[1]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):31-36.
　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(03):31-36.
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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()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年03期
页码:
31-36
栏目:
临床研究
出版日期:
2023-03-20

文章信息/Info

Title:
A clinical study of the treatment of cervical spondylotic radiculopathy by deflected supine traction combined with Chinese herbal steaming
作者:
宋永伟; 范华雨; 樊金辉; 曹向阳; 鲍铁周; 蔡尚欢; 张杰; 海渊
(河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002)
Author(s):
SONG Yongwei; FAN Huayu; FAN Jinhui; CAO Xiangyang; BAO Tiezhou; CAI Shanghuan; ZHANG Jie; HAI Yuan
Luoyang Orthopedic-Traumatological Hospital of Henan Province/Henan Provincial Orthopedic Hospital,Luoyang 471002,Henan,China
关键词:
颈椎病;  神经根病;  牵引术;  熏洗疗法;  临床试验
Keywords:
cervical spondylosis;  radiculopathy;  traction;  steaming washing therapy;  clinical trial
摘要:
目的:观察卧位偏向牵引联合中药薰蒸治疗神经根型颈椎病的临床疗效。方法:将120例神经根型颈椎病患者随机分为卧位偏向牵引组、卧位常规牵引组、坐位牵引组,每组40例。卧位牵引治疗包括前屈位牵引8 d、中立位牵引2 d、背伸位牵引4 d; 卧位偏向牵引组在前屈位牵引时采用卧位偏向牵引,中立位、背伸位牵引时采用常规卧位牵引; 卧位常规牵引组全程采用常规卧位牵引法牵引; 坐位牵引组采用传统坐位间歇牵引法。3组患者均采用中药薰蒸治疗。牵引和中药薰蒸均每日2次,连续治疗14 d。分别于治疗前和治疗结束后,采用视觉模拟量表(visual analogue scale,VAS)评价患者颈部疼痛情况,测量患者颈椎旋转、前屈活动度,采用田中靖久神经根型颈椎病症状量表20分法和颈椎功能障碍指数(neck disability index,NDI)评价临床疗效,采用剪切波弹性成像技术测量斜方肌的杨氏模量值。结果:①颈部疼痛VAS评分。治疗结束后,3组患者颈部疼痛VAS评分均小于治疗前[(5.70±0.82)分,(1.43±0.68)分,t=37.779,P=0.000;(5.43±0.81)分,(2.53±0.93)分,t=15.945,P=0.000;(5.43±0.98)分,(3.00±1.13)分,t=16.013,P=0.000],卧位偏向牵引组患者颈部疼痛VAS评分小于卧位常规牵引组和坐位牵引组(LSD-t=6.040,P=0.000; LSD-t=7.562,P=0.000),卧位常规牵引组患者颈部疼痛VAS评分小于坐位牵引组(LSD-t=2.051,P=0.044)。②颈椎旋转活动度。治疗结束后,3组患者颈椎旋转活动度均大于治疗前(46.60°±10.45°,63.65°±7.79°,t=-9.379,P=0.000; 45.95°±9.24°,57.58°±7.54°,t=-6.694,P=0.000; 48.22°±9.96°,53.72°±9.39°,t=-2.298,P=0.000),卧位偏向牵引组患者颈椎旋转活动度大于卧位常规牵引组和坐位牵引组(LSD-t=-3.280,P=0.001; LSD-t=-5.371,P=0.000),卧位常规牵引组患者颈椎旋转活动度大于坐位牵引组(LSD-t=-2.083,P=0.040)。③颈椎前屈活动度。治疗结束后,3组患者颈椎前屈活动度均大于治疗前(28.45°±3.18°,41.57°±2.88°,t=-18.310,P=0.000; 27.70°±3.07°,38.95°±3.38°,t=-16.843,P=0.000; 28.15°±3.30°,35.25°±3.80°,t=-9.692,P=0.000),卧位偏向牵引组患者颈椎前屈活动度大于卧位常规牵引组和坐位牵引组(LSD-t=-3.482,P=0.001; LSD-t=-8.374,P=0.000),卧位常规牵引组患者颈椎前屈活动度大于坐位牵引组(LSD-t=-4.901,P=0.000)。④田中靖久神经根型颈椎病症状量表20分法评分。治疗结束后,3组患者田中靖久神经根型颈椎病症状量表20分法评分均大于治疗前[(7.58±3.87)分,(16.10±2.04)分,t=-14.437,P=0.000;(7.38±3.31)分,(13.25±2.10)分,t=-12.361,P=0.000;(7.25±2.99)分,(12.65±2.70)分,t=-10.696,P=0.000],卧位偏向牵引组患者田中靖久神经根型颈椎病症状量表20分法评分大于卧位常规牵引组和坐位牵引组(LSD-t=-6.172,P=0.001; LSD-t=-6.450,P=0.000),卧位常规牵引组患者田中靖久神经根型颈椎病症状量表20分法评分与坐位牵引组比较,差异无统计学意义(LSD-t=-1.113,P=0.271)。⑤NDI。治疗结束后,3组患者NDI均小于治疗前[(49.85±15.29)%,(18.93±12.05)%,t=10.694,P=0.000;(51.73±15.31)%,(29.95±9.08)%,t=10.728,P=0.000;(53.10±12.67)%,(33.85±10.33)%,t=7.190,P=0.000],卧位偏向牵引组患者NDI小于卧位常规牵引组和坐位牵引组(LSD-t=4.622,P=0.001; LSD-t=5.951,P=0.000),卧位常规牵引组患者NDI与坐位牵引组比较,差异无统计学意义(LSD-t=1.790,P=0.077)。