摘要
目的:以总体疗效、症状与功能综合评分及体征改善率评价除项背部的手法操作外,配合头面部推拿的益脑推拿法治疗椎动脉型颈椎病的临床疗效。方法:纳入2004-06/2006-02山东中医药大学附属医院门诊椎动脉型颈椎病患者160例,随机(采用SAS统计软件产生随机数字)分为益脑推拿组和常规推拿组,各80例。益脑推拿组:除常规推拿外对患者进行头颈部循经推拿,按揉印堂、太阳、四白、百会等穴,以得气为度;右手拇指端桡侧和其余四指指端从前方向后下方扫散两侧胆经,左右各10遍;从前发际向后拿五经,操作6遍。再自第3,4颈椎下将颈部稍微托起,与水平方向呈15°～20°角拔伸,着力点位于棘突之间,持续时间不少于1min,反复5遍;然后由下而上沿直线平推,包括督脉和两侧膀胱经的颈段,每条线各6遍,共12遍。常规推拿组:常规取穴推拿如益脑推拿组,然后实施颈椎拔伸法。两组每次治疗时间均为25min,隔日1次,15次为1疗程。疗程结束后,参照国家中医药管理局制定的《中医病证诊断疗效标准》和王楚怀等所制定的颈性眩晕症状与功能评估表,对两组的总体疗效、症状与功能综合评分及体征改善率进行评估。结果:参与实验的颈椎病患者160例都进入结果分析。①益脑推拿组、常规推拿组的显效率分别为71%,50%,差异有显著性意义,(Ridit分析,u=7.4193,P<0.05)。②治疗后两组症状与综合评分较治疗前均有提高,差异有显著性意义(28.44±1.52,13.93±2.14;26.34±2.20,14.07±2.19;t=49.4428,35.3540,P<0.05),且益脑推拿组优于常规推拿组(t=6.0832,P<0.05)。③益脑推拿组棘突移位和生理曲度方面的体征改善率显著高于常规推拿组,差异有显著性意义(83.82%,68.66%;46.67%,37.18%;P<0.05),但两组在钩椎关节增生、椎间孔变窄方面的体征改善率差异无显著性意义(P>0.05)。结论:益脑推拿法治疗椎动脉型颈椎病的显效率、提高症状与功能综合评分及改善棘突移位和生理曲度方面优于常规推拿方法,是临床颈椎病治疗的一项有效治疗技术。
AIM： Besides the total curative effect, synthetical scores on symptoms and functions, as well as improvement rates of syndromes, the Yi-Nao manipulation on head and face in treating cervical spondylosis of vertebral artery type is investigated.
METHODS： From June 2004 to February 2006, 160 cases with cervical spendylosis of vertebral artery type were selected from the Outpatient Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, and were divided into experimental group （n=80） and control group （n=80） according to the random digit table by SAS software, Experimental group： On basis of routine manipulation, Yi-Nao manipulation was conducted in cervical in line with corresponding meridians, including Yintang （Extra）, Taiyang （Extra）, Sibai （ST 2） and Baihui （DU 20）, etc in the suitable needling sensation; Bilateral Gallbladder Meridian was dispersed by thumb radial and tips of other four fingers in right hand from anterior to lower posterior, 10 times in each side; from anterior hairline to posterior for 6 times, and then the cervical vertebra in L3-4 was plucked stressing on spinous process at the angle of 15° to 20° for more than 1 minute, and repeated for 5 times. Afterward, the straight pushing manipulation was performed on cervical vertebra of Du Meridian and bilateral Urinary Bladder Meridian for 6 times in each side, totally 12 times. Control group： Routine manipulation was conducted in the same acupoints as experimental group, followed by plucking cervical vertebra. Both groups were treated for 25 minutes once daily for 15 days as a course. After treatment, the clinical curative effects, synthetical scores on symptoms and functions, and improvement rates of syndromes were evaluated in two groups, referring to standardization of diagnosis and curative effect on disease and syndrome of TCM established by State Administration of Traditional Chinese Medicine and evaluation sheet of symptom and function on cervical vertigo formulated by Wang Chu-huai et al.
RESULTS： Totally 160 patients of cervical spondylosis were involved in the result analysis. ①The marked effectiveness rate was respectively 71% in experimental group and 50% in control group, with the significant difference （Ridit analysis, u=7.419 3, P〈0.05）.②he synthetical evaluations on symptoms and functions were increased significantly in two groups after treatment （28.44±1.52, 13.93±2.14; 26.34±2.20, 14.07±2.19; t=49.42 8, 35.354 0, P 〈 0.05）, and better in experimental group than in control group （t=6.083 2, P 〈 0.05）. ③The improvement rates of syndromes （spinous process displacement and physical curvature） were markedly higher in experimental group than in control group （83.82%, 68.66%; 46.67%, 37.18%; P 〈 0.05）. But there was no significant difference in the improvement rates of Luschka＇s joint hyperplasia and intervertebral foramen narrowing （P 〉 0.05）. CONCLUSION： Yi-Nao manipulation is better than routine manipulation in increasing marked effectiveness rates, synthetical evaluation on symptoms and functions and improving syndromes, such as spinous process displacement and physical curvature. Therefore, it is worth being applied to treat cervical spondylosis for clinical practice.
出处
《中国临床康复》
CSCD
北大核心
2006年第39期27-29,共3页
Chinese Journal of Clinical Rehabilitation
基金
山东省中医药管理局资助课题(2005-219)~~
