C臂引导下针刀治疗神经根型颈椎病的临床研究

摘要

[Objective] To research the clinical efficacy of using needle-knife to release the Cervical zygapophysial soft tissue by C-arm fluoroscopy-guided in neck posterior approach to treat cervical spondylotic radiculopathy(CSR). [Methods] From 2011 July to 2012 May, 30 patients were treated by using needle-knife to release the cervical zygapophysial soft tissue by C-arm fluoroscopy-guided. 30 patients were treated by using injecting into paravertebral by cervical posterior approach to block nerve. We analyzed two groups scores in before treatment and 1 week, 1 month, 6 months after treatment. [Results] According to “The evaluation index system of cervical spondylotic radiculopathy”, the results showed that scores of two groups had no significant difference(P=0.15>0.05) before treatment, after 1 week, the scores of two groups had significant difference( P=0.00<0.05), the scores of injection group were higher than needle-knife group. After 1 month, the scores of two groups had significant difference( P=0.000<0.05), the scores of needle-knife group were higher than the injection group. After 6 months, the scores of needle-knife group were higher than the injection group, the scores of two groups had significant difference(P=0.01<0.05). [Conclusion] Using needle-knife to release the cervical zygapophysial soft tissue by C-arm fluoroscopy-guided in neck posterior approach to treat CSR could get better long-term effect than using injecting into paravertebral by cervical posterior approach to block nerve, and also could get better safety and practicality. It was a kind of method to develop Traditional Chinese Medicine treatment into modernization.%[目的]研究C臂引导下针刀颈后侧入路颈椎小关节突周围软组织松解治疗神经根型颈椎病（cervical spondylotic radiculopathy, CSR）的临床疗效。[方法]自2011年7月至2012年11月，在C臂透视引导下分别采用针刀松解颈椎小关节突周围软组织和颈后侧入路椎旁神经阻滞治疗CSR患者60例（以下分别简称为针刀治疗组和阻滞治疗组，每组30例），对所有患者在治疗前、治疗后1周、1月、6月进行评分。[结果]按《神经根型颈椎病疗效评定指标体系》进行评分，治疗前两组患者评分无显著性差异(P=0.15)，治疗结束后1周的评分显示阻滞治疗组和针刀治疗组的疗效均显著，但阻滞治疗组的疗效优于针刀治疗组，且有统计学意义（P=0.00）；治疗后1月的评分显示针刀治疗组的疗效优于阻滞治疗组，且也有统计学意义（P=0.00）；治疗后6月的评分显示针刀治疗组的疗效仍优于阻滞治疗组，且有统计学意义（P=0.01）。[结论]采用C臂透视引导下针刀松解颈椎小关节突周围软组织比颈后侧入路椎旁神经阻滞治疗CSR具有更好的远期疗效，而且有较好的安全性和实用性，是一种符合中医药向现代化发展的治疗方法。