推拿手法治疗寰枢椎不稳行后路手术术后局部疼痛的疗效观察
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摘要
目的：
验证推拿手法对寰枢椎不稳行后路手术术后局部残留的疼痛的疗效,为推拿手法在寰枢椎不稳行后路手术患者术后康复中的应用提供临床依据。方法：
选择自2009年4月至2011年1月在闽东医院住院治疗的寰枢椎不稳患者24例,均采用我们提出的寰椎椎弓根钉新的置钉方法,24例患者术后第二天拍颈椎正侧位片和椎弓根钉钉道轴位CT扫描,了解置钉成功率。按入院时间顺序按随机数字表法随机分为手法治疗组和对照组：
1.手法治疗组：自术后2-3天开始在颈托保护下坐立施行推拿手法,2周之内手法施于肩背部,以点、按、弹拨、揉、滚法施于斜方肌、背阔肌、冈上肌、冈下肌、大圆肌、小圆肌等,两周后在施行手法过程中可去除颈托,至第三周在前期治疗的基础上,增加颈部肌肉松解手法,以点、按、弹拨手法,施于颈部夹肌、肩胛提肌、棘间韧带、棘上韧带等,手法治疗时压痛点为重要施术部位,每日施行两次,每次20分钟。
2.对照组：观察患者颈肩部疼痛程度,必要时应用镇痛药物(本研究应用洛芬待因片),对于疼痛影响睡眠的应用镇静安眠药物(本研究应用舒乐安定)。
手法治疗前后对颈肩部疼痛程度(按2002年8月第10届国际疼痛大会通过的数字评分法,即NRS)进行疼痛评分,手法治疗后对颈椎活动度进行测量。对所得数据采用spss13.0进行统计学分析,p<0.05为差异有显著意义。
结果：
1、手法治疗组经手法治疗后疼痛评分较对照组有明显差异。
2、手法治疗组经手法治疗后颈椎前屈、左右旋转及左右侧屈活动度与对照组比较具有明显差异,而颈椎后伸活动度无明显差异。
结论：
1、推拿手法治疗寰枢椎不稳行后路手术术后局部残留的疼痛疗效肯定,值得临床推广应用。
2、推拿手法缓解寰枢椎不稳行后路手术术后局部残留的疼痛,可促进颈椎功能的更快恢复。
3、中西医结合可以对寰枢椎不稳进行更好的治疗,可以改善寰枢椎不稳患者的生活质量。
Objective:Verify the effect of massage which be used to treat pain for the patients with atlantoaxial instability who were operated on posteriorly。To Provide the clinical evidence for the use of massage in the patients with atlantoaxial instability who were operated on posteriorly。Learn about the safety and success rate of the new method of pedicle screws。
Methods:24 patients with atlantoaxial instability who hospitalized in our hospital during April 2009 to January 2010。All the patients were operated on posteriorly with the new method of pedicle screws。The next day we cheek X-ray and CT examination o understand the success rate of pedicle screws after surgery。The patients were divided into 3 groups at random with chronological order:1. massage group:we use the massage under the protection of neck collar with the patients in an armchair。Massage the shoulder and backside for two weeks after surgery。Massag trapezius, latissimus dorsi, supraspinatus, infraspinatus muscle, teres major, teres minor with the methods of point, press, plucked, kneading, rolling。After two weeks we can massage without the protection of neck collar。Increase the massage to release techniques neck muscle and massage the folder muscle, levator scapulae, interspinous ligament, supraspinous ligament with point, press, plucked。Spot is the important part when you massage, twice a day,20 minutes one time。2. Control group:Observed the with shoulder and neck pain, we should give the patients analgesic drugs when they can not endure the pain (In this study, we use ibuprofen and codeine phosphate)。If the pain impede sleep we should give the patients sedation (In this study,we use estazolam tablets)。We can use the NRS to get pain score。Measure the cervical vertebra for range of motion after massage。Then we should analyze the data use the SPSS 13.0。This shows a significant difference when p<0.05。Results:There are significant difference between massage group and control group in NRS。There are significant difference between massage group control group in anteflexion、rotation、flexor。In the part of extension showed no significant difference between two groups。
Conclusions:The effect of massage which be used to treat pain for the patients with atlantoaxial instability who were operated on posteriorly has a affirmative curative effect。It has the worthy if used in clinical。Massage can promote the features of the cervical a quick recovery。we can get better treatment if use the traditional Chinese medicine and Western medicine。
验证推拿手法对寰枢椎不稳行后路手术术后局部残留的疼痛的疗效,为推拿手法在寰枢椎不稳行后路手术患者术后康复中的应用提供临床依据。方法：
选择自2009年4月至2011年1月在闽东医院住院治疗的寰枢椎不稳患者24例,均采用我们提出的寰椎椎弓根钉新的置钉方法,24例患者术后第二天拍颈椎正侧位片和椎弓根钉钉道轴位CT扫描,了解置钉成功率。按入院时间顺序按随机数字表法随机分为手法治疗组和对照组：
1.手法治疗组：自术后2-3天开始在颈托保护下坐立施行推拿手法,2周之内手法施于肩背部,以点、按、弹拨、揉、滚法施于斜方肌、背阔肌、冈上肌、冈下肌、大圆肌、小圆肌等,两周后在施行手法过程中可去除颈托,至第三周在前期治疗的基础上,增加颈部肌肉松解手法,以点、按、弹拨手法,施于颈部夹肌、肩胛提肌、棘间韧带、棘上韧带等,手法治疗时压痛点为重要施术部位,每日施行两次,每次20分钟。
