神经根型颈椎病中西医结合保守治疗与干预机制研究进展

Research Progress on Integrated Chinese-Western Conservative Treatment and Intervention Mechanisms for Cervical Spondylotic Radiculopathy

摘要: 神经根型颈椎病(CSR)是颈椎退行性疾病中最常见的亚型之一。长期伏案、不良姿势及慢性劳损所致的颈椎力学失衡，被认为是其高发与年轻化的重要原因。神经根受压后可引发放射性疼痛、感觉异常及运动功能受限，长期疼痛还可能诱发中枢敏化和情绪障碍，进而显著降低患者生活质量。对于无进行性神经损伤者，中西医保守治疗仍是临床首选方案。西医治疗以非甾体抗炎药、神经营养药物、牵引及物理治疗为主，侧重于控制炎症、减轻水肿和改善局部受压；中医治疗则基于“筋骨失衡”、“本虚标实”的病机认识，采用中药、针灸、推拿等方法，从整体调节、力学重建及多靶点干预等层面发挥作用。文章系统梳理CSR中西医保守治疗的研究进展，重点归纳其共同作用机制，包括减轻机械压迫、下调TNF-α和IL-1β等炎症介质、改善神经根局部微循环、调节神经递质释放及促进颈椎生物力学平衡重建。同时，总结中西医结合在增效减毒、缓解症状及降低复发风险方面的潜在优势。针对当前研究中存在的疗效评价主观性较强、机制研究与临床转化衔接不足、干预参数标准化程度不高等问题，提出未来可结合多组学技术、客观生物标志物及动态力学监测手段，构建更加客观、标准化的评价体系，以为CSR保守治疗的精准化和规范化提供参考。

Abstract: Cervical spondylotic radiculopathy (CSR) is a common degenerative cervical disorder characterized by radiating pain, sensory disturbance, and motor dysfunction caused by nerve root compression. With the increasing prevalence of prolonged sedentary work, poor posture, and chronic cervical strain, CSR has shown a trend toward younger onset and imposes a substantial burden on quality of life. For patients without progressive neurological deficits, conservative treatment remains the first-line approach. In Western medicine, nonsteroidal anti-inflammatory drugs, neurotrophic agents, cervical traction, and physical therapy are commonly used to reduce inflammation, relieve edema, and alleviate neural compression. In traditional Chinese medicine, herbal medicine, acupuncture, and Tuina are widely applied to regulate the whole body, restore musculoskeletal balance, and exert multi-target therapeutic effects. This review summarizes recent advances in conservative treatment for CSR from the perspectives of both Western medicine and traditional Chinese medicine, with a focus on their shared therapeutic mechanisms, including anti-inflammatory regulation, improvement of local microcirculation, modulation of neurotransmitter release, relief of mechanical compression, and restoration of cervical biomechanical balance. In addition, the potential advantages of integrated Chinese and Western medicine in symptom control, efficacy enhancement, and recurrence prevention are discussed. Future studies should further strengthen objective efficacy evaluation, standardize intervention protocols, and promote the integration of mechanistic research with clinical translation, so as to support the development of more precise and standardized conservative management strategies for CSR.