经皮颈椎间盘射频消融术联合银质针治疗颈性眩晕临床疗效观察

皮铎波; 鲍骏侃; 陈龙; 张颖

doi:10.16766/j.cnki.issn.1674-4152.002679

经皮颈椎间盘射频消融术联合银质针治疗颈性眩晕临床疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002679

绍兴文理学院附属医院疼痛科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2019KY728

详细信息

通讯作者:
皮铎波, E-mail: sx19881988@126.com

中图分类号: R441.2R454.1R653
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- 文章访问数: 166
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-18
- 网络出版日期: 2022-11-30

Clinical observation of percutaneous radiofrequency ablation of cervical intervertebral disc combined with silver needle in the treatment of cervical vertigo

Department of Pain, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的观察经皮颈椎间盘射频消融术联合银质针治疗颈性眩晕患者的临床疗效。方法选择2019年6月—2021年6月绍兴文理学院附属医院确诊为颈性眩晕患者119例作为研究对象，使用随机数字表法将患者分为A组(射频+银质针组，41例)、B组(射频组，39例)、C组(银质针组，39例)。A组患者用颈椎间盘射频联合银质针治疗，B组患者仅用颈椎间盘射频治疗，C组单用银质针治疗。采用颅彩色多普勒超声(TCD)血流检测3组患者干预前及治疗1周、1个月后、3个月后左侧椎动脉(LVA)、右侧椎动脉(RVA)和基底动脉(BA)收缩期最大血流速度(Vmax)，并应用眩晕残障程度评定量表评估患者眩晕程度。结果干预后3组患者椎动脉血流动力学均有所改善，干预3个月后，A组LVA-Vmax为(45.51±4.73)cm/s、RVA-Vmax为(45.48±4.70)cm/s、BA-Vmax为(45.54±4.76)cm/s, 高于B组[(43.11±4.82)cm/s、(43.01±4.79)cm/s、(43.62±3.95)cm/s]和C组[(43.06±4.98)cm/s、(43.08±4.81)cm/s、(43.11±3.06)cm/s], 差异有统计学意义(均P＜0.05)。干预后，3组患者眩晕残障程度评分各项指标均有所降低，干预1个月后3组各项指标水平最低，3组间比较差异有统计学意义(均P＜0.05)。结论采用颈椎间盘射频联合银质针治疗颈性眩晕，疗效明显优于单用颈椎间盘射频治疗及银质针治疗。
- 经皮颈椎间盘射频消融术 /
- 银质针 /
- 颈性眩晕
Abstract: Objective To investigate the clinical effect of percutaneous radiofrequency ablation of cervical intervertebral disc combined with silver needle for cervical vertigo treatment. Methods A total of 119 patients with cervical vertigo diagnosed in the Pain Clinic of the Affiliated Hospital of Shaoxing University of Arts and Sciences from June 2019 to June 2021 were collected. The patients were randomly divided into group A (RF + silver needle group, n=41), group B (RF group, n=39) and group C (silver needle group, n=39). Patients in group A were treated with cervical intervertebral disc radiofrequency combined with silver needle, patients in group B were treated with cervical intervertebral disc radiofrequency only, and patients in group C were treated with silver needle only. The maximum systolic blood flow velocity (Vmax) of left vertebral artery (LVA), right vertebral artery (RVA) and basilar artery (BA) in the three groups before intervention and 1 week, 1 month and 3 months after treatment were measured by cranial colour Doppler ultrasound. The vertigo disability rating scale was used in evaluating the degree of vertigo. Results After the intervention, the vertebral artery haemodynamics of the three groups improved. After 3 months of intervention, the LVA-Vmax [(45.51 ± 4.73) cm/s], RVA-Vmax [(45.48 ± 4.70) cm/s], BA-Vmax [(45.54 ± 4.76) cm/s] of group A were higher than those of group B [LVA-Vmax, (43.11±4.82) cm/s; RVA-Vmax, (43.01±4.79) cm/s; BA-Vmax, (43.62±3.95) cm/s] and group C [LVA-Vmax, (43.06±4.98) cm/s; RVA-Vmax, (43.08±4.81) cm/s; BA-Vmax, (43.11±3.06) cm/s], the differences were statistically significant (all P < 0.05). After the intervention, all the indicators of the vertigo and disability scores of the three groups decreased, and the three groups had the lowest levels of the indicators after 1 month of intervention, and the differences were statistically significant (all P < 0.05). Conclusion The curative effect of cervical disc radiofrequency combined with silver needle in the treatment of cervical vertigo is significantly better than that of cervical disc radiofrequency therapy and silver needle alone.
- Percutaneous radiofrequency ablation of cervical intervertebral disc /
- Silver needle /
- Cervical vertigo

