浮针联合Mulligan手法治疗椎动脉型颈椎病的疗效观察及对血清TXB2、TNF-α、NSE水平及血流动力学的影响.pdf
《浮针联合Mulligan手法治疗椎动脉型颈椎病的疗效观察及对血清TXB2、TNF-α、NSE水平及血流动力学的影响.pdf》由会员分享,可在线阅读,更多相关《浮针联合Mulligan手法治疗椎动脉型颈椎病的疗效观察及对血清TXB2、TNF-α、NSE水平及血流动力学的影响.pdf(7页珍藏版)》请在文库网上搜索。
1、上海针灸杂志 2023 年 11 月第 42 卷第 11 期 1177 文章编号:1005-0957(2023)11-1177-07 临床研究 浮针联合 Mulligan 手法治疗椎动脉型颈椎病的疗效观察及对血清 TXB2、TNF-、NSE 水平及血流动力学的影响 任勇1,吴建梅2,苏靖3(1.四川省医学科学院 四川省人民医院,成都 610100;2.成都市温江区中医医院,成都 611100;3.成都市新都区妇幼保健院,成都 610500)【摘要】目的 观察浮针联合 Mulligan 手法治疗瘀血阻络型椎动脉型颈椎病的临床疗效及对血清血栓素B2(B2 of thromboxane,TXB2)、
2、肿瘤坏死因子-(tumor necrosis factor-,TNF-)、神经元特异性烯醇酶(neuron specific enolase,NSE)水平及血流动力学的影响。方法 将 124 例瘀血阻络型椎动脉型颈椎病患者随机分为观察组和对照组,每组 62 例。对照组患者采用 Mulligan 手法治疗,观察组采用浮针联合 Mulligan 手法治疗。观察两组治疗前后血清 TXB2、TNF-、前列腺素 E2(prostaglandin E2,PGE2)、NSE、一氧化氮(nitric oxide,NO)和白介素-6(interleukin-6,IL-6)水平,观察两组治疗前后椎动脉阻力指数(r
3、esistance index,RI)、椎动脉和椎基底动脉平均峰流速、椎动脉型颈椎病功能评定量表(vertebral artery type cervical spondylosis functional assessment scale,FS-CSA)、改良颈性眩晕症状与功能评估量表(modified evaluation scale for cervical vertigo,ESCV)评分、中医证候积分、颈椎椎体水平位移、椎体角度位移和椎体屈伸活动范围情况,并比较两组临床疗效。结果 两组治疗后血清 TNF-、TXB2 和 PGE2水平降低(P0.05),且观察组低于对照组(P0.05)。两
4、组治疗后血清 NSE 和 IL-6 水平降低,NO 水平升高(P0.05);且观察组血清 NSE、IL-6 低于对照组(P0.05),NO 高于对照组(P0.05)。两组治疗后椎动脉和椎基底动脉平均峰流速提高(P0.05),椎动脉 RI 降低(P0.05);且观察组椎动脉和椎基底动脉平均峰流速高于对照组(P0.05),椎动脉 RI 低于对照组(P0.05)。两组治疗后 ESCV 评分、FS-CSA 和中医证候积分降低(P0.05);且观察组低于对照组(P0.05)。两组治疗后椎体角度位移和椎体水平位移降低(P0.05),椎体屈伸活动范围增大(P0.05);观察组椎体角度位移、椎体水平位移低于对
5、照组(P0.05),椎体屈伸活动范围大于对照组(P0.05)。对照组总有效率为 85.5%,观察组为 96.8%,两组比较差异有统计学意义(P0.05)。结论 浮针联合 Mulligan 手法治疗瘀血阻络型椎动脉型颈椎病,可减轻炎症反应,调节血管内皮功能,改善颈部血流,有助于改善颈椎功能,提高临床疗效。【关键词】浮针;瘀血阻络;Mulligan 手法;颈椎病;椎动脉;炎性因子;内皮功能;血流动力学【中图分类号】R246.2 【文献标志码】A DOI:10.13460/j.issn.1005-0957.2023.11.1177 Efficacy observation of superficia
6、l needling combined with Mulligan manipulation in the treatment of cervical spondylosis of vertebral artery type and its effect on serum TXB2,TNF-,NSE levels and hemodynamics REN Yong1,WU Jianmei2,SU Jing3.1.Sichuan Academy of Medical Sciences-Sichuan Provincial Peoples Hospital(East Hospital),Cheng
7、du 610100,China;2.Wenjiang District Chinese Medicine Hospital,Chengdu 611100,China;3.Chengdu Xindu Maternal&Child Health Care Hospital,Chengdu 610500,China Abstract Objective To observe the clinical efficacy of superficial needling combined with Mulligan manipulation in treating vertebral artery typ
8、e cervical spondylosis with stagnant blood obstructing the meridians pattern,and the基金项目:成都市卫生健康委员会科研项目(2021405)作者信息:任勇(1987),男,康复治疗技师,Email: 通信作者:吴建梅(1988),女,主治医师,硕士,Email: 1178 Shanghai J Acu-mox,Nov 2023,Vol 42,No 11 effects on serum thromboxane B2(B2 of thromboxane,TXB2),tumour necrosis factor-(
