超声引导下副神经阻滞联合内热针疗法治疗颈型颈椎病患者的近期疗效

Short-term efficacy of ultrasound-guided accessory nerve block combined with inner-heat acupuncture for neck type of cervical spondylosis

目的评价超声引导下副神经阻滞联合内热针疗法治疗颈型颈椎病患者的近期疗效。方法收集2018年11月至2019年10月湖北省第三人民医院疼痛科收治的颈型颈椎病患者48例,按照随机数字表法将其分为副神经阻滞联合内热针组(联合组,n=24)和内热针组(内热针组,n=24)。联合组的患者在每次副神经阻滞完成后第2日行同侧内热针治疗。内热针组仅采用颈部内热针导热治疗。两组各治疗2次。于治疗前1 d、全部治疗完成后第1 d、2周、1个月时分别记录并观察患者的视觉模拟评分(VAS)、颈痛量表(NPQ)评分,并在全部治疗完成后1个月时,根据VAS评分与NPQ评分,以及患者的主观症状评估疗效。记录治疗期间患者不良反应如全脊髓麻醉、局麻药中毒等发生情况。结果与治疗前相比,两组患者全部治疗结束后第1日两项评分均有改善(P<0.05);且副神经阻滞联合内热针组在全部治疗完成后第1日两项评分改善程度优于内热针组(P<0.05),两组患者在全部治疗完成后2周、1个月时两项评分改善程度差异均无统计学意义(P>0.05)。两组患者均未见全脊髓麻醉、局麻药中毒等不良反应。结论超声引导下副神经阻滞联合内热针治疗颈型颈椎病患者在治疗完成后2周、1个月时,与内热针治疗相比,两者疗效相当,提示副神经阻滞并无优化内热针治疗颈型颈椎病的效果。

Objective To investigate the short-term efficacy of ultrasound-guided accessory nerve block combined with inner-heat acupuncture in the treatment of patients with cervical spondylosis of neck type.Methods A total of 48 patients with cervical spondylosis admitted to the Department of Painology,the Third People's Hospital of Hubei Province,from November 2018 to October 2019,were collected.According to the random number table,the patients were divided into accessory nerve block combined with inner-heat acupuncture group(combined group,n=24)and inner-heat acupuncture group(inner-heat acupuncture group,n=24).Patients were treated with ipsilateral inner-heat acupuncture on the second day after each accessory nerve block in the combined group,and only the inner-heat acupuncture in the inner-heat acupuncture group.The visual analogue scale(VAS)and neck pain questionnaire(NPQ)scores were recorded and observed 1 day before the treatment,and 1 day,2 weeks and 1 month after the treatment,and the efficacy was evaluated according to VAS and NPQ scores and subjective symptoms at 1 month after the treatment.The incidence of adverse reactions such as total spinal anesthesia and local anesthetic poisoning during treatment were recorded.Results Compared with pretreatment,the scores of the above two items were improved at the first day after the treatment(P<0.05);the improvement degree of the two scores in the combined group was better than that in the inner-heat acupuncture therapy group at the first day after the treatment(P<0.05).There was no significant difference in the improvement of the two scores at 2 weeks and 1 month after the treatments(P>0.05).No adverse reactions such as total spinal anesthesia and local anesthetic poisoning occurred in the two groups.Conclusion The efficacy of ultrasound-guided accessory nerve block combined with inner-heat acupuncture is comparable to the only inner-heat acupuncture for the patients with cervical spondylosis at 2 weeks and 1 month after the treatment,without any optimization for the inner-heat acupuncture therapy combining the accessory nerve block.