摘要
背景
随着电力等能源的发展应用,电话、电视、电脑等的通用,人们生活节奏的加快和社会压力的增加,颈椎病的发病率在短短数年内迅速增高,其中神经根型颈椎病(Cervical Spondylotic Radieulopathy, CSR)在各型颈椎病中发病率最高,约占60-70%,是临床上最常见类型。CSR是由于长期慢性劳损加之颈椎退行性改变、颈椎关节失稳及其周围韧带损伤所引起颈肩部的肌肉痉挛,主要临床症状为持续性或间断性的颈连肩痛或肌肉僵硬不舒,伴上肢疼痛或麻木,上背部肌肉酸痛,头颈部活动明显受限。大量临床实践证明,针灸疗法治疗CSR疗效良好。其中针刺颈夹脊穴取得良好的疗效,其机制研究也取得一定的成果,是治疗CSR的常用方法。单纯针刺颈夹脊穴治疗CSR,我们发现颈项酸痛、活动受限缓解起效较慢,如果采用经筋辨证以远端取穴配合运动针法治疗,疼痛的改善较为明显,且该法对颈项酸痛板滞、活动受限、病程短者疗效尤佳。
目的
观察经筋辨证配合运动针法治疗神经根型颈椎病(CSR)的临床疗效,从而为治疗本病提供疗效确切而持久的针灸治疗方案,同时运用经筋辨证为可靠的理论分析基础,促进中医临床回归经典。
方法
采用随机对照试验的临床研究方法。选取符合纳入标准的神经根型颈椎病患者60例为研究对象,按1：1比例随机分为治疗组和对照组,治疗组采用经筋辨证配合运动针法,对照组采用传统针刺方案治疗。分别于治疗前0天、半疗程后、1疗程后、治疗后1个月、治疗后3个月用Northwick Park颈痛量表(NPQ)及VAS评分记录观察疗效,并随时记录研究过程中的不良事件。采用统计软件SPSS17.0对所收集的数据进行统计分析。
结果
1、治疗前,治疗组与对照组的一般情况、NPQ及VAS评分无显著差异(P>0.05)。
2、半疗程后,两组的NPQ及VAS评分与治疗前有显著差异(P<0.05)。1疗程后,两组的NPQ及VAS评分与治疗前有显著差异(P<0.05)。
3、半疗程后,治疗组的NPQ及VAS评分明显下降,低于对照组,有显著差异(P<0.05)。1疗程后,治疗组的NPQ及VAS评分与对照组无显著差异(P>0.05)。治疗后1个月,治疗组的NPQ及VAS评分明显下降,低于对照组,有显著差异(P<0.05)。治疗后3个月,两组的NPQ及VAS评分对比无显著差异(P>0.05)。
4、两组治疗过程中均未出现晕针、滞针、弯针、断针、血肿等不良事件。
结论
两种针刺方案治疗CSR都取得良好的临床疗效,都能改善患者的颈痛及上肢麻木等症状,且经筋辨证配合运动针法在近期及远期疗效上要明显优于传统针刺的对照组。
Background:
With the development and general application of electricity and other energy, telephone, television, computers, people speed up the rhythm of life and social pressures increase, the incidence of cervical disease increased rapidly in a few years, Cervical Spondylotic Radieulopathy (CSR for short) is in the incidence of cervical disease in the highest, accounting for about 60-70%, which is the most common type of clinical. CSR is due to chronic fatigue combined with cervical degeneration, cervical joint instability caused by ligament injury in and around the shoulder and neck muscle spasms. The CSR's clinical symptoms were persistent or intermittent neck with shoulder pain or muscle stiffness and discomfort, with upper limb pain or numbness, upper back muscle pain, head and neck significantly limited. A large number of clinical practice has proved a good efficacy of acupuncture therapy for CSR. The point JIAJI goes valid, its mechanism has achieved some results, is the common method of treatment of CSR. To cure CSR with simple acupuncture point of neck JIAJI, we found that neck pain and limited mobility lighten slowly. If adopted by acupuncture and movement with dialectic of channels and tendons treatment, the pain improvement is more obvious, and to the stiff neck pain, limited mobility, the shorter duration patients,this method is preferred.
Objective:
Observing the clinical efficacy of acupuncture and movement with dialectic of channels and tendons treatment to Cervical Spondylotic Radieulopathy(CSR), thus providing the curative effect and long-lasting acupuncture treatment programs for the disease. At the same time, use the dialectic of channels and tendons as the basis of theoretical analysis, thus promoting Chinese clinical regressing to the classic.
Methods:
We use a randomized controlled trial of clinical research methods. Selecting 60 patients of Cervical Spondylotic Radieulopathy(CSR) as the cases of study, according to the ratio of 1:1 were randomly divided into treatment group(acupuncture and movement with dialectic of channels and tendons treatment) and control group(traditional acupuncture).Record and observe the scores of NPQ and VAS which to evaluate the efficacy at 0 days before treatment, and a half course, one course of treatment and 1 month, 3 months after treatment, and record the adverse events in the course of the study, and use the statistical methods for analysis.
