【作者】 赵明广；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 颈椎病(cervical spondylosis)是颈椎间盘组织退行性变继发病理改变累及周围组织结构并出现相应临床症状。近年来由于生活方式的改变使本病的发病年龄有年轻化趋势,形成了与现代社会劳动群体相伴随的现代病。其中尤其以神经根型颈椎病(Cervical Spondylotic Radiculopathy CSR)最多见,约占颈椎病发病率50%-60%,对人体健康造成严重影响。针刺治疗CSR可消除水肿,消炎止痛,改善局部血液循环供应,解除肌肉痉挛,减轻对神经的刺激和压迫,对改善疼痛、麻木、头晕等症状可有立竿见影的效果,且副作用小、疗效好、费用低,有着明显的优势,为目前CSR的主要治疗方法之一。目的：本课题采用随机对照研究,运用输穴结合夹脊穴治疗神经根型颈椎病患者,并通过与单纯使用夹脊穴和常规针灸取穴疗法对比,观察本疗法的临床疗效,为针灸疗法治疗神经根型颈椎病提供选穴组方依据。方法：研究对象选取2011年3月至2012年3月期间在台湾新北市天泽中医诊所的患者为研究的目标人群,将其中符合病例筛选标准的90例神经根型颈椎病患者,按1：1：1的比例随机分配至综合疗法A组(输穴结合夹脊穴组)、B组(夹脊穴组),C组(普通针刺组)每组各30例。各组均每周连续治疗5次,休息两天,10次为一个疗程,共治疗2个疗程。通过记录两组患者临床症状体征评分,简化McGill量表评分,观察本疗法对神经根型颈椎病患者的临床疗效。结果：本研究采用随机对照试验方法进行临床试验,共有合格受试者90例。随机分为三组,每组各30例患者。三组患者治疗前一般资料比较,三组患者在性别、年龄、病程分布上差异无统计学意义(P>0.05),具有可比性。治疗前三组患者临床症状体征积分、PRI积分、VAS评分、PPI积分经统计学分析,差异无统计学意义(P>0.05),具有可比性。1.三组患者临床症状体征评分比较治疗前三组神经根型颈椎病患者的20分法量表比较,差异无统计学意义(P>0.05),具有可比性。经不同针刺疗法治疗后,三组患者临床症状体征评分较治疗前均有明显提高,三组20分法量表评分差异有统计学意义(P<0.01)。进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.01)；A组与C组评分差异具有统计学意义(P<0.01)；B组与C组评分差异具有统计学意义(P<0.01)。上述结果提示,经不同方案治疗后,输穴结合夹脊穴治疗神经根型颈椎病对患者的临床症状和体征具有明显改善作用,其疗效优于单纯使用夹脊穴,或者常规针刺方法。2.三组患者PRI评分比较治疗前三组患者PRI评分比较,差异无统计学意义,具有可比性(P>0.05)。经不同疗法治疗后,三组PRI评分均有明显下降,经统计学分析,差异具有统计学以(P<0.01)。进一步进行两两比较,A组与B组、A组与C组PRI评分比较差异具有统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。提示输穴结合夹脊穴治疗神经根型颈椎病,可以明显改善患者改良疼痛量表PRI评分,其疗效优于单纯夹脊穴疗法及常规针刺疗法,而进一步组间比较,单纯选用夹脊穴疗法和常规针刺疗法对于降低患者PRI评分差异无统计学意义(P>0.05)。3.三组患者VAS评分值比较治疗前三组患者VAS评分比较,差异无统计学意义(P>0.05),具有可比性。经不同疗法治疗后,三组患者VAS评分较治疗前均有明显下降,三组差异有统计学意义(P<0.01)。进一步进行两两比较,A组与B组差异具有统计学意义(P<0.01)；A组与C组评分差异具有统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。上述结果提示,输穴结合夹脊穴治疗神经根型颈椎病,可以明显改善患者视觉模拟评分,其疗效优于单纯夹脊穴疗法及常规针刺疗法,而进一步组间比较,单纯选用夹脊穴疗法和常规针刺疗法对于降低患者视觉模拟评分差异无统计学意义(P>0.05)。4.三组患者PPI评分比较治疗前,三组患者PPI评分比较,差异无统计学意义,具有可比性(P>0.05)。三组患者经不同治疗方法后,PPI评分值均有下降,组间比较差异具有统计学意义(P<0.01)。进一步两两比较,A组与B组差异具有统计学意义(P<0.01)；A组与C组评分差异具有统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。上述结果提示,输穴结合夹脊穴治疗神经根型颈椎病,可以明显改善患者现时疼痛强度PPI评分,其疗效优于单纯夹脊穴疗法及常规针刺疗法,而进一步组间比较,单纯选用夹脊穴疗法和常规针刺疗法对于降低患者现时疼痛强度差异无统计学意义(P>0.05)。5.三组患者临床疗效比较三组患者临床疗效比较,A组显效18例、有效10例、无效2例；B组显效10例、有效12例、无效8例；C组显效13例、有效11例、无效6例；A组总有效率93.3%,B组总有效率73.3%,C组总有效率80.0%,经Ridit分析,差异有统计学意义(P<0.05)。结论：本研究数据结果提示输穴结合夹脊穴治疗神经根型颈椎病对于改善患者临床症状、体征具有良好疗效,同时,可以显著降低患者SF-MPQ量表中各项疼痛指数评分。本疗法采用输穴结合夹脊穴,针刺颈夹脊穴气至病所,具有直接激发经气,疏通经络的作用。并根据循经取穴的原则,以“输主体重节痛”的经典理论为依据,选取五输穴之输穴配合治疗本病,既体现了针灸疗法选穴组方原则中近治与远治相结合的原则,又充分利用了特定穴的功效,进行辨经选穴治疗,分经论治,条理分明,规律性强,疗效高。本疗法选穴组方简洁明了,疗效肯定,值得临床推广。更多还原

【Abstract】 Cervial sppondylosis is due to cervical intervertebral disc degenerative changes and subsequent pathological process. Because of the rapid change in lifestyle in china, there is concern that cervical spondylosis may become epidemic, And the type of cervical spondylotic radiculopaty is the most common, its incidence is50%-60%. It dose harm to our health and also bings some negative influences on our daily life and work.ObjectiveThis study adapted randomly researching menthod, and we adopted the treatment of Shu acupoints combined Jiaji points for the CSR patients, meanwhile, compared with merely Jiaji acupoints and common acupoints therapy, to observe the clinical effect on CSR patients, and provide the basis for clinical application.Methodsduiring the period of2011/3to2012/3. we selected90simple CSR patients who accepted treatment in Tai Wan Mingshi hospital, randomly