摘要
目的:观察分型分期治疗颈源性肩背痛的临床疗效。方法:采用随机数字表将符合要求的76例颈源性肩背痛患者随机分为治疗组和对照组,每组38例。治疗组按照分型分期原则治疗:颈椎间盘源型患者,急性期采用手法配合药物治疗,缓解期采用手法治疗;颈椎椎体失稳型患者,采用手法治疗。对照组采用牵引配合药物治疗。分别于治疗前和治疗结束后采用酶联免疫吸附法测定所有患者血清中白细胞介素-1β受体拮抗剂、白细胞介素-6及肿瘤坏死因子的浓度;同时于治疗后以参照《中医病证诊断疗效标准》中颈椎病的疗效标准拟定的临床疗效评定标准评定患者的临床疗效。结果:①白细胞介素-1β受体拮抗剂浓度。治疗前2组患者血清白细胞介素-1β受体拮抗剂浓度比较,差异无统计学意义(t=1.021,P=0.308);治疗后2组患者血清白细胞介素-1β受体拮抗剂浓度均增加,治疗组的增加程度大于对照组(t=3.477,P=0.001)。②血清白细胞介素-6浓度。治疗前2组患者血清白细胞介素-6浓度比较,差异无统计学意义(t=0.497,P=0.621);治疗后2组患者血清白细胞介素-6浓度均降低,治疗组的降低程度大于对照组(t=2.637,P=0.010)。③血清肿瘤坏死因子浓度。治疗前2组患者血清肿瘤坏死因子浓度比较,差异无统计学意义(t=1.547,P=0.126);治疗后2组患者血清肿瘤坏死因子浓度均降低,治疗组的降低程度大于对照组(t=2.201,P=0.031)。④临床疗效。2组患者临床疗效比较,治疗组优于对照组(Z=-2.230,P=0.020)。结论:分型分期治疗能提高颈源性肩背痛患者血清中白细胞介素-1β受体拮抗剂的浓度,降低白细胞介素-6和肿瘤坏死因子的浓度,临床疗效显著,是治疗颈源性肩背痛的有效方法。
Objective：To observe the clinical curative effect of typing and staging treatment on cervicogenic shoulder and back pain.Methods：Seventy-six patients with cervicogenic shoulder and back pain were randomly divided into treatment group and control group according to the random number table,38 cases in each group.Patients in the treatment group were treated according to the following typing and staging principles as：cases in cervical discogenic type were administrated with manipulation combined with medicine in the acute stage and were administrated with manipulation during catabasis;while the others in cervical vertebral instability type were administrated with manipulation.And patients in the control group were treated by traction combined with medicine.The concentration of interleukin-1beta（IL-1beta）receptor antagonist,interleukin-6（IL-6）and tumor necrosis factor（TNF）in blood serum of all the patients were measured according to enzyme linked immunosorbent assay before and after the treatment respectively.And the clinical curative effects were evaluated according to the self-designed evaluation standards of the curative effects for cervical spondylosis referring to the standards specified in Standard for diagnosis and therapeutic effectiveness evaluation of traditional Chinese medicine syndromes after the treatment.Results：①Concentration of IL-1beta receptor antagonist：There was no statistical difference in the concentration of IL-1beta receptor antagonist between the 2 groups before the treatment（t=1.021,P=0.308）;while the concentration of IL-1beta receptor antagonist of the 2 groups were all increased after the treatment,and the increasing degree of treatment group was higher than that of the control group（t=3.477,P=0.001）.②IL-6 concentration：There was no statistical difference in IL-6 concentration between the 2 groups before the treatment（t=0.497,P=0.621）;while the IL-6 concentration of the 2 groups were all decreased after the treatment,and the reducing degree of treatment group was higher than that of the control group（t=2.637,P=0.010）.③TNF concentration：There was no statistical difference in TNF concentration between the 2 groups before the treatment（t=1.547,P=0.126）;while the TNF concentration of the 2 groups were all decreased after the treatment,and the reducing degree of treatment group was higher than that of the control group（t=2.201,P=0.031）.④Clinical curative effect：The clinical curative effect of treatment group was better than that of the control group（Z=-2.230,P=0.020）.Conclusion：Typing and staging treatment can improve the concentration of IL-1beta receptor antagonist and reduce the concentration of IL-6 and TNF in blood serum of patients with cervicogenic shoulder and back pain while,and it is an effective method for cervicogenic shoulder and back pain.
出处
《中医正骨》
2012年第3期20-22,25,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
浙江省中医药青年课题研究计划(2009YA015)
关键词
肩痛
背痛
颈椎病
椎间盘移位
受体
白细胞介素1Ⅱ型
白细胞介素6
肿瘤坏死因子类
治疗
临床研究性
Shoulder pain
Back pain
Cervical spondylosis
Intervertebral disk displacement
Receptors
interleukin-1 type Ⅱ
Interleukin-6
Tumor necrosis factors
Therapies
investigational
