Clinical Study On Improvement Of The Range Of Motion (ROM) About Cervical Spine Of Patients With Cervialspondylotic Radiculopathy Treated By The Traditional Chinese Medicine Synthetical Therapy

中国中医科学院2007级硕士研究生学位论文AbstractBackgroundCervicalspondylotic radiculopathy is characterised by the following leading symptoms in the counterpart region caused by cervical spine degeneration, nerve root repression and other pathogenic factors:a certain degree of pain, cervial vertebra functional restrictions, numbness, sense disability and reflex abnormality. And it's the highest incidence (60～70%) in cervical spondylosis.With the increasing number of incidence of cervical disease which gradually attracts the extensive focus of medical field, the related clinical research needs to deepen further.Object1.To reflect the advantage of synthetical therapies of traditional Chinese medicine through the improvement about cervical spine ROM in all directions.The improvement of cervical spine ROM indexes in all directions can provide the auxiliary evidence for the synthetical TCM Therapies clinical expansion.2.In order to provide new views and methods for the CSR treatment, hope to reflect the advantage of the treatment of the testing group through the analysis of the improvement about cervical spine ROM in two groups.MethodsThe randomized method were used to divide 100 patients into testing group (50 cases) and the control group (50 cases), all cases were consistent with diagnostic criteria of CSR. Among the case,29 patients were male and 71 patients were female, ranging in age form 45 to 65 years, with an average of 52.25 years, course of disease was 3 days to 5 years. The cases in testing group were treated with rotation-traction manipulation+Particles for neck pain+cervical neck pain rehabilitation exercises and the control group were treated with cervical traction+ Diclofenac Sodium Sustained Release Tablets+wear neck treatment, were both treated two weeks, and patients' data which included cervical flexion, extension, left and right lateral bending, left and right rotation activity before and after treatment 1,3,5,7,9,11,13 days and 1 month 3 monthes,6 monthes measured by helmet-style activities instrument were recorded.Results1. Assessment of the overall efficacy of the two groupsThere is significant difference of cervicalspondylotic radiculopathy treated by the TCM synthetical therapy in the both groups before and after treatment. After treatment and 1 month,3 months and 6 months the respectively total effciency of testing group is 94%,94%,92%,94% while the control group is 68%,68%,66%,66%. The testing group is better than the control group. No adverse reactions occurred in any group.2. Cervical mobility comparison of two groups in all derections and every visiting pointThe improvement of the testing group are superior to the control group in cervical flexion index begin with the fourth return visit (p＜0.05); The improvement of the testing group are superior to the control group in cervical extension index begin with the first follow-up (p＜0.01); The improvement of the testing group are superior to the control group in cervical left lateral bending index begin with the sixth return visit (p＜0.01); The improvement of the testing group are superior to the control group in cervical right lateral bending index begin with the fourth return visit (p＜0.05); The improvement of the testing group are superior to the control group in Cervical left rotation index begin with the sixth return visit (p＜0.05); The improvement of the testing group are superior to the control group in Cervical right rotation index begin with the third return visit (p＜0.05).3 Comparison of the cervical range movements's difference between the first time visit and the in-treatment/follow-up period in all directions/visit pointComparing with the differents of the two groups, by rank sum test., limitation of activity to improve the flexion test group at the 1st referral and subsequent referral, follow-up were better than the control group (P＜0.01); extension activity difference values were compared by rank sum test, the test group extension activities to improve confined in the 4th referral and 3 months follow-up and 6 month follow-up were better than the control group (P＜0.05); left bend activity difference values were compared by rank sum test, the test group to improve the left flexor activity subject to section 2,6,7 and 1,3,6 month follow-up referral times were better than the control group (P＜0.05); the right flexor activity difference values were compared by rank sum test, the test group to improve the limitation of activity in the right flexor June follow-up, better than the control group (P＜0.05); L activity difference values were compared by rank sum test, the test group to improve the lateral activity subject to section 4,5,6,7 th referral and follow-up period were the control group (P＜0.05); dextral activity difference values were compared by rank sum test, the test group activities to improve the D-2nd referral and subsequent referral, follow-up were