針灸推拿結(jié)合中藥治療脊髓型頸椎病的臨床效果觀察

曾海娟 （廣西羅城縣中醫(yī)醫(yī)院,廣西羅城546499）

針灸推拿結(jié)合中藥治療脊髓型頸椎病的臨床效果觀察

曾海娟 （廣西羅城縣中醫(yī)醫(yī)院,廣西羅城546499）

【摘 要】目的:探討針灸推拿與中藥聯(lián)合治療脊髓型脊椎病的臨床療效.方法:選取2010-02/2015-01我院收治的82例脊髓型脊椎病患者為研究對(duì)象,隨機(jī)分為對(duì)照組（n=41）和觀察組（n=41）.對(duì)照組實(shí)施針灸推拿治療,觀察組采取針灸推拿聯(lián)合中藥治療,對(duì)兩組患者治療后效果進(jìn)行分析.結(jié)果:觀察組治療后總有效率為95.12%,明顯較對(duì)照組70.73%高,差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）;治療前VAS評(píng)分無(wú)差異,經(jīng)治療后VAS評(píng)分均明顯下降,且觀察組VAS評(píng)分顯著較對(duì)照組低,差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）.結(jié)論:脊髓型頸椎病患者實(shí)施針灸推拿聯(lián)合中藥聯(lián)合治療的效果顯著,可快速控制疼痛感,減輕痛苦,對(duì)改善預(yù)后具有積極作用,值得推廣.

【關(guān)鍵詞】脊髓型脊椎病;中藥治療;針灸推拿

0 引言

脊髓型頸椎病為常見(jiàn)脊椎病類型,椎間盤(pán)退變?yōu)椴±砘A(chǔ),引發(fā)相鄰節(jié)段椎體退變,形成脊髓、血管壓迫、供血障礙,嚴(yán)重影響患者生活質(zhì)量［1］.本研究對(duì)脊髓型頸椎病實(shí)施針灸推拿聯(lián)合中藥方案治療,現(xiàn)進(jìn)行如下報(bào)道.

1 資料和方法

1.1 一般資料 選取2010-02/2015-01我院收治的82例脊髓型脊椎病患者為研究對(duì)象,患者均符合中華醫(yī)學(xué)會(huì)骨科分會(huì)制定的脊髓型脊椎病診斷標(biāo)準(zhǔn)［2］.其中男45例,女37例,年齡36～59（平均45.3±4.1）歲;病程1個(gè)月～9年,平均病程（4.3±1.2）年;骨質(zhì)增生19例,頸椎間盤(pán)突出43例,黃韌帶骨化肥厚16例,其他4例.納入標(biāo)準(zhǔn):符合脊髓型脊椎病診斷標(biāo)準(zhǔn); 18～60歲;與本研究配合.排除標(biāo)準(zhǔn):脊椎嚴(yán)重外傷者;合并肝、腎、心功能障礙者;自身免疫性疾病者;妊娠期女性.將82例患者隨機(jī)分為對(duì)照組（n=41）和觀察組（n=41）,兩組患者一般資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）,具有可比性.

1.2 方法 對(duì)照組單用針灸及推拿方法治療,觀察組采取針灸推拿加中藥聯(lián)合治療.

1.2.1 針灸治療 選擇頸椎骨質(zhì)增生節(jié)段及頸椎間盤(pán)突出兩棘突之間旁開(kāi)0.5寸,使用30號(hào)毫針直刺0.5寸,有四肢麻木感后取出,不留針;單個(gè)節(jié)段病變,取雙側(cè)夾脊穴,對(duì)各節(jié)段選擇相應(yīng)棘突夾脊穴;輔穴為下肢風(fēng)市、環(huán)跳、三陰交、懸鐘、陽(yáng)陵泉、行間、昆侖;上肢取肩貞、天宗、手五里、手三里、外關(guān)、曲池等穴位,以平補(bǔ)平瀉法,30 min/次,以上手法1次/d.

1.2.2 推拿療法 患者坐端,頭部取足少陽(yáng)膽經(jīng)、督脈,用手指推動(dòng)穴位,手掌根推兩側(cè)及枕部;頸部以拿、揉、分筋、揉捏等手法,交替進(jìn)行頸部項(xiàng)韌帶、頸項(xiàng)肌,拇指推動(dòng)大椎穴;棘突兩側(cè)用拿、捏、擦等手法,從上至下進(jìn)行推拿,采取交替手法,重復(fù)3次,以上手法1次/d.

1.2.3 中藥治療 血竭5 g、穿山甲10 g、紅花12 g、沒(méi)藥8 g、當(dāng)歸15 g、黃芪24 g、山茱萸15 g、熟地黃15 g、牛膝12 g、冰片8 g、杜仲15 g.10劑,1劑/d,水煎取汁300 m L,分早晚飯后溫服.

1.3 觀察指標(biāo) 治療1個(gè)月后進(jìn)行療效判斷,根據(jù)《骨科疾病診療指南》［3］中脊髓型頸椎病療效判斷標(biāo)準(zhǔn)進(jìn)行評(píng)估.顯效:疼痛、肌肉無(wú)力、持物不穩(wěn)等癥狀消失,可正常活動(dòng);有效:癥狀好轉(zhuǎn),能基本生活自理;無(wú)效:癥狀無(wú)改善,甚至有加重.視覺(jué)模擬評(píng)分（visual analogue scale,VAS）進(jìn)行疼痛評(píng)估,0分無(wú)痛,10分為嚴(yán)重疼痛.

