目的 观察选择性颈神经阻滞联合激痛点灭活治疗神经根型颈椎病（CSR）的临床疗效。方法 选取2023年3月—9月于上海松江区泗泾医院疼痛门诊就诊的CSR患者60例,按随机数字表法分为三组,每组20例。治疗组（A组）行选择性颈神经根+脊神经后内侧支阻滞治疗联合激痛点灭活,对照1组（B组）仅行选择性颈神经根+脊神经后内侧支阻滞治疗,对照2组（C组）采用颈部牵引+药物治疗。治疗后第1、4、12周随访患者,进行疗效评价。比较三组患者随访时颈部、上肢疼痛或不适感的疼痛视觉模拟评分法（VAS）评分及颈椎功能障碍指数（NDI）评分。结果 （1） 治疗前后组内比较：治疗后1、4、12周,各组VAS评分和NDI评分均较治疗前明显降低（P<0.01）。（2） 治疗后组间比较：与C组比较,A组和B组各时间点的VAS评分、NDI评分均明显降低（P<0.05）;与治疗后12周,A组VAS评分、NDI评分均明显低于B组（P<0.05）。提示A组远期疗效显著优于B组和C组。结论 采用选择性颈神经阻滞联合激痛点灭活治疗CSR,两种疗法相辅相成,可起到优势互补的作用,且具有起效快、疗效持久的特点。
Objective To observe the clinical efficacy of selective cervical nerve block combined with myofascial trigger point inactivation in the treatment of cervical spondylotic radiculopathy （CSR）. Methods Sixty CRS patients visiting the pain clinic at Songjiang District Sijing Hospital between March and September 2023 were randomly divided into three groups by random number table method, with 20 cases in each group. The treatment group （group A） received selective cervical nerve root and posteromedial branch block combined with myofascial trigger point inactivation treatment, the control group 1 （group B） received selective cervical nerve root and posteromedial branch block alone, and the control group 2 （group C） was treated with cervical traction and drugs. The patients were followed up at 1, 4, and 12 weeks after treatment for efficacy evaluation. The visual analogue scale （VAS） scores of neck and upper limb and the neck disability index （NDI） were compared across three groups. Results （1）Intra-group comparison revealed significant decreases in the VAS and NDI scores 1, 4, and 12 weeks after treatment in all groups （P<0.01）. （2） Pairwise comparison revealed that group A and group B consistently showed significantly lower VAS and NDI scores than group C at selected post-treatment time points （P<0.05）. Notably, group A exhibited significantly lower VAS and NDI scores than group B at the 12th week （P<0.05）, indicating a superior long-term effect. Conclusion The combined approach of myofascial trigger point inactivation and selective cervical nerve block for treating CRS demonstrates a synergistic effect, characterized by both rapid and sustained efficacy.
[1] Lim WB, Al-Dadah O.Conservative treatment of knee osteoarthritis: a review of the literature[J]. World J Orthop,2022, 13(3): 212-229.
[2] Liu L, Huang QM, Liu QG, et al.Evidence for dry needling in the management of myofascial trigger points associated with low back pain: a systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2018, 99(1): 144-152.
[3] Chiarotto A, Clijsen R, Fernandez-de-Las-Penas C, et al. Prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2016, 97(2): 316-337.
[4] 王丽娜,黄强民.激痛点技术的理论和实践进展[J].中国疼痛医学杂志,2021,27(6):413-419.
[5] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[6] Sterling M, Rebbdck T.The neck disability index (NDI)[J]. Aust J Physiother, 2005, 51(4): 271.
[7] Akahori S, Nishimura Y, Eguchi K, et al.Comparative study of anterior transvertebral foraminotomy and anterior cervical discectomand fusion for unilateral cervical spondylotic radiculopathy[J]. World Neurosurg, 2022. 171: e516-e523.
[8] Huang QM, Lv JJ, Ruanshi QM, et al.Spontaneous electrical activities at myofascial trigger points at different stagesof recovery from injury in a rat model[J]. Acupunct Med, 2015, 33(4): 319–324.
[9] Zhang H, Lü JJ, Huang QM, et al.Histopathology natures of myofascial trigger points in different stages in rat model[J]. Acupunct Med, 2017, 35(6): 445-451.
[10] Gerwin RD.Diagnosis of myofascial pain syndrome[J]. Phys Med Rehabil Clin N Am, 2014, 25(2): 341-355.
[11] 王丽娜,黄强民.激痛点技术的理论和实践进展[J].中国疼痛医学杂志,2021,27(06):413-419.
[12] 陈德成,杨观虎,王富春,等.试论阿是穴、压痛点和激痛点的关系[J].中国针灸,2017,37(2):122-214.
[13] 郭少卿,徐基民,马彦韬,等.基于肌筋膜触发点的研究探讨针灸穴位和经络本质[J]. 中国针灸,2021,41(7):633-639.
[14] Sikdar S, Shah JP, Gebreab T, et al.Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue[J]. Arch Phys Med Rehabil, 2009, 90(11): 1829-1838.
[15] 万瑞莲,浦少峰,王建光.超声引导下星状神经节阻滞联合盐酸乙哌立松治疗颈源性头痛的临床研究[J].临床和实验医学杂志,2022,21(11):1218-1222.
[16] 刘园,郭毅,李博,等.超声引导下颈椎旁神经阻滞联合银质针导热疗法治疗神经根型颈椎病疗效及对颈部生物学相关参数的影响[J].现代中医药,2021,41(5):90-93.
[17] 胡乃朋. 超声引导下复方倍他米松注射治疗神经根型颈椎病的作用研究[J].中国伤残医学,2021,29(18):27-28.
