摘要
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。
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.
出处
《中医正骨》
2014年第7期13-16,共4页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
浙江省中医药(中西医)重点学科经费资助(2012-XK-D20)
浙江省中医药科研基金资助项目(2006C116)
关键词
脑震荡后综合征
颈椎
针刺疗法
正骨手法
治疗
临床研究性
Post-concussion syndrome
Cervical vertebrae
Acupuncture therapy
Bone setting manipulation
Therapies,investigational
