针药灸综合治疗神经根型颈椎病的临床研究

摘要

目的：观察针药灸综合治疗神经根型颈椎病的临床效果。方法：将我院收治的136例神经根型颈椎病患者按照随机数字表法分为对照组和治疗组各68例。对照组患者给予针刺联合独活寄生蠲痹汤口服治疗；治疗组则在对照组基础上加用雷火灸联合治疗，10 d为1个疗程，连续治疗2个疗程。比较2组的临床疗效，治疗前后用疼痛视觉模拟评分法（ Visual Analogue Scale ，VAS）、疼痛强度（ Present Pain Intensity ，PPI）、疼痛分级指数（ Pain Rating Index ，PRI）评估颈肩疼痛，采用JOA评分标准评价患者神经功能，监测治疗前后患者血液流变学指标变化，检测治疗前后红细胞沉降率（ Erythrocyte Sedimentation Rate，ESR）、超敏C反应蛋白（C-reactive Protein，CRP）水平变化。结果：与对照组相比，观察组的临床治疗效果更为突出，其有效率91.2％明显高于对照组患者75％（χ2＝6.332，P＜0.05）；观察组治疗后的颈肩痛、神经功能改善优于对照组，其VAS、PPI、PRI评分（2.15±0.84）、（2.11±0.29）、（12.42±1.37）明显低于对照组的（4.30±1.13）、（2.56±0.42）、（20.36±1.54），JOA评分（15.83±2.78）则显著高于对照组患者（11.27±2.60）（P＜0.05）；观察组患者的血液动力改善优于对照组，其血液流变学指标与对照组相比降低更为明显（ P＜0.05）；观察组患者经治疗后ESR、CRP水平与对照组相比显著降低（ P＜0.05）。结论：针药灸综合治疗神经根型颈椎病疗效肯定，利于缓解颈肩疼痛，提高神经功能，凸显出中医多途径论治颈椎病的优势与特色，其机制与改善颈椎局部血液流变状态、抗炎有一定的相关性，值得临床深入探究。%Objective:To study the clinical efficacy of treating nerve-root type cervical spondylosis patients with acupuncture and thunder-fire moxibustion as well as Chinese medicine .Methods:A total of 136 cases were randomly divided into control group of 68 cases and treatment group of 68 cases.Patients in the control group were treated with acupuncture and Pubescent Angelica and Taxillus Impediment-Alleviating Decoction;while patients in the treatment group were treated with thunder-fire moxibustion on the basis of control therapy , 10 days for a course , 2 courses for treatment .Aimed at comparing the effect , the neck and shoulder pain with VAS, PPI and PRI scores and the nerve function with JOA scores , change of blood rheology indexes and change of ESR and CRP levels were evaluated .Results:The clinical effect of treatment group was significantly better compared with control group , and its clinical effective rate was 91.2%,which was higher than the control group′s 75% (χ2 =6.332,P<0.05);The neck shoulder pain and neurological function of patients in the treatment group were better improved than the control group , and the VAS,PPI and PRI scores were respectively (2.15 ±0.84), (2.11 ±0.29) and (12.42 ±1.37), which were lower than the con-trol group′s (4.30 ±1.13), (2.56 ±0.42) and (20.36 ±1.54), while the JOA score was (15.83 ±2.78), which was signifi-cantly higher than that of the control group (11.27 ±2.60)(P<0.05);The improvement of hemodynamic of patients in the treat-ment group was better than the control group , and the blood rheology indexes were lower than the control group ( P<0.05 );The levels of ESR and CRP were lower than the control group (P<0.05).Conclusion:Clinical efficacy of treating nerve-root type cer-vical spondylosis patients with acupuncture and thunder-fire moxibustion as well as Chinese medicine has satisfactory clinical effect .The therapy can effectively alleviate the neck and shoulder pain and improve the neurological function , which shows the ad-vantages and characteristics of treating cervical spondylosis with Chinese medicine .The mechanism may be associated with impro-ving the local blood rheological state of cervical vertebrae , which is worth of wide application in the clinical practice .