中医正骨
中醫正骨
중의정골
THE JOURNAL OF TRADITIONAL CHINESE ORTHOPEDICS AND TRAUMATOLOGY
2014年
7期
13-16
,共4页
脑震荡后综合征%颈椎%针刺疗法%正骨手法%治疗,临床研究性
腦震盪後綜閤徵%頸椎%針刺療法%正骨手法%治療,臨床研究性
뇌진탕후종합정%경추%침자요법%정골수법%치료,림상연구성
Post-concussion syndrome%Cervical vertebrae%Acupuncture therapy%Bone setting manipulation%Therapies,investigational
目的：观察针刺配合手法治疗“脑外伤后综合征”的临床疗效，探讨“脑外伤后综合征”的发病原因。方法：将符合要求的191例脑外伤后综合征患者随机分为2组，观察组95例，对照组96例。观察组采用针刺风池穴、风府穴、大椎穴和“项四花穴”，配合改良的冯氏旋转复位手法进行治疗，对照组采用药物治疗。分别于治疗前和治疗6周后观察2组患者的椎动脉血流速度和精神状态，并于治疗结束2个月后采用《神经病学》中脑外伤后综合征的疗效标准评定患者的临床综合疗效。结果：①椎动脉血流速度。治疗前2组患者左侧椎动脉血流速度比较，差异无统计学意义[（41．24±6．63）cm·s-1，（40．68±7．76）cm·s-1，t＝0．541，P＝0．589；（17．24±4．41）cm·s-1，（16．68±4．06）cm·s-1，t＝0．922，P＝0．358）]；治疗后2组患者左侧椎动脉收缩期和舒张期血流速度均增大（t＝21．930，P＝0．000；t＝32．298，P＝0．000；t＝9．645，P＝0．000；t＝7．640，P＝0．000）；治疗后观察组左侧椎动脉收缩期和舒张期血流速度均大于对照组[（55．72±9．29）cm·s-1，（47．67±7．22）cm·s-1，t＝6．685，P＝0．000；（21．92±6．43）cm·s-1，（19．61±5．58）cm·s-1，t＝2．644，P＝0．009]。治疗前2组患者右侧椎动脉血流速度比较，差异无统计学意义[（42．98±7．33）cm·s-1，（41．76±7．46）cm·s-1，t＝0．753，P＝0．415；（18．05±5．38）cm·s-1，（17．75±5．63）cm·s-1，t＝0．487，P＝0．627]；治疗后2组患者右侧椎动脉收缩期和舒张期血流速度均增大（t＝19．457，P＝0．000；t＝30．621，P＝0．000；t＝13．271，P＝0．000；t＝3．357，P＝0．002）；治疗后观察组右侧椎动脉收缩期和舒张期血流速度均大于对照组[（56．84±8．43） cm·s-1，（47．73±7．68）cm·s-1，t＝11．254，P＝0．000；（22．76±7．16）cm·s-1，（19．82±5．58）cm·s-1，t＝4．165，P＝0．001]。②精神状态。2组患者治疗前90项症状清单评分比较，差异无统计学意义（t＝0．471，P＝0．639）；治疗后2组患者的评分均降低[（169．07±28．23）分，（133．17±24．05）分，t ＝37．861，P＝0．000；（171．05±29．84）分，（144．79±25．17）分，t ＝21．355，P＝0．000]；观察组治疗后评分低于对照组（t＝3．273，P＝0．001）。③临床综合疗效。观察组痊愈60例、好转30例、无效5例；对照组痊愈28例、好转47例、无效21例。观察组临床综合疗效优于对照组，差异有统计学意义（Z＝-5．009，P＝0．000）。结论：针刺配合手法是治疗脑外伤后综合征的有效方法，脑外伤后综合征的发病可能与隐匿性上颈椎损伤有关。
目的：觀察針刺配閤手法治療“腦外傷後綜閤徵”的臨床療效，探討“腦外傷後綜閤徵”的髮病原因。方法：將符閤要求的191例腦外傷後綜閤徵患者隨機分為2組，觀察組95例，對照組96例。觀察組採用針刺風池穴、風府穴、大椎穴和“項四花穴”，配閤改良的馮氏鏇轉複位手法進行治療，對照組採用藥物治療。分彆于治療前和治療6週後觀察2組患者的椎動脈血流速度和精神狀態，併于治療結束2箇月後採用《神經病學》中腦外傷後綜閤徵的療效標準評定患者的臨床綜閤療效。結果：①椎動脈血流速度。治療前2組患者左側椎動脈血流速度比較，差異無統計學意義[（41．24±6．63）cm·s-1，（40．68±7．76）cm·s-1，t＝0．541，P＝0．589；（17．24±4．41）cm·s-1，（16．68±4．06）cm·s-1，t＝0．922，P＝0．358）]；治療後2組患者左側椎動脈收縮期和舒張期血流速度均增大（t＝21．930，P＝0．000；t＝32．298，P＝0．000；t＝9．645，P＝0．000；t＝7．640，P＝0．000）；治療後觀察組左側椎動脈收縮期和舒張期血流速度均大于對照組[（55．72±9．29）cm·s-1，（47．67±7．22）cm·s-1，t＝6．685，P＝0．000；（21．92±6．43）cm·s-1，（19．61±5．58）cm·s-1，t＝2．644，P＝0．009]。治療前2組患者右側椎動脈血流速度比較，差異無統計學意義[（42．98±7．33）cm·s-1，（41．76±7．46）cm·s-1，t＝0．753，P＝0．415；（18．05±5．38）cm·s-1，（17．75±5．63）cm·s-1，t＝0．487，P＝0．627]；治療後2組患者右側椎動脈收縮期和舒張期血流速度均增大（t＝19．457，P＝0．000；t＝30．621，P＝0．000；t＝13．271，P＝0．000；t＝3．357，P＝0．002）；治療後觀察組右側椎動脈收縮期和舒張期血流速度均大于對照組[（56．84±8．43） cm·s-1，（47．73±7．68）cm·s-1，t＝11．254，P＝0．000；（22．76±7．16）cm·s-1，（19．82±5．58）cm·s-1，t＝4．165，P＝0．001]。②精神狀態。2組患者治療前90項癥狀清單評分比較，差異無統計學意義（t＝0．471，P＝0．639）；治療後2組患者的評分均降低[（169．07±28．23）分，（133．17±24．05）分，t ＝37．861，P＝0．000；（171．05±29．84）分，（144．79±25．17）分，t ＝21．355，P＝0．000]；觀察組治療後評分低于對照組（t＝3．273，P＝0．001）。③臨床綜閤療效。觀察組痊愈60例、好轉30例、無效5例；對照組痊愈28例、好轉47例、無效21例。觀察組臨床綜閤療效優于對照組，差異有統計學意義（Z＝-5．009，P＝0．000）。結論：針刺配閤手法是治療腦外傷後綜閤徵的有效方法，腦外傷後綜閤徵的髮病可能與隱匿性上頸椎損傷有關。
