针刀治疗颈型颈椎病的临床研究进展

Clinical Research Progress of Needling Knife Therapy for Cervical Spondylosis of Cervical Type

摘要: 颈椎病(Cervical Spondylosis)是以椎间盘的退行性改变为主要原因，继发引起周围组织结构改变而引起一系列临床表现的疾病。其流行病学表示：颈椎病是一种高发于40~50岁的常见病，其中40岁以上成年人的发病率高达80%以上。颈型颈椎病(Cervical Type Cervical Spondylopathy)作为其中高发类型，主要以颈肩部疼痛不适、颈部活动受限、颈部肌肉僵硬及相应的压痛为主要临床表现特征，有很高的临床研究价值。近年来，针刀以其周期短、见效快及疗效好等优势成为治疗颈型颈椎病的优选治疗方案。笔者总结近5年内的相关文献，从治疗方案及作用机制两个方面总结针刀治疗颈型颈椎病的常见方式，以期为临床治疗提供可靠指导思路。结论：1) 针刀治疗选点以压痛点、筋节点为主，超声下可见局部结构肌纤维肥厚、增生及紊乱。2) 针刀治疗除以筋节选点外，还重视弓弦理论，以此为基础提出T形针刀术，重点松解弓弦结合部的位置，这些位置主要集中在颈部骨性标志处。除颈部位置，王泽宇等人还依据此理论将治疗选点扩展到骶部，取得了很好的临床疗效。3) 联合治疗选择的手法，均重点放松颈部肌肉、整复小关节紊乱，以恢复颈椎动静力平衡。4) 中药的选择以活血化瘀、疏风驱寒为主。5) 作用机制主要体现在：针刀可降低肌肉硬度、提高压力痛阈值、降低血清炎症介质、提高髓核细胞凋亡率、降低凋亡相关蛋白表达。

Abstract: Epidemiological data indicate that cervical spondylosis is a common disorder, frequently affecting individuals aged 40~50 years. In fact, the prevalence rate exceeds 80% among adults over 40 years old. Cervical-type cervical spondylosis, one of the most prevalent subtypes, predominantly presents with pain and discomfort in the neck and shoulder regions. Patients often describe a dull, persistent ache that may radiate to the upper arms. Limited neck mobility is another hallmark symptom. Simple actions such as turning the head to look over the shoulder or tilting the head back can become exceedingly painful and challenging. Stiff neck muscles are also common, causing the neck to feel tight and rigid. Palpation of specific areas may reveal corresponding tenderness. This subtype of cervical spondylosis holds significant clinical research value due to its widespread impact on daily activities and its effect on a large population. In recent years, needle knife therapy has emerged as a promising treatment modality for cervical-type cervical spondylosis. It has gained popularity due to its advantages of a short treatment cycle, rapid onset of action, and high efficacy. The author has reviewed relevant literature over the past five years and analyzed the common treatment approaches of needle knife therapy for cervical-type cervical spondylosis from two perspectives: treatment plans and mechanism of action. From the perspective of point selection in needle knife therapy, they mainly focus on trigger points and tendon nodes. Under ultrasound imaging, researchers have observed that local muscle fibers exhibit hypertrophy, proliferation, and disorganization. Tendon nodes are the regions where tendons attach to bones or other tissues. These nodes may become tense and painful due to abnormal muscle tension. By targeting these specific points, needle knife therapy directly addresses the source of pain. In addition to tendon node selection, needle knife therapy integrates the bow-string theory. Based on this theory, the T-shaped needle knife technique was developed. This technique focuses on relaxing the junctions between muscles and bony landmarks, which are primarily located in the neck region. The neck is likened to a bow, while the muscles and ligaments act as strings. When the balance between these components is disrupted, pain and dysfunction ensue. By relaxing these critical junctions, the therapy helps restore the normal biomechanical balance of the cervical spine. Wang Zeyu et al. further extended the treatment approach to include the sacral region based on this theory, achieving favorable clinical outcomes. As an integral part of the spine, the proper functioning of the sacrum is closely associated with the health of the cervical spine. The combined therapeutic techniques emphasize relaxing neck muscles and correcting small joint subluxations. Relaxed neck muscles alleviate pain and enhance neck mobility, whereas restoring the normal alignment of small joints contributes to maintaining the dynamic and static balance of the cervical spine. Traditional Chinese medicine (TCM) interventions primarily focus on promoting blood circulation, resolving stasis, dispelling wind, and warming cold conditions. These actions facilitate the nourishment of damaged tissues, reduce inflammation, and improve the overall function of the cervical spine. The mechanism of action for needle knife therapy is multifaceted. It reduces muscle hardness, thereby increasing the pain threshold. Additionally, it decreases the levels of serum inflammatory mediators, which play a critical role in the pain and swelling associated with cervical spondylosis. It also enhances the apoptosis rate of nucleus pulposus cells and downregulates the expression of apoptosis-related proteins, which thereby slowing the degenerative process of the intervertebral discs. Overall, needle knife therapy provides a comprehensive and effective solution to treating cervical-type cervical spondylosis.