“三通四联”针灸综合疗法治疗神经根型颈椎病的临床观察

Clinical Observation on the Treatment of Cervical Spondylotic Radiculopathy by Combined Therapy of"Three Channels and Four Combinations"Acupuncture

目的观察“三通四联”针灸综合疗法与常规针刺治疗神经根型颈椎病(CSR)的临床疗效。方法纳入本院收治的CSR患者60例,随机分为对照组(常规针刺)和观察组(“三通四联”针灸综合疗法),各30例,选取颈夹脊穴(双)、天柱穴(双)、曲池穴(双)、外关穴(双)、后溪穴(双)、申脉穴(双)、阿是穴,上肢麻木加少海穴、手三里穴,上肢疼痛加合谷穴。对照组予常规针刺治疗,观察组予“三通四联”针灸综合疗法,针刺得气后予1)电针:同侧颈夹脊穴接电针,密波,频率80~100 Hz;2)TDP照射:电针治疗的同时配合TDP照射局部皮肤30 min。3)刺络拔罐:取大椎穴、颈夹脊穴(双)、大杼穴(双)、肩井穴(双),使用梅花针垂直重叩穴位处,局部肌肤红晕渗血,有轻痛感为佳,随即在对应处予一次性定量火罐(专利号:ZL 201520834109.5)拔罐放血治疗,留罐10 min。两组均每日治疗1次,每周5次,10次为1疗程,治疗周期为2疗程。分别于治疗前后及1个月后随访,比较两组患者的疼痛视觉模拟(VAS)评分、田中靖久颈椎病症状量表20分法(TZCS)评分及健康状况调查问卷(SF-36)评分。结果治疗后两组TZCS评分、SF-36量表各因子评分较治疗前升高(P<0.05),且观察组治疗后及随访期评分高于对照组(P<0.05);治疗后两组患者疼痛VAS评分较治疗前降低(P<0.05),且观察组治疗后及随访期评分均低于对照组(P<0.05);观察组治疗后总有效率高于对照组(P<0.05)。结论“三通四联”针灸综合疗法治疗CSR临床疗效显著,能够快速减轻患者痛苦,改善颈肩部肌肉僵直紧张、上肢疼痛麻木症状,改善日常生活能力,提高生活质量,远期疗效佳。

Objective:To study the clinical efficacy of combined therapy of"Three channels and four combina-tions"acupuncture and conventional acupuncture in the treatment of cervical spondylotic radiculopathy(CSR).Methods:60 patients with CSR admitted to our hospital were randomly divided into control group(routine acu-puncture)and observation group(combined therapy of"Three channels and four combinations"acupuncture),with 30 cases in each group.cervical Jiaji(bilateral),Tianzhu(bilateral),Quchi(bilateral),Waiguan(bilateral),Houxi(bilateral),Shenmai(bilateral),Ashi acupoints were selected,and added with Shaohai and Shousanli acu-points for upper limb numbness,and Hegu acpoint for upper limb pain.The control group was given conventional acupuncture treatment,and the observation group was given combined therapy of"Three channels and four combi-nations"acupuncture.After the qi was obtained by acupuncture,patients were given:1)Electroacupuncture:the same side of the cervical Jiaji acupoint was received with electroacupuncture and dense wave was given at a fre-quency of 80~100 Hz;2)TDP irradiation:electroacupuncture combined with TDP irradiation of local skin for 30 min;3)Acupoint cupping:At the Dazhui,cervical Jiaji(bilateral),Dazhu(bilateral),and Jianjing(bilateral)acu-points,acupoint cupping was used to vertically tap the points firmly until the local skin reddened and mild bleed-ing occurred,accompanied by a sensation of mild pain,which was considered optimal.Subsequently,a disposable,calibrated fire cupping treatment(patent number:ZL 201520834109.5)was applied over the corresponding areas for bloodletting.The cups were retained for 10 minutes.Both groups received this treatment once daily,five times per week,with each set of 10 treatments constituting one course of therapy.The overall treatment regimen consist-ed of two courses.Patients from both groups were followed immediately after treatment completion,as well as one month later,to compare changes in their Visual Analogue Scale(VAS)scores for pain,Takakura′s 20-point Cervi-cal Spondylosis Symptom Scale(TZCS),and Short Form Health Survey(SF-36)scores.Results:TZCS score and SF-36 scale scores were higher after treatment than before treatment(P<0.05),and the scores of observation group after treatment and follow-up period were higher than those of control group(P<0.05).After treatment,the pain VAS score of the two groups was lower than that before treatment(P<0.05),and the score of the observation group was lower than that of the control group after treatment and during follow-up period(P<0.05).The total ef-fective rate of the observation group was higher than that of the control group(P<0.05).Conclusion:The com-bined therapy of"Three channels and four combinations"acupuncture has significant clinical efficacy in the treat-ment of cervical radiculopathy,which can quickly reduce the pain of patients,improve the rigidity and tension of neck and shoulder muscles,upper limb pain and numbness symptoms,improve daily life ability and improve the quality of life,and has good long-term effect,and is worthy of clinical promotion.