针刺激痛点联合超声引导下神经根阻滞治疗神经根型颈椎病的疗效观察

Effect of trigger point acupuncture combined with ultrasound-guided nerve root block in the treatment of cervical radiculopathy

目的探讨针刺激痛点联合超声引导下颈神经根阻滞治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的临床疗效。方法选取2020年10月至2021年4月在徐州医科大学附属医院疼痛科就诊的CSR患者,采用随机数字表法分为针刺激痛点联合神经阻滞组(试验组)和单纯神经阻滞组(对照组),每组30例。两组患者均接受超声引导下颈神经根阻滞,试验组在对照组单纯神经阻滞疗法的基础上联合针刺疗法。观察两组患者治疗前、治疗后1个月、治疗后2个月及治疗后3个月的VAS疼痛评分、颈椎功能障碍指数(neck disability index,NDI)及颈部关节活动度(cervical range of motion,CROM)差异,比较两组患者补救镇痛药物使用情况和不良反应发生情况。结果两组患者治疗后1个月、治疗后2个月、治疗后3个月时VAS疼痛评分、NDI及CROM均较同组治疗前降低,差异有统计学意义(P<0.05)。两组患者治疗后1个月时VAS疼痛评分、NDI差异无统计学意义(P>0.05),而试验组CROM低于对照组(P<0.05);试验组在治疗后2个月、治疗后3个月时VAS疼痛评分、NDI及CROM均低于对照组(P<0.05);两组患者补救镇痛药物使用情况差异无统计学意义(P>0.05),均未出现头晕、恶心、呕吐、局麻药中毒、感染、神经损伤及气胸等不良反应。结论针刺激痛点联合超声引导下颈神经根阻滞治疗CSR疗效显著,优于单纯神经阻滞治疗。

Objective To explore the effect of trigger point acupuncture combined with ultrasound-guided nerve root block in the treatment of cervical spondylotic radiculopathy(CSR).Methods A total of 60 CRS patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from October 2020 to April 2021 were enrolled.According to the random number table method,they were divided into two groups(n=30):a trigger point acupuncture+nerve block group(test group)and a nerve block group(control group).Both groups received ultrasound-guided cervical nerve root block,where the test group underwent trigger point acupuncture in addition to nerve block which was used in the control group.Both groups were compared for Visual Analogue Scale(VAS)scores,neck disability index(NDI)and cervical range of motion(CROM)before treatment and at post-treatment 1,2 and 3 months.Their use of rescue analgesics and the occurrence of adverse reactions were compared between the two groups.Results Both groups showed decreases in VAS scores,NDI and CROM at post-treatment 1,2 and 3 months,compared with those before treatment(P<0.05).There was no statistical difference in VAS scores and NDI between the two groups at post-treatment 1 month(P>0.05),while CROM in the test group was significantly lower than that in the control group(P<0.05).The test group showed significantly lower VAS scores,NDI and CROM than the control group at post-treatment 2 and 3 months(P<0.05).There was no statistical difference in the use of rescue analgesics between the two groups(P>0.05).There were no adverse reactions such as dizziness,nausea,vomiting,local anesthetic poisoning,infection,nerve injury and pneumothorax in the two groups.Conclusions Trigger point acupuncture combined with ultrasound-guided nerve root block has definite clinical effect in the treatment of CSR,which is superior to nerve root block alone.