Abstract
OBJECTIVE: To observe the clinical efficacy of supine massage in the treatment of vertebral artery type cervical spondylosis. METHODS: Seventy-six patients with vertebral artery cervical spondylosis were randomly divided into two groups: 40 cases in the observation group were treated with supine tui-na. In the control group, 36 cases were treated with intravenous drip of acupuncture injection. Results: The cure rate of the observation group was 60.0%, and the total effective rate was 97.5%; the cure rate of the control group was 41.7%, and the total effective rate was 83.4%. When comparing the two groups, there was a significant difference by statistical treatment (P<0.05). Conclusion: The treatment of vertebral artery type cervical spondylosis by supine massage can significantly improve the clinical symptoms and signs of patients with vertebral artery type cervical spondylosis, and the curative effect is significantly better than that of the control group.
Vertebral artery cervical spondylosis (CSA) is a type of cervical spondylosis caused by insufficient blood supply to the vertebrobasilar artery due to compression or spasm of the vertebral artery. Clinical symptoms mainly include dizziness and headache, neck and shoulder pain, blurred vision, tinnitus, facial numbness, upper limb numbness, and fainting in case of sudden collapse. Vertebral artery type cervical spondylosis is a relatively common type of cervical spondylosis, and its incidence is second only to neurogenic cervical spondylosis, which seriously endangers human health and quality of life. With the change of people’s work style, living habits and accelerated work pace, the development of this disease is now more frequent and younger [1]. From July 2006 to March 2008, we treated 40 cases of vertebral artery cervical spondylosis with supine massage, and we summarize our report as follows.
1 Clinical data
1.1 Diagnostic criteria
With reference to the Diagnostic Efficacy Criteria for Chinese Medicine Diseases promulgated by the State Administration of Traditional Chinese Medicine [2] and the criteria formulated at the 2nd Symposium on Cervical Spondylosis held in Qingdao in October 1992 [3], the following criteria were formulated: (1) Previous episodes of sudden collapse with cervical vertigo. (2) Positive rotational neck test. (3) X-ray showed segmental instability or osteophytes of the hook vertebral joint. (4) Mostly accompanied by sympathetic symptoms.
1.2 Inclusion criteria
(1) Meet the above criteria for vertebral artery type cervical spondylosis. (2) Not pregnant or lactating women. (3) Patients who guarantee to cooperate with the treatment and complete the whole course of treatment.
1.3 Exclusion criteria
(1) Other subtypes of cervical spondylosis. (2) Vertigo caused by cerebral, otogenic, ophthalmogenic, traumatic, neurological, intracranial tumors, etc. (3) Subclavian artery ischemia syndrome. (4) Combination of primary diseases of the heart, liver, kidney, hematopoietic system and other serious diseases, psychiatric patients. (5) Those who failed to complete the treatment process according to the experimental plan.
1.4 General information
All 76 cases were outpatients of our hospital and were randomly divided into 2 groups. Among the 40 cases in the observation group, there were 22 males and 18 females, the oldest was 64 years old, the youngest was 18 years old, and the average was 46.8 years old; the longest duration of the disease was 7 years, the shortest was 1 month, and the average was 3.6 years. Among the 36 cases in the control group, there were 16 males and 20 females, with the maximum age of 62 years, the minimum age of 21 years, and the average age of 45.3 years; the longest duration of the disease was 6.5 years, the shortest was 2 months, and the average was 3.4 years.
2 Treatment methods
2.1 Observation group: supine position massage treatment was used
Patients were placed in supine position. The head is padded with a thin pillow. The operator sits in the anterior position of the patient’s head. First, use the single palm multi-finger to hold and knead the muscles of the neck and collar; then place both hands multi-finger on the neck and collar, and use both hands multi-finger to alternately knead the muscles and collar ligaments on both sides of the neck, and repeatedly operate for 5-10 minutes to fully relax the muscles of the neck and collar. The palm of one hand holds the back of the occipital area. The other hand holds its lower jaw. Do upward head traction with both hands at the same time, do forward flexion, lateral flexion, rotation and other actions under traction, and then relax; then do head traction as above, turn the head to one side under traction, and do supine neck wrenching with both hands simultaneously in the opposite direction, and the same method on the opposite side. Finally, do the cervical neck to relax the neck muscle groups. ③ head side lying position with a single palm multi-finger finger press one side of the Fengfu point to the mastoid process. The opposite side is operated as above; 3 to 5 times each. ④ Apply the straight pushing method of opening the heavenly gate in the forehead, followed by the large fish interval from the center of the forehead to both sides of the sun to do sub-push. Each 3 ~ 5 times: replace the thumb to rub the Hall of the Gods, double thumbs to rub the forehead to the sun 2 ~ 3 times; then change the multi-finger belly to lightly rub the two temporal side, the large fissure to rub both sides of the forehead. Repeat the operation for 3 to 5 minutes: then rub the thumb along the line of the Governor’s vein to the Baihui point. Rub along the bladder meridian on both sides of the head to the shoulder well point, then switch to the finger press method on the above meridian line and operate for 3 minutes, and finally press the points of Baihui, Fengchi, Fengfu, and Touwei. Each for 1 minute; finally finish the operation with fingertip tapping method with both hands. The above operations were performed once a day, and 6 times were considered as 1 course of treatment, and the next course of treatment was performed at an interval of 1 day, for a total of 2 courses of treatment.
