[1]李正祥,李秀彬,吴松.脊柱微调手法联合远近配穴针刺治疗神经根型颈椎病的临床研究[J].中医正骨,2020,32(08):1-5.
　LI Zhengxiang,LI Xiubin,WU Song.A clinical study of spinal fine-tuning manipulation combined with acupuncture at distal and proximal acupoints for treatment of cervical spondylotic radiculopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(08):1-5.
点击复制

脊柱微调手法联合远近配穴针刺治疗神经根型颈椎病的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年08期
页码:
1-5
栏目:
临床研究
出版日期:
2020-08-20

文章信息/Info

Title:
A clinical study of spinal fine-tuning manipulation combined with acupuncture at distal and proximal acupoints for treatment of cervical spondylotic radiculopathy
作者:
李正祥1; 李秀彬1; 吴松2
(1.温岭市中医院,浙江 温岭 317500; 2.湖北中医药大学,湖北 武汉 430061)
Author(s):
LI Zhengxiang1; LI Xiubin1; WU Song2
1.Wenling Hospital of Traditional Chinese Medicine,Wenling 317500,Zhejiang,China 2.Hubei University of Chinese Medicine,Wuhan 430061,Hubei,China
关键词:
颈椎病;  推拿; 脊柱;  针刺疗法;  穴; 夹脊;  穴; 太溪;  配穴法;  肌张力;  斜方肌;  颈椎曲度
Keywords:
cervical spondylosis;  manipulation; spinal;  acupuncture therapy;  Point ex-b2(JIAJI);  Point ki3(TAIXI);  point combination;  muscle tonus;  trapezius muscle;  cervical curvature
摘要:
目的:探讨脊柱微调手法联合远近配穴针刺治疗神经根型颈椎病的临床疗效及对患者颈部肌张力和颈椎曲度的影响。方法:将90例神经根型颈椎病患者随机分为手法组、针刺组、手法联合针刺组,每组30例。手法组行脊柱微调手法治疗,针刺组行远近配穴针刺治疗,手法联合针刺组每次脊柱微调手法治疗后行远近配穴针刺治疗; 远近配穴为颈夹脊穴配双侧太溪穴。每日治疗1次,5次为1个疗程,连续治疗3个疗程。分别于治疗前和治疗结束后,采用疼痛视觉模拟量表(visual analogue score,VAS)评价患者颈部疼痛情况,采用颈椎功能障碍指数(neck disability index,NDI)量表评价颈椎功能,采用颈椎病临床评价量表(clinical assessment scale for cervical spondylosis,CASCS)进行总体疗效评价,检测患者静息状态下斜方肌肌张力(以压力-位移曲线下面积表示,数值越大、肌张力越低),在颈椎侧位X线片上测量颈椎曲度。结果:①临床疗效评价结果。治疗前3组患者CASCS评分、颈部疼痛VAS评分、NDI评分总体比较,差异均无统计学意义[(63.2±7.2)分,(62.7±8.9)分,(64.1±6.3)分,F=0.265,P=0.768;(7.3±1.0)分,(7.4±1.5)分,(7.4±0.8)分,F=0.077,P=0.926;(30.7±14.1)分,(34.6±16.4)分,(32.8±12.9)分,F=0.541,P=0.584]; 治疗结束后,3组患者CASCS评分、颈部疼痛VAS评分、NDI评分总体比较,差异均有统计学意义[(81.8±6.4)分,(84.3±7.3)分,(92.3±3.7)分,F=25.080,P=0.000;(4.2±0.9)分,(3.5±1.3)分,(3.0±0.4)分,F=12.290,P=0.000;(21.4±11.4)分,(24.0±13.5)分,(15.1±12.0)分,F=4.132,P=0.019]; 手法联合针刺组CASCS评分高于手法组和针刺组(P=0.012,P=0.000),颈部疼痛VAS评分、NDI评分低于手法组和针刺组(P=0.002,P=0.049; P=0.042,P=0.009); 针刺组CASCS评分、NDI评分与手法组相比差异均无统计学意义(P=0.164,P=0.081),颈部疼痛VAS评分低于手法组(P=0.018)。②颈部肌张力检测结果。治疗前3组患者静息状态下斜方肌肌张力总体比较,差异无统计学意义[(15.2±4.3),(16.8±2.4),(16.3±3.2),F=1.748,P=0.180]; 治疗结束后,3组患者静息状态下斜方肌肌张力总体比较,差异有统计学意义[(26.3±5.2),(28.7±4.9),(29.5±3.8),F=3.811,P=0.026]; 手法联合针刺组斜方肌肌张力低于手法组(P=0.008),与针刺组比较差异无统计学意义(P=0.483); 针刺组与手法组斜方肌肌张力比较差异无统计学意义(P=0.071)。③颈椎曲度测量结果。治疗前3组患者颈椎曲度值总体比较,差异无统计学意义[(5.2±1.8)mm,(4.9±2.1)mm,(5.3±1.5)mm,F=0.394,P=0.676]; 治疗结束后,3组患者的颈椎曲度值总体比较差异有统计学意义[(9.0±3.6)mm,(6.9±3.9)mm,(9.2±4.0)mm,F=3.308,P=0.041]; 手法联合针刺组颈椎曲度大于针刺组(P=0.034),与手法组比较差异无统计学意义(P=0.839); 手法组颈椎曲度大于针刺组(P=0.028)。结论:脊柱微调手法联合远近配穴针刺治疗神经根型颈椎病,可有效缓解患者颈部疼痛、改善颈椎功能,且能降低斜方肌肌张力、改善颈椎曲度; 总体疗效优于单纯针刺和手法治疗,降低斜方肌肌张力的效果优于单纯手法治疗,改善颈椎曲度的效果优于单纯针刺治疗。
Abstract:
To explore the clinical curative effects of spinal fine-tuning manipulation combined with acupuncture at distal and proximal acupoints for treatment of cervical spondylotic radiculopathy(CSR)and its effects on patients' cervical muscular tension and cervical curvature.Methods:Ninety CSR patients were enrolled in the study and were randomly divided into manipulation group,acupuncture group and combination therapy group,30 cases in each group.The patients in manipulation group and acupuncture group were treated

