防风汤加减结合项三针治疗神经根型颈椎病的临床研究
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摘要
目的观察防风汤加减结合项三针(针刺颈夹脊、颈百劳和阿是穴)治疗神经根型颈椎病(CSR)风寒痹阻证的疗效及安全性。方法将140例患者随机分为对照组和治疗组,各70例,对照组给予甲钴胺+复方硫酸软骨素,治疗组给予防风汤加减+项三针,疗程均为4周。比较2组患者治疗前后颈痛量表(NPQ)、颈椎病临床评价量表(CASCS)、颈椎关节活动度量表(CROM)和CSR风寒痹阻证中医证候评分;检测左侧椎动脉的平均流速(LBVA-Vm)、基底动脉平均流速(VA-Vm)、右侧椎动脉的平均流速(RBVA-Vm)、椎动脉阻力指数(VA-RI)和椎基底动脉内径(VAD);检测血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和神经肽Y(NPY)和核因子-κB(NF-κB)的含量;观察2组有效率和不良反应发生率。结果研究期间脱落6例。治疗后治疗组总有效率94.2%,高于对照组的84.8%(P<0.05);治疗组NPQ和中医证候评分低于对照组(P<0.05),CASCS和CROM评分高于对照组(P<0.05);治疗组BVA-Vm、VA-Vm、BVA-Vm和VAD水平高于对照组(P<0.05),VA-RI水平低于对照组(P<0.05);治疗组IL-1β、TNF-α、NPY和NF-κB含量低于对照组(P<0.05);治疗组不良反应发生率2.9%,低于对照组(22.7%,P<0.05)。结论防风汤加减结合项三针可明显改善CSR风寒痹阻证患者的临床症状,不良反应发生率低,值得临床推广应用。
OBJECTIVE To observe the efficacy and safety of Fangfeng decoction and nape tri-acupuncture-jia ji(EX-B2), bai lao(EX-HN14) and ashi point combined therapy in treating cervical spondylotic radiculopathy(CSR) with wind-cold obstruction syndrome. METHODS 140 patients were randomly divided into the control group and the treatment group with 70 cases in each. The control group was given mecobalamin + compound chondroitin sulfate, and the treatment group was given modified Fangfeng decoction + tri-acupuncture. The course of treatment were both 4 weeks. The Northwick Park Neck Pain Questionnaire(NPQ), clinical assessment scale for cervical spondylosis(CASCS), cervical range of motion(CROM) and TCM syndrome scores of CSR wind-cold obstruction syndrome were compared between the two groups both before and after treatment. The left bilateral vertebral artery velocity mean(LBVA-Vm), vertebral artery velocity mean(VA-Vm), right bilateral vertebral artery velocity mean(RBVA-Vm), vertebral artery resistance index(VA-RI) and Vertebrobasilar artery velocity mean(VAD) were detected. The content of serum interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), neuropeptide Y(NPY) and nuclear factor κB(NF-κB) were measured. The effective rate and the incidence of adverse reactions in the two groups were observed. RESULTS 6 cases were abscission during the research. After treatment, the total effective rate of the treatment group was 94.2%, which was significantly higher than that of the control group(84.8%, P<0.05). The scores of NPQ and TCM syndrome in the treatment group were significantly lower than those in the control group(P<0.05), and the scores of CASCS and CROM were significantly higher than those in the control group(P<0.05). The levels of BVA-Ym, VA-Vm, BVA-Vm and VAD in the treatment group were higher than those in the control group(P<0.05), and the levels of VA-RI were lower than those in the control group(P<0.05). The contents of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), neuropeptide Y(NPY) and nuclear factor κB(NF-κB) in the treatment group were significantly lower than those in the control group(P<0.05). The incidence of adverse reactions in the treatment group was 2.9%, significantly lower than that in the control group(22.7%, P<0.05). CONCLUSION Modified Fangfeng decoction and tri-acupuncture combined therapy can significantly improve the clinical symptoms of CSRS patients with wind-cold obstruction syndrome, with a low incidence of adverse reactions, which is worthy of clinical application.
