目的 探讨腹部摩法结合颈椎旋转定位扳法治疗椎动脉型颈椎病痰湿阻络证的效果.方法 选取2022年1月—2022年12月期间黑龙江中医药大学附属第二医院收治的90例椎动脉型痰湿阻络证患者,采用随机数字表法分为腹摩组、扳法组、联合组,每组各30例.3组患者均给予西药与常规推拿治疗,在此基础上,腹摩组施以腹部摩法,扳法组施以颈椎旋转定位扳法,联合组给予腹部摩法+颈椎旋转定位扳法,3组患者均治疗2周.观察比较3组患者临床疗效、安全性以及治疗前后中医证候积分、眩晕症状评分(Evaluation scale for cervical vertigo,ESCV评分)、颈椎功能评分[颈椎功能障碍指数(Neck disability index,NDI)及日本骨科协会(Japanese orthopaedic association scores,JO A)]、椎-基底动脉血流动力学[平均血流速度(Velocitymean,Vm)、收缩期峰值血流速度(Velocity systolic,Vs)、舒张期末血流速度(Vend of diastolic velocity,Vd)、阻力指数(Resistance index,RI)、搏动指数(Pulsation index,PI)值].结果 治疗后联合组临床总有效率96.67％(29/30)高于腹摩组70.00％(21/30)与扳法组80.00％(24/30),差异有统计学意义(P＜0.05).治疗后3组患者中医证候积分均较治疗前降低,差异有统计学意义(P＜0.05);且联合组中医证候积分明显低于腹摩组与扳法组,差异有统计学意义(P＜0.05).治疗后3组患者ESCV评分均较治疗前降低,差异有统计学意义(P＜0.05);且联合组ESCV评分明显低于腹摩组与扳法组,差异有统计学意义(P＜0.05).治疗后3组患者NDI评分较治疗前降低,JOA评分较治疗前升高,差异有统计学意义(P＜0.05);且联合组NDI评分明显低于腹摩组与扳法组,JOA评分明显高于腹摩组与扳法组(P＜0.05).治疗后3组患者椎-基底动脉Vm、Vs、Vd参数均较治疗前升高,RI、PI参数均较治疗前降低,差异有统计学意义(P＜0.05);且联合组Vm、Vs、Vd参数明显高于腹摩组与扳法组,RI、PI参数明显低于腹摩组与扳法组,差异有统计学意义(P＜0.05).治疗期间,3组患者安全性分级与不良反应发生率比较,差异无统计学意义(P＞0.05).结论 腹部摩法结合颈椎旋转定位扳法治疗椎动脉型颈椎病痰湿阻络证安全、有效,有利于改善颈椎功能,调节椎-基底动脉血流动力学,进而缓解眩晕症状.
Clinical Observation on the Treatment of Vertebral Artery Type of Cervical Spondy-losis(Syndrome of Phlegm-Dampness Obstructing Collaterals)by Abdominal Mas-sage Combined with Cervical Fixed-Position Rotary Pulling Manipulation
Objective To observe the effect of abdominal massage combined with cervical fixed-position rotary pulling manipulation on vertebral artery type of cervical spondylosis(syndrome of phlegm-dampness obstructing collater-als).Methods Ninety patients with vertebral artery type of cervical spondylosis(syndrome of phlegm-dampness obstruc-ting collaterals)treated in the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from January to December in 2022 were assigned by the random number table method into three groups of abdominal massage(group A),cervical fixed-position rotary pulling manipulation(group B),and abdominal massage+cervical fixed-position rotary pulling manipulation(group C),with 30 patients in each group.All the three groups were treated with corresponding regimens on the basis of Western medicine and conventional massage for 2 weeks.The clinical efficacy and safety were compared among the three groups.The TCM symptom score,Evaluation Scale for Cervical Vertigo(ESCV)score,cervical vertebral function indicators[neck disability index(NDI)and Japanese Orthopaedic Association(JO A)scores],and vertebrobasilar hemody-namic parameters[velocity mean(Vm),systolic velocity(Vs),diastolic velocity(Vd),resistance index(RI),and pulsatili-ty index(PI)]were determined before and after treatment for all the three groups.Results The total response rate in group C(96.67％,29/30)was higher than those in groups A(70.0％,21/30)and B(80.0％,24/30)(P＜0.05).After treatment,the TCM symptom score and ESCV score decreased in all the three groups,and the scores in group C were lower than those in the other two groups(P＜0.05).The treatment in all the three groups decreased the NDI score and increased the JO A score,and group C had lower NDI score and higher JO A score than the other two groups(P＜0.05).In addition,the treatment in all the three groups increased Vm,Vs,and Vd and decreased RI and PI,and group C had higher Vm,Vs,and Vd and lower RI and PI than the other two groups(P＜0.05).There was no significant difference in the safety grading or incidence of adverse reactions among the three groups during the treatment period(P＞0.05).Conclusion Abdominal massage combined with cervical fixed-position rotary pulling manipulation is safe and effective in the treatment of verte-bral artery type of cervical spondylosis due to phlegm-dampness obstructing collaterals.It can improve the cervical verte-bral function,regulate vertebrobasilar hemodynamics,and relieve vertigo.
Vertebral Artery Type of Cervical SpondylosisSyndrome of Phlegm-Dampness Obstructing Collater-alsAbdominal MassageCervical Fixed-Position Rotary Pulling ManipulationHemodynamics
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