不同针灸方法联合独活寄生汤...疗神经根型颈椎病的疗效观察_李天发.pdf

基金项目:安徽省重大疑难疾病中西医协同攻关项目(2021)70 号-6作者简介:李天发(1966.12)，男，硕士，副主任中医师，研究方向:针灸治疗颈椎病、情志病，E-mail:L针灸经络不同针灸方法联合独活寄生汤治疗神经根型颈椎病的疗效观察李天发1高华2王二争3(1 阜阳市中医医院针推二科，阜阳，236001;2 黄山市人民医院康复科，黄山，245099;3 安徽中医药大学第二附属医院康复科，合肥，230061)摘要目的:探究不同针灸方法联合独活寄生汤对神经根型颈椎病患者的疗效。方法:选取2021 年9 月至2022 年6 月阜阳市中医医院收治的神经根型颈椎病患者 90 例作为研究对象，按照治疗方式的不同分为针刺组、针刀组和温针灸组，每组 30 例，所有患者均给予医院统一制备的独活寄生汤治疗，在此基础上，针刺组给予穴位针刺治疗，针刀组给予针刀穴位刺入治疗，温针灸组给予艾灸联合针刺治疗，均持续治疗 2 周，比较 3 组的临床疗效、治疗前后的颈椎活动度、颈椎功能评分、疼痛评分、超敏 C 反应蛋白(hs-CP)水平以及治疗期间的不良反应情况。结果:针刀组治疗总有效率(93.33%)高于温针灸组(73.33%)和针刺组(70.00%)，差异均有统计学意义(均 P 0.05);治疗后，3 组患者的颈椎活动度评分均提高，且针刀组评分明显高于温针灸组和针刺组(P 0.05);治疗后，3 组患者椎功能评分均提高，且针刀组评分明显高于温针灸组和针刺组(P 0.05);3 组患者疼痛评分均降低，且针刀组疼痛评分明显低于温针灸组和针刺组(P 0.05)。治疗后，3 组患者血清水平均下降，且针刀组明显低于针刺组和温针灸组(P 0.05);针刺组、针刀组、温针灸组的不良反应率分别为 10.00%、6.67%、10.00%，3 组差异无统计学意义(P 0.05)。结论:与针刺组和温针灸组比较，针刀联合独活寄生汤治疗神经根型颈椎病效果更加显著，可有效改善患者颈椎功能，提高颈椎活动度，对于减轻患者痛苦，调节炎症介质水平具有重要作用。关键词针灸;针刀;温针灸;独活寄生汤;神经根型颈椎病;颈椎功能评分;超敏 C 反应蛋白;不良反应Efficacy of Different Acupuncture-moxibustion Protocols Combined with DuhuoJisheng Decoction on Cervical Spondylopathy of Nerve oot TypeLI Tianfa1，GAO Hua2，WANG Erzheng3(1 Second Department of Acupuncture and Massage，Fuyangshi Hospital of TCM，Fuyang 236001，China;2 ehabilitationDepartment of Huangshan City Peoples Hospital，Huangshan 245099，China;3 ehabilitation Departmentof The Second Affiliated Hospital of Anhui University of Chinese Medicine，Hefei 230061，China)AbstractObjective:To explore the efficacy of different acupuncture-moxibustion protocols combined with Duhuo Jisheng Decoc-tion on cervical spondylopathy of nerve root type in patients Methods:Ninety patients with cervical spondylopathy of nerve roottype admitted to Fuyangshi Hospital of TCM from September 2021 to June 2022 were selected and divided into an acupuncturegroup(n=30)，an acupotomy group(n=30)，and a warming acupuncture-moxibustion group(n=30)according to the differenttreatment methods All patients were treated with Duhuo Jisheng Decoction uniformly prepared by this hospital Additionally，the pa-tients in the acupuncture group were treated with acupoint needling，those in the acupotomy group were with mini-scalpel needlingat acupoints，and those in the warming acupuncture-moxibustion group were with moxibustion combined with acupuncture After twoweeks of treatment，the clinical efficacy，cervical activity，cervical function score，pain score，high-sensitivity C-reactive protein(hsCP)level before and after treatment，and adverse reactions during the treatment were compared among the three groups e-sults:The total effective rate of the acupotomy group was 93.33%，higher than 73.33%of the warming acupuncture-moxibustiongroup and 70.00%of the acupuncture group(P 0.05)After treatment，the scores of cervical activity in the three groups wereimproved，and the score in the acupotomy group was higher than those in the warming acupuncture-moxibustion group and the acu-puncture group(P 0.05)After treatment，the vertebral function scores of the three groups were improved，and the score of theacupotomy group was higher than those of the warming acupuncture-moxibustion group and the acupuncture group(P 0.05)Thepain scores of the patients in the three groups decreased，and the pain score in the acupotomy group was lower than those in the325世界中医药2023 年 2 月第 18 卷第 4 期warming acupuncture-moxibustion group and the acupuncture group(P 0.05)After treatment，the serum levels of the patients inthe three groups decreased，and serum levels in the acupotomy group were lower than those in the acupuncture group and the war-ming acupuncture-moxibustion group(P 0.05)The adverse reaction rates of the acupuncture group，the acupotomy group，and thewarming acupuncture-moxibustion group were 10.00%，6.67%，and 10.00%respectively(P 0.05)Conclusion:Compared withacupuncture and warming acupuncture-moxibustion，the acupotomy combined with Duhuo Jisheng Decoction is more significant inthe treatment of cervical spondylopathy of nerve root type，which can effectively improve the cervical function of patients，improvethe range of motion of cervical vertebrae，and play an important role in relieving the pain of patients and regulating the level of in-flammatory factorsKeywordsAcupuncture and moxibustion;Acupotomy;Warming acupuncture-moxibustion;Duhuo Jisheng Decoction;Cervicalspondylopathy of nerve root type;Cervical function score;High-sensitivity C-reactive protein;Adverse reactions中图分类号:274.9;684文献标识码:Adoi:10 3969/j issn 1673 7202 2023 04 014神经根型颈椎病(Cervical Spondylotic adicu-lopathy，CS)是由颈椎间盘突出、退变、骨质增生、节段性不稳或骨赘形成而对椎管内或椎间孔出的颈神经根产生刺激或压迫引起的，约占颈椎病的60%1-2。主要临床表现为颈肩痛、麻、酸、胀，并伴有上肢放射痛或麻木且具有神经分布特征，严重者可出现上肢肌肉萎缩和无力3。目前该病主要包括手术治疗和保守治疗，由于手术治疗存在高并发症和手术禁忌证等，多数患者选择保守治疗，保守治疗具有成本低、疗效好、不良反应少等优势。保守治疗以针灸为主，其优于中药、理疗和手法，且针灸作为中医的瑰宝，具有调节阴阳平衡、活血化瘀、松筋通络、调节神经功能，同时搭配中药内服，益气活血、消肿除痹，进一步改善 CS 患者的临床症状和颈椎功能6-7。基于此，为系统了解不同针灸疗法联合中药内服治疗 CS 的确切疗效，为治疗 CS 提供高质量的优化方案，本研究着重探讨普通针刺、针刀、温针灸联合独活寄生汤治疗 CS 的疗效。1资料与方法1.1一般资料选取 2021 年 9 月至 2022 年 6 月阜阳市中医医院收治的神经根型颈椎病患者 90 例作为研究对象，按照治疗方式的不同分为针刺组、针刀组、和温针灸组，每组 30 例。针刺组中男 16 例，女 14 例，年龄 28 65 岁，平均年龄(45.26 9.17)岁，