文章摘要
夏楠,谢凌锋,郑倩,孟凡阳,黄杰.基于功能损伤分类的模式化诊疗流程治疗慢性颈痛的疗效观察[J].中华物理医学与康复杂志,2018,40(10):769-773
基于功能损伤分类的模式化诊疗流程治疗慢性颈痛的疗效观察
  
DOI:
中文关键词: 慢性颈痛  标准化治疗流程  模式化治疗  姿势评估
英文关键词: Neck pain  Standardized treatment  Pattern-specific treatment  Posture analysis
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作者单位
夏楠,谢凌锋,郑倩,孟凡阳,黄杰 430030 武汉华中科技大学同济医学院附属同济医院康复科 
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中文摘要:
      目的 探讨基于功能损伤分类的模式化诊疗流程对慢性颈痛(CNP)的治疗效果。 方法 选取2016年3月至2017年10月期间在我院门诊就诊的慢性颈痛患者93例,采用随机数字表法将其分为实验组及对照组。对照组患者按照常规接诊流程进行治疗,实验组患者则根据基于功能损伤分类的模式化诊疗流程进行接诊治疗,要求所有医生、治疗师均遵循既定诊疗原则进行物理检查、分型和治疗,治疗内容包括疼痛局部管理、牵引、软组织放松、松动技术、力量训练、姿势控制与运动训练、健康教育共7个部分。2组患者均在2周内完成3~6次门诊治疗,每次治疗90 min,并要求完成每周3次,每次30 min的家庭自主训练。于干预前、治疗2周末、1个月后随访时分别采用疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)对患者进行评定;于干预前、1个月后随访时使用姿势分析系统对患者头颈姿势角度指标进行对比分析,检测指标包括颅椎角(CVA)、肩前伸角(PSA)及矢状面头部仰角(SHA)。 结果 在研究过程中共有6例患者脱落,余87例患者均完成既定方案训练及随访。治疗2周末时发现实验组颈椎前屈末端疼痛VAS评分显著低于对照组(P=0.04);并且实验组治疗2周末时NDI评分与基线间差值显著高于对照组(P<0.05)。1个月后随访时发现实验组CVA改善幅度明显优于对照组(P=0.01);其它疗效指标组间差异均未发现有统计学意义(P>0.05)。 结论 基于功能损伤分类的颈痛物理诊疗流程能更有效帮助CNP患者快速缓解颈前屈末端疼痛,在一定程度上改善患者颈部功能及日常活动能力,对长期头颈姿势矫正也具有一定效果;该物理诊疗流程可能有助于规范颈痛诊疗行为,帮助制订标准化颈痛治疗流程。
英文摘要:
      Objective To explore the effect of pattern-specific physical therapy based on functional impairment on chronic neck pain (CNP). Methods Ninety-three CNP patients treated in the outpatient department of our hospital between March 2016 and November 2017 were randomly divided into a study group (n=46) and a control group (n=47). The control group received routine physical treatment, while the study group was treated with pattern-specific physical therapy involving local pain management, traction, soft tissue relaxation, mobilization, strength training, posture control training and active exercise as well as health education. Each was based on a physical examination and pattern classification by doctors and therapists. The subjects in both groups were required to complete 3 to 6 ninety-minute sessions of outpatient treatment and 6 thirty-minute sessions of self-training at home over 2 weeks. Pain intensity and cervical dysfunction were rated using a visual analogue scale (VAS) and a neck disability index (NDI) before and after the two-week intervention and one month later. Before the intervention and during the follow-up, postural analyses for the head and neck in a standing position were performed. The cranial vertebral angle (CVA), protracted shoulder angle (PSA) and sagittal head elevation were measured. Results Eighty-seven participants completed the treatments and follow-up. After the 2-week intervention, the average VAS rating at the end of cervical anteflection in the study group was significantly lower than that in the control group (P≤0.05). Significantly greater improvement in the NDI scores was observed in the study group than the control group (P≤0.05). During the follow-up, it was found that the average CVA score had improved more significantly in the study group than with the control group (P≤0.01), but there were no significant differences in the other measurements between the two groups. Conclusion This pattern-specific physical therapy process is more effective for relieving the end pain during cervical anteflection quickly. It can improve functioning and ability in daily activities to some degree, as well as correct head and neck posture in the long term. It may be helpful in regulating physical therapy for neck pain and for developing a standardized treatment protocol for CNP.
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