1.4 統(tǒng)計(jì)學(xué)處理 采用SPSS19.0進(jìn)行數(shù)據(jù)分析,計(jì)數(shù)資料采用x2檢驗(yàn);計(jì)量資料采用t檢驗(yàn),表示, P＜0.05為差異有統(tǒng)計(jì)學(xué)意義.

2 結(jié)果

觀察組治療后總有效率為95.12%,明顯較對(duì)照組70.73%高,差異有統(tǒng)計(jì)學(xué)意義（P＜0.05,表1）.

表1 兩組患者治療后臨床效果比較 ［n=41,n（%）］

治療前VAS評(píng)分無(wú)差異,經(jīng)治療后均明顯下降,且觀察組VAS評(píng)分顯著較對(duì)照組低,差異有統(tǒng)計(jì)學(xué)意義（P＜0.05,表2）.

3 討論

脊髓型頸椎病是頸椎退行性病變形成的椎間盤(pán)突出,致使椎體后緣骨質(zhì)增生,黃韌帶肥厚、小關(guān)節(jié)增生肥大等,導(dǎo)致椎管狹窄,血供缺乏,致使頸椎供血不足,從而產(chǎn)生持物不穩(wěn)、四肢麻痹、頸肩疼痛等癥狀,嚴(yán)重影響患者生存質(zhì)量.

表2 兩組患者治療前后不同時(shí)間段的VAS評(píng)分比較

本研究對(duì)脊髓型頸椎病患者實(shí)施針灸推拿與中藥聯(lián)合治療,結(jié)果顯示觀察組療效明顯優(yōu)于對(duì)照組（P＜0.05）.可見(jiàn),針灸推拿治療,輔以中藥可取得標(biāo)本兼治作用.針灸推拿可通過(guò)緩解肌肉痙攣,減輕脊柱病理性牽拉,同時(shí)也能經(jīng)過(guò)按摩將椎間隙寬度改善,降低椎間盤(pán)壓力,利于頸髓循環(huán).中藥方中血竭及沒(méi)藥、乳香、紅花、冰片等,有益氣補(bǔ)血,活血化瘀,通絡(luò)除濕,補(bǔ)腎健脾之效;穿山甲能除濕祛風(fēng),散結(jié)攻堅(jiān);杜仲、熟地黃、牛膝、山茱萸可壯肝養(yǎng)腎,對(duì)促進(jìn)脊髓血供,改善癥狀具有積極效果.安連生等［3］認(rèn)為解除脊髓壓迫,恢復(fù)血供,是減輕疼痛感的關(guān)鍵.本研究VAS評(píng)分顯示,觀察組明顯較低,可見(jiàn),中藥可以與針灸推拿相輔相成,從而促進(jìn)療效.

綜合上述,對(duì)脊髓型頸椎病實(shí)施針灸推拿聯(lián)合中藥方案治療的效果顯著,可減輕患者身體負(fù)擔(dān),緩解痛苦,對(duì)改善預(yù)后具有積極意義,值得推廣.

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［2］席世珍,王佳佳,何蘭蘭.優(yōu)值牽引配合中藥薰蒸治療神經(jīng)根型頸椎病的護(hù)理［J］.中醫(yī)正骨,2014,26（10）:79-80.

［3］安連生,韋 堅(jiān),陳升旭,等.韋氏頸椎手法配合中藥燙療治療神經(jīng)根型頸椎病的臨床研究［J］.中醫(yī)正骨,2014,26（6）:35-38.

Observation on the clinical effect of acupuncture and massage combined w ith Chinese herbal medicine for cervical spondylosis of cervical spine

ZENGHai-Juan
Traditional Chinese Medicine Hospital of Luocheng,Luocheng 546499,China

【Abstract】AIM:To investigate the clinical effect of acupuncture and moxibustion combined with Chinese medicine in treating spinal cord disease.METHODS:A total of 82 patients with spinal vertebral disease in our hospital from February 2013 to January 2015 were selected as the research object and randomly divided into control group and observation group,with 41 cases in each group.Patients in the control group accepted acupuncture and massage therapy,and patients in the observation group accepted acupuncture and moxibustion combined with Chinese medicine.The clinical effect of two groups were compared and analyzed after treatment.RESULTS:The total effective rate of the observation group was 95.12%,and which was higher than 70.73%of the control group.The difference was statistically significant（P＜0.05）.Therewas no significant difference between two groups in VAS score before treatment.After treatment,VAS score of the observation group was reduced significantly than that of the control group（P＜0.05）.CONCLUSION:The implementation of acupuncture and massage combined with traditional Chinese medicine has significant curative effecton patientswith pinal cord spondylopathy,can control pain rapidly,relieve pain,p lay a positive role to improve the prognosis,and is worthy to be popularized.

【Keywords】spinal cord disease;traditional Chinese medicine therapy;acupuncture and massage

【中圖分類號(hào)】R274

【文獻(xiàn)標(biāo)識(shí)碼】A

文章編號(hào):2095-6894（2015）07-071-02

收稿日期:2015-05-23;接受日期:2015-06-05

作者簡(jiǎn)介:曾海娟.本科,住院醫(yī)師.研究方向:針灸推拿.Tel:0778-8212179 E-mail:280020343@qq.com