针刺治疗颈椎病椎动脉型的临床研究
摘要
目的:
颈椎病是当前严重影响人们正常工作、生活的常见病,给患者及家属带来莫大的痛苦和不便。随着经济的发展,生活节奏的加快,人类越来越“忽视”自己的健康。长时间的读书看报、不分昼夜的工作、风雨中的奔波、精神高度紧张、甚至过度享受改善人类生活、工作环境的空调都成了诱发颈椎病的罪魁祸首,部分患者产生下头昏、呕吐甚至昏厥等不良症状,严重影响正常的学习工作。颈椎病常被分为六型:椎动脉型、神经根型、脊髓型、交感神经型、颈型、混合型。椎动脉型颈椎病以头晕、头痛、耳鸣等为主要表现,头疼与眩晕交替出现,颈项转动时可诱发本病。
观察针刺对椎动脉型颈椎病患者的临床疗效,比较治疗组与对照组治疗前后脑血管多普勒检查椎动脉供血指征,为针灸治疗椎动脉型颈椎病提供有效的治疗方法,并为针灸治疗椎动脉型颈椎病提供科学的依据。
方法:
全部50例研究对象均为湖北省中医院针灸科住院患者,均符合CSA的中西医诊断标准,且经X线检查确诊为椎动脉型颈椎病,按随机的原则分为两组。
针刺治疗组30例,主穴:风池、C_(6)夹脊,配穴:百会、人中、内关、足三里、太冲、大杼、绝骨,随症加减:头痛加太阳、率谷、后溪、申脉,头昏加太溪、曲泉、丰隆,颈椎痛加颈椎痛点、大椎。
操作方法:选取好穴位,常规皮肤消毒,捻转进针,其中足三里、太溪、绝骨用捻转补法,其余穴位施以泻法。留针30分钟,每10分钟行针一次。每周六次,四周为一疗程。
对照组(推拿组)20例,采用推拿手法治疗点按风池、风府、肩井、天杆、曲池、手三里、小海、合谷等穴、另采用押法、按法、揉法、合法、拔伸法、拔抻旋转法等手法治疗。每周六次,四周为一疗程。
一疗程后比较治疗组与对照组脑血管多普勒检查椎动脉洪血指征及症状、疼痛指征,判断两者的可比性、差异性、优越性。结果:1.通过X~2检验两组资料具有可比性。2.临床疗效评定:针刺组显效率73.3%,有效率93.3%,推拿组显效率65%,有效率85%。经Ridit分析,P<0.05,两组疗效差异显著,针刺组疗效优于推拿组。3.治疗前后脑血管多普勒检查椎动脉供血指征变化情况:治疗后两组脑血管多普勒检查椎动脉供血指征均较治疗前明显好转。
结论:
与西医药及手术治疗存在各种副作用及潜在的并发症相比,中医治疗该病的特色和优势逐渐体现出来,并越来越受到人们的重视。其中针刺和手法治疗最受患者青睐,本课题拟两法疗效对比进行探讨,以期为临床提供较为科学的治疗该病的方法。针刺和推拿均能改善椎动脉供血及症状、疼痛指征,对椎动脉型颈椎病均有较好的治疗作用,但针刺组疗效明显优于推拿组,针刺治疗椎动脉型颈椎病疗效显著,应用方便、且无任何毒副作用,便于患者接受,值得在临床上进一步推广应用。
讨论:
CSA的发病因素主要是颈椎退行性改变,但应重视椎动脉本身病变所产生的自身原发性病变。在治疗上,应充分利用现代仪器,现代手段,结合病史早期诊断,因人而异,针对症状、体征、病程、患者体质严格掌握适应证,把握治疗时机,综合治疗,才能取得良好的治疗效果。
Objective:
To observe the clinic effects of acupuncture on cervical spondylotic vertebral arteriopathy(CSA),provide effective therapeutic methods for acupuncture to treat CSA and a scientific theroy by comparing the indexes of vertebral artery providing blood tested by cerebrovascular TCD before and after treatment between the treated group and the control group.