divided the cases into three groups, each group30cases. The A group adapted the menthod of Shu acupoints combined with Jiaji acupoints; the B group treated with merely Jiaji acupoints; and the C group used commin method alone. Each group accepted5times therapy every week, and then there was2days for rest,10times for a course of treatment, and2threapeutic courses, then for every paatient, the clinical symptoms, signs scores and the SF-MPQ scale were recored, SPSS sotrware was used for statistical analysis.Results1according to the clinical symptoms and signs scores:the three groups before treatmen was no significant difference (P>0.05). After the treatment, the scores of the three groups were increased. And the difference was significant (P<0.01). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups, B and C groups (P<0.01). therefore the intergration therapeutics group was more effective than the other two groups in increasing the symptoms and signs scores.2according to the PRI scores:after treament, there was remarkable dicerase of the PRI scores, and the difference was significant (P<0.01). and the multiple comparisons showed that there was significant difference between A and B group, A and C groups (P<0.01). But B and C groups had no statistical significance (P>0.05). The result pointed out that the intergration therapeutics group was more effective than the other two groups indecreasing the PRI scores.3according to the VAS scores:after treament, there was remarkable dicerase of the VAS scores, and the difference was significant (P<0.01). and the multiple comparisons showed that there was significant difference between A and B group, A and C groups (P<0.01). But B and C groups had no statistical significance (P>0.05). The result pointed out that the intergration therapeutics group was more effective than the other two groups indecreasing the VAS scores.4according to the PPI scores:after treament, there was remarkable dicerase of the PRI scores, and the difference was significant (P<0.01). and the multiple comparisons showed that there was significant difference between A and B group, A and C groups (P<0.01). But B and C groups had no statistical significance (P>0.05). The result pointed out that the intergration therapeutics group was more effective than the other two groups indecreasing the PPI scores.5the clinical efficacy of the effect, in treatment group, the clinical markedly effective18cases, effective10cases, inefficacy2cases, the effective rate was93.3%, while in Jiaji group, markedly effective10cases, effective12cases, inefficacy8cases, the effective rate was73.3%, the common acupoints group, markedly effective13cases, effective11cases, inefficacy6cases, the effective rate was80.0%, the curative effect of the treatment group was better than others (P<0.05)ConclusionIn the study the rusult showed that, the therapy of Shu acupoints combined with Jiaji acupoints has better clinical efficacy in ameliorate patients’ clinical symptoms, sings, and relieve pain. Needling cervical Jiaji points can promot the movement of the channel-qi and dredging meridians, and combine with the Shu acupoints along channel, that not only illustrate the nearby and remote therapeutic effect, but also take advantage of the specific acupoints. The concisely point prescriptions is worth spreading and exercising widely.更多还原