理筋正骨手法结合运动训练治疗慢性颈痛的临床观察
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摘要
目的评价理筋正骨手法结合运动训练治疗慢性颈痛(chronic neck pain,CNP)的临床疗效。方法将65例CNP患者,随机分为治疗组33例和对照组32例,治疗组采用理筋正骨手法结合运动训练,对照组采用中频电疗法结合运动训练。治疗前后运用视觉模拟量表(visual analogue scale, VAS)、颈部肌群肌耐力、表面肌电中位频率值(median frequency, MF)以及Northwick Park颈痛量表(Northwick Park Questionnaire, NPQ)对患者颈部功能进行评估、比较,并用中医病证诊断疗效标准进行疗效观察(评估过程采用盲法)。结果最终59例患者完成治疗,治疗组31例,对照组28例。与本组治疗前比较,两组治疗后疼痛减轻、颈部肌肉耐力提升、疲劳度下降,NPQ颈痛量表评分下降(均P<0.05);治疗组在疼痛和疲劳度改善情况上优于对照组(P<0.05);治疗组总有效率[87.1%(27/31)]高于对照组总有效率[64.3%(18/28),P<0.05]。结论理筋正骨手结合运动训练可有效减轻CNP患者的疼痛,增加颈部肌肉耐力,减轻肌肉疲劳度,改善患者的生活质量,其疗效优于中频电疗法结合运动训练。
Objective To evaluate the clinical efficacy of sinew-regulating and bone-setting manipulation(SRBSM) combined with exercise therapy(ET) in treating chronic neck pain. Methods Sixty-five patients with chronic neck pain who met the inclusion criteria were randomly assigned to a treatment group(33 cases) and a control group(32 cases). Patients in the treatment group received SRBSM combined with ET, while those in the control group was treated with intermediate frequency electrotherapy and ET. Visual Analogue Scale(VAS), cervical muscle endurance, surface median frequency(MF), and Northwick Park Questionnaire(NPQ) were used to evaluate and compare the patients′ neck function before and after treatment. The efficacy was observed with diagnosis and efficacy standards of TCM.(The assessment process was blinded.) Results Finally 59 patients completed the treatment, 31 in the treatment group and 28 in the control group. Compared with the same group before treatment, the pain was significantly attenuated, neck muscle endurance elevated, and muscle fatigue(MF) decreased after treatment, and NPQ score dropped(all P<0.05). The treatment group was superior in terms of pain attenuation and MF improvement(P<0.05). The total effective rate was 87.1%(27/31) in the treatment group and 64.3%(18/28) in the control group(P<0.05). Conclusions SRBSM combined with ET could effectively relieve pain of patients with chronic neck pain, elevate neck muscle endurance, reduce MF, and improve patients′ quality of life. Its efficacy was superior to intermediate frequency electrotherapy combined with ET.
Objective To evaluate the clinical efficacy of sinew-regulating and bone-setting manipulation(SRBSM) combined with exercise therapy(ET) in treating chronic neck pain. Methods Sixty-five patients with chronic neck pain who met the inclusion criteria were randomly assigned to a treatment group(33 cases) and a control group(32 cases). Patients in the treatment group received SRBSM combined with ET, while those in the control group was treated with intermediate frequency electrotherapy and ET. Visual Analogue Scale(VAS), cervical muscle endurance, surface median frequency(MF), and Northwick Park Questionnaire(NPQ) were used to evaluate and compare the patients′ neck function before and after treatment. The efficacy was observed with diagnosis and efficacy standards of TCM.(The assessment process was blinded.) Results Finally 59 patients completed the treatment, 31 in the treatment group and 28 in the control group. Compared with the same group before treatment, the pain was significantly attenuated, neck muscle endurance elevated, and muscle fatigue(MF) decreased after treatment, and NPQ score dropped(all P<0.05). The treatment group was superior in terms of pain attenuation and MF improvement(P<0.05). The total effective rate was 87.1%(27/31) in the treatment group and 64.3%(18/28) in the control group(P<0.05). Conclusions SRBSM combined with ET could effectively relieve pain of patients with chronic neck pain, elevate neck muscle endurance, reduce MF, and improve patients′ quality of life. Its efficacy was superior to intermediate frequency electrotherapy combined with ET.
引文
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[2] 张恩铭, 王安利, 李新建, 等. 女性慢性颈痛患者颈深肌肉形态特征及其与颈肩部姿势相关性研究[J]. 中国运动医学杂志, 2016, 35(9): 816-821.
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[8] 栾国瑞, 陈朝晖, 时威, 等. 简易颈椎操对颈椎活动度和疼痛改善作用的效果观察[J]. 中医药临床杂志, 2014, 26(5): 488-490.
