针刺颈夹脊穴联合曲度牵引对混合型颈椎病患者椎动脉血流速度和颈椎生理曲度的影响及治疗后颈椎生理曲度影响因素分析  

Effects of acupuncture at neck-clip-ridge point combined with curvature traction on vertebral artery blood flow velocity and cervical physiological curvature in patients with mixed cervical spondylosis and analysis of influencing factors of cervical physiological curvature after treatment

作　　者：石荣菊 许蕾 张超 SHI Rongju;XU Lei;ZHANG Chao(Department of Rehabilitation Medicine,Nanjing Jiangbei Hospital,Nanjing,Jiangsu 210048)

机构地区：[1]南京江北医院康复医学科,江苏南京210048

出　　处：《河北中医》2025年第3期461-467,共7页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察针刺颈夹脊穴联合曲度牵引对混合型颈椎病患者椎动脉血流速度和颈椎生理曲度的影响,并分析治疗后混合型颈椎病患者颈椎生理曲度的独立影响因素。方法选择2019年1月至2022年12月南京江北医院康复医学科收治的212例混合型颈椎病患者为研究对象,根据治疗方法分为对照组(n=141)和治疗组(n=71)。对照组予针刺颈夹脊穴治疗,治疗组在对照组治疗基础上加曲度牵引治疗,2组均治疗4周。比较2组治疗前后椎动脉收缩期血流速度(PSV)、平均血流速度(Vm)及舒张期末血流速度(EDV)、颈椎生理曲度、疼痛视觉模拟评分(VAS)及颈椎功能障碍指数(NDI)评分。再根据治疗后患者颈椎生理曲度分为异常组(n=137)和正常组(n=75),分析治疗后混合型颈椎病患者颈椎生理曲度的独立影响因素,建立并验证Logistic回归模型,分析各危险因素与治疗方法对患者颈椎生理曲度影响的交互作用。结果与本组治疗前比较,治疗4周后,2组椎动脉PSV、Vm、EDV、颈椎生理曲度、VAS及NDI评分均显著改善(P<0.05),且治疗组改善效果优于对照组(P<0.05)。年龄、吸烟史、糖尿病、久坐工作、治疗方法、病程、空腹血糖(FPG)、糖化血红蛋白(HbA1c)及同型半胱氨酸(Hcy)水平对混合型颈椎病患者颈椎生理曲度有显著影响(P<0.05)。多因素Logistic回归分析显示,年龄、糖尿病、久坐工作及治疗方法为混合型颈椎病患者治疗后颈椎生理曲度异常的独立影响因素(P<0.05);利用以上4个因素建立Logistic回归模型,预测混合型颈椎病患者治疗后颈椎生理曲度异常的概率最高约登指数为0.781,相对应的灵敏度为92.5%,特异度为85.6%,准确度为89.1%,模型稳定且性能较好;交互作用分析结果显示,久坐工作和治疗方法对混合型颈椎病患者颈椎生理曲度的影响在相加模型[相对超额危险度(RERI)=1.876,95%CI:0.792~4.101;交互作用归因比(AP)=0.782,95%CI:0.1Objective To investigate the acupuncture at neck-clip-ridge point combined with curvature traction on vertebral artery blood flow velocity and cervical physiological curvature in patients with mixed cervical spondylosis,and analyze the independent influencing factors cervical physiological curvature after treatment.Methods A total of 212 patients with mixed cervical spondylosis admitted to Department of Rehabilitation Medicine,Nanjing Jiangbei Hospital from January 2019 to December 2022 were enrolled,and they were assigned into treatment group(n=71)and control group(n=141)according to different treatment methods.All patients were managed by acupuncture at neck-clip-ridge point,and those in treatment group were additionally treated with curvature traction.Treated for 4 weeks,the aim was to compare peak systolic velocity(PSV),mean blood velocity(Vm)and end diastolic velocity(EDV)of vertebral artery(VA),cervical physiological curvature,visual analogue scale(VAS)for pain,neck disability index(NDI).The patients with mixed cervical spondylosis were further divided into abnormal cervical curvature(CC)group(n=137)and normal CC group(n=75)according to the cervical physiological curvature after treatment.Independent influencing factors of cervical physiological curvature after treatment were analyzed,and a Logistic regression model was established and verified to analyze the interaction points of the influence of various risk factors and treatment methods on cervical physiological curvature.Results At week 4 of treatment,PSV,Vm and EDV of VA,cervical physiological curvature,VAS,NDI in groups were remarkably improved(P<0.05),improvement of which in the treatment group were significantly better(P<0.05).Age,smoking history,diabetes mellitus,sedentary work,treatment methods,disease course,fasting plasma glucose(FPG),glucose hemoglobin(HbA 1c)and homocysteine(Hcy)levels had significant effects on the cervical physiological curvature(P<0.05).Multivariate Logistic regression analysis showed that age,diabetes mellitus,sedentary wo

关 键 词：颈椎病 针刺疗法 穴 夹脊 牵引术 椎动脉 血流速度 颈椎生理曲度 

分 类 号：R681.531.205[医药卫生—骨科学] R245.311[医药卫生—外科学] R687.35[医药卫生—临床医学]