中医骨伤手法联合桂枝新加汤治疗神经根型颈椎病的临床研究

Clinical study of traditional Chinese medicine bone injury manipulation combined with Guizhi Xinjia decoction in the treatment of cervical spondylotic radiculopathys

目的 探讨中医骨伤手法结合桂枝新加汤治疗神经根型颈椎病(CSR)的效果及对炎症介质、疼痛及颈椎功能的影响。方法 前瞻性选取2022年2月至2023年2月林州市中医院收治的60例CSR患者为研究对象,按随机数表法分为观察组和对照组各30例,对照组患者采取中医骨伤手法,观察组患者采取中医骨伤手法联合桂枝新加汤治疗,均连续治疗两个疗程(一个疗程15 d)。比较两组患者的中医疗效,以及治疗前后的中医证候积分、视觉模拟评分法(VAS)、炎症介质[白介素-6 (IL-6)、白三烯B4 (LTB4)、肿瘤坏死因子(TNF-α)、白三烯C4 (LTC4)]水平、颈椎功能障碍指数(NDI)、生活质量简表(SF-36)评分和椎动脉血流速度(左右侧椎动脉血流量、血流速度),同时比较两组患者治疗期间的不良反应情况。结果 观察组患者的治疗总有效率为90.00%,明显高于对照组的66.67%,差异有统计学意义(P<0.05);治疗后,两组患者的中医证候评分和VAS分值均呈降低趋势,且治疗一个疗程后、两个疗程后,观察组患者的中医证候评分和VAS分值明显低于对照组,差异均有统计学意义(P<0.05);治疗后,两组患者的血清LTB4、LTC4、IL-6、TNF-α水平均呈降低趋势,左侧、右侧椎动脉血流速度、血流量均呈升高趋势,且治疗一个疗程后、两个疗程后,观察组患者的血清LTB4、LTC4、IL-6、TNF-α水平明显低于对照组,左侧、右侧椎动脉血流速度、血流量明显高于对照组,差异均有统计学意义(P<0.05);治疗后,两组患者的NDI分值均降低,SF-36分值均升高,且治疗两个疗程后,观察组患者的NDI分值低于对照组,SF-36分值高于对照组,差异均有统计学意义(P<0.05);观察组患者治疗期间的不良反应总发生率为13.33%,对照组为10.00%,差异无统计学意义(P>0.05)。结论 中医骨伤手法联合桂枝新加汤治疗CSR患者效果可靠,其可增加抗炎效果、调节椎动脉血流,从而减轻疼痛程度,改善临床症状,促进颈椎功能好转,且不良反应少。

Objective To investigate the efficacy of TCM bone injury manipulation combined with Guizhi Xin-jia Decoction in the treatment of cervical spondylotic radiculopathy(CSR),as well as its effects on inflammatory media-tors,pain,and cervical function.Methods A prospective study was conducted on 60 patients with CSR admitted to Lin-zhou Hospital of Traditional Chinese Medicine from February 2022 to February 2023,and the patients were randomly di-vided into an observation group and a control group,with 30 patients in each group.The control group applied tradition-al Chinese medicine(TCM)bone injury manipulation,while the observation group used TCM bone injury manipulation combined with Guizhi Xinjia Decoction,both for two consecutive courses(15 days as one course).The efficacy of TCM was compared between the two groups,as well as the TCM symptom scores,Visual Analogue Scale(VAS),inflammato-ry mediators[interleukin-6(IL-6),leukotriene B4(LTB4),tumor necrosis factor(TNF-α),leukotriene C4(LTC4)],cer-vical dysfunction index(NDI),short form-36 quality of life questionnaire(SF-36)scores,and vertebral artery blood flow velocity(left and right vertebral artery blood flow and blood flow velocity)before and after treatment,and the ad-verse reactions during treatment.Results The total effective rate of treatment in the observation group was 90.00%,which was significantly higher than 66.67%in the control group(P<0.05).After treatment,the scores of TCM syndrome and VAS in both groups showed a decreasing trend,and the scores of TCM syndrome and VAS in the observation group were significantly lower than those in the control group after 1 course and 2 courses of treatment(P<0.05).After treat-ment,the levels of serum LTB4,LTC4,IL-6,and TNF-αin both groups showed a decreasing trend,and the blood flow velocity and blood flow volume of left and right vertebral arteries showed an increasing trend;after 1 course and 2 cours-es of treatment,the levels of serum LTB4,LTC4,IL-6,and TNF-αin the observation group were significantly lower than those in the control group,and the blood flow velocity and blood flow volume of left and right vertebral arteries were significantly higher than those in the control group;the differences were statistically significant(P<0.05).After treatment,the NDI scores in both groups decreased,and the SF-36 scores increased;after 2 courses of treatment,the NDI scores in the observation group were significantly lower than those in the control group,and the SF-36 scores were significantly higher than those in the control group;the differences were statistically significant(P<0.05).The total inci-dence of adverse reactions during treatment was 13.33%in the observation group and 10.00%in the control group,with no statistically significant difference(P>0.05).Conclusion The efficacy of TCM bone injury manipulation combined with Guizhi Xinjia Decoction in treating CSR patients is reliable.It can increase anti-inflammatory effects,regulate ver-tebral artery blood flow,thereby reducing pain levels,improving clinical symptoms,and promoting improvement in cer-vical function,with few adverse reactions.