超声引导下针刀治疗颈椎病有效层次的多中心随机对照试验

A Multicenter Randomized Controlled Trial of Effective Levels of Ultrasound-guided Acupotomy for Cervical Spondylosis

目的 观察超声引导下针刀治疗颈椎病松解皮下-浅筋膜-深筋膜-骨膜等不同深度解剖层面与临床效果的关系。方法 将120例颈椎病患者按照中央随机法分为4组,分别为皮下针刀松解组、浅筋膜针刀松解组、深筋膜针刀松解组、骨膜针刀松解组,每组各30例。在相同的治疗选点(两侧天柱次、完骨次,C2、C5~7棘突,两侧肩井次、巨骨次)前提下,采用超声引导下针刀松解至皮下层、浅筋膜层、深筋膜层、骨膜层4个层次组,每周治疗1次,连续治疗3周。分别于治疗前和治疗结束后1周、治疗结束后3个月进行田中靖久颈椎病评分量表评定,以及治疗前和治疗结束后3个月进行疗效评定。结果 治疗结束后3个月骨膜针刀松解组总有效率为96.67%,较浅筋膜针刀松解组90.00%、深筋膜针刀松解组86.67%和皮下针刀松解组63.33%显著增高(P<0.05);在田中靖久评分方面,4组均能提高田中靖久颈椎病评分(P<0.05),骨膜针刀松解组评分水平较其余3组显著增加(P<0.05)。结论 针刀治疗颈椎病患者松解至骨膜层能更显著地减轻颈部疼痛,改善颈部功能,提高临床疗效,值得推广和应用。

Objective To observe the relationship between the different depth anatomical levels of subcutaneous-superficial fascial-deep fascial-periosteal release and clinical outcomes of ultrasound-guided needle knife treatment for cervical spondylosis.Methods One hundred and twenty patients with cervical spondylosis were divided into 4 groups:subcutaneous needle knife release group,superficial fascial needle knife release group,deep fascial needle knife release group,and periosteal needle knife release group according to the central randomization method,with 30 cases in each group.Under the premise of the same treatment selection points(Tianzhu sub and finish bone sub,C2 and C5-7 spinous process on both sides,shoulder well sub and giant bone sub on both sides),ultrasound-guided needle knife was used to release to subcutaneous layer,superficial fascial layer,deep fascial layer and periosteal layer in 4 groups,and the treatment was carried out once a week for 3 weeks.The Yasuhisa Tanaka Cervical Spondylosis Rating Scale was evaluated before and 1 week after the end of treatment and 3 months after the end of treatment,respectively,and the efficacy was evaluated before and 3 months after the end of treatment.Results The total effective rate of 96.67%in the periosteal needle release group at 3 months after the end of treatment was significantly higher than 90.00%in the superficial fascial needle release group,86.67%in the deep fascial needle release group,and 63.33%in the subcutaneous needle release group(P<0.05);in terms of the Tanaka Yasuhisa score,all four groups were able to improve the Tanaka Yasuhisa cervical spondylosis score(P<0.05),and the periosteal needle release group had a significantly cervical spondylosis score level significantly increased compared with the remaining three groups(P<0.05).Conclusion Needle knife treatment for patients with cervical spondylosis can more significantly reduce neck pain,improve neck function and enhance clinical efficacy,which is worth promoting and applying.