목적：관찰침자배합수법치료“뇌외상후종합정”적림상료효，탐토“뇌외상후종합정”적발병원인。방법：장부합요구적191례뇌외상후종합정환자수궤분위2조，관찰조95례，대조조96례。관찰조채용침자풍지혈、풍부혈、대추혈화“항사화혈”，배합개량적풍씨선전복위수법진행치료，대조조채용약물치료。분별우치료전화치료6주후관찰2조환자적추동맥혈류속도화정신상태，병우치료결속2개월후채용《신경병학》중뇌외상후종합정적료효표준평정환자적림상종합료효。결과：①추동맥혈류속도。치료전2조환자좌측추동맥혈류속도비교，차이무통계학의의[（41．24±6．63）cm·s-1，（40．68±7．76）cm·s-1，t＝0．541，P＝0．589；（17．24±4．41）cm·s-1，（16．68±4．06）cm·s-1，t＝0．922，P＝0．358）]；치료후2조환자좌측추동맥수축기화서장기혈류속도균증대（t＝21．930，P＝0．000；t＝32．298，P＝0．000；t＝9．645，P＝0．000；t＝7．640，P＝0．000）；치료후관찰조좌측추동맥수축기화서장기혈류속도균대우대조조[（55．72±9．29）cm·s-1，（47．67±7．22）cm·s-1，t＝6．685，P＝0．000；（21．92±6．43）cm·s-1，（19．61±5．58）cm·s-1，t＝2．644，P＝0．009]。치료전2조환자우측추동맥혈류속도비교，차이무통계학의의[（42．98±7．33）cm·s-1，（41．76±7．46）cm·s-1，t＝0．753，P＝0．415；（18．05±5．38）cm·s-1，（17．75±5．63）cm·s-1，t＝0．487，P＝0．627]；치료후2조환자우측추동맥수축기화서장기혈류속도균증대（t＝19．457，P＝0．000；t＝30．621，P＝0．000；t＝13．271，P＝0．000；t＝3．357，P＝0．002）；치료후관찰조우측추동맥수축기화서장기혈류속도균대우대조조[（56．84±8．43） cm·s-1，（47．73±7．68）cm·s-1，t＝11．254，P＝0．000；（22．76±7．16）cm·s-1，（19．82±5．58）cm·s-1，t＝4．165，P＝0．001]。②정신상태。2조환자치료전90항증상청단평분비교，차이무통계학의의（t＝0．471，P＝0．639）；치료후2조환자적평분균강저[（169．07±28．23）분，（133．17±24．05）분，t ＝37．861，P＝0．000；（171．05±29．84）분，（144．79±25．17）분，t ＝21．355，P＝0．000]；관찰조치료후평분저우대조조（t＝3．273，P＝0．001）。③림상종합료효。관찰조전유60례、호전30례、무효5례；대조조전유28례、호전47례、무효21례。관찰조림상종합료효우우대조조，차이유통계학의의（Z＝-5．009，P＝0．000）。결론：침자배합수법시치료뇌외상후종합정적유효방법，뇌외상후종합정적발병가능여은닉성상경추손상유관。
Objective:To observe the clinical curative effects of acupuncture therapy combined with manipulation therapy in the treat-ment of post-concussion syndrome(PCS)and to explore the cause of PCS.Methods:One hundred and ninety-one patients with PCS enrolled in the study were randomly divided into observation group(95 cases)and control group(96 cases).The patients in observation group were treated with acupuncture therapy at Point GB20(Fengchi),Point GV16(Fengfu),Point GV14(Dazhui)and four nuchal points(Xiangsi-hua),combined with improved Feng’s spinal manipulation(FSM)therapy,while the others in control group were treated with drug therapy. The blood flow velocity of vertebral artery and the mental state were observed and compared between the 2 groups before treatment and after 6-week treatment respectively,and the total clinical curative effects were also evaluated