Results:
1. Before treatment, the treatment group and control group in general, NPQ and VAS score was no significant difference (P> 0.05).
2. After a half course and one course treatment, compared with the before treatment, there is significantly different (P<0.05) in two groups'scores of NPQ and VAS.
3. After a half course treatment, treatment group's scores of NPQ and VAS are lower than control group's, there are significant differences (P<0.05). After one course treatment, there are no significant differences (P>0.05) in two groups'scores of NPQ and VAS.1 month after treatment, treatment group's scores of NPQ and VAS are lower than control group's, there are significant differences (P<0.05).3 months after treatment, there are no significant differences (P>0.05) in two groups'scores of NPQ and VAS.
4. In the course of the study, there are no adverse events, such as halo pin, curved needle, broken needle, and hematoma.
Conclusion:
Acupuncture and movement with dialectic of channels and tendons treatment and traditional acupuncture are the effective methods to treat CSR. Both treatments can improve the neck pain and upper limb numbness of the patients of CSR. Acupuncture and movement with dialectic of channels and tendons treatment is better than traditional acupuncture in short-term and long-term effect.
引文
[1]孙永章,韦以宗,韦春德,等.颈椎病病因探讨[J].中华中医药杂志,2005；20(2)：118-120.
[2]韦以宗.颈曲紊乱分型诊断与胸椎关系[J].世界中医骨科杂志,2004；6(2)：13-16.
[3]孙星标.仰卧牵引整复手法治疗青少年症状性颈椎曲度异常体会[J].现代中西医结合杂志,2005；14(15)：2037-2038.
[4]周熙.罗凛教授动伸手法治疗颈肩综合征机理探讨[J].按摩与引导,2008；1(24)：2-3.
[5]章诗银,曹其鉴,黄孝宽,熊健.颈肩综合症的病因及诊断治疗[J].中国骨伤,1996：9(4)：47-48.
[6]徐三文,汪厚根.谈颈肩综合征的中医外治[J]. Journal External Therapy ofTCM,1999：8(4)：40-41.
[7]姜淑云,房敏,左亚忠.颈部肌群与颈椎病[J].颈腰痛杂志,2006；27(3)：235-237.
[8]何利雷.穴位埋线治疗颈椎病的研究进展[J].中华现代中医学杂志,2006；2(3)：200-202.
[9]Slipman, Curtis W. MD, Lipetz, Jason S. MD, DePalma, Michael J. MD, Jackson, Howard B. MD. Therapeutic Selective Nerve Root Blockin the Nonsurgical Treatment of Traumatically Induced Cervical Spondylotic Radicular Pain [J]. American Journal of Physical Medicine& Rehabilitation,2004; 83(6): 446-454.
[10]陈道振,樊孝俊,眭承志.青少年期颈椎病病因研究进展[J].中医正骨,2007；19(9)： 65-67.
[11]王诗忠,陈水金,宋红梅.颈椎间歇性拔伸手法治疗青年颈椎病的疗效分析[J].中国康复理论与实践,2005；11(11)：956.
[12]李保林.颈丛加痛点阻滞治疗颈肩综合征37例[J].中国临床康复,2003；7(2)：278.
[13]Dryden T, Baskwill A, Preyde M. Massage therapy for the orthopaedic patient: a review[J].Orthop Nurs,2004; 23(5):327-332.
[14]Dillard JN, Knapp S. Complementary and alternative pain therapy in the emergency department[J]. Emerg Med Clin North Am,2005; 23(2):529-549.
[15]Pallegama, R. W., Ranasinghe, A. W, Weerasinghe, V.S, et, al. Anxiety and personality traits in patients with muscle related temporomandibular disorders[J]. Journal of Oral Rehabilitation,2005; 32(10):701-707.
[16]Hernandez-Re if M, Field T, Krasnegor J,et, al. Lower back pain is reduced and range of motion increased after massage therapy[J]. Int J Neuroscience, 2001; 106(3-4):131-145.
[17]Murthy G, Hargens AR, Lehman S, et, al. Ischemia causes muscles fatigue [J]. J Orthop Res,2001; 19(3):436-440.
[18]王顺.牵引治疗颈椎病的研究进展(附：仰卧间歇顺势位牵引治疗神经根型颈椎病的临床观察)[D].黑龙江：黑龙江中医药大学,2007.
[19]张益珍,王晓红等.颈椎病康复的生物力学特性初步研究[J].中国医学物理学杂志,2004；21(4)：246-247.
[20]林明.牵引加第周波治疗颈肩综合征180例疗效观察[J].广州医药,2003；34(1)：64-65.
[21]孙磊.论颈肩综合征的中西医及针灸治疗[J].青海医药杂志,1997；27(10)：45-46.
[22]李增春,陈德玉等.第三届颈椎病专题座谈会纪要[C].中华外科杂志,2008；46(23)：1796-1799.
