| Objective:To evaluate the clinical efficacy of traditional Chinese medicine(traditional Chinese medicine,hot pressing,traction and cryogenic plasma nucleus pulposoplasty for the treatment of cervical spondylotic radiculopathy,and to discuss the treatment of deity by hypothermic plasma nucleus pulposoplasty through the changes of the pressure,imaging changes and hemodynamic parameters of the intervertebral disc before and after the operation.The mechanism of action of cervical spondylotic radicular disease.Methods:A single center,non randomized controlled clinical trial design was used to collect 80 patients with cervical spondylotic radicular disease.According to informed consent,A,B,C and D were divided into four groups,20 cases in each group.Group A was treated with hot iron with traditional Chinese medicine plus cervical traction on the basis of basic drug therapy;group B was treated with low temperature plasma nucleus pulposoplasty and cervical vertebra traction on the basis of basic drug therapy on the basis of basic drug treatment.Group C on the basis of basic treatment,low temperature plasma nucleus pulposoplasty and hot pressing of traditional Chinese medicine were performed on the basis of basic therapy;group D was based on basic treatment basis.Low temperature plasma nucleus pulposoplasty is only performed on the gap of responsibility.The VAS score before and after treatment,the symptom score of Jingzhong long cervical spondylosis and the clinical efficacy were observed and compared.Mechanism study:to select a reasonable and feasible method of intervertebral pressure measurement by measuring the pressure in the intervertebral disc on the adult sheep’s lumbar spine specimen,and collect 80 cases of the patients with cervical spondylotic radiculopathy with hypothermic plasma nucleus pulposoplasty,and remove the cryogenic plasma nucleus pulposoplasty after the contraindication..The changes in the pressure of intervertebral disc,VAS score,the symptom scale of Jingchang cervical spondylosis,and the changes of image were observed before and after the operation,and the mechanism of the treatment of Radicular Cervical Spondylosis with low temperature plasma nucleus pulposoplasty was preliminarily investigated.In addition,53 cases of the cervical spondylosis with the head symptoms of the cervical spondylosis were selected,and MRI was selected.Bilateral vertebral basilar artery diameter and hemodynamic changes were measured before and after transcranial color Doppler ultrasound,and 30 patients with single segmental cervical spondylosis with dizziness,headache and other head symptoms were selected to analyze the improvement of the head symptoms and intervertebral discs in each segment of the cervical spondylosis after operation.Correlation between pressure changes and hemodynamic parameters of vertebral basilar artery.Results:After treatment,the VAS score and Cervical spondylosis rating scale were better than those before treatment.The VAS score and Cervical spondylosis rating scale in group B,Cand D were better than that of group A at same time point.The VAS score and Cervical spondylosis rating scale was no difference between group B and C,which was better than the same time of group D,except of 6 months after surgery.There were statistically significant differences in the time points before and after treatment in group A,B,C and D.There was no significant difference in the time points after treatment in group A.Three months and six months after treatment,the VAS score and Cervical spondylosis rating scale in group B,C and D were significantly better than 7 days after treatment.The VAS score and cervical spondylosis rating scale of group B,C and D was no difference six months after treatment.The efficacy of the four groups was compared:group B,C and D were significantly better than group A,while group B and group C were no different.The efficacy of group B,C were better than group D three months after surgery,whinch was no difference six months after surgery.There was a statistically significant difference of the intravertebral disc pressure before and after surgery.The stability of the operative segment was unchanged.The VAS score and Cervical spondylosis rating scale of each time point after surgery was better than preoperative;which was same between six months and three months after surgery.Six momths after surgery was better than the last follow-up and 7 days after surgery.And 7 days after surgery was better than the last follow-up.MRI showed that there was no significant change in the diameter of bilateral basilar artery before and 1 days after operation.However,the hemodynamic parameters of the bilateral vertebral basilar artery were measured before and 1 days after the operation with transcranial color Doppler ultrasound.The peak systolic flow velocity(PSV),end diastolic flow velocity(EDV)and mean flow velocity(MV)were significantly higher than those before the operation,and the difference was statistically significant,but the pulsation index(PI)was significant.There was no significant difference in the resistance index(RI)compared with that before the operation.The correlation analysis showed that the correlation between the improvement of the head symptoms in each segment and the changes in the intervertebral disc pressure was poor,but the correlation with the changes of the hemodynamic parameters was higher,and the C3/4 and C4/5 segments were highly correlated(r>0.9).Conclusion:①The clinical symptoms of the cervical shoulder and arm pain of the patients with cervical spondylotic radiculopathy can be relieved to some extent by the hot ironing and occipital maxillary traction with traditional Chinese medicine.It is easy to operate,reliable in curative effect,comfortable and easy to accept,and can give full play to the advantages of the external treatment of Chinese medicine,but the symptom is slow.②The treatment of cervical spondylotic radiculopathy can be quickly relieved by the hot ironing or occipital maxillofacial traction combined with low temperature plasma nucleus pulposus,and the symptoms are further improved with time.The effect is satisfactory in the near future,and it is safe and reliable,but the improvement of the long-term effect is still insufficient.③The short-term curative effect of low temperature plasma nucleus pulposus plasty on cervical spondylotic radicular disease is obviously better than that of middle and long term.The symptoms were repeated for more than 12 months.The reason may be related to its limited decompression ability,inability to inhibit intervertebral disc degeneration and inability to correct local mechanical imbalance.④Low temperature plasma needle pressure by a transducer connection module of ecg monitoring instrument measuring the pressure in the intervertebral disc method,though there are some errors,but can reflect pressure of the intervertebral disc.⑤The mechanism of cryogenic plasma nucleus pulposoplasty for the treatment of Radicular Cervical Spondylosis may be to reduce the pressure in the intervertebral disc and to relieve the stimulation of the sympathetic nerve,especially by changing the hemodynamics of the vertebral basilar artery to improve the intracranial blood supply to alleviate the related head symptoms.⑥In clinical practice,patients with single-segment radiculopathy-type cervical spondylosis(c3/4)or c4/5 with headache,dizziness and other symptoms can be treated with low-temperature plasma myeloplasty. |
PDF Full Text Request