2.对照组：观察患者颈肩部疼痛程度,必要时应用镇痛药物(本研究应用洛芬待因片),对于疼痛影响睡眠的应用镇静安眠药物(本研究应用舒乐安定)。
手法治疗前后对颈肩部疼痛程度(按2002年8月第10届国际疼痛大会通过的数字评分法,即NRS)进行疼痛评分,手法治疗后对颈椎活动度进行测量。对所得数据采用spss13.0进行统计学分析,p<0.05为差异有显著意义。
结果：
1、手法治疗组经手法治疗后疼痛评分较对照组有明显差异。
2、手法治疗组经手法治疗后颈椎前屈、左右旋转及左右侧屈活动度与对照组比较具有明显差异,而颈椎后伸活动度无明显差异。
结论：
1、推拿手法治疗寰枢椎不稳行后路手术术后局部残留的疼痛疗效肯定,值得临床推广应用。
2、推拿手法缓解寰枢椎不稳行后路手术术后局部残留的疼痛,可促进颈椎功能的更快恢复。
3、中西医结合可以对寰枢椎不稳进行更好的治疗,可以改善寰枢椎不稳患者的生活质量。
Objective:Verify the effect of massage which be used to treat pain for the patients with atlantoaxial instability who were operated on posteriorly。To Provide the clinical evidence for the use of massage in the patients with atlantoaxial instability who were operated on posteriorly。Learn about the safety and success rate of the new method of pedicle screws。
Methods:24 patients with atlantoaxial instability who hospitalized in our hospital during April 2009 to January 2010。All the patients were operated on posteriorly with the new method of pedicle screws。The next day we cheek X-ray and CT examination o understand the success rate of pedicle screws after surgery。The patients were divided into 3 groups at random with chronological order:1. massage group:we use the massage under the protection of neck collar with the patients in an armchair。Massage the shoulder and backside for two weeks after surgery。Massag trapezius, latissimus dorsi, supraspinatus, infraspinatus muscle, teres major, teres minor with the methods of point, press, plucked, kneading, rolling。After two weeks we can massage without the protection of neck collar。Increase the massage to release techniques neck muscle and massage the folder muscle, levator scapulae, interspinous ligament, supraspinous ligament with point, press, plucked。Spot is the important part when you massage, twice a day,20 minutes one time。2. Control group:Observed the with shoulder and neck pain, we should give the patients analgesic drugs when they can not endure the pain (In this study, we use ibuprofen and codeine phosphate)。If the pain impede sleep we should give the patients sedation (In this study,we use estazolam tablets)。We can use the NRS to get pain score。Measure the cervical vertebra for range of motion after massage。Then we should analyze the data use the SPSS 13.0。This shows a significant difference when p<0.05。Results:There are significant difference between massage group and control group in NRS。There are significant difference between massage group control group in anteflexion、rotation、flexor。In the part of extension showed no significant difference between two groups。
Conclusions:The effect of massage which be used to treat pain for the patients with atlantoaxial instability who were operated on posteriorly has a affirmative curative effect。It has the worthy if used in clinical。Massage can promote the features of the cervical a quick recovery。we can get better treatment if use the traditional Chinese medicine and Western medicine。
引文
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[3]清.吴谦等.《正骨心法要旨》[M].[卷一]外治法.手法释义：公元1742年.
[4]付军,催增宾等.浅谈推拿手法与疗效的关系[J].天津中医药大学学报,2007,26(4)：179-180.
[5]姜宏,等.穴位指压推拿治疗腰腿痛的镇痛疗效观察与研究[J].颈腰痛杂志,1994;(1)：9-11.
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[7]Verow H. DhamiM, Howly T, et al. Spine manipulative and Beta-endorphin: a controlled study of the effect of spinal manipulation and plasma Beta-endorphin leaves in nomal mine Manipulative physiology 1986,9:15-23.
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[9]张建华,孙安达。推拿牵引治疗腰椎间盘突出症前后血单胺类物质含量变化分析.中国骨伤,1999；9(12)：47-48.
[10]刘至诚,等、按摩对肢体损伤家兔血中皮质醇的调整作用。中古中医骨伤科杂志,1999；(5)：7-10.
[11]韩济生.针刺镇痛原理[M].上海科技出版社,1999,2-11、34-41.