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表 1 3组颈性眩晕患者干预前后椎动脉血流动力学比较(x±s，cm/s)

Table 1. Comparison of vertebral artery hemodynamics before and after intervention among three groups of patients with cervical vertigo(x±s, cm/s)

组别	例数	LVA-Vmax		RVA-Vmax		BA-Vmax
组别	例数	干预前	干预3个月后	干预前	干预3个月后	干预前	干预3个月后
A组	41	38.57±4.36	45.51±4.73^a	38.45±4.31	45.48±4.70^a	40.27±3.92	45.54±4.76^a
B组	39	38.49±4.69	43.11±4.82^ab	38.56±4.51	43.01±4.79^ab	40.17±3.95	43.62±3.95^ab
C组	39	38.51±4.66	43.06±4.98^ab	38.59±4.65	43.08±4.81^ab	40.21±4.06	43.11±3.06^ab
F值		0.003	3.371	0.011	3.510	0.006	4.134
P值		0.997	0.038	0.989	0.033	0.994	0.018
注：与同组干预前比较，^aP < 0.05；与同时间点A组比较，^bP < 0.05。

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表 2 3组颈性眩晕患者DHI评分比较(x±s，分)

Table 2. Comparison of DHI scores among three groups of patients with cervical vertigo(x±s, points)

组别	例数	功能				躯体
组别	例数	干预前	干预1周后	干预1个月后	干预3个月后	干预前	干预1周后	干预1个月后	干预3个月后
A组	41	20.05±2.16	10.06±2.56^a	8.84±2.86^a	10.02±1.96^a	12.12±2.23	9.17±2.36^a	9.05±1.16^a	9.19±2.53^a
B组	39	20.35±2.06	11.56±2.56^ab	11.59±2.93^ab	11.96±2.87^ab	12.21±2.21	10.57±2.56^ab	9.89±2.16^ab	11.13±2.32^ab
C组	39	20.13±2.07	11.60±2.16^ab	10.11±2.06^abc	11.65±2.78^ab	12.15±2.38	10.36±2.33^ab	9.14±1.16^abc	11.17±2.39^ab
F值		0.217	5.233	10.771	6.675	0.016	3.928	3.448	8.839
P值		0.805	0.007	< 0.001	0.002	0.984	0.022	0.035	< 0.001

组别	例数	情感				总分
组别	例数	干预前	干预1周后	干预1个月后	干预3个月后	干预前	干预1周后	干预1个月后	干预3个月后
A组	41	15.51±2.52	9.15±2.56^a	8.95±1.96^a	8.74±2.76^a	47.23±2.17	22.16±3.61^a	20.16±2.19^a	22.56±2.69^a
B组	39	15.89±2.50	10.55±2.36^ab	9.96±2.56^ab	10.12±2.85^ab	48.13±2.07	24.16±3.79^ab	23.74±2.66^ab	24.53±3.65^ab
C组	39	15.79±2.35	10.45±2.43^ab	9.92±1.56^abc	10.15±2.79^ab	47.91±2.63	23.98±2.95^ab	22.66±2.19^abc	23.66±3.63^ab
F值		0.258	4.085	3.089	3.337	1.673	4.094	24.455	3.493
P值		0.773	0.019	0.049	0.039	0.192	0.019	< 0.001	0.034
注：组内各时间点两两比较, 差异均有统计学意义；与同组干预前比较，^aP < 0.05；与同时间点A组相比，^bP < 0.05；与同时间点B组相比，^cP < 0.05。