Methods
Study was performed on 50 patients with CSA,which was proved by X-ray,who was from in-patient departments of acupuncture and moxibustion of HuBei hospital of traditional Chinese medicine and was randomdly divided into 2 groups:acupuncture group,which was composed of 30 patient who were treated only by acupuncture;control group,comprised 20 patients treated by massage therapy.We compared the indexes of vertebral artery providing blood tested by cerebrovascular TCD,syndrom and the index of ache before and after treatment between the treated group and the control group,and estimate the comparability,difference and superior.
Result
1 There is comparability between the two groups verified by X~2-test.
2 Clinic Evaluation The remarkably improved rate of the acupuncture group was 73.3%and the effective rate was 93.3%.The remarkably improved rate of the massage group was 65%and the effective rate was 85%.Analyzed by radit,there were significant differences between the two groups(P<0.05),Obviously,the acupuncture group was superior to the massage group. 3 The changes of the indexes of vertebral artery providing blood tested by cerebrovascular TCD before and after treatment:Compared to that before treating,the indexes of vertebral artery providing blood after treating were significantly improved.
Conclusion
Both acupucture andmassagecan improve the blood-providing, syndrom and decrease the index of ache,both have preferable therapeutic effects on CSA,but the acupuncture group is superior to massage one.Acupucture has remarkable clinic effects on CSA,it can be applied conveniently and it likely has no vice or poisonous effects.It can be accepted and shoud be worth applying further in practic.
颈椎病是当前严重影响人们正常工作、生活的常见病,给患者及家属带来莫大的痛苦和不便。随着经济的发展,生活节奏的加快,人类越来越“忽视”自己的健康。长时间的读书看报、不分昼夜的工作、风雨中的奔波、精神高度紧张、甚至过度享受改善人类生活、工作环境的空调都成了诱发颈椎病的罪魁祸首,部分患者产生下头昏、呕吐甚至昏厥等不良症状,严重影响正常的学习工作。颈椎病常被分为六型:椎动脉型、神经根型、脊髓型、交感神经型、颈型、混合型。椎动脉型颈椎病以头晕、头痛、耳鸣等为主要表现,头疼与眩晕交替出现,颈项转动时可诱发本病。
观察针刺对椎动脉型颈椎病患者的临床疗效,比较治疗组与对照组治疗前后脑血管多普勒检查椎动脉供血指征,为针灸治疗椎动脉型颈椎病提供有效的治疗方法,并为针灸治疗椎动脉型颈椎病提供科学的依据。
方法:
全部50例研究对象均为湖北省中医院针灸科住院患者,均符合CSA的中西医诊断标准,且经X线检查确诊为椎动脉型颈椎病,按随机的原则分为两组。
针刺治疗组30例,主穴:风池、C_(6)夹脊,配穴:百会、人中、内关、足三里、太冲、大杼、绝骨,随症加减:头痛加太阳、率谷、后溪、申脉,头昏加太溪、曲泉、丰隆,颈椎痛加颈椎痛点、大椎。
操作方法:选取好穴位,常规皮肤消毒,捻转进针,其中足三里、太溪、绝骨用捻转补法,其余穴位施以泻法。留针30分钟,每10分钟行针一次。每周六次,四周为一疗程。
对照组(推拿组)20例,采用推拿手法治疗点按风池、风府、肩井、天杆、曲池、手三里、小海、合谷等穴、另采用押法、按法、揉法、合法、拔伸法、拔抻旋转法等手法治疗。每周六次,四周为一疗程。
一疗程后比较治疗组与对照组脑血管多普勒检查椎动脉洪血指征及症状、疼痛指征,判断两者的可比性、差异性、优越性。结果:1.通过X~2检验两组资料具有可比性。2.临床疗效评定:针刺组显效率73.3%,有效率93.3%,推拿组显效率65%,有效率85%。经Ridit分析,P<0.05,两组疗效差异显著,针刺组疗效优于推拿组。3.治疗前后脑血管多普勒检查椎动脉供血指征变化情况:治疗后两组脑血管多普勒检查椎动脉供血指征均较治疗前明显好转。
结论:
与西医药及手术治疗存在各种副作用及潜在的并发症相比,中医治疗该病的特色和优势逐渐体现出来,并越来越受到人们的重视。其中针刺和手法治疗最受患者青睐,本课题拟两法疗效对比进行探讨,以期为临床提供较为科学的治疗该病的方法。针刺和推拿均能改善椎动脉供血及症状、疼痛指征,对椎动脉型颈椎病均有较好的治疗作用,但针刺组疗效明显优于推拿组,针刺治疗椎动脉型颈椎病疗效显著,应用方便、且无任何毒副作用,便于患者接受,值得在临床上进一步推广应用。
讨论:
CSA的发病因素主要是颈椎退行性改变,但应重视椎动脉本身病变所产生的自身原发性病变。在治疗上,应充分利用现代仪器,现代手段,结合病史早期诊断,因人而异,针对症状、体征、病程、患者体质严格掌握适应证,把握治疗时机,综合治疗,才能取得良好的治疗效果。
Objective:
To observe the clinic effects of acupuncture on cervical spondylotic vertebral arteriopathy(CSA),provide effective therapeutic methods for acupuncture to treat CSA and a scientific theroy by comparing the indexes of vertebral artery providing blood tested by cerebrovascular TCD before and after treatment between the treated group and the control group.
