自制颈部锻炼操结合推拿治疗颈型颈椎病的临床研究
摘要
目的:基于"脊柱整体观"自制功能锻炼操,观察自制颈部锻炼操结合推拿治疗颈型颈椎病的疗效。方法:将59例颈型颈椎病患者通过随机数字表法分为3组。A组19例,采用自制颈部锻炼操治疗;B组20例,采用推拿手法治疗;C组20例,采用自制颈部锻炼操结合推拿手法治疗。分别于治疗前、治疗后及治疗后6个月,运用Borden氏法测量患者X线颈椎曲度变化、视觉模拟评分法(VAS评分)评价患者疼痛程度、田中靖久颈椎评分表评判颈椎功能,上述3个指标共同评价患者不同阶段的治疗效果变化。结果:治疗后3组患者颈椎曲度比较,差异无统计学意义(P>0.05);治疗后6个月,A组、C组患者颈椎曲度均高于B组(P<0.01);A组患者颈椎曲度与C组比较,差异无统计学意义(P>0.05)。治疗后B组、C组患者VAS评分均低于A组(P<0.05或P<0.01);治疗后B组患者VAS评分与C组比较,差异无统计学意义(P>0.05)。治疗后6个月,A组、C组患者VAS评分均低于B组(P<0.01);A组患者VAS评分低于C组,差异无统计学意义(P>0.05)。治疗后3组患者田中靖久颈椎评分比较,差异无统计学意义(P>0.05)。治疗后6个月,A组、C组患者田中靖久颈椎评分均高于B组,差异均有统计学意义(P<0.01);A组患者田中靖久颈椎评分与C组比较,差异无统计学意义(P>0.05)。结论:推拿治疗颈型颈椎病的近期疗效明显优于颈部锻炼操锻炼,然而远期疗效低于颈部锻炼操锻炼;自制颈部锻炼操结合推拿治疗颈型颈椎病可获得更好的近期、远期疗效。
引文
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[24]房敏,严隽陶.颈部软组织病变在颈椎发病中的作用[J].中国骨伤,2001,14(2):30-31.
[25]覃一珏,陈曦,黄进,等.正骨手法对颈性失眠患者匹茨堡睡眠质量指数及体动记录仪指标的影响[J].中医药导报,2017,23(12):60-62,65.
[26]杨雪.神经根型颈椎病牵引推拿术后功能锻炼的价值[J].中医正骨,1996,8(6):11-12,52.
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[28]沈国权.脊柱手法治疗中的整体观念[C]//第四届全国推拿学术交流会,1995.
[29]师宁宁,沈国权,何水勇,等.脊柱推拿手法中的整体观念及其临床应用[J].中国中医骨伤科杂志,2015,23(2):67-69.
[2]王峻良,顾非.近十年颈型颈椎病研究综述[J].颈腰痛杂志,2014,35(3):211-213.
[3]贾连顺.颈椎病的诊断学基础[J].脊柱外科杂志,2004,2(3):187-189.
[4]PEDZIWIATR H.Psychological attachment in patients with spondylosis of cervical and lumbar spine[J].Advances in experimental medicine and biology,2013(755):357-363.
[5]黄征宙.颈型颈椎病的治疗进展[J].全科护理,2015,13(23):2245-2247.
[6]WOOD T G,COLLOCA C J,MATTHEWS R.A pilot randomized clinical trial on the relative effect of instrumental(MFMA)versus manual(HVLA)manipulation in the treatment of cervical spine dysfunction[J].Journal of ma nipula tive and physiological therapeutics,2001,24(4):260-271.
[7]贺志亮.桂枝加葛根汤治疗颈型颈椎病的临床疗效观察[D].北京:中国中医科学院,2015.
[8]陈民,林学波,郑秋坚,等.中西药治疗颈型颈椎病的疗效对比[J].广东医学,2007,28(11):1860-1862.
