【摘要】：目的：通過對(duì)頸部強(qiáng)筋束骨手法+穴位自我按摩手法+頸椎功能保健操和雙氯芬酸鈉緩釋片+頸椎牽引+頸部制動(dòng)進(jìn)行隨機(jī)對(duì)照臨床研究,探討中醫(yī)綜合治療、保健措施在治療頸型頸椎病方面的療效和安全性。通過對(duì)于中醫(yī)整體治療措施在治療頸型頸椎病方面的臨床療效及安全性研究,嘗試建立頸型頸椎病的預(yù)防、保健、治療規(guī)范；初步探討及建立頸型頸椎病整體治療的“醫(yī)院-家庭”模式、“醫(yī)患合作”模式,從而達(dá)到預(yù)防、保健、治療的有機(jī)結(jié)合。方法：選擇符合頸性頸椎病診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)的患者119例。隨機(jī)進(jìn)行分組,選取60例納入試驗(yàn)組,59例納入對(duì)照組。其中試驗(yàn)組以頸部強(qiáng)筋束骨手法+穴位自我按摩手法+頸椎功能保健操治療,其中強(qiáng)筋束骨手法隔兩天一次,每次約20分鐘,持續(xù)2周；穴位自我按摩手法早晚各一次；頸椎保健操每日1-2次,鍛煉開始時(shí)逐步適應(yīng),周期為1個(gè)月。對(duì)照組以雙氯芬酸鈉緩釋片+頸椎牽引+頸部制動(dòng)治療,其中口服雙氯芬酸鈉緩釋片一次1粒(75mg),一日1次；牽引治療每天1次,每次牽引20分鐘；頸部制動(dòng)為每天治療后即刻頸圍佩戴4小時(shí)。對(duì)首次治療(前、后)、治療1周,治療2周(手法治療結(jié)束)、隨訪1個(gè)月、隨訪2個(gè)月及隨訪3個(gè)月進(jìn)行VAS評(píng)分、NDI評(píng)分以及頸椎活動(dòng)度評(píng)分。治療1療程后評(píng)價(jià)兩組病例的臨床療效,搜集數(shù)據(jù),采用SPSS19.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果：將兩組患者的治療前一般資料(包括性別、年齡、病程、工作狀態(tài)等各項(xiàng)指標(biāo))進(jìn)行基線比較,經(jīng)X2檢驗(yàn)及t檢驗(yàn),之間的差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。經(jīng)統(tǒng)計(jì),兩組總療效比較,試驗(yàn)組療效：治愈71.7%,顯效28.3%,有效0%,無效0%,總有效率100%；對(duì)照組療效：治愈23.7%,顯效62.7%,有效13.6%,無效0%,總有效率100%。經(jīng)檢驗(yàn),具有顯著性統(tǒng)計(jì)學(xué)意義(P0.01)。通過對(duì)試驗(yàn)組和對(duì)照組患者治療前后VAS評(píng)分、NDI評(píng)分以及頸椎活動(dòng)評(píng)分進(jìn)行組內(nèi)及組間比較,均具有顯著性統(tǒng)計(jì)學(xué)意義(P0.01)。本次研究全過程未出現(xiàn)不良反應(yīng)及安全事故發(fā)生,治療后連續(xù)隨訪3月,未見有后遺癥。結(jié)論：頸部強(qiáng)筋束骨手法+穴位自我按摩手法+頸椎功能保健操與雙氯芬酸鈉緩釋片+頸椎牽引+頸部制動(dòng)均能改善頸型頸椎病的癥狀及體征。通過兩組觀察數(shù)據(jù)比較,頸部強(qiáng)筋束骨手法+穴位自我按摩手法+頸椎功能保健操明顯優(yōu)于雙氯芬酸鈉緩釋片+頸椎牽引+頸部制動(dòng)。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R274.9

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