“筋骨并重、医患合作”理论在青年颈型颈椎病防治中应用的临床研究

发布时间：2018-08-19 07:51

【摘要】：目的：通过对颈部强筋束骨手法+穴位自我按摩手法+颈椎功能保健操和双氯芬酸钠缓释片+颈椎牵引+颈部制动进行随机对照临床研究,探讨中医综合治疗、保健措施在治疗颈型颈椎病方面的疗效和安全性。通过对于中医整体治疗措施在治疗颈型颈椎病方面的临床疗效及安全性研究,尝试建立颈型颈椎病的预防、保健、治疗规范；初步探讨及建立颈型颈椎病整体治疗的“医院-家庭”模式、“医患合作”模式,从而达到预防、保健、治疗的有机结合。方法：选择符合颈性颈椎病诊断标准、纳入标准的患者119例。随机进行分组,选取60例纳入试验组,59例纳入对照组。其中试验组以颈部强筋束骨手法+穴位自我按摩手法+颈椎功能保健操治疗,其中强筋束骨手法隔两天一次,每次约20分钟,持续2周；穴位自我按摩手法早晚各一次；颈椎保健操每日1-2次,锻炼开始时逐步适应,周期为1个月。对照组以双氯芬酸钠缓释片+颈椎牵引+颈部制动治疗,其中口服双氯芬酸钠缓释片一次1粒(75mg),一日1次；牵引治疗每天1次,每次牵引20分钟；颈部制动为每天治疗后即刻颈围佩戴4小时。对首次治疗(前、后)、治疗1周,治疗2周(手法治疗结束)、随访1个月、随访2个月及随访3个月进行VAS评分、NDI评分以及颈椎活动度评分。治疗1疗程后评价两组病例的临床疗效,搜集数据,采用SPSS19.0统计软件对数据进行统计分析。结果：将两组患者的治疗前一般资料(包括性别、年龄、病程、工作状态等各项指标)进行基线比较,经X2检验及t检验,之间的差异均无统计学意义(P＞0.05)。经统计,两组总疗效比较,试验组疗效：治愈71.7%,显效28.3%,有效0%,无效0%,总有效率100%；对照组疗效：治愈23.7%,显效62.7%,有效13.6%,无效0%,总有效率100%。经检验,具有显著性统计学意义(P0.01)。通过对试验组和对照组患者治疗前后VAS评分、NDI评分以及颈椎活动评分进行组内及组间比较,均具有显著性统计学意义(P0.01)。本次研究全过程未出现不良反应及安全事故发生,治疗后连续随访3月,未见有后遗症。结论：颈部强筋束骨手法+穴位自我按摩手法+颈椎功能保健操与双氯芬酸钠缓释片+颈椎牵引+颈部制动均能改善颈型颈椎病的症状及体征。通过两组观察数据比较,颈部强筋束骨手法+穴位自我按摩手法+颈椎功能保健操明显优于双氯芬酸钠缓释片+颈椎牵引+颈部制动。
[Abstract]:Objective: to investigate the comprehensive treatment of traditional Chinese medicine (TCM) through a randomized controlled clinical study on cervical traction and cervical braking of cervical vertebrae with cervical strong tendons, bone manipulation, acupoint self-massage and diclofenac sodium sustained-release tablets. Efficacy and safety of health measures in the treatment of cervical spondylosis. Through the clinical efficacy and safety study on the whole treatment of cervical spondylosis of cervical type, the author tries to establish the standard of prevention, health care and treatment of cervical spondylosis of cervical type. To explore and establish the model of "hospital-family" and "doctor-patient cooperation" in the overall treatment of cervical spondylosis, so as to achieve the organic combination of prevention, health care and treatment. Methods: 119 patients with cervical spondylosis were selected. 60 cases were randomly divided into the experimental group and 59 cases in the control group. Among them, the experimental group was treated with cervical muscular bone manipulation acupoint self-massage manipulation cervical vertebrae function exercise, in which the strong-tendon bone manipulation was used once every two days for about 20 minutes each time for 2 weeks, and the acupoint self-massage manipulation was done once in the morning and evening. Cervical exercise 1-2 times a day, exercise began to adapt gradually, the cycle is 1 month. The control group was treated with diclofenac sodium sustained release tablets for cervical traction cervical immobilization, including oral diclofenac sodium sustained release tablets (75mg) once a day, traction treatment once a day, traction for 20 minutes. Neck immobilization is worn around the neck for 4 hours immediately after treatment every day. The first treatment (before, after), 1 week and 2 weeks (end of manual therapy) were followed up for 1 month, followed up for 2 months and 3 months for VAS score and cervical mobility score. After one course of treatment, the clinical effect of the two groups was evaluated, and the data were collected and analyzed by SPSS19.0 software. Results: the baseline data (including sex, age, course of disease, working state) of the two groups before treatment were compared. There was no significant difference between the two groups by X2 test and t test (P > 0.05). According to the statistics, the total curative effect of the two groups was compared. The experimental group was cured 71.7, marked 28.3am, effective 0, ineffective 0, total effective 100; in the control group, 23.7cm, 62.7, 13.6, 0, 100, the total effective rate was 1000.In the control group, the curative effect was 23.7cm, the significant effect was 62.7%, the effective 13.6g was effective, the ineffectual was 0.0.The total effective rate was 100. The results showed that there was significant statistical significance (P0.01). The scores of VAS and activity of cervical vertebrae before and after treatment in the experimental group and the control group were compared with each other and there was significant statistical significance (P0.01). There were no adverse reactions and safety accidents in the whole course of the study, and no sequelae were observed after 3 consecutive months of follow-up. Conclusion: the function exercises of cervical vertebrae with self-massage and diclofenac sodium sustained-release tablets can improve the symptoms and signs of cervical spondylosis. According to the observation data of the two groups, the cervical vertebrae function exercise was better than that of diclofenac sodium sustained-release tablet in cervical traction and cervical braking.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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