点拨法联合舒筋通络颗粒治疗神经根型颈椎病临床观察

Clinical Efficacy of Bowstring Mechanics Massage Combined with Shujin Tongluo Granules in the Treatment of Cervical Spondylotic Radiculopathy

目的观察基于弓弦力学理论行点拨法联合舒筋通络颗粒治疗神经根型颈椎病(CSR)的临床疗效。方法将144例患者随机分为3组各48例。A组予舒筋通络颗粒治疗;B组予推拿点拨手法治疗;C组予点拨法推拿联合舒筋通络颗粒治疗;3组均治疗4周。观察各组治疗的有效率和疼痛改善情况。比较治疗前后各组患者视觉模拟量表(VAS)评分、颈部残疾指数(NDI)、颈椎日本骨科协会治疗评估量表(JOA)评分及颈椎活动度(ROM);检测各组治疗前后血清中神经肽Y(NPY)、环氧化酶-2(COX-2)、血清中核转录因子-κB(NF-κB)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平。结果治疗4周后,与A、B组相比,C组总有效率明显较高(P<0.01)。各组NDI及VAS评分均明显降低(P<0.01),JOA评分及颈椎活动度均明显升高(P<0.01);NPY、COX-2、IL-1β、TNF-α及NF-κB水平明显降低(P<0.05),C组均优于A、B组(P<0.05)。结论弓弦力学点拨法联合舒筋通络颗粒治疗CSR(气滞血瘀证)临床疗效确切,其机制可能与降低神经根周围炎症因子、疼痛因子的含量有关。

Objective:To investigate the clinical efficacy and mechanism of bowstring mechanics massage com-bined with Shujin Tongluo Granules in the treatment of cervical spondylotic radiculopathy(CSR).Methods:Total-ly 144 cases of cervical spondylotic radiculopathy with syndrome of blood stasis due to qi deficiency were random-ly divided into 3 groups,with 48 cases in each group.Group A was treated with Shujin Tongluo Granules.Group B was treated with bowstring mechanics massage.Group C was treated with bowstring mechanics massage combined with Shujin Tongluo Granules.Each group was treated for 4 weeks.The effective rate and therapeutic effect of each group were observed.Visual Analogue Score(VAS),neck Disability Index(NDI),Japanese Orthopedic Associ-ation(JOA)score,cervical Range of Motion(ROM)were compared before and after treatment.Serum levels of neu-ropeptide Y(NPY),cyclooxygenase-2(COX-2),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and nu-clear factor-κB(NF-κB)were measured before and after treatment.Results:After 4 weeks of treatment,the total clinical effective rate of group C was significantly higher than that of group A and B(P<0.01).NDI and VAS scores were significantly reduced(P<0.01).JOA and ROM scores were significantly increased(P<0.01).Serum levels of NPY,COX-2,IL-1β,TNF-αand NF-κB were significantly lower(P<0.05),and group C was better than those of group A and B(P<0.05).Conclusion:Bowstring mechanics massage combined with Shujin Tongluo Granules is effective in treating CSR with syndrome of blood stasis due to qi deficiency.Its mechanism may be re-lated to reducing the contents of inflammatory factors and pain factors around nerve roots.