基于肌骨超声对循经取穴治疗颈型颈椎病的疗效观察及疼痛相关研究

Efficacy Observation of Along-meridian Acupoint Selection for Cervical Spondylosis of Neck Type Based on Musculoskeletal Ultrasound and Pain-related Research

目的观察循经取穴治疗颈型颈椎病的临床疗效及肌骨超声下压痛点下肌层高回声区大小与疼痛的关系。方法将56例颈型颈椎病患者采用中央随机系统及配对设计随机分为肺经组(28例)和心经组(28例),因心经组脱落1例故最终纳入统计为27例。两组分别取相应经络上的腧穴进行针刺治疗,共治疗2周。比较两组治疗前后经肌骨超声检查的压痛点下肌层高回声区大小,观察两组治疗前、治疗后、治疗后4周和治疗后12周疼痛视觉模拟量表(VAS)、颈椎功能障碍指数(NDI)及健康调查简表(SF-36)的评分变化,分析治疗前后压痛点下肌层高回声区大小与疼痛的相关性。结果治疗后,两组压痛点下肌层高回声区大小均较同组治疗前缩小(P<0.01),两组组间比较差异无统计学意义(P>0.05)。两组治疗后各时间点VAS、NDI和SF-36评分均较同组治疗前改善(P<0.01),肺经组治疗后及治疗后4周VAS、NDI和SF-36评分均优于心经组(P<0.05)。VAS、NDI和SF-36评分中,时间因素和组别均存在交互作用,差异均具有统计学意义(P<0.05)。治疗前和治疗后,压痛点下肌层高回声区大小与VAS评分均呈正相关性(P<0.05)。两组治疗期间均未发生不良反应事件。结论循经取穴治疗颈型颈椎病可改善患者症状,提高生活质量,且肺经腧穴疗效优于心经腧穴。循经取穴治疗可缩小压痛点下肌层高回声区大小,且与VAS评分呈正相关;压痛点下肌层高回声区大小或可作为颈型颈椎病疼痛疗效评价的指标。

Objective To observe the clinical efficacy of along-meridian acupoint selection in treating cervical spondylosis of neck type and the correlation between the size of the hyperechoic area in the muscular layer under the tender points and pain using musculoskeletal ultrasound(MSUS).Method Fifty-six patients with cervical spondylosis of neck type were randomized into a Lung Meridian group(28 cases)and a Heart Meridian group(28 cases)using the central randomization system and paired design.Due to one dropout case,27 subjects in the Heart Meridian group were recruited for the final statistical analysis.Each group received a 2-week acupuncture treatment selecting points from the corresponding meridian.Before and after the treatment,the size of hyperechoic muscular area under the tender points was compared using MSUS.Before and after the treatment and at post-treatment week 4 and week 12,changes in the visual analog scale(VAS),neck disability index(NDI),and 36-item short-form health survey(SF-36)scores were observed.The correlation between the hyperechoic area size under the pre-treatment and post-treatment tender points and pain was also analyzed.Result After the treatment,the size of the hyperechoic area in the muscular layer under the tender points shrank in both groups(P<0.01),while the between-group difference was statistically insignificant(P>0.05).The VAS,NDI,and SF-36 scores were improved after the treatment in both groups(P<0.01);the VAS,NDI,and SF-36 scores in the Lung Meridian group were superior to those in the Heart Meridian group after the treatment and at the post-treatment week 4(P<0.05).There were interactions between time and group in the VAS NDI,and SF-36 scores(P<0.05).Before and after the treatment,there was a positive correlation between the size of the muscular hyperechoic area under the tender points and the VAS score(P<0.05).There were no adverse reactions during the treatment in either group.Conclusion Along-meridian acupoint selection can improve the symptoms and enhance the quality of life in patients with cervical spondylosis of neck type,and the Lung meridian acupoints can produce more significant efficacy than the Heart Meridian acupoints.Besides,along-meridian acupoint selection can shrink the size of the muscular hyperechoic area under the tender points,and the size has a positive correlation with the VAS score;the muscular hyperechoic area size under the tender points can be taken as an indicator to estimate the efficacy in treating pain in cervical spondylosis of neck type.