⑥斜方肌杨氏模量值。治疗结束后,3组患者斜方肌杨氏模量值均小于治疗前[(92.67±17.96)%,(62.80±13.35)%,t=14.696,P=0.000;(87.05±12.30)%,(77.03±13.10)%,t=5.959,P=0.000;(87.33±14.48)%,(82.58±15.81)%,t=2.337,P=0.025],卧位偏向牵引组患者斜方肌杨氏模量值小于卧位常规牵引组和坐位牵引组(LSD-t=4.811,P=0.001; LSD-t=6.044,P=0.000),卧位常规牵引组患者斜方肌杨氏模量值与坐位牵引组比较,差异无统计学意义(LSD-t=1.711,P=0.091)。结论:卧位偏向牵引联合中药薰蒸治疗神经根型颈椎病,能够缓解颈部疼痛、改善颈部功能和斜方肌僵硬,疗效优于常规卧位牵引和坐位牵引联合中药薰蒸。
Abstract:
Objective:To observe the clinical efficacy of deflected supine traction combined with Chinese herbal steaming in the treatment of cervical spondylotic radiculopathy(CSR).Methods:A total of 120 CSR patients were randomly divided into a deflected supine traction(DST)group,a conventional supine traction(CST)group,and a sitting traction(ST)group,with 40 cases in each group.The supine traction consisted of traction in the forward flexion position for 8 days,in the neutral position for 2 days,and in the back flexion position for 4 days.In the DST group,DST was adopted in the traction in the forward flexion position,and CST was adopted in the traction in the neutral position and back flexion position.In the CST group,CST was employed throughout the whole treatment cycle.In the ST group,conventional intermittent ST was employed.All patients were treated with Chinese herbal steaming.Traction and Chinese herbal steaming were performed twice a day for 14 days.Before and after treatment,the visual analogue scale(VAS)was used to evaluate the cervical pain of patients,and ranges of motion in cervical rotation and cervical flexion were measured.The clinical efficacy was evaluated by the Yasuhisa Tanaka 20 Score Scale and neck disability index(NDI).Young's modulus of trapezius muscle was measured by shear wave elasticity imaging(SWEI).Results:①Cervical pain VAS score.After treatment,cervical pain VAS scores in all groups were lower than those before treatment(5.70±0.82 vs 1.43±0.68 points,t=37.779,P=0.000; 5.43±0.81 vs 2.53±0.93 points,t=15.945,P=0.000; 5.43±0.98 vs 3.00±1.13 points,t=16.013,P=0.000).The cervical pain VAS score in the DST group was lower than those in the CST group and the ST group(LSD-t=6.040,P=0.000; LSD-t=7.562,P=0.000).The cervical pain VAS score in the CST group was lower than that in the ST group(LSD-t=2.051,P=0.044).②Range of motion in cervical rotation.After treatment,ranges of motion in cervical rotation in all groups were greater than those before treatment(46.60°±10.45° vs 63.65°±7.79°,t=-9.379,P=0.000; 45.95°±9.24° vs 57.58°±7.54°,t=-6.694,P=0.000; 48.22°±9.96° vs 53.72°±9.39°,t=-2.298,P=0.000).The range of motion in cervical rotation in the DST group was greater than those in the CST group and the ST group(LSD-t=-3.280,P=0.001; LSD-t=-5.371,P=0.000).The range of motion in cervical rotation in the CST group was greater than that in the ST group(LSD-t=-2.083,P=0.040).