摘要
颈椎是人体在活动中,在关节中旋转活动次数最频繁的脊柱节段。自人类出生后,就面临着必需且频繁的活动。因长期慢性劳损,颈椎退变,骨质增生,椎棘突移位以及椎间孔周围软组织的炎症、充血、水肿压迫神经根、椎动脉、脊髓等出现一系列临床症状,导致颈椎病的发生。根据压迫部位和症状不同,颈椎病可分为神经根型、脊髓型、椎动脉型、交感神经型、混合型等。据中医研究院骨科研究所统计：神经根型颈椎病占颈椎病的60%。由于神经根型颈椎病是最常见类型,故对该型颈椎病的预防及治疗显得尤为重要。
目的：本文系统的综述了祖国医学和现代医学对神经根型颈椎病的认识、治疗,以穴位敷贴配合传统针法治疗神经根型颈椎病,探讨该方法治疗神经根型颈椎病的临床价值。
方法：在广州中医药大学第一附属医院门诊及病房,选择符合纳入标准的60例神经根型颈椎病患者并对其进行治疗,以计算机随机分组,治疗组30例以穴位敷贴配合针法治疗,先采用传统针刺取穴,以75%酒精棉球常规消毒,采用苏州天协牌一次性针灸针(0.22mm×25mm)进行针刺得气后,行平补平泻,每穴每次均操作1分钟,加电留针30分钟(用G—6805型电针仪选取6个穴位用疏密波通电),隔天治疗1次,每周治疗3次,3次为一疗程,共2个疗程。针刺治疗后,再予中药贴敷。每次6穴(贴敷穴位可从百劳,大杼,阿是(大椎与肩井连线中点),病变颈椎夹脊穴,肾俞,压痛点选取6个穴位,贴敷膏药),贴敷时间为4 h,隔天治疗1次,每周治疗3次,3次为一疗程。共2个疗程。对照组30例以针刺取穴方案治疗。观察两组的临床疗效及Northwick Park颈痛量表(NPQ)、NRS等量表的疗效评价数值,然后进行对比研究。
结果：1.课题临床观察显示,穴位敷贴配合针法治疗组、针刺取穴对照治疗一周后总有效率分别为93.3%、83.3%,显效率90.0%、73.3%；治疗两周后总有效率分别为96.7%、83.3%,显效率93.4%、70%,经统计学处理无显著差异(P>0.05),说明穴位敷贴配合针法治疗组及针刺取穴对照组临床疗效均优。
2.两组治疗一周后及两周后的NPQ,NRS(颈椎病疼痛评价量表)评分比较有显著性差异(P<0.05),两组组间有统计学差异,说明在镇痛效果、改善症状及体征方面穴位敷贴配合针法治疗组明显优于针刺取穴对照组。
结论：单纯针刺取穴治疗颈椎病(神经根型),疗效固然明显,本课题再配以穴位贴敷,镇痛,改善症状及体征方面效果更显著,优于针刺取穴对照组,为临床提供了简便,疗效确切,安全性高且经济实惠,具有较好临床推广价值的中医治疗方法。
Cervical vertebra is the most frequent rotary spine section in human activity. Since human birth, it faces a necessary and frequent activity. For chronic strain, cervical vertebra degeneration, hyperosteogeny, vertebral spinous shift and the inflammation of soft tissue around the hole, swelling oppressing nerve roots, vertebral artery and spinal cord, etc, leads to a series of clinical symptoms of cervical spondylosis. According to the oppression, it can be divided into different catergories-radiculopathic type, vertebroarterial type, myelopathic type, and cervical sympathetic, and otherwise, the radiculopathic type has the highest attack rate, which covers 60% of Cervical Spondylosis, and commonly signifies other types of Cervical Spondylosis Because cervica radiculopathy is the most common type of this type of cervical spondylosis, so the prevention and treatment is particularly important.
Objective:The paper summarized the motherland medicine system and modern medical cervicalspondy-lotic radiculopathy of knowledge, and the traditional acupuncture treatment with herbal patches to discusses clinical value of the methods to treat cervicalspondy-lotic radiculopathy.
Method:Sixty patients enrolled from the outpatient and impatient of Guangzhou TCM university NO.1 hospital, were randomly divided into two groups. Treatment group is treated with traditional acupuncture and herbal patches(six acupoints, lasting four hours), once every other day, three times a week as one course. The whole treatment lasted two courses. The control group is treated with only acupuncture. The efficiency was measured with NPQ, NRS evaluation drafts.
Result
1. Total cured rate of experimental group is 96.7%, obvious effective rate is 93.4%, better than 83.3%,70%of the control group. P>0.05 shows that both are good methods in treating Cervical Spondylosis.
2. Comprehension evaluation of the cervical Spondylosis, the experimental group is obviously better than the control group (P<0.05) that means the acupuncture-herbal patch group has better curative effects than the cont rol group at the pain killing, signs and symptoms improving.
Conclusion:The acupuncture-herbal patch, compared with the only acupuncture treatment, has more advantages as the following:relieving pain, improve symptoms. So it provides a convenient, effective, safe, effecting-quickly and economic clinical method of great practical value.
引文
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