Methods
Study was performed on 50 patients with CSA,which was proved by X-ray,who was from in-patient departments of acupuncture and moxibustion of HuBei hospital of traditional Chinese medicine and was randomdly divided into 2 groups:acupuncture group,which was composed of 30 patient who were treated only by acupuncture;control group,comprised 20 patients treated by massage therapy.We compared the indexes of vertebral artery providing blood tested by cerebrovascular TCD,syndrom and the index of ache before and after treatment between the treated group and the control group,and estimate the comparability,difference and superior.
Result
1 There is comparability between the two groups verified by X~2-test.
2 Clinic Evaluation The remarkably improved rate of the acupuncture group was 73.3%and the effective rate was 93.3%.The remarkably improved rate of the massage group was 65%and the effective rate was 85%.Analyzed by radit,there were significant differences between the two groups(P<0.05),Obviously,the acupuncture group was superior to the massage group. 3 The changes of the indexes of vertebral artery providing blood tested by cerebrovascular TCD before and after treatment:Compared to that before treating,the indexes of vertebral artery providing blood after treating were significantly improved.
Conclusion
Both acupucture andmassagecan improve the blood-providing, syndrom and decrease the index of ache,both have preferable therapeutic effects on CSA,but the acupuncture group is superior to massage one.Acupucture has remarkable clinic effects on CSA,it can be applied conveniently and it likely has no vice or poisonous effects.It can be accepted and shoud be worth applying further in practic.
引文
[1]张少祥.压痛点推拿治疗椎动脉型颈椎病70例[J].安徽中医学院学报,1993(1):21-22
[2]王道全.推拿治疗椎动脉型颈椎病50例[J].山东中医学院学报,1990(1):42-43
[3]李加斌.一指禅手法治疗椎动脉型颈椎病60例[J].江苏中医,1994(10):29-30
[4]强刚,欧阳怀东.推拿治疗椎动脉型颈椎病180例报告[J].中医正骨,1995(2):21-22
[5]刘辉.搬头法治疗椎动脉型颈椎65例疗效观察[J].四川中医,1990(3):44
[6]吴毅文,余家阔,吴建贤.牵引推拿治疗椎动脉型颈椎病110例临床观察[J].中国运动医学杂志,1993(3):129-133
[7]朱金山.四应法推拿治疗椎动脉型颈椎病30例[J].按摩与导引,1985(3):16
[8]安连生.综合手法治疗难治性椎动脉型颈椎病[J].广西中医药,1985(5):24
[9]姚志方.针刺治疗颈椎病椎动脉型34例疗效观察[J].福建中医学院学报,1996(1):25-26
[10]刘悦.直接灸治疗椎动脉型颈椎病性头晕16例[J].按摩与导引,1994(5):43-44
[11]王文莉.推拿配合真武汤治疗椎动脉型颈椎病21例[J].成都中医学院学报,1994(1):48-49
[12]王易虎,郭建生,施宇翔,等.颈痛宁对椎动脉型颈椎病的疗效分析及实验研究[J].陕西医学杂志,1991(11):660-662
[13]余维豪,金来贵,李萍,等.整体脉冲治疗仪治疗椎动脉型颈椎病114例疗效观察[J].中国针灸,1995(6):21-22
[14]周世芳.体外反搏治疗椎动脉型颈椎病[J].中国康复医学杂志,1994(2):71-72
[15]华桂如,殷风华,郭瑞芬.低频脉冲碰场治疗椎动脉型颈椎病[J].中国理疗杂志,1993(3):154-155
[16]李炎高.推拿牵引理疗治疗神经根型和椎动脉型颈椎病632例疗效观察[J].按摩与导引,1994(3):9-10
[17]倪红联,罗志军椎动脉型颈椎病的选择性牵引治疗[J]浙江临床医学,2000,9(2):623.