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参考文献(16)

[1]	辛荣超, 党建军, 郑勇, 等. 颈性眩晕患者颈椎动力位X线及椎动脉彩超检查的影像学特点分析[J]. 临床医学研究与实践, 2021, 6(35): 108-110. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202135034.htm XIN R C, DANG J J, ZHENG Y, et al. Analysis of imaging characteristics of cervical dynamic X-ray and vertebral artery color Doppler examination in patients with cervical vertigo[J]. Clinical medicine research and practice, 2021, 6(35): 108-110. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202135034.htm
[2]	郝军, 常虎飞, 盛旻, 等. 刺五加对颈性眩晕患者多巴胺D2受体基因CpG岛甲基化及体外小胶质细胞的M1/M2极性的影响[J]. 实用药物与临床, 2022, 25(1): 26-31. https://www.cnki.com.cn/Article/CJFDTOTAL-LYLC202201003.htm HAO J, CHANG H F, SHENG M, et al. Effects of Acanthopanax senticosus on CpG island methylation of dopamine D2 receptor gene in patients with cervical vertigo and M1/M2 polarity of microglia in vitro[J]. Practical drugs and clinic, 2022, 25(1): 26-31. https://www.cnki.com.cn/Article/CJFDTOTAL-LYLC202201003.htm
[3]	刘道龙, 褚雪菲, 萨仁, 等. 阴阳调和针法治疗颈性眩晕120例临床观察[J]. 中国中医基础医学杂志, 2021, 27(9): 1430-1432. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202109022.htm LIU D H, CHU X F, SA R, et al. Clinical observation on 120 cases of cervical vertigo treated by Yin Yang harmonizing acupuncture[J]. Chinese Journal of basic Chinese medicine, 2021, 27(9): 1430-1432. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202109022.htm
[4]	史帆, 宋文慧, 刘昌文, 等. 前庭诱发肌源电位评价颈性眩晕与前庭功能的相关性[J]. 中国骨伤, 2022, 35(2): 148-152. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGU202202011.htm SHI F, SONG W H, LIU C W, et al. Vestibular evoked myogenic potential to evaluate the correlation between cervical vertigo and vestibular function[J]. China bone injury, 2022, 35(2): 148-152. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGU202202011.htm
[5]	林雪维. 补气养血健脾汤联合针灸治疗气血亏虚型颈性眩晕的临床观察[J]. 中国中医药科技, 2022, 29(1): 142-143. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY202201067.htm LIN X W. Clinical observation of Buqi Yangxue Jianpi Decoction combined with acupuncture in the treatment of cervical vertigo of Qi and blood deficiency type[J]. China Science and technology of traditional Chinese medicine, 2022, 29(1): 142-143. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY202201067.htm
[6]	中华医学会神经病学分会. 眩晕诊治专家共识[J]. 中华神经科杂志, 2010, 43(5): 369-374. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJB201802001.htm Neurology branch of Chinese Medical Association. Expert consensus on the diagnosis and treatment of vertigo[J]. Chinese Journal of Neurology, 2010, 43(5): 369-374. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJB201802001.htm
[7]	刘晓卫, 李雪芬, 徐建珍, 等. 眩晕残障程度评定量表在眩晕患者跌倒风险预测中的应用研究[J]. 护士进修杂志, 2019, 34(13): 1184-1187. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201913008.htm LIU X W, LI X F, XU J Z, et al. Study on the application of vertigo disability rating scale in the prediction of fall risk of vertigo patients[J]. Journal of nurse training, 2019, 34(13): 1184-1187. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201913008.htm