better than the control group (P＜0.05).4. Self-comparison in all directions of cervical range movementCervical flexion test group in the direction of the 2nd return visit with the first visit compared with cervical range of values P＜0.05, the 3rd and subsequent referral, follow-up consultation with the first cervical range of values compared to P＜0.01, differences were statistical significance; the control group in 6,7 second return visit compared with the first visit, P＜0.01, in the follow-up period compared with the first visit, P＜0.05, differences were statistically significant; cervical extension directions in the test group 3 return visit with the first diagnosis cervical range of values compared to P＜0.05,4 th and subsequent referral, follow-up consultation with the first cervical range of values compared to P＜0.01, differences were statistically significant; the control group in 4 referral compared with the first visit, P＜0.05, in the 5th referral and subsequent referral, follow-up period compared with the first visit, P＜0.01, differences were statistically significant; cervical left bend in the direction of the test group 2 referral and subsequent referral, follow-up consultation with the first cervical range of values compared to P＜0.01, significant difference; the control group at the 3rd and subsequent referral referral, follow-up consultation with the first cervical range of values compared to P＜0.01, significant difference; Cervical the right bend in the direction of the test group after the 2nd referral and referral, follow-up consultation with the first cervical range of values compared to P＜0.01, significant difference; the control group at 3 After the second return visit and referral, follow-up consultation with the first cervical range of values compared to P＜0.01, significant difference; cervical direction of the test group L 2 in the first return visit and the first diagnosis cervical range of values compared to P＜0.05,3rd and subsequent referral, follow-up consultation with the first cervical range of values compared to P＜0.01, differences were statistically significant; the control group at the 3rd referral compared with the first visit, P＜0.05, in 4 referral and subsequent referral, follow-up period compared with the first visit, P＜0.01, differences were statistically significant; cervical direction of the test group D-2 referral in consultation with the first cervical range of values compared to P＜0.05, after the 3rd referral and referral, follow-up consultation with the first cervical range of values compared to P＜0.01, differences were statistically significant; the control group after the 3rd referral and referral, follow-up compared with the first visit, P＜0.01, the differences were statistically significant.5. Comparison in cervical range movement'score between the two groupsTest group and control group before treatment the number of cases cervical range of points, compared by x2 test, x2=0.003, P=0.956＞0.05, no significant difference between the two groups is similar to the average level, indicating the two groups before treatment of cervical activity degree of comparability of the distribution points; first visit 1,2,3,4 times when the two groups after statistical analysis showed no significant (P＞0.05), that the cervical range of no difference; s 5,6,7th visit and 1 month,3 months,6 months follow-up, the difference was significant (P＜0.05), and the test group, the average rating lower than the control group.6 Comparison in improvement's number of Cervical range of movement's scoreComparing with the nunber of before and after's score of cervical movement range's decline of the two groups, by statistical analysis, all the P value of after the 2nd,6ed treatment and the follow-up-period are less than 0.05 and have significant difference. The test group's average rating is higher than the contrl groups'.Conclusion1. Both TCM synthetical therapy and Western medicial synthetical therapy have significant effectiveness in improving cervial vertebra functional restrictions of the patients with cervial spondylotic radiculopathy.2. During treatment, the onset time of TCM synthetical therapy is earlier than Western medicine synthetical therapy.3. During follow-up,the effect of TCM synthetical therapy is more durable than Western medicine synthetical therapy in improving the nerve root type cervical spondylosis of the cervical function in all directions.4. During both treatment and follow-up period, the TCM synthetical therapy is better than the Western medicine synthetical therapy in improving cervial vertebra functional restrictions of the patients with cervialspondylotic radiculopathy. In summary, both TCM synthetical therapy and Western medicial synthetical therapy have significant effectiveness in improving cervial vertebra functional restrictions of the patients with cervialspondylotic radiculopathy. Comparing with TCM synthetical therapy and Western medicine synthetical therapy, TCM synthetical therapy's efficacy is more effective, onset time is earlier, duration of effect is longer.