龙军

【摘 要】目的：观察推拿结合颈椎端提法联合半夏白术天麻汤加减治疗椎动脉型颈椎病的临床疗效。方法：将76例椎动脉型颈椎病患者按照随机抽签法分为治疗组和对照组，每组38例。对照组采用半夏白术天麻汤加减口服治疗，治疗组在对照组基础上联合推拿结合颈椎端提法干预。观察2组临床疗效，治疗前后症状改善情况，治疗后临床症状功能评分以及不良反应情况。结果：治疗组治愈19例，显效15例，有效2例，无效2例，总有效率为94.74%;对照组治愈12例，显效13例，有效5例，无效8例，总有效率为78.95%。2组比较，差异有统计学意义（P < 0.05）。治疗后，2组症状指标左椎动脉、右椎动脉、基底动脉较治疗前均有改善（P < 0.05），且治疗组优于对照组（P < 0.05）。治疗组治疗后眩晕评分、头痛评分、肩颈痛评分、旋颈试验评分、生活及工作评分、心理及社会适应评分均高于对照组，差异有统计学意义（P < 0.05）。不良反应总发生率治疗组为5.26%，对照组为7.89%，2组比较，差异无统计学意义（P > 0.05）。结论：在椎动脉型颈椎病患者中实施半夏白术天麻汤加减联合推拿结合颈椎端提法干预的疗效明确。

【关键词】 颈椎病;椎动脉型;半夏白术天麻汤;推拿;颈椎端提法;临床疗效

【ABSTRACT】Objective：To observe the clinical effect of massage combined with cervical vertebra end lifting combined with modified Banxia Baizhu Tianma Tang（半夏白术天麻汤）in the treatment of cervical spondylosis of vertebral artery type.Methods：Seventy-six cases with cervical spondylosis of vertebral artery type were randomly divided into a treatment group and a control group，38 cases in each group.The control group was treated with Banxia Baizhu Tianma Tang，and the treatment group was treated with massage and cervical vertebra lifting intervention on the basis of the treatment for the control group.The clinical effect，improvement of symptoms before and after treatment，functional score of clinical symptoms and adverse reactions were observed.Results：In the treatment group，19 cases recovered，15 cases were markedly effective，2 cases were effective，2 cases were ineffective，and the total effective rate was 94.74%;while in the control group，12 cases recovered，13 cases were markedly effective，5 cases were effective，8 cases were ineffective，and the total effective rate was 78.95%.The difference between the two groups was statistically significant（P < 0.05）.After treatment，the symptoms of left vertebral artery，right vertebral artery and basilar artery in the two groups were improved（P < 0.05），and the treatment group was better than the control group（P < 0.05）.The scores of vertigo，headache，shoulder and neck pain，neck rotation test，life and work，psychological and social adaptation in the treatment group were significantly higher than those in the control group（P < 0.05）.The total incidence of adverse reactions was 5.26% in the treatment group and 7.89% in the control group.There was no significant difference between the two groups（P > 0.05）.Conclusion：The therapeutic effect of Banxia Baizhu Tianma Tang combined with massage and cervical vertebra end lifting intervention is clear.

【Keywords】cervical spondylosis;vertebral artery type;Banxia Baizhu Tianma Tang（半夏白術天麻汤）;massage;cervical vertebra end lifting;clinical effect

椎动脉型颈椎病（cervical spondylosis of vertebral artery type，CSA）属于临床常见疾病，主要是因为颈椎退行性病变而致，临床表现包括眩晕、头痛、后枕颈项疼痛不适等症状[1]。其中，头痛、头晕容易促使颈部突然旋转进而导致病情加重，而且患者头痛症状常常偏于一侧，尤其以颞部较为多见;疼痛症状多数表现为跳痛、胀痛，且不敢活动颈部;部分患者可出现颈肌紧张、痉挛症状，以及病变椎体节段处棘旁伴有压痛;部分患者可出现斜方肌发硬、胸锁乳突肌痉挛发硬，予以旋转试验则可明显加重其头晕、头痛症状。据临床相关报道显示，CSA发病率位列临床颈椎病第2位，仅次于神经根型颈椎病，约占颈椎病的20.00%～30.00%[2]。……