推拿治疗椎动脉型颈椎病的时效性研究

目的 探讨推拿治疗时间对椎动脉型颈椎病（cervical spondylosis of vertebral artery，CSA）的影响。方法 选取符合纳入标准的CSA患者90例，按随机数字表法随机分为推拿10 min组、推拿20 min组和推拿30 min组，行常规推拿手法治疗，比较治疗前后所有患者临床疗效、颈椎功能评分以及经颅多普勒（transcranial Doppler，TCD）超声检测情况。结果 3组患者临床疗效的分布比较，差异均具有统计学意义（P<0.05），推拿20 min组和30 min组临床疗效均明显优于10 min组。推拿10 min组治疗前后颈椎功能评分比较，差异无统计学意义（P＞0.05），而推拿20 min组和30 min组治疗后颈椎功能评分均较治疗前明显改善（P＜0.05）。推拿20 min、30 min组较10 min组颈椎功能评分改善程度更加明显（P＜0.05）；推拿20 min组和30 min组相比较，颈椎功能评分改善程度差异无统计学意义（P＞0.05）。3组患者治疗前后相比，两侧椎动脉的血流速度均有明显改善（P＜0.05）；与推拿10 min组比较，推拿20 min、30 min组治疗后两侧椎动脉的血流速度改善更加明显（P＜0.05），推拿20 min和30 min组比较，治疗后两侧椎动脉血流速度的改善程度无统计学意义（P＞0.05）。结论 推拿治疗CSA具有时间累积效应，随着推拿时间的延长，疗效提高，但是到达一定时间疗效不再增加；推拿治疗时间的选择在20 min左右为最佳。

A Study on Time of Massage in Treatment of Cervical Spondylosis of Vertebral Artery Type

Objective To investigate the influence of the time of massage in the treatment of cervical spondylosis of vertebral artery type (CSA). Methods A total of 90 patients with CSA were enrolled and randomly divided into 10-minute massage group, 20-minute massage group, and 30-minute massage group. All the groups were treated with routine massage. The clinical outcome, cervical vertebra function score, and transcranial Doppler findings were compared between the groups before and after treatment. Results There was a significant difference in the distribution of clinical outcomes between the three groups (P<0.05), and the 20-minute massage group and 30-minute massage group had significantly better clinical outcomes than the 10-minute massage group. After treatment, the 10-minute massage group showed no significant change in the cervical vertebra function score after treatment (P>0.05), while the 20-minute massage group and 30-minute massage group had significant improvements in the cervical vertebra function score after treatment (P<0.05). The 20-minute massage group and 30-minute massage group had significantly greater improvements in the cervical vertebra function score compared with the 10-minute massage group (P<0.05), and there was no significant difference in the improvement in cervical vertebra function score between the 20-minute massage group and the 30-minute massage group(P>0.05). All the groups had significant improvements in the blood flow velocity of the left and right vertebral arteries after treatment (P<0.05); compared with the 10-minute massage group, the 20-minute massage group and 30-minute massage group had significantly greater improvements in the blood flow velocity of the left and right vertebral arteries after treatment (P<0.05), while there was no significant difference between the 20-minute massage group and the 30-minute massage group (P>0.05). Conclusion Massage treatment has a time cumulative effect in the treatment of CSA; the treatment outcome is gradually improved over the time of massage and is not improved any more after a certain time. The best time of massage treatment is about 20 minutes.