according to the therapeutical effect evaluation standard of PCS extracted from Neurology 2 months after the treatment.Results:There was no statistical difference in blood flow velocity of left vertebral artery in systolic phase and diastolic phase between the 2 groups before the treatment(41.24 +/-6.63 vs 40.68 +/-7.76 cm/s,t=0.541,P=0.589;17.24+/-4.41 vs 16.68+/-4.06 cm/s,t=0.922,P=0.358),while the blood flow velocities of left verte-bral artery in systolic phase and diastolic phase increased in both of the 2 groups after the treatment(t=21.930,P=0.000;t=32.298, P=0.000;t=9.645,P=0.000;t=7.640,P=0.000).The blood flow velocities of left vertebral artery in systolic phase and diastolic phase of observation group were greater than those of control group(55.72 +/-9.29 vs 47.67 +/-7.22 cm/s,t =6.685,P=0.000;21.92+/-6.43 vs 19.61 +/-5.58 cm/s,t=2.644,P=0.009).There was no statistical difference in blood flow velocity of right vertebral artery in systolic phase and diastolic phase between the 2 groups before the treatment(42.98+/-7.33 vs 41.76+/-7.46 cm/s,t=0.753, P=0.415;18.05 +/-5.38 vs 17.75 +/-5.63 cm/s,t=0.487,P=0.627),while the blood flow velocities of right vertebral artery in sys-tolic phase and diastolic phase increased in both of the 2 groups after the treatment(t=19.457,P=0.000;t=30.621,P=0.000;t=13.271,P=0.000;t=3.357,P=0.002).The blood flow velocities of right vertebral artery in systolic phase and diastolic phase of obser-vation group were greater than those of control group(56.84+/-8.43 vs 47.73+/-7.68 cm/s,t=11.254,P=0.000;22.76+/-7.16 vs 19.82+/-5.58 cm/s,t=4.165,P=0.001).There was no statistical difference in symptom checklist-90 scores between the 2 groups be-fore the treatment(t=0.471,P=0.639).The scores decreased in both the 2 groups after the treatment(169.07+/-28.23 vs 133.17+/-24.05 points,t=37.861,P=0.000;171.05 +/-29.84 vs 144.79 +/-25.17 points,t=21.355,P=0.000).The scores of observation group were lower than those of control group after the treatment(t=3.273,P=0.001).Sixty patients obtained an excellent result,30 good and 5 poor in the observation group,while 28 patients obtained an excellent result,47 good and 21 poor in the control group.The observation group surpassed the control group in the total curative effect and there was statistical differences between the 2 groups(Z=-5.009,P=0.000).Conclusion:Combination of acupuncture therapy with manipulation therapy is effective in the treatment of PCS,and the cause of PCS may be concerned with the concealed upper cervical vertebra injury.
