穴位贴敷联合仰卧间歇角度牵引对神经根型颈椎病颈部生物学相关参数的影响

Effect of acupoint application combined with supine intermittent angle traction on neckbiological parameters in patients with cervical spondylotic radiculopathy

目的探讨穴位贴敷联合仰卧间歇角度牵引对神经根型颈椎病颈部生物学相关参数的影响。方法随机对照试验设计。将符合入选标准的2019年2月-2021年2月黑龙江中医药大学附属第二医院100例神经根型颈椎病患者,采用随机数字表法分为2组,每组50例。对照组采用西医常规疗法治疗,观察组采用穴位贴敷联合仰卧间歇角度牵引治疗。2组均治疗3个月。采用日本骨科协会评估治疗(JOA评分)、颈椎功能障碍指数(NDI)评价患者颈椎功能状态,VAS量表评估颈椎疼痛程度;利用三维绘制技术绘制椎间孔容积,建立颈椎三维有限元模型并进行力矩加载,做旋转、侧弯、后伸、前屈运动,测试C4~7椎体各节段椎间盘应力及颈椎活动度,评价临床疗效。结果观察组总有效率为94.0%(47/50)、对照组为70.0%(35/50),2组比较差异有统计学意义(χ^(2)=9.76,P=0.002)。治疗后,观察组JOA评分高于对照组(t=6.23,P<0.01),NDI评分、VAS评分低于对照组(t值分别为5.17、9.13,P<0.01),椎间孔容积[(8.45±1.27)mm^(3)比(7.18±1.38)mm^(3),t=4.79]高于对照组(P<0.01)。治疗后,观察组C_(4~7)颈椎前屈[(7.15±0.87)°比(5.64±0.78)°,t=9.14]、后伸[(8.53±0.73)°比(7.15±0.68)°,t=9.78]、侧弯[(6.57±0.71)°比(5.28±0.67)°,t=9.34]、旋转[(7.89±0.52)°比(6.54±0.48)°,t=13.49]活动度高于对照组(P<0.01);C_(4~7)椎间盘前屈[(1.41±0.09)kPa比(2.01±0.12)kPa,t=28.28]、后伸[(1.54±0.07)kPa比(2.01±0.08)kPa,t=31.26]、侧弯[(1.24±0.07)kPa比(1.89±0.13)kPa,t=31.13]、旋转[(1.23±0.06)kPa比(1.85±0.11)kPa,t=34.99]应力低于对照组(P<0.01)。结论穴位贴敷联合仰卧间歇角度牵引可较好改善神经根型颈椎病患者颈部疼痛及颈椎功能,促进颈部生物力学恢复。

Objective To explore the effect of intermittent angle traction on the supine position combined with acupoint application on the changes of cervical radiculopathy related biological parameters.Methods Randomized controlled trial.A total of 100 patients with radiculopathy cervical spondylosis treated in the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from February 2019 to February 2021 were selected and randomly divided into observation group(n=50)and control group(n=50).Patients in the control group were given conventional treatment with western medicine,and patients in the observation group were given acupoint application combined with supine intermittent angle traction combined with treatment.Both groups were treated for 3 months.The Japanese Orthopaedic Association Spinal Cord Function(JOA),Cervical Disability Index(NDI),Pain Visual Analogue Score(VAS)and the changes in intervertebral foramen volume of two groups were compared before and after treatment.The difference in clinical efficacy between the two groups after treatment was observed.We took a thin spiral CT film of the patient's cervical spine,established a three-dimensional finite element model of the cervical spine,and compared the differences in related indicators between the two groups before and after treatment.Results The total effective rate was 94.0%(47/50)in the observation group and 70.0%(35/50)in the control group,and there was a significant difference between the two groups(χ^(2)=9.76,P=0.002).After treatment,the JOA score in the observation group was significantly higher than that of the control group(t=6.23,P<0.01),the NDI score,VAS score were significantly lower than those in the control group(t values were 5.17,9.13,P<0.01),the intervertebral foraminal volume[(8.45±1.27)mm^(3) vs.(7.18±1.38)mm^(3),t=4.79]was significantly higher than that of the control group(P<0.01),and C_(4-7) cervical vertebra flexion[(7.15±0.87)°vs.(5.64±0.78)°,t=9.14],retroflexion[(8.53±0.73)°vs.(7.15±0.68)°,t=9.78],sidebend[(6.57±0.71)°vs.(5.28±0.67)°,t=9.34],rotated[(7.89±0.52)°vs.(6.54±0.48)°,t=13.49]were significantly higher than those in the control group(P<0.01);C_(4-7) disc flexion[(1.41±0.09)kPa vs.(2.01±0.12)kPa,t=28.28],retroflexion[(1.54±0.07)kPa vs.(2.01±0.08)kPa,t=31.26],sidebend[(1.24±0.07)kPa vs.(1.89±0.13)kPa,t=31.13],rotated[(1.23±0.06)kPa vs.(1.85±0.11)kPa,t=34.99]were significantly lower than those in the control group(P<0.01).Conclusion The supine intermittent Angle traction combined with acupoint application in the treatment of cervical spondylotic radiculopathy can relieve the neck pain,improve the neck function,restore the physiological curvature of the cervical spine,and promote the recovery of cervical biomechanics.