2.2 Control group: treated with intravenous drip of Acanthopanax injection.
The efficacy of the treatment was evaluated by using 40ml of Zing Wu Jia Injection (Guo Yao Zheng Zi Z23020810) produced by Heilongjiang Wandashan Pharmaceutical Factory, plus 250ml of 0.9% sodium chloride injection intravenously, once a day, 6 times as a course of treatment, with an interval of 1 day between courses, and 2 consecutive courses of treatment.
3 Observation results
3.1 Therapeutic efficacy criteria
Refer to the “Diagnostic Efficacy Criteria for Chinese Medicine Diseases” promulgated by the State Administration of Traditional Chinese Medicine [2]. Cured: symptoms such as vertigo disappeared and normal work and life resumed. No recurrence in six months of follow-up. Improvement: vertigo and other symptoms are significantly reduced and do not affect work and life. Occasional aggravation during the follow-up period, which is reduced after treatment. Ineffective: No improvement or slight reduction of vertigo and other symptoms. During the follow-up period, vertigo and other symptoms occurred from time to time, which obviously affected work and life.
3.2 Comparison of clinical efficacy between the two groups (see the table)
Table Comparison of clinical efficacy between two groups Example (%)
Group
Number of cases
Cured
Improved
Ineffective
Total effective rate
Observation group
Control group
40
36
24 (60.0)
15 (41.7)
15 (37.5)
15 (41.7)
1 (2.5)
6 (16.6)
97.5
83.4
As shown in the table, the cure rate of the observation group was 60.0%, and the total effective rate was 97.5%; the cure rate of the control group was 41.7%, and the total effective rate was 83.4%. The cure rate and total effective rate of the observation group were significantly better than those of the control group, and there was a significant difference between the two groups after statistical treatment (X2=4.37, P<0.05). It indicates that the clinical efficacy of supine massage in treating patients with vertebral artery cervical spondylosis is significantly better than that of the control group.
4 Discussion
The most important cause of the development of vertebral artery-type cervical spondylosis is due to direct compression of the vertebral artery or the sympathetic plexus on its surface by vertebral instability of the cervical spine or hyperplasia of the hook spine joint [4-5]. In the cervical vertebrae, the barbules, the transverse process and the joint capsule and periosteum around the superior articular process continue each other to form a thin fibrous fascial sheath-like structure that envelops the vertebral artery and vein; there are some fibrous tissue connections between the barbules and the outer membrane of the transverse process called the “barbule-vertebral artery-spinal nerve complex”. At the same time, there are also some fibrous tissues between the transverse processes. When the cervical spine is repeatedly subjected to acute and chronic injuries, the intervertebral soft tissues can become aseptic inflammation and cause soft tissue congestion and edema and fibrous tissue hyperplasia, eventually forming scar adhesions, which can compress and stimulate the vertebral artery and surrounding sympathetic nerve fibers, resulting in the corresponding clinical symptoms [6].
Supine thrusting is a treatment method that the author has applied more often in the clinical treatment of cervical spondylosis, which has the characteristics of safety, mild patient response, and good efficacy. This method is good for relieving cervical soreness, unfavorable neck movement, upper limb radiating pain, and nerve root symptoms and signs such as head percussion, neck compression, and positive brachial plexus nerve pull test [7]. The patient’s neck muscles are easily relaxed in the supine position, and the patient is less likely to be tense, which facilitates doctor-patient cooperation. Supine extraction can widen the vertebral space and release the compression of the vertebral artery by osteophytes or degenerated discs, so that the blood supply to the brain tends to be normal. This results in the elimination of clinical symptoms [8]. In the supine position [9], the angle of extraction and extension can be adjusted according to the condition of the cervical spine and the position of the cervical spine, thus reflecting the flexible and versatile characteristics of the manipulation and improving the therapeutic effect. Therefore, the supine position massage technique significantly improved the clinical symptoms and signs of patients, and its efficacy was significantly due to the control group.