Randomized controlled trial on cervical spondylotic radiculopathy of wind-cold-damp type treated with acupuncture and thunder-fire moxibustion

目的:探讨针刺联合雷火灸治疗风寒湿型神经根型颈椎病(CSR)的疗效及对正中神经、尺神经F波的传导速度和血清中超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6、IL-1β、肿瘤坏死因子α(TNF-α)的影响。方法:将94例风寒湿型神经根型颈椎病患者随机分为对照组和联合组,每组47例。对照组选取风池、天柱、颈夹脊、大椎等穴针刺治疗,30 min/次,1次/日,5次/周,共4周。联合组在对照组基础上采用雷火灸风池、颈夹脊、大椎、肩井和天宗,20 min/次,隔日1次,共4周。治疗结束后,比较两组患者疗效,对简化McGill问卷(SF-MPQ)、颈部特异性量表和健康状况调查表(SF-36)进行评分,利用肌电图诱发电位仪检测患者正中神经和尺神经F波的传导速度,免疫比浊法检测血清中hs-CRP含量,酶联免疫吸附法检测血清中IL-6、IL-1β、TNF-α的含量。结果:联合组的总有效率为95.7%(45/47)高于对照组80.9%(38/47,P<0.05)。与本组治疗前比较,两组患者SF-MPQ、颈部特异性量表和SF-36量表评分明显改善(P<0.05),正中神经和尺神经的F波传导速度加快(P<0.05),血清中hs-CRP、IL-6、IL-1β和TNF-α下降(P<0.05)。与对照组比较,联合组SF-MPQ、颈部特异性量表和SF-36量表评分的改善更为明显(P<0.05),正中神经和尺神经的F波传导速度更快(P<0.05),血清中hs-CRP、IL-6、IL-1β和TNF-α含量下降亦更为显著(P<0.05)。结论:针刺联合雷火灸可以改善风寒湿型神经根型颈椎病患者的临床症状,减轻炎性反应。

Objective To explore the therapeutic effect of acupuncture combined with thunder-fire moxibustion on cervical spondylotic radiculopathy of wind-cold-damp type and its impacts on the conduction velocity of F wave of median nerve and ulnar nerve,as well as hypersensitive C-responsive protein(hs-CRP),interleukin 6(IL-6),IL-1βand tumor necrosis factorα(TNF-α)in serum.Methods A total of 94 patients with cervical spondylotic radiculopathy of wind-cold-damp type were randomly divided into a control group and a combined therapy group,47 cases in each group.In the control group,acupuncture was applied to Fengchi(GV20),Tianzhu(BL10),Neck-Jiaji(EX-B5),Dazhui(GV14)and others,30 min each time,once daily,5 times a week,totally for 4 weeks.In the combined therapy group,on the base of the treatment as the control group,the thunder-fire moxibustion was adopted over GV20,EX-B5,GV14,Jianjing(ST21)and Tianzong(SI11),20 min each time,once every other day,for 4 weeks in total.After the treatment,the curative effect was compared in the patients between two groups.The short-form McGill pain questionnaire(SF-MPQ),the neck specificity scale and the MOS 36-item short form health survey(SF-36)were scored.The conduction velocity of F wave in median nerve and ulnar nerve was detected by electromyography.The expression of hs-CRP was measured by immunoturbidimetry.IL-6,IL-1βand TNF-αin serum were determined by enzyme linked immunosorbent assay.Results The total effective rate in the combined therapy group was 95.7%(45/47),which was higher than 80.9%(38/47)in the control group(P<0.05).Compared with their own pretreatment,the scores of SF-MPQ,neck specificity scale and SF-36 were all obviously improved after treatment in the patients of either group(P<0.05),while the conduction velocity of F wave in median nerve and ulnar nerve was accelerated and hs-CRP,IL-6,IL-1βand TNF-αin serum were decreased(P<0.05).Compared with the control group,the improvements in the scores of SF-MPQ,neck specificity scale and SF-36 were more obvious(P<0.05),the increase of the conduction velocity of F wave in median nerve and ulnar nerve and the decrease of hs-CRP,IL-6,IL-1βand TNF-αin serum were more remarkable(P<0.05)in the combined therapy group.Conclusion Acupuncture combined with thunder-fire moxibustion relieves the clinical symptoms of cervical spondylotic radiculopathy of wind-cold-damp type.