| 王德民.基于激痛点理论探讨温针“颈六针”联合通督理筋手法推拿对椎动脉型颈椎病椎动脉血流动力学、血管内皮功能及颈肌MRI影像学的影响[J].浙江中西医结合杂志,2026,36(6): |
| 基于激痛点理论探讨温针“颈六针”联合通督理筋手法推拿对椎动脉型颈椎病椎动脉血流动力学、血管内皮功能及颈肌MRI影像学的影响 |
| Wang Demin 1, Fu Yunqi 2, Xu Yongliang 1, Cai Huaping 1, He Diying 1, Dai Liang 3*,Chen Shunxi41Department of Massage, Zhuji Hospital of Traditional Chinese Medicine, Zhuji 311800, Zhejiang Province |
| 投稿时间：2025-06-10 修订日期：2026-05-23 |
| DOI： |
| 中文关键词: 椎动脉型颈椎病 血流动力学 血管内皮功能 激痛点 温针 推拿 激痛点 |
| 英文关键词:vertebral artery type cervical spondylosis Hemodynamics Endothelial function of blood vessels Pain points Warm needle Tuina massage Trigger point |
| 基金项目:浙江省中医药科技计划，编号：2024ZL1160 |
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| 中文摘要: |
| 目的:基于激痛点理论探讨温针“颈六针”联合通督理筋手法推拿治疗椎动脉型颈椎病(CSA)对椎动脉血流动力学、血管内皮功能及颈肌MRI影像学的影响。方法:选择医院2023年10月~2024年10月收治的98例CSA患者作为研究对象,随机分为对照组和温针推拿组,各49例。对照组给予常规治疗,温针推拿组在对照组基础上给予温针“颈六针”联合通督理筋手法推拿。连续治疗4周后评估疗效,随访6个月观察复发情况。治疗前后分别采用经颅多普勒超声(TCD)测量椎动脉收缩期峰值流速(PSV)、舒张末期流速(EDV),计算阻力指数(RI)；采用酶联免疫吸附法(ELISA)检测血清一氧化氮(NO)、内皮素-1(ET-1)、血管内皮细胞粘附分子(VCAM-1)水平；采用MRI 测量颈肌的T2值、C4-C5水平颈后肌群总截面积和颈肌脂肪浸润面积占比,计算脂肪浸润程度(FI)；采用颈性眩晕症状与功能评估量表(ESCV)和视觉模拟评分(VAS)评估症状改善情况,采用颈椎病临床评价量表(CASCS)和巴氏指数(BI)评估功能恢复情况。观察治疗期间不良反应发生情况。结果:温针推拿组治疗总有效率91.84%(45/49)高于对照组75.51%(37/49)(P＜0.05),复发率4.08%(2/49)低于对照组16.33%(8/49)(P＜0.05),不良反应率4.08(2/49)与对照组8.16%(4/49)比较未见统计学差异(P＞0.05)。治疗后,两组椎动脉PSV、EDV均上升,且温针推拿组均高于对照组(P＜0.05)；治疗后,两组血清NO提高,且温针推拿组高于对照组(P＜0.05)；两组血清ET-1、VCAM-1均降低,且温针推拿组均低于对照组(P＜0.05)。治疗后,两组颈后肌群总截面积提高,且温针推拿组高于对照组(P＜0.05)；两组T2值、FI均降低,且温针推拿组均低于对照组(P＜0.05)。治疗后,两组CASCS、BI评分提高,且温针推拿组均高于对照组(P＜0.05)；两组ESCV、VAS评分均降低,且温针推拿组均低于对照组(P＜0.05)。结论:基于激痛点理论的温针“颈六针”联合通督理筋手法推拿可显著CSA患者的椎动脉血流动力学、修复血管内皮功能、逆转颈肌退行性改变,疗效优于常规治疗,且安全性良好。 |
| 英文摘要: |
| Objective: Based on the theory of pain points, this study aims to explore the effects of warm needling "Neck Six Needles" combined with Tongdu Lijin massage on the hemodynamics, endothelial function, and neck muscle MRI imaging of cervical spondylosis of vertebral artery type (CSA).Method: 98 CSA patients admitted to the hospital from October 2023 to October 2024 were selected as the study subjects and randomly divided into a control group and a warm needle massage group, with 49 cases in each group. The control group received conventional treatment, while the warm needle massage group received warm needle "neck six needles" combined with Tongdu Liangjin massage on the basis of the control group. Evaluate the efficacy after 4 weeks of continuous treatment, and observe the recurrence situation during a 6-month follow-up. Before and after treatment, transcranial Doppler ultrasound (TCD) was used to measure peak systolic velocity (PSV) and end diastolic velocity (EDV) of the vertebral artery, and resistance index (RI) was calculated; Enzyme linked immunosorbent assay (ELISA) was used to detect serum levels of nitric oxide (NO), endothelin-1 (ET-1), and vascular endothelial cell adhesion molecule (VCAM-1); Using MRI to measure the T2 value of cervical muscles, the total cross-sectional area of cervical posterior muscles at C4-C5 levels, and the proportion of cervical muscle fat infiltration area, calculate the degree of fat infiltration (FI); The improvement of symptoms was evaluated using the Cervical Vertigo Symptom and Function Assessment Scale (ESCV) and Visual Analog Scale (VAS), while the recovery of function was evaluated using the Clinical Evaluation Scale for Cervical Spondylosis (CASCS) and Babbitt Index (BI). Observe the occurrence of adverse reactions during treatment. Result: The total effective rate of the warm needle massage group was 91.84% (45/49), which was higher than the control group"s 75.51% (37/49) (P<0.05). The recurrence rate was 4.08% (2/49), which was lower than the control group"s 16.33% (8/49) (P<0.05). There was no statistical difference in the adverse reaction rate between 4.08% (2/49) and the control group"s 8.16% (4/49) (P>0.05). After treatment, both groups of vertebral artery PSV and EDV increased, and the warm needle massage group was higher than the control group (P<0.05); After treatment, the serum NO levels in both groups of vertebrae increased, and the warm needle massage group was higher than the control group (P<0.05); Both groups showed a decrease in serum levels of ET-1 and VCAM-1, and the warm needle massage group was lower than the control group (P<0.05). After treatment, the total cross-sectional area of the cervical muscles in both groups increased, and the warm needle massage group was higher than the control group (P<0.05); The T2 values and FI of both groups decreased, and the warm needle massage group was lower than the control group (P<0.05). After treatment, the CASCS and BI scores of both groups improved, and the warm needle massage group was higher than the control group (P<0.05); The ESCV and VAS scores of both groups decreased, and the warm needle massage group was lower than the control group (P<0.05). Conclusion: Based on the theory of pain points, the combination of warm needle "neck six needles" and Tongdu Lijin massage can significantly improve vertebral artery hemodynamics, repair vascular endothelial function, and reverse cervical muscle degeneration in CSA patients. The efficacy is superior to conventional treatment and the safety is good. |
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