[1]孙武权,房敏,周楠,等.颈椎特异性短杠杆微调手法治疗神经根型颈椎病的多中心临床研究[J].中医正骨,2018,30(05):1-5.
　SUN Wuquan,FANG Min,ZHOU Nan,et al.A multicenter clinical study of cervical specific short-lever fine-regulation manipulation for treatment of cervical spondylotic radiculopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(05):1-5.
点击复制

颈椎特异性短杠杆微调手法治疗神经根型颈椎病的多中心临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年05期
页码:
1-5
栏目:
临床研究
出版日期:
2018-05-20

文章信息/Info

Title:
A multicenter clinical study of cervical specific short-lever fine-regulation manipulation for treatment of cervical spondylotic radiculopathy
作者:
孙武权1; 房敏1; 周楠1; 沈国权1; 詹红生2; 钟力炜3; 王勇4; 龚利1; 朱清广5; 李建华1; 文世梅1
1.上海中医药大学附属岳阳中西医结合医院,上海 200437; 2.上海中医药大学附属曙光医院, 上海 201203; 3.上海市第一人民医院,上海 200080; 4.上海交通大学医学院附属瑞金医院, 上海 200025; 5.上海市中医药研究院推拿研究所,上海 200437
Author(s):
SUN Wuquan1; FANG Min1; ZHOU Nan1; SHEN Guoquan1; ZHAN Hongsheng2; ZHONG Liwei3; WANG Yong4; GONG Li1; ZHU Qingguang5; LI Jianhua1; WEN Shimei1
1.Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China 2.Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China 3.The First People's Hospital of Shanghai,Shanghai 200080,China 4.Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College,Shanghai 200025,China 5.The Institute of Massaging Affiliated to Shanghai Academy of Traditional Chinese Medicine,Shanghai 200437,China
关键词:
颈椎病;  神经根病;  手法; 整骨;  特异性微调手法;  临床试验;  多中心研究
Keywords:
cervical spondylosis;  radiculopathy;  manipulation; osteopathic;  specific spine adjustment technique;  clinical trial;  multicenter study
文献标志码:
A
摘要:
目的:评价应用颈椎特异性短杠杆微调手法治疗神经根型颈椎病的价值。方法:从4家医院选取神经根型颈椎病患者120例,随机分期为3组,每组40例。宣教组通过健康教育指导患者纠正以往各种可能诱发颈椎病的不良习惯,长杠杆手法组按照《推拿学》中颈椎病推拿手法操作规范进行手法治疗,短杠杆手法组采用颈椎特异性短杠杆微调手法治疗。3组患者均治疗4周,然后分别采用颈椎功能障碍指数(the neck disability index,NDI)、颈椎病治疗成绩评分、简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分评价临床疗效,并根据患者的颈椎病治疗成绩评分和治疗费用计算疗效费用比。结果:治疗前3组患者的NDI比较,差异无统计学意义[(39.80±4.31)%,(39.90±4.31)%,(39.45±4.53)%,F=0.122,P=0.885]。治疗结束后3组患者的NDI比较,差异有统计学意义[(32.40±5.62)%,(11.45±6.49)%,(7.75±4.94)%,F=216.088,P=0.000]; 短杠杆手法组的NDI低于宣教组和长杠杆手法组(P=0.000,P=0.013),长杠杆手法组的NDI低于宣教组(P=0.000)。3组患者治疗前后NDI差值比较,差异有统计学意义[(7.40±4.18)%,(28.45±4.16)%,(31.70±3.09)%,F=470.802,P=0.000]; 短杠杆手法组治疗前后NDI差值大于宣教组和长杠杆手法组(P=0.000,P=0.001),长杠杆手法组治疗前后NDI差值大于宣教组(P=0.000)。治疗前3组患者的治疗成绩评分比较,差异无统计学意义[(57.33±7.07)%,(57.50±8.32)%,(58.10±6.41)%,F=0.124,P=0.884]。治疗结束后3组患者的治疗成绩评分比较,差异有统计学意义[(66.47±5.95)%,(88.28±6.19)%,(91.03±8.90)%,F=142.267,P=0.000]; 短杠杆手法组和长杠杆手法组治疗结束后的治疗成绩评分均高于宣教组(P=0.000,P=0.000); 短杠杆手法组和长杠杆手法组治疗结束后的治疗成绩评分比较,差异无统计学意义(P=0.199)。3组患者治疗前后治疗成绩评分差值比较,差异有统计学意义[(9.13±7.79)%,(30.78±8.98)%,(32.93±8.18)%,F=99.672,P=0.000]; 短杠杆手法组和长杠杆手法组治疗前后治疗成绩评分差值均大于宣教组(P=0.000,P=0.000); 短杠杆手法组和长杠杆手法组治疗前后治疗成绩评分差值比较,差异无统计学意义(P=0.482)。治疗前3组患者的SF-36评分比较,差异无统计学意义[(98.09±7.84)分,(98.02±10.94)分,(99.48±11.78)分,F=0.253,P=0.777]。治疗结束后3组患者的SF-36评分比较,差异有统计学意义[(106.76±6.21)分,(113.30±8.75)分,(118.14±8.26)分,F=21.367,P=0.000]; 短杠杆手法组治疗结束后的SF-36评分高于宣教组和长杠杆手法组(P=0.000,P=0.018),长杠杆手法组治疗结束后的SF-36评分高于宣教组(P=0.001)。3组患者治疗前后SF-36评分差值比较,差异有统计学意义[(8.67±5.69)分,(15.28±7.46)分,(18.66±7.19)分,F=22.151,P=0.000]; 短杠杆手法组和长杠杆手法组治疗前后SF-36评分差值均大于宣教组(P=0.000,P=0.000); 短杠杆手法组和长杠杆手法组治疗前后SF-36评分差值比较,差异无统计学意义(P=0.073)。短杠杆手法组的疗效费用比高于长杠杆手法组[(37.86±7.99)%,(33.21±8.63)%,t=-2.331,P=0.035]。结论:颈椎特异性短杠杆微调手法治疗神经根型颈椎病,疗效优于单纯宣教和长杠杆手法,疗效费用比优于长杠杆手法治疗。
Abstract:
Objective:To evaluate the applied values of cervical specific short-lever fine-regulation manipulation in the treatment of cervical spondylotic radiculopathy(CSR).Methods:One hundred and twenty patients with CSR were selected out from four hospitals and were randomly divided into education group,long-lever manipulation group and short-lever manipulation group,40 cases in each group.The patients in education group got health education and were guided to correct all kinds of previous bad habits that might induce cervical spondylosis.The patients in long-lever manipulation group were treated with manipulation therapy according to the operation specification of TUINA manipulation of cervical spondylosis which was extracted from TUINA Science.The patients in short-lever manipulation group were treated with cervical specific short-lever fine-regulation manipulation.All patients in the 3 groups were treated for 4 weeks,and