9、TNF-),neuron specific enolase(NSE)levels and haemodynamics.Method A total of 124 patients with vertebral artery type cervical spondylosis due to stagnant blood obstructing the meridians pattern were randomly divided into the observation group and the control group,with 62 cases in each group.Patient
10、s in the control group were treated with Mulligan manipulation,and patients in the observation group were treated with superficial needling combined with Mulligan manipulation.The serum levels of TXB2,TNF-,prostaglandin E2(PGE2),NSE,nitric oxide(NO)and interleukin-6(IL-6),the resistance index(RI)of
11、vertebral artery,mean peak velocity of vertebral artery and vertebrobasilar artery,vertebral artery type cervical spondylosis functional assessment scale(FS-CSA),modified evaluation scale for cervical vertigo(ESCV)score,traditional Chinese medicine(TCM)syndrome score,horizontal displacement of cervi
12、cal vertebral body,angular displacement of cervical vertebral body and flexion and extension range of motion of vertebral body before and after treatment were compared between the two groups,and the clinical efficacy was compared between the two groups.Result The levels of TNF-,TXB2 and PGE2 in the
13、two groups were decreased after treatment(P0.05),and those in the observation group were lower than those in the control group(P0.05).After treatment,the levels of serum NSE and IL-6 were decreased in the two groups(P0.05),and the level of NO was increased.The serum NSE and IL-6 in the observation g
14、roup were lower than those in the control group(P0.05),and NO was higher than that in the control group(P0.05).After treatment,the mean peak velocity of vertebral artery and vertebrobasilar artery in the two groups increased(P0.05),and RI of vertebral artery decreased(P0.05).The mean peak velocity o
15、f vertebral artery and vertebrobasilar artery in the observation group was higher than that in the control group(P0.05),and RI of vertebral artery was lower than that in the control group(P0.05).After treatment,the ESCV score,FS-CSA and TCM syndrome score were decreased in the two groups(P0.05),and
16、those in the observation group was lower than those in the control group(P0.05).After treatment,the angular displacement and horizontal displacement of the vertebral body in the two groups were decreased(P0.05),and the range of motion of the vertebral body was increased(P0.05).The angular displaceme
17、nt and horizontal displacement of the vertebral body in the observation group were lower than those in the control group(P0.05),and the range of flexion and extension of the vertebral body was higher than that in the control group(P0.05).The total effective rate was 85.5%in the control group and 96.