参考文献/References:

[1] 杨子明,李放,陈华江.颈椎病的分型、诊断及非手术治疗专家共识(2018)[J].中华外科杂志,2018,56(6):401-402.
[2] 陈明,韩涛,朱立国,等.颈椎病的防治研究刍议[J].海南医学院学报,2020,26(4):311-315.
[3] 瞿强.神经根型颈椎病的治疗研究进展[J].医学理论与实践,2020,33(3):377-378.
[4] ZUO G,GAO T C,XUE B H,et al.Assessment of the efficacy of acupuncture and chiropractic on treating cervical spondylosis radiculopathy:a systematic review and meta-analysis[J].Medicine,2019,98(48):e17974.
[5] 杨超,吕立江,王玮娃,等.基于“筋骨失衡,以筋为先”理念探讨颈型颈椎病的治疗[J].中医正骨,2019,31(4):64-65.
[6] 李义凯.手法治疗颈椎病的若干问题[J].中医正骨,2018,30(3):4-6.
[7] 郭伟,赵颀,龚成,等.颈椎力学评价指标在非手术疗法治疗神经根型颈椎病疗效评价中的应用[J].中医正骨,2018,30(3):22-26.
[8] 神经根型颈椎病诊疗规范化研究专家组.神经根型颈椎病诊疗规范化的专家共识[J].中华外科杂志,2015,53(11):812-814.
[9] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[10] 伍少玲,马超,伍时玲,等.颈椎功能障碍指数量表的效度与信度研究[J].中国康复医学杂志,2008,23(7):625-628.
[11] 张鸣生,许伟成,林仲民,等.颈椎病临床评价量表的信度与效度研究[J].中华物理医学与康复杂志,2003,25(3):25-28.
[12] 裴帅,姜宏,刘锦涛,等.颈椎曲度与颈椎病严重程度相关性的研究进展[J].中医正骨,2020,32(3):35-38.
[13] 郜顺兴.我国颈椎病定义及分型的历史沿革[J].中医正骨,2020,32(4):44-47.
[14] 周思涵,张喜林,杨晓伟,等.脊柱微调手法临床研究进展[J].按摩与康复医学,2018,9(9):91-92.
[15] 吴志伟,孔令军,宋朋飞,等.颈椎病“筋骨评估”模式构建研究[J].中华中医药杂志,2019,34(12):5837-5841.
[16] 张阳春,李秀彬,陈筱.脊柱微调手法治疗神经根型颈椎病30例疗效观察[J].浙江中医杂志,2015,50(8):586.
[17] 李秀彬,李正祥,王立新,等.脊柱微调手法对神经根型颈椎病的颈椎曲度的影响[J].中华中医药学刊,2012,30(8):1782-1784.
[18] 孙武权,谢贤斐,王佳勤,等.脊柱微调手法治疗神经根型颈椎病疗效与颈椎曲度变化观察[J].中华中医药杂志,2010,25(9):1526-1528.
[19] 王雁慧.针灸治疗颈椎病的临床疗效分析及机理探讨[J].中医临床研究,2020,12(8):94-96.
[20] 陈晖阳,谢怡琳,杨小芬.电针颈夹脊穴治疗神经根型颈椎病的疗效观察[J].光明中医,2015,30(10):2180-2182.
[21] 鲁玉玲.电针夹脊穴对颈椎病的临床效果分析[J].中国社区医师,2020,36(2):92.
[22] 于国强,李晓陵,王丰,等.针刺太溪穴脑功能磁共振成像研究[J].针灸临床杂志,2013,29(3):51-53.
[23] 欧阳怀亮,曲姗姗,张继苹,等.针刺健康志愿者太溪穴静息态fMRI脑功能成像研究[J].中国中医基础医学杂志,2014,20(4):527-529.
[24] 陈翔峰,张晓艳,吴松.针刺太溪、复溜治疗神经根型颈椎病疗效观察[J].湖北中医药大学学报,2015,17(2):103-104.