the clinical curative effects were evaluated and compared between the 3 groups by using neck disability index(NDI),treatment outcome score of cervical spondylosis and short form 36 health survey questionnaire(SF-36)score respectively,and the effectiveness-cost ratio was calculated according to patients' treatment outcome scores of cervical spondylosis and cost of treatment.Results:There was no statistical difference in NDI between the 3 groups before the treatment(39.80+/-4.31,39.90+/-4.31,39.45+/-4.53%,F=0.122,P=0.885).There was statistical difference in NDI between the 3 groups after the end of the treatment(32.40+/-5.62,11.45+/-6.49,7.75+/-4.94%,F=216.088,P=0.000).The NDI was lower in short-lever manipulation group compared to education group and long-lever manipulation group(P=0.000,P=0.013),and was lower in long-lever manipulation group compared to education group(P=0.000).There was statistical difference between the 3 groups in the differences of NDI between pretreatment and posttreatment(7.40+/-4.18,28.45+/-4.16,31.70+/-3.09%,F=470.802,P=0.000).The difference of NDI between pretreatment and posttreatment was larger in short-lever manipulation group compared to education group and long-lever manipulation group(P=0.000,P=0.001),and was larger in long-lever manipulation group compared to education group(P=0.000).There was no statistical difference in the treatment outcome scores between the 3 groups before the treatment(57.33+/-7.07,57.50+/-8.32,58.10+/-6.41%,F=0.124,P=0.884).There was statistical difference in the treatment outcome scores between the 3 groups after the end of the treatment(66.47+/-5.95,88.28+/-6.19,91.03+/-8.90%,F=142.267,P=0.000).The treatment outcome scores were higher in short-lever manipulation group and long-lever manipulation group compared to education group(P=0.000,P=0.000)and there was no statistical difference in the treatment outcome scores between short-lever manipulation group and long-lever manipulation group(P=0.199)after the end of the treatment.There was statistical difference between the 3 groups in the differences of treatment outcome scores between pretreatment and posttreatment(9.13+/-7.79,30.78+/-8.98,32.93+/-8.18%,F=99.672,P=0.000).The differences of treatment outcome scores between pretreatment and posttreatment were larger in short-lever manipulation group and long-lever manipulation group compared to education group(P=0.000,P=0.000).There was no statistical difference between short-lever manipulation group and long-lever manipulation group in the differences of treatment outcome scores between pretreatment and posttreatment(P=0.482).There was no statistical difference in SF-36 scores between the 3 groups before the treatment(98.09+/-7.84,98.02+/-10.94,99.48+/-11.78 points,F=0.253,P=0.777).There was statistical difference in SF-36 scores between the 3 groups after the end of the treatment(106.76+/-6.21,113.30+/-8.75,118.14+/-8.26 points,F=21.367,P=0.000).The SF-36 scores were higher in short-lever manipulation group compared to education group and long-lever manipulation group(P=0.000,P=0.018),and were higher in long-lever manipulation group compared to education group after the end of the treatment(P=0.001).There was statistical difference between the 3 groups in the differences of SF-36 scores between pretreatment and posttreatment(8.67+/-5.69,15.28+/-7.46,18.66+/-7.19 points,F=22.151,P=0.000).The differences of SF-36 scores between pretreatment and posttreatment were larger in short-lever manipulation group and long-lever manipulation group compared to education group(P=0.000,P=0.000).There was no statistical difference between short-lever manipulation group and long-lever manipulation group in the differences of SF-36 scores between pretreatment and posttreatment(P=0.073).The effectiveness-cost ratio was higher in short-lever manipulation group compared to long-lever manipulation group(37.86+/-7.99 vs 33.21+/-8.63%,t=-2.331,P=0.035).Conclusion:The curative effect of cervical specific short-lever fine-regulation manipulation is better than that of health education and that of long-lever manipulation in the treatment of CSR,and it is superior to long-lever manipulation in effectiveness-cost ratio.

