非手术脊柱减压治疗神经根型颈椎病疗效观察及其机制研究

发布时间：2018-03-15 12:09

本文选题：椎间盘　切入点：神经根型颈椎病　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的观察非手术脊柱减压治疗系统牵引治疗神经根型颈椎病的临床疗效,并从神经电生理学和分子生物学角度探讨其作用机制,为临床治疗神经根颈椎病提供实验依据。方法采用随机,对照,单盲的方法,将符合实验要求的60例患者分为观察组和对照组,每组各30例。观察组在常规治疗基础上给予非手术脊柱减压系统牵引治疗,对照组同样在常规治疗基础上给予传统的颌枕带坐位颈椎牵引治疗;两组均治疗20次,分4周完成。两组分别在治疗前及治疗4周后采用疼痛视觉模拟评分(VAS)观察其疗效,采用肌电图仪观察正中神经和尺神经的F波传导速度,采用ELISA法检测血清中TNF-α、IL-6的水平,治疗结束后评价临床疗效。结果(1)观察组和对照组治疗前、后VAS评分比较:治疗前两组VAS评分差异无统计学意义(P0.05),治疗后两组评分均较治疗前降低,且观察组降低的幅度明显,与对照组差异有统计学意义(P0.05)。(2)观察组和对照组正中神经和尺神经F波传导速度值比较:治疗前两组F波传导速度差异无统计学意义(P0.05),两组治疗后F波传导速度均升高,但观察组升高更明显,差异有统计学意义(P0.05)。(3)观察组和对照组治疗前、后血清TNF-α、IL-6变化水平:两组患者治疗前TNF-α、IL-6差异统计学意义(P0.05),与治疗前比较,两组治疗后血清TNF-α、IL-6水平均降低,但观察组降低更明显,差异有统计学意义(P0.05)。(4)观察组治愈17例、显效9例、有效3例、无效1例,总显效率为86.7%;对照组分别为11、10、5、4例和70.0%;观察组总显效率明显高于对照组(P0.05)。结论非手术脊柱减压系统牵引治疗神经根型颈椎病的效果优于普通颌枕带牵引,减轻炎症反应,有效阻断病变神经病程发展,促进受损神经修复,改善传导可能是其作用机制,非手术脊柱减压治疗系统安全,舒适,无创,故值得在临床推广应用。
[Abstract]:Objective to observe the clinical effect of non-operative spinal decompression system traction in the treatment of cervical spondylopathy of nerve root type, and to explore its mechanism from the aspects of neurophysiology and molecular biology. Methods 60 patients with cervical spondylosis were divided into observation group and control group. Each group (30 cases) was treated with non-operative spinal decompression system traction on the basis of routine treatment, while the control group was treated with traditional cervical traction treatment of maxillary occipital and sitting position on the basis of routine treatment, both groups were treated for 20 times. The therapeutic effect was observed by visual analogue pain score (VASS) before treatment and 4 weeks after treatment. The F-wave conduction velocity of median nerve and ulnar nerve was observed by electromyography, and the serum TNF- 伪 IL-6 level was detected by ELISA method. Results: before and after treatment, there was no significant difference in VAS score between the two groups before and after treatment. The scores of the two groups were lower than those before treatment, and the extent of the decrease in the observation group was obvious, and there was no significant difference between the two groups before and after treatment. Comparison of F-wave conduction velocities of median nerve and ulnar nerve between the observation group and the control group: there was no significant difference in F wave conduction velocity between the two groups before and after treatment, and the F wave conduction velocity increased after treatment in both groups. But the increase of TNF- 伪 IL-6 was more obvious in the observation group than that in the control group (P 0.05). The level of serum TNF- 伪 IL-6 in the observation group and the control group before and after treatment was significantly higher than that in the control group (P 0.05). The levels of serum TNF- 伪 IL-6 in the two groups were lower than those in the control group before and after treatment (P < 0.05), and the levels of serum TNF- 伪 IL-6 in the two groups were significantly lower than those in the control group before and after treatment (P < 0.05). In the observation group, 17 cases were cured, 9 cases were effective, 3 cases were effective, and 1 case was ineffective. The total effective rate was 86.7 in the control group and 1110 in 4 cases and 70.0 in the control group, respectively, and the total effective rate in the observation group was significantly higher than that in the control group (P 0.05). Conclusion the effect of non-operative spinal decompression system traction on cervical spondylosis of nerve root type is better than that of common maxillary occipital traction, and the inflammatory reaction is alleviated. It may be the mechanism of blocking the development of pathological neuropathy, promoting the repair of injured nerve and improving the conduction. The non-operative spinal decompression treatment system is safe, comfortable and non-invasive, so it is worth popularizing in clinic.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.55

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