OBJECTIVE To observe the efficacy and safety of Fangfeng decoction and nape tri-acupuncture-jia ji(EX-B2), bai lao(EX-HN14) and ashi point combined therapy in treating cervical spondylotic radiculopathy(CSR) with wind-cold obstruction syndrome. METHODS 140 patients were randomly divided into the control group and the treatment group with 70 cases in each. The control group was given mecobalamin + compound chondroitin sulfate, and the treatment group was given modified Fangfeng decoction + tri-acupuncture. The course of treatment were both 4 weeks. The Northwick Park Neck Pain Questionnaire(NPQ), clinical assessment scale for cervical spondylosis(CASCS), cervical range of motion(CROM) and TCM syndrome scores of CSR wind-cold obstruction syndrome were compared between the two groups both before and after treatment. The left bilateral vertebral artery velocity mean(LBVA-Vm), vertebral artery velocity mean(VA-Vm), right bilateral vertebral artery velocity mean(RBVA-Vm), vertebral artery resistance index(VA-RI) and Vertebrobasilar artery velocity mean(VAD) were detected. The content of serum interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), neuropeptide Y(NPY) and nuclear factor κB(NF-κB) were measured. The effective rate and the incidence of adverse reactions in the two groups were observed. RESULTS 6 cases were abscission during the research. After treatment, the total effective rate of the treatment group was 94.2%, which was significantly higher than that of the control group(84.8%, P<0.05). The scores of NPQ and TCM syndrome in the treatment group were significantly lower than those in the control group(P<0.05), and the scores of CASCS and CROM were significantly higher than those in the control group(P<0.05). The levels of BVA-Ym, VA-Vm, BVA-Vm and VAD in the treatment group were higher than those in the control group(P<0.05), and the levels of VA-RI were lower than those in the control group(P<0.05). The contents of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), neuropeptide Y(NPY) and nuclear factor κB(NF-κB) in the treatment group were significantly lower than those in the control group(P<0.05). The incidence of adverse reactions in the treatment group was 2.9%, significantly lower than that in the control group(22.7%, P<0.05). CONCLUSION Modified Fangfeng decoction and tri-acupuncture combined therapy can significantly improve the clinical symptoms of CSRS patients with wind-cold obstruction syndrome, with a low incidence of adverse reactions, which is worthy of clinical application.
引文
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[2] ZHANG GY,ZHOU MQ,TANG W,et al.System evaluation and meta analysis on clinical efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy [J].J Acup-Moxib,2016,26(4):41-49.
[3] GUO QF,WANG L,ZHANG BK,et al.Standalone anterior cervical discectomy and fusion versus combination with foraminotomy for the treatment of cervical spondylotic radiculopathy secondary to bony foraminal stenosis[J].World Neurosurg,2016,95(11):134-142.
[4] 孙宇,陈琪福.第二届颈椎病专题座谈会纪要 [J].中华外科杂志,1993,31(8):472.
[5] 中药新药临床研究指导原则[M].北京:人民卫生出版社,2002:130-131.
[6] 朱琳琳,蔡向红,尹逊路,等.针刺青灵组穴治疗神经根型颈椎病疗效观察[J].中国中医基础医学杂志,2018,24(6):813-814,817.
[7] GUO QF,ZHANG M,WANG L,et al.Deep surgical site infection after anterior decompression and fusion with plate fixation for cervical spondylotic radiculopathy or myelopathy[J].Clin Neuro Neur,2016,141(2):13-18.
[8] 黄帝内经[M].北京:人民卫生出版社,1978:385.
[9] 孙思邈.备急千金要方[M].沈阳:辽宁科学技术出版社,1997:163.
[10] 平少华,张岩,梁春雨.通塞脉片联合颈椎牵引治疗椎动脉型颈椎病60例[J].南京中医药大学学报,2015,31(1):90-92.
[11] 池澄清.针灸孔穴及其疗法便览[M].北京:人民卫生出版社,1959:4.
[12] ZHOU JF,LI XW,ZHAO JC,et al.Treatment of 30 patients with cervical spondylotic radiculopathy by acupuncture plus warming-needle moxibustion:a randomized controlled trial [J].J Acup-Moxib,2014,24(4):24-28.
[13] LEE DH,JAE HC,CHANG JH,et al.Multilevel posterior foraminotomy with laminoplasty versus laminoplasty alone for cervical spondylotic myelopathy with radiculopathy:a comparative study[J].Spine J,2018,18(3):414-421.