18、8%in the observation group,and the difference was statistically significant(P0.05).Conclusion Superficial needling combined with Mulligan manipulation in the treatment of vertebral artery type cervical spondylosis due to stagnant blood obstructing the meridians pattern can reduce inflammatory reacti
19、on,regulate vascular endothelial function,improve cervical blood flow,help to improve cervical function,and improve clinical efficacy.Key words Superficial needling;Stagnant blood obstructing the meridians;Mulligan manipulation;Cervical spondylosis;Vertebral artery;Inflammatory factors;Endothelial f
20、unction;Hemodynamics 颈椎病以颈部僵硬、酸胀感、疼痛为主要表现,是临床上发病率最高的退行性颈椎疾病,依据分型可分为椎动脉型、神经根型、混合型等1。椎动脉型颈椎病是颈椎病最常见的类型,是由于椎动脉受到压迫或刺激,以致血管狭窄、迂曲,造成椎-基底动脉供血不足,可伴有恶心呕吐、眩晕、耳鸣,甚至突然猝倒等2。2014 年美国劳工统计局统计表明,本病发生与职业相关;2015 年欧盟职业安全健康署提出,近年来职业病相关的颈椎病发生率逐年升高3。国内吴云霞等4发现农民、办公室人员、工人罹患颈椎病的概率较高,其中办公室人员最高。椎动脉型颈椎病患者存在炎性因子失衡、血管内皮功能损伤,并且还伴
21、有颈动脉血流动力学障碍,各因素互为影响,最终加重压迫症状5。椎动脉型颈椎病手术治疗风险较大,多采用内科保守治疗。中医学认为本病隶属于“颈痹”范畴,瘀血阻滞颈部是发病的关键,瘀血阻络是常见的中医证型6。上海针灸杂志 2023 年 11 月第 42 卷第 11 期 1179 20 世纪 80 年代末,新西兰物理治疗师 Brian R Mulligan提出Mulligan手法治疗颈椎病,被证实非常安全有效。浮针是中医特色外治法,笔者采用浮针联合Mulligan 手法治疗本病并对其作用机制进行探讨。1 临床资料 1.1 一般资料 本研究纳入的均为 2018 年 11 月至 2021 年 12 月因瘀血
22、阻络型椎动脉型颈椎病于四川省医学科学院四川省人民医院康复科及成都市温江区中医医院针灸科行治疗的患者 124 例,采用随机数字表法分为观察组和对照组,每组 62 例。两组一般资料比较,差异无统计学意义(P0.05),具有可比性,详见表 1。本项目经成都市温江区中医医院医院伦理会批准(编号 2021001)。表 1 两组一般资料比较 组别 例数 年龄/岁(xs)性别/例 体质量/kg(xs)病程/月(xs)基础病/例 男 女 糖尿病 高血脂 高血压 其他 对照组 62 395 36 26 68.45.4 18.22.9 6 18 9 6 观察组 62 415 37 25 68.05.7 17.82
23、.8 5 16 10 4 1.2 诊断标准7 既往有猝倒发作史,眩晕,颈肩疼痛,肢端麻木反复发作,并且在颈部转动时加重;按压疼痛,旋颈试验呈阳性;X 线摄片提示钩椎关节增生或节段性不稳定。瘀血阻络型8患者主要症状为颈肩刺痛,眩晕;次要症状为肢端麻木,舌淡红苔薄白,有瘀斑,脉细涩。1.3 纳入标准 确诊椎动脉型颈椎病的住院患者;中医证型为瘀血阻络型;年龄 1865 岁,签署知情同意书;1 个月内未接受其他临床研究。1.4 排除标准 合并肩关节周围炎、前斜角肌综合征者;伴有颈椎骨折、滑脱、恶性肿瘤者;凝血功能异常者;既往已经行手术治疗者;妊娠期不便纳入者;针刺禁忌证者;合并有基础严重疾病及精神病者
24、;不能坚持完整治疗疗程者;眩晕为其他因素所致者。1.5 剔除、中止和脱落标准 患者依从性较差,在治疗期间,未按规定接受治疗,无法判断疗效者;患者因某种原因自行退出研究者;研究期间还在治疗其他疾病,影响安全性判断及疗效判断者;发生严重不良反应,不能继续研究者;患者病情加重,需要立即停止研究者。2 治疗方法 2.1 对照组 采用 Mulligan 手法治疗。治疗前先进行前屈、后伸、侧屈、旋转等 6 个方向的颈部活动,观察是否存在颈部疼痛、不对称、活动受限。自然体位下小关节滑动技术(natural apophyseal glides,NAGS),指导患者取坐位,医师徒手推关节突部位或棘突,使小关节产
25、生节律性滑动,滑动方向斜向上指向眼球,沿着小关节面进行,在小关节滑动的中点到终末端行被动活动,呈节律性,根据患者耐受情况调整力度,以患者耐受,并且不造成疼痛为准。反 NAGS 技术,该技术常在 NAGS手法治疗 3 次后效果不理想时进行,患者取坐位,使下位椎体(治疗平面处)的小关节滑动,方向为斜向上。持续 NAGS,患者在自然体位下主动进行颈部 6 个方向的活动,若活动过程中出现某一个方向疼痛、活动受限,则指导患者在该方向做主动活动时尽可能做到最大范围,沿小关节面方向持续推棘突,方向为斜向上,若活动过程中出现多个方向活动受限,则选择症状最明显的方向,必要时可选择多种技术。同一节段同一运动方向治
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- 联合 Mulligan 手法 治疗 椎动脉 颈椎病 疗效 观察 血清 TXB2 TNF NSE 水平 血流 动力学 影响
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