[8]	赵海玲, 李建强, 庄靖卿, 等. 中医特色护理在颈源性眩晕伴焦虑、抑郁病人中的应用[J]. 护理研究, 2017, 31(2): 221-223. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201702028.htm ZHAO H L, LI J Q, ZHUANG J Q, et al. Application of traditional Chinese medicine characteristic nursing in patients with cervical vertigo with anxiety and depression[J]. Nursing research, 2017, 31(2): 221-223. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201702028.htm
[9]	金丽华, 楼航芳, 连建伟, 等. 天麻钩藤饮联合倍他司汀治疗眩晕症患者疗效的临床研究[J]. 中华全科医学, 2020, 18(3): 480-483. doi: 10.16766/j.cnki.issn.1674-4152.001278 JIN L H, LOU H F, LIAN J W, et al. Clinical study on the efficacy of Tianma goutengyin combined with betahistine in the treatment of vertigo[J]. Chinese general practice, 2020, 18(3): 480-483. doi: 10.16766/j.cnki.issn.1674-4152.001278
[10]	潘文莉, 蒙锦霞. 观察中医护理联合健康教育护理模式对颈椎病患者的临床护理分析[J]. 饮食保健, 2019, 6(7): 262-263. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL202008029.htm PAN W L, MENG J X. To observe the clinical nursing analysis of traditional Chinese medicine nursing combined with health education nursing model for patients with cervical spondylosis[J]. Diet health care, 2019, 6(7): 262-263. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL202008029.htm
[11]	YOGANANDAN N, UMALE S, STEMPER B, et al. Fatigue responses of the human cervical spine intervertebral discs[J]. J Mech Behav Biomed Mater, 2017, 69: 30-38.
[12]	张阳, 李放, 孙天胜. 颈性眩晕发病机制新进展[J]. 中国骨与关节杂志, 2018, 7(5): 373-376. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL201805015.htm ZHANG Y, LI F, SUN T S. New progress in the pathogenesis of cervical vertigo[J]. Chinese Journal of Bone and Joint, 2018, 7(5): 373-376. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL201805015.htm
[13]	彭宝淦, 杨亮. 颈性头晕的发病机制[J]. 武警医学, 2017, 28(5): 433-436. https://www.cnki.com.cn/Article/CJFDTOTAL-WJYX201705002.htm PENG B G, YANG L. Pathogenesis of cervical dizziness[J]. Armed police medicine, 2017, 28(5): 433-436. https://www.cnki.com.cn/Article/CJFDTOTAL-WJYX201705002.htm
[14]	王福根. 银质针导热治疗颈腰背痛[M]. 郑州: 河南科学技术出版社, 2020: 74. WANG F G. Silver needle heat conduction treatment of neck, waist and back pain[M]. Zhengzhou: Henan science and Technology Press, 2020: 74.
[15]	王瑞军, 高春华, 姜昊, 等. 颈椎间盘神经分布的研究进展[J]. 中华灾害救援医学, 2017, 5(4): 230-234. https://www.cnki.com.cn/Article/CJFDTOTAL-JYZH201704017.htm WANG R J, GAO C H, JIANG H, et al. Research progress of nerve distribution in cervical intervertebral disc[J]. China disaster rescue medicine, 2017, 5(4): 230-234. https://www.cnki.com.cn/Article/CJFDTOTAL-JYZH201704017.htm
[16]	李利斌, 孙菊光, 史江峰. Epley法结合针刺快速治疗后半规管原发性良性阵发性位置性眩晕临床分析[J]. 中华全科医学, 2018, 16(12): 2085-2087. doi: 10.16766/j.cnki.issn.1674-4152.000568 LI L B, SUN J G, SHI J F. Clinical analysis of Epley method combined with acupuncture for rapid treatment of primary benign paroxysmal positional vertigo in the posterior semicircular canal[J]. Chinese general practice, 2018, 16(12): 2085-2087. doi: 10.16766/j.cnki.issn.1674-4152.000568