参考文献/References:

[1] 陈俊,严晓春.脊柱短杠杆微调手法治疗颈型颈椎病的临床研究[J].中国中医骨伤科杂志,2009,17(11):32-34.
[2] 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,2010,16(9):1526-1528.
[3] 朱清广,房敏,沈国权,等.微调手法对颈椎病患者颈肌力学性能影响研究[J].北京中医药,2011,30(3):180-182.
[4] 何水勇,沈国权.颈椎微调手法对颈性眩晕患者头颅空间回复能力的影响[J].江西中医学院学报,2011,23(4):19-21.
[5] 张乐,廖军,谢巧瑜,等.推拿治疗颈椎病的临床研究进展[J].健康研究,2012,32(6):457-459.
[6] 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.
[7] 孙宇,李贵存.第二届颈椎病专题座谈会纪要[J].中华外科杂志,1993,31(8):472-476.
[8] 俞大方.推拿学[M].上海:上海科学技术出版社,1985:82-85.
[9] 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.
[10] 王晓红,何成奇,丁明甫,等.颈椎病治疗成绩评分表[J].华西医学,2005,20(2):232-233.
[11] 朱立国,于杰,高景华,等.孙氏旋转手法治疗神经根型颈椎病临床规范化研究[J].医学研究杂志,2007,36(7):71.
[12] 张喜林,沈国权.脊柱微调手法中整体观念思想的基础及临床实践[J].按摩与康复医学,2015,7(7):19-22.
[13] 朱清广,房敏,潘磊,等.推拿手法对颈椎病患者颈椎节段三维空间位置的影响[J].中国中西医结合杂志,2012,32(7):922-925.
[14] 于文明.中医临床诊疗技术研究工作指南[M].北京:中国中医药出版社,2010:15-17.

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(05):8.
[2]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.
[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(05):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]袁娜,金秀均,魏戌,等.常规疗法联合耳穴埋豆治疗急性期神经根型颈椎病[J].中医正骨,2017,29(01):71.
[12]雷腾飞,张玉民,熊轶喆,等.复方紫荆消伤巴布膏外用联合益气活血方内服治疗神经根型颈椎病的临床研究[J].中医正骨,2018,30(03):13.
　LEI Tengfei,ZHANG Yumin,XIONG Yizhe,et al.A clinical study of external application of Fufang Zijing Xiaoshang Babugao(复方紫荆消伤巴布膏)combined with oral application of Yiqi Huoxue Fang(益气活血方)for treatment of cervical spondylotic radiculopathy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(05):13.
[13]袁菊莲,罗伦,赵燕,等.八段锦锻炼联合常规康复疗法在老年神经根型颈椎病患者康复治疗中的应用[J].中医正骨,2019,31(08):25.
　YUAN Julian,LUO Lun,ZHAO Yan,et al.Application of BADUANJIN(八段锦)exercises combined with conventional rehabilitation therapy to the rehabilitation of cervical spondylotic radiculopathy in aged patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(05):25.
[14]宋永伟,范华雨,樊金辉,等.卧位偏向牵引联合中药薰蒸治疗神经根型颈椎病的临床研究[J].中医正骨,2023,35(03):31.
　SONG Yongwei,FAN Huayu,FAN Jinhui,et al.A clinical study of the treatment of cervical spondylotic radiculopathy by deflected supine traction combined with Chinese herbal steaming[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(05):31.
[15]吴卓檀,任晓平,兰荣玉,等.活血化瘀类中成药辅助治疗神经根型颈椎病有效性的网状Meta分析[J].中医正骨,2024,36(1):33.
　WU Zhuotan,REN Xiaoping,LAN Rongyu,et al.Clinical outcomes of promoting blood circulation and removing blood stasis Chinese patent drugs for adjuvant treatment of cervical spondylotic radiculopathy:a network meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(05):33.

备注/Memo

备注/Memo:
基金项目:上海市进一步加快中医药事业发展三年行动计划项目(2014-2016年)(ZY3-LCPT-1-1007) 通讯作者:房敏 E-mail:zhounan83@126.com
更新日期/Last Update: 1900-01-01