脊髓型颈椎病中医综合治疗的临床研究

目的：评价中药、手法、电针中医综合疗法治疗脊髓型颈椎病的效果和安全性。方法选择2009年1月-2012年12月在首都医科大学电力教学医院住院明确诊断为脊髓型颈椎病的患者60例，随机分为治疗组和对照组，各30例。治疗组采用颈椎旋提手法联合中药及电针灸综合疗法。对照组采用颈椎枕颌吊带牵引，口服腺苷钴胺片及维生素B1片，理疗综合疗法。分别于治疗前、连续治疗3周后、治疗后第3个月采用“北医三院颈椎脊髓功能状态评定法”对临床症状和体征进行效果评定。分别于治疗前、连续治疗3周后行影像学及体感诱发电位检查，对颈椎的曲度、角度位移、水平位移、椎管失状径、突出物失状径及椎管失状径/突出物失状径比值进行前后对比。结果两组连续治疗3周后脊髓功能状态评定评分治疗组：（50.20±8.28）分，对照组：（44.06±9.15）分]与治疗前治疗组：（21.06±9.48）分，对照组：（24.70±8.05）分]比较，差异均有高度统计学意义（均P〈0.01）；两组治疗后第3个月随访脊髓功能状态评定评分治疗组：（51.13±8.38）分，对照组：（43.20±11.65）分]与连续治疗3周后比较，差异均有高度统计学意义（均P〈0.01）；连续治疗3周后及治疗后第3个月随访组间差异均有高度统计学意义（均P〈0.01）；治疗组有效率（93.3%）和对照组有效率（83.4%）比较差异有统计学意义（P〈0.05）；治疗后各影像学观测指标与治疗前比较差异无统计学意义，组间差异亦无统计学意义（均P〉0.05）。结论脊髓型颈椎病中医综合治疗效果肯定，影像学及体感诱发电位指标评估中医综合疗法安全可行。

Clinical study of comprehensive treatment by traditional Chinese medicine for cervical spondylotic myelopathy

Objective To evaluate the efficacy and safety of comprehensive treatment by traditional Chinese medicine including herb, manipulation and electro-acupuncture of cervical spondylotic myelopathy. Methods 60 inpatients with cervical spondylotic myelopathy from January 2009 to December 2012 in Beijing Electric Power Hospital, Capital Medical University were divided randomly into the testing group and the control group, with 30 cases in each group. The testing group was treated with herb, manipulation and electro-acupuncture and the control group was treated with cervical traction, Cobamamide and vitamin B1 tablets, physical therapy. The clinical signs and symptoms were measured before and after 3 weeks continuous treatment, 3 months after treatment. The X-ray cervical curvature, vertebra hori-zontal and angle displacement and MRI sagittal diameter of spinal canal and disk prominence were observed before and after 3 weeks continuous treatment. Results The spinal cord neural function after 3 weeks continuous treatment of the two groups the testing group： （50.20±8.28） points, the control group： （44.06±9.15） points] were significantly different compared with before treatment the testing group： （21.06±9.48） points, the control group： （24.70±8.05） points] （all P〈0.01）. The spinal cord neural function after treatment for 3 months of the two groups the testing group： （51.13±8.38） points, the control group：（43.20±11.65） points] was significantly different compared with after 3 weeks continuous treatment （all P〈 0.01）; the difference between the two groups was significant after 3 weeks continuous treatment and 3 months after treatment （all P〈0.01）. The effective rate was 93.3% for testing group, 83.4% for control group, the difference was statistically significant （P〈0.05）. There was no significant difference of imaging observation indexes before and after 3 weeks continuous treatment, there was no significant difference between the two groups （all P〉0.05