[18]陈月桂,蔡韵琴,李正英椎动脉型颈椎病的综合康复治疗[J]现代康复,2000,4(4):602
[19]常伟,李吉平中西医结合治疗椎动脉型颈椎病58例[J]吉林中医药,1999,5:38
[20]Hukuboa.Trans-unto-d'scol approach a combined anterior and late real approach 40 cervical disc.JNeurosurg.1976,285
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[22]陈鸿儒,董火斤,陈双,等.双减压椎间融合术治疗椎动脉型颈椎病[J].骨与关节损伤杂志,1993(1):3-6
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[2]王道全.推拿治疗椎动脉型颈椎病50例[J].山东中医学院学报,1990(1):42-43
[3]李加斌.一指禅手法治疗椎动脉型颈椎病60例[J].江苏中医,1994(10):29-30
[4]强刚,欧阳怀东.推拿治疗椎动脉型颈椎病180例报告[J].中医正骨,1995(2):21-22
[5]刘辉.搬头法治疗椎动脉型颈椎65例疗效观察[J].四川中医,1990(3):44
[6]吴毅文,余家阔,吴建贤.牵引推拿治疗椎动脉型颈椎病110例临床观察[J].中国运动医学杂志,1993(3):129-133
[7]朱金山.四应法推拿治疗椎动脉型颈椎病30例[J].按摩与导引,1985(3):16
[8]安连生.综合手法治疗难治性椎动脉型颈椎病[J].广西中医药,1985(5):24
[9]姚志方.针刺治疗颈椎病椎动脉型34例疗效观察[J].福建中医学院学报,1996(1):25-26
[10]刘悦.直接灸治疗椎动脉型颈椎病性头晕16例[J].按摩与导引,1994(5):43-44
[11]王文莉.推拿配合真武汤治疗椎动脉型颈椎病21例[J].成都中医学院学报,1994(1):48-49
[12]王易虎,郭建生,施宇翔,等.颈痛宁对椎动脉型颈椎病的疗效分析及实验研究[J].陕西医学杂志,1991(11):660-662
[13]余维豪,金来贵,李萍,等.整体脉冲治疗仪治疗椎动脉型颈椎病114例疗效观察[J].中国针灸,1995(6):21-22
[14]周世芳.体外反搏治疗椎动脉型颈椎病[J].中国康复医学杂志,1994(2):71-72
[15]华桂如,殷风华,郭瑞芬.低频脉冲碰场治疗椎动脉型颈椎病[J].中国理疗杂志,1993(3):154-155
[16]李炎高.推拿牵引理疗治疗神经根型和椎动脉型颈椎病632例疗效观察[J].按摩与导引,1994(3):9-10
[17]倪红联,罗志军椎动脉型颈椎病的选择性牵引治疗[J]浙江临床医学,2000,9(2):623.
[18]陈月桂,蔡韵琴,李正英椎动脉型颈椎病的综合康复治疗[J]现代康复,2000,4(4):602
[19]常伟,李吉平中西医结合治疗椎动脉型颈椎病58例[J]吉林中医药,1999,5:38
[20]Hukuboa.Trans-unto-d'scol approach a combined anterior and late real approach 40 cervical disc.JNeurosurg.1976,285
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