[23]许扬,赵英凯,程建斌.颈肩综合征的临床辨证思路与治疗方法探讨[J].中国针灸,2007；27(5)：379-382.
[24]卢言平.葛芪二仙汤治疗神经根型颈椎病的临床与实验研究[D].山东：山东中医药大学,2004.
[25]王超明.从心肝论治神经根型颈椎病116例[J].中国中医药科技,2009；16(4)：273.
[26]李健康.加昧桂枝加葛根汤治疗神经根型颈椎病80例疗效观察[J].西部医学,2009；21(7)：1190-1191.
[27]董福慧.奇正消痛贴膏治疗颈椎病的临床疗效观察[J].继续医学教育,2005；19(7)： 72-76.
[28]尚秀葵,孟向文,董红英,等.针刺“四天”穴为主治疗神经根型颈椎病临床观察[J].中国针灸,2002；22(11)：732-734.
[29]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,1994：186.
[30]张铁英,孙琳,黄梅颖.辨经取穴治疗神经根型颈椎病360例疗效观察[J].针灸临床杂志,2005；21(5)：18-19.
[31]李亚伟,骆晓金.养子时刻开穴治疗神经根型颈椎病200例[J].山东中医杂志,2004：23(6)：348-349.
[32]滕雨虹,李俊营,滕义和.第二掌骨侧针法治疗神经根型颈椎病32例[C].针灸 技术规范及学术发展研讨会论文集,2006：214-215.
[33]王真真.腕踝针治疗神经根型颈椎病快速镇痛效应的临床观察[D].山东：山东中医药大学,2009.
[34]万碧江.穴位透刺治疗神经根型颈椎病临床研究[D].湖北：湖北中医学院,2006.
[35]宣丽华,甘海球.腹针治疗神经根型颈椎病的临床研究[J].中华中医药学刊,2008：26(10)：2126-2127.
[36]刘宇波.“五联法”治疗神经根型颈椎病疗效观察[J].实用中医内科杂志,2009；23(6)：42-42.
[37]韦英才.经筋针刺法结合壮药外敷治疗神经根型颈椎病128例临床分析[J].河北中医,2001；23(1)：42.
[38]姜京明,廖恒等.针刺加穴位注射治疗神经根型颈椎病的临床疗效观察[J].针灸临床杂志,2009；25(5)：6-7.
[39]金保社.综合治疗神经根型颈椎病50例临床观察[J].中国实用神经疾病杂志,2007：10(5)：92-93.
[40]胡娟.经筋手法结合牵引、药枕治疗神经根型颈椎病[J].按摩与导引,2007；23(1)：15-17.
[41]沈雪勇.经络腧穴学[M].北京：中国中医药出版社,2003；13-14.
[42]杨丽美.《内经》经筋理论的应用[J].宁夏医学院学报,2006；28(3)：262-263.
[43]吴焕淦,张仁等.从经筋理论探讨针刺麻醉[J].上海针灸杂志,2006；25(12)：40-43.
[44]陆彦青.经筋刺法治疗中风后痉挛性偏瘫[J].针灸临床杂志,2007；23(8)：1-3.
[45]陈锦宏.经筋针刺治疗牙痛[J].中国针灸,2008；28(9)：641.
[46]杨璇.“经筋刺法”治疗急性期周围性面神经麻痹的临床观察[D].湖北：湖北中医学院,2009.
[47]谭涛,王世成等.经筋刺法及理筋手法对颈椎病手术后上肢屈肌痉挛患者肌电F波的影响[J].中国针灸,2006；26(10)：725-728.
[48]管宏钟,赵宏杰.薛立功教授经筋理论及长圆针疗法概述[J].中国针灸,2006;26(4)：297.
[49]沈志生.《内经》经筋理论的再认识[J].中国针灸,2006;26(9)：639-640.
[50]秦玉革.《内经》经筋的实质是神经[J].中国针灸,2006；26(2)：147-150.
[51]梁宜,方剑乔.《灵枢》经筋理论探析[J].中医杂志,2008；49(6)：488-490.
[52]郭冬梅.运动针疗法及其在痛症治疗中的应用探讨[J].针灸临床杂志,1999；15(5)：5-6.
[53]赵利华.运动针法治疗急性腰扭伤并腰椎间盘突出的临床观察[J].上海针灸杂志,2005；24(4)：17-18.
[54]程永,林贤梅等.运动针法配合刺络拔罐治疗肩周炎40例疗效观察[J].新中医,2005;37(5)：60-61.
[55]闫海国.动态针刺法治疗神经根型颈椎病疗效观察[J].辽宁中医杂志,2003；30(7)： 517.
[56]吴忠源,黄素芳等.运动针法治疗神经根型颈椎病40例临床疗效观察[J].中国实用医药,2009；4(26)：209-210.
[57]王启才.针灸治疗学[M].北京：中国中医药出版社,2003,201.
[58]管宏钟,赵宏杰.薛立功教授经筋理论及长圆针疗法概述[J].中国针灸,2006；26(4)：297-300.