相似文献/References:

[1]孙献武,于香兰,邵海燕,等.应用三维动静态平衡康复模式治疗 非脊髓型颈椎病的临床研究[J].中医正骨,2015,27(11):8.
　SUN Xianwu,YU Xianglan,SHAO Haiyan,et al.Clinical study on three-dimensional dynamic and static equilibrium rehabilitation modality in the treatment of non-myelopathy type cervical spondylosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):8.
[2]徐帮杰,杨楠,白伟杰,等.坐位定点旋转整复法治疗腰椎间盘突出症的疗效观察[J].中医正骨,2015,27(11):17.
　XU Bangjie,YANG Nan,BAI Weijie,et al.Observation on the curative effect of fixed-point rotational reduction in sitting position in the treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):17.
[3]韦英成,董彤,吴肖梅,等.推拿手法治疗神经根型颈椎病的研究进展[J].中医正骨,2015,27(10):65.
[4]张莉,秦丹霞,张细姣.Orem自理理论在前路手术治疗脊髓型颈椎病 围手术期护理中的应用[J].中医正骨,2015,27(09):75.
[5]邸保林,董国顺,林红猛.俯卧斜扳法治疗神经根型颈椎病[J].中医正骨,2015,27(07):70.
[6]白玉,王爱国.郭春园教授治疗颈椎病的学术思想探究[J].中医正骨,2015,27(02):64.
[7]郝庆英,刘楚吟,付婵娟,等.Hybrid手术治疗脊髓型颈椎病的护理[J].中医正骨,2015,27(02):78.
[8]王翔,詹红生,张明才,等.石氏手法治疗神经根型颈椎病的疗效观察[J].中医正骨,2015,27(04):12.
　WANG Xiang,ZHAN Hongsheng,ZHANG Mingcai,et al.Observation on the curative effect of Shi's manipulation in the treatment of cervical spondylotic radiculopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):12.
[9]史俊德,梁舒涵,海渊.毛书歌教授治疗寰枢关节错缝的经验[J].中医正骨,2015,27(04):76.
[10]王树强,杨振国,刘文斌,等.董建文教授治疗神经根型颈椎病的经验[J].中医正骨,2015,27(01):69.
[11]江建春.神经根型颈椎病的中医药治疗研究概况[J].中医正骨,2015,27(11):71.
[12]徐创龙,唐春兰,刘红平,等.卧位调衡手法联合颈部五禽操治疗神经根型颈椎病的临床研究[J].中医正骨,2017,29(06):20.
　XU Chuanglong,TANG Chunlan,LIU Hongping,et al.A clinical study of regulating balance manipulation in clinostatism combined with cervical five mimic-animal boxing for treatment of cervical spondylotic radiculopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(08):20.
[13]李义凯.手法治疗颈椎病的若干问题[J].中医正骨,2018,30(03):4.
[14]裴帅,俞鹏飞,沈晓峰,等.颈椎后伸位扳法干预下颈椎生理曲度与颈椎矢状位参数变化的相关性分析[J].中医正骨,2021,33(11):36.
　PEI Shuai,YU Pengfei,SHEN Xiaofeng,et al.An analysis of the correlation between cervical physiological curvature and cervical sagittal parameters variation under the intervention of cervical pulling manipulation in backward-extension position[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):36.

备注/Memo

备注/Memo:
基金项目:浙江省中医药科技计划项目(2018ZT012) 通讯作者:吴松 E-mail:119065124@qq.com
更新日期/Last Update: 2020-08-20