[9]JUN S,LEE J H,GONG H M,et al.Efficacy and safety of combined treatment of miniscalpel acupuncture and non-steroidal anti-inflammatory drugs:an assessorblinded randomized controlled pilot study[J].Trials,2018,19(1):36.
[10]冯跃,陈香竹,肖显俊,等.推拿治疗颈型颈椎病筋结处的超微结构及组织酶学的实验研究[J].时珍国医国药,2014,25(12):3064-3066.
[11]PASSMORE S R,BURKE J R,GOOD C,et al.Spinal manipulation impacts cervical spine movement and fitts'task performance:a single-blind randomized before-after trial[J].Journal of manipulative and physiological therapeutics,2010,33(3):189-192.
[12]贾琪,何晓华.电针配合穴位注射治疗颈型颈椎病[J].中医临床研究,2016,8(7):36-37.
[13]SEO S Y,LEE K B,SHIN J S,et al.Effectiveness of Acupuncture and Electroacupuncture for Chronic Neck Pain:A Systematic Review and Meta-Analysis[J].The American journal of Chinese medicine,2017,45(8):1573-1595.
[14]王轶稀.颈型颈椎病的中医推拿手法治疗临床疗效评价[D].北京:北京中医药大学,2008.
[15]秦标,王宁,杨丽艳,等.改良PNF技术配合龙氏正骨手法治疗颈型颈椎病的疗效观察[J].中医药导报,2017,23(20):90-92.
[16]万超,沈惠良,刘钊.Borden氏法与Harrison氏法测量颈椎曲度的一致性比较[J].中国脊柱脊髓杂志,2012,22(1):34-36.
[17]MANCHIKANTI L,DERBY R,BENYAMIN R M,et al.A systematic review of mechanical lumbar disc decompression with nucleoplasty[J].Pain physician,2009,12(3):561-572.
[18]孙建峰,丁晓虹,段俊峰,等.颈椎病的分型与诊断[J].颈腰痛杂志,2014,35(2):108-111.
[19]WUEST S,SYMONS B,LEONARD T,et al.Preliminary report:biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation[J].Journal of manipulative and physiological therapeutics,2010,33(4):273-278.
[20]SNIJDERS C J,HOEK VAN DIJKE G A,ROOSCH E R.A biomechanical model for the analysis of the cervical spine in static postures[J].Journal of biomechanics,1991,24(9):783-792.
[21]柯伟明,吕俊彪,周小鸿,等.刃针微创术配合正骨手法治疗颈型颈椎病的临床研究[J].中医药导报,2018,24(7):71-72,80.
[22]PLASTARAS C T,SCHRAN S,KIM N,et al.Complementary and alternative treatment for neck pain:chiropractic,acupuncture,TENS,massage,yoga,Tai Chi,and Feldenkrais[J].Physical medicine and rehabilitation clinics of North America,2011,22(3):521-537,IX.
[23]王桂茂,纪清,赵国红.按揉法推拿对颈型颈椎病疼痛改善的近期效应评价[J].时珍国医国药,2012,23(9):2261-2262.
[24]房敏,严隽陶.颈部软组织病变在颈椎发病中的作用[J].中国骨伤,2001,14(2):30-31.
[25]覃一珏,陈曦,黄进,等.正骨手法对颈性失眠患者匹茨堡睡眠质量指数及体动记录仪指标的影响[J].中医药导报,2017,23(12):60-62,65.
[26]杨雪.神经根型颈椎病牵引推拿术后功能锻炼的价值[J].中医正骨,1996,8(6):11-12,52.
[27]张茂狮,蒋海鹰,李兆文,等.颈椎保健操的应用研究[J].福建中医药,2002,33(4):4-6.
[28]沈国权.脊柱手法治疗中的整体观念[C]//第四届全国推拿学术交流会,1995.
[29]师宁宁,沈国权,何水勇,等.脊柱推拿手法中的整体观念及其临床应用[J].中国中医骨伤科杂志,2015,23(2):67-69.