③Range of motion in cervical flexion.After treatment,the ranges of motion in cervical flexion in all groups were greater than those before treatment(28.45°±3.18° vs 41.57°±2.88°,t=-18.310,P=0.000; 27.70°±3.07° vs 38.95°±3.38°,t=-16.843,P=0.000; 28.15°±3.30° vs 35.25°±3.80°,t=-9.692,P=0.000).The range of motion in cervical flexion in the DST group was greater than those in the CST group and the ST group(LSD-t=-3.482,P=0.001; LSD-t=-8.374,P=0.000).The range of motion in cervical flexion in the CST group was greater than that in the ST group(LSD-t=-4.901,P=0.000).④Yasuhisa Tanaka 20 Score Scale score.After treatment,Yasuhisa Tanaka 20 Score Scale scores in all groups were higher than those before treatment(7.58±3.87 vs 16.10±2.04 points,t=-14.437,P=0.000; 7.38±3.31 vs 13.25±2.10 points,t=-12.361,P=0.000; 7.25±2.9 vs 12.65±2.70 points,t=-10.696,P=0.000).The Yasuhisa Tanaka 20 Score Scale score in the DST group was higher than those in the CST group and the ST group(LSD-t=-6.172,P=0.001; LSD-t=-6.450,P=0.000).There was no statistically significant difference in Yasuhisa Tanaka 20 Score Scale score between the CST group and the ST group(LSD-t=-1.113,P=0.271).⑤NDI.After treatment,NDI in all groups was lower than that before treatment(49.85±15.29 vs 18.93±12.05%,t=10.694,P=0.000; 51.73±15.31 vs 29.95±9.08%,t=10.728,P=0.000; 53.10±12.67 vs 33.85±10.33%,t=7.190,P=0.000).The NDI in the DST group was lower than those in the CST group and the ST group(LSD-t=4.622,P=0.001; LSD-t=5.951,P=0.000).There was no statistically significant difference in NDI between the CST group and the ST group(LSD-t=1.790,P=0.077).⑥Young's modulus of trapezius muscle.After treatment,Young's modulus of trapezius muscle in all groups was lower than those before treatment(92.67±17.96 vs 62.80±13.35%,t=14.696,P=0.000; 87.05±12.30 vs 77.03±13.10%,t=5.959,P=0.000; 87.33±14.48 vs 82.58±15.81%,t=2.337,P=0.025).The Young's modulus of trapezius muscle in the DST group was lower than those in the CST group and the ST group(LSD-t=4.811,P=0.001; LSD-t=6.044,P=0.000).There was no statistically significant difference in Young's modulus of trapezius muscle between the CST group and the ST group(LSD-t=1.711,P=0.091).Conclusion:In the treatment of CSR,DST combined with Chinese herbal steaming can relieve cervical pain and improve cervical function and trapezius muscle stiffness,and the efficacy is superior to those of CST and ST combined with Chinese herbal steaming.

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更新日期/Last Update: 1900-01-01