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[12] 张佳玮, 毕胜. 慢性颈痛的肌肉机制研究进展[J]. 中国康复医学杂志, 2016, 31(10): 1175-1178.
[13] Falla D, Bilenkij G, Jull GA. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task[J]. Spine, 2004, 29(13): 1436-1440.
[14] 张昊, 房敏, 蒋诗超, 等. 推拿干预疼痛传导途径的研究进展[J]. 中华中医药杂志, 2013, 1(1): 171-174.
[15] Halvorsen M, Abbott A, Peolsson A, et al. Endurance and fatigue characteristics in the neck muscles during sub-maximal isometric test in patients with cervical radiculopathy[J]. Eur Spine J, 2014, 23(3): 590-598.
[16] Jull GA, O′Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: Thecraniocervical flexion test[J]. J Manipulative Physiol Ther, 2008, 31(7): 525-533.
[17] 于洪军, 李成伟, 于淼. 肌纤维募集定律的理论溯源及其对力量训练实践的影响[J]. 体育科学, 2016, 36(11): 56-65.
[18] 卫小梅, 郭铁成. 悬吊运动疗法——一种主动训练及治疗肌肉骨骼疾患的方法[J]. 中华物理医学与康复杂志, 2006, 28(4): 281-283.
[19] 迈尔斯, 关玲, 周维金等主编. 解剖列车: 徒手与动作治疗的肌筋膜经线[M]. 北京: 北京科学技术出版社, 2016: 97-99.
[20] 胡小珍, 姚新苗, 徐守宇. sEMG在颈痛患者颈肌功能特征研究中的应用[J]. 中国康复医学杂志, 2016, 31(5): 578-582.
[2] 张恩铭, 王安利, 李新建, 等. 女性慢性颈痛患者颈深肌肉形态特征及其与颈肩部姿势相关性研究[J]. 中国运动医学杂志, 2016, 35(9): 816-821.
[3] Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: Revision 2017: Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association[J]. J Orthop Sports Phys Ther, 2017, 47(7): A1-A83.
[4] 中华医学会疼痛学分会. 临床诊疗指南-疼痛学分册[M]. 北京: 人民卫生出版社, 2007: 96.
[5] 郑筱萸主编. 中医新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 347.
[6] 黄桂成主编. 中医筋伤学[M]. 北京: 中国中医药出版社, 2016: 154-155.
[7] 孙树椿主编. 清宫正骨手法图谱[M]. 北京: 中国中医药出版社, 2012: 71-72.
[8] 栾国瑞, 陈朝晖, 时威, 等. 简易颈椎操对颈椎活动度和疼痛改善作用的效果观察[J]. 中医药临床杂志, 2014, 26(5): 488-490.
[9] 诸毅晖主编. 康复评定学[M]. 上海: 上海科学技术出版社, 2008: 123.
[10] 李建华, 王健主编. 表面肌电图诊断技术临床应用[M]. 杭州: 浙江大学出版社, 2015: 195-196.
[11] 国家中医药管理局. 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 189-190.
[12] 张佳玮, 毕胜. 慢性颈痛的肌肉机制研究进展[J]. 中国康复医学杂志, 2016, 31(10): 1175-1178.
[13] Falla D, Bilenkij G, Jull GA. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task[J]. Spine, 2004, 29(13): 1436-1440.
[14] 张昊, 房敏, 蒋诗超, 等. 推拿干预疼痛传导途径的研究进展[J]. 中华中医药杂志, 2013, 1(1): 171-174.
[15] Halvorsen M, Abbott A, Peolsson A, et al. Endurance and fatigue characteristics in the neck muscles during sub-maximal isometric test in patients with cervical radiculopathy[J]. Eur Spine J, 2014, 23(3): 590-598.
[16] Jull GA, O′Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: Thecraniocervical flexion test[J]. J Manipulative Physiol Ther, 2008, 31(7): 525-533.
[17] 于洪军, 李成伟, 于淼. 肌纤维募集定律的理论溯源及其对力量训练实践的影响[J]. 体育科学, 2016, 36(11): 56-65.
[18] 卫小梅, 郭铁成. 悬吊运动疗法——一种主动训练及治疗肌肉骨骼疾患的方法[J]. 中华物理医学与康复杂志, 2006, 28(4): 281-283.
[19] 迈尔斯, 关玲, 周维金等主编. 解剖列车: 徒手与动作治疗的肌筋膜经线[M]. 北京: 北京科学技术出版社, 2016: 97-99.
[20] 胡小珍, 姚新苗, 徐守宇. sEMG在颈痛患者颈肌功能特征研究中的应用[J]. 中国康复医学杂志, 2016, 31(5): 578-582.