神經阻滯療法治療頸性疼痛療效及安全性的系統評價_《中國循證醫學雜志》

作者：

許菁 , 賈功偉 , 譚波濤 ,  虞樂華

1. 重慶醫科大學附屬第二醫院康復醫學科（重慶 400010）;

關鍵詞：

神經阻滯療法頸性疼痛系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120230

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目的　系統評價神經阻滯療法治療頸性疼痛的療效及安全性。
方法　計算機檢索The Cochrane Library、PubMed、Ovid、ISI、EBSCO、CBM和CNKI數據庫，檢索時限均從建庫至2011年11月，并輔以文獻追溯、手工檢索的方法，收集國內外公開發表的關于神經阻滯療法治療頸性疼痛的療效及安全性的隨機對照試驗。由2位研究者按照納入和排除標準篩選文獻、提取資料并評價納入研究的方法學質量后，采用RevMan 5.0 軟件進行Meta分析。
結果　最終納入10個RCT，共625例患者。定性分析結果顯示神經阻滯治療頸性疼痛的短期療效明顯優于安慰劑組、認知療法組以及經皮電神經刺激組；聯合神經阻滯治療的短期療效明顯優于單一神經阻滯。Meta分析結果顯示枕大神經阻滯與C2/3椎旁阻滯的短期療效［SMD=–0.13，95%CI（–0.58，0.32），P=0.58］及中期療效［SMD=–0.01，95%CI（–0.46，0.44），P=0.98］差異無統計學意義；注射液中是否添加激素的短期療效［SMD=0.16，95%CI（–0.13，0.44），P=0.28］及長期療效［SMD=0.27，95%CI（–0.02，0.55），P=0.07］差異無統計學意義。
結論　現有臨床證據顯示神經阻滯治療頸性疼痛安全性好，且短期療效有一定優勢，聯合阻滯療效可能更佳，但阻滯液中是否添加激素及不同阻滯方法的選擇對療效無明顯影響。受納入研究質量和數量限制，且總體樣本量少，上述結論尚需開展更多高質量、大樣本研究加以驗證。

引用本文： 許菁,賈功偉,譚波濤,虞樂華. 神經阻滯療法治療頸性疼痛療效及安全性的系統評價. 中國循證醫學雜志, 2012, 12(12): 1497-1502. doi: 10.7507/1672-2531.20120230 復制

1.	Cté P, Cassidy D, Carroll L. The Saskatchewan health and back pain survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine, 1998, 23(15): 1689-1698.
2.	Binder AI. Cervical spondylosis and neck pain. BMJ, 2007, 334: 527–531.
3.	Jette AM, Smith K, Haley SM, et al. Physical therapy episodes of care for patients with low back pain. Phys Ther, 1994, 74: 101-110.
4.	John DC, Joshua AC, James ME, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 2008, 38(9): A1-A34.
5.	Gross A, Miller J, Sylva JD, et al. Manipulation or Mobilisation for neck pain: A Cochrane Review. Manual Therapy, 2010, 15(4): 315-333.
6.	Langevin P, Lowcock J, Nolan M, et al. Botulinum toxin for subacute/chronic neck pain(Review). Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD008626. DOI: 10.1002/14651858.CD008626.pub2.
7.	劉兵, 梁新梅. 頸源性頭痛及其神經阻滯療法. 中國疼痛醫學雜志, 2009, 15(6): 363-365.
8.	譚冠先. 神經阻滯療法. 見: 譚冠先, 主編. 疼痛診療學. 第2版. 人民衛生出版社, 2010. 44-44.
9.	Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache, 1990, 30(11): 725-726.
10.	Inan N, Ceyhan A, Inan L, et al. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol, 2002, 16(3): 239-243.
11.	Gale G, Nussbaum D, Rothbart P, et al. A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain. Pain Res Manag, 2003, 7(4): 185-189.
12.	Naja ZM, El-Rajab M, Al-Tannir MA, et al. Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Practice, 2006, 6(2): 89-95.
13.	Manchikanti L, Singh V, Falco F J, et al. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine, 2008, 33(17): 1813-1820.
14.	Manchikanti L, Cash KA, Pampati V, et al. Cervical epidural injections in chronic discogenic neck pain without disc herniation or radiculitis: preliminary results of a randomized, double-blind, controlled trial. Pain Physician, 2010, 13(4): E265-278.
15.	Manchikanti L, Singh V, Falco FJ, et al. Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician, 2010, 13(5): 437-450.
16.	鄭寶森, 史可梅, 鄧迺封, 等. 神經阻滯與經皮電刺激治療頸源性頭痛的對照研究. 天津醫科大學學報, 2002, 8(3): 344-346.
17.	王威, 王保國, 劉延青, 等. 不同神經阻滯方法治療頸源性頭痛的療效觀察. 中國康復醫學雜志, 2005, 20(8): 585-588.
18.	申穎, 白鶯, 金旭, 等. 甘油果糖復合神經阻滯治療頸源性頭痛的臨床觀察. 中國康復理論與實踐, 2008, 14(6): 506-507.
19.	莊志剛, 王秀巖. 椎旁神經阻滯治療頸源性頭痛對比觀察. 中國實用神經疾病雜志, 2011, 14(4): 12-13.

1. Cté P, Cassidy D, Carroll L. The Saskatchewan health and back pain survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine, 1998, 23(15): 1689-1698.
2. Binder AI. Cervical spondylosis and neck pain. BMJ, 2007, 334: 527–531.
3. Jette AM, Smith K, Haley SM, et al. Physical therapy episodes of care for patients with low back pain. Phys Ther, 1994, 74: 101-110.
4. John DC, Joshua AC, James ME, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther, 2008, 38(9): A1-A34.
5. Gross A, Miller J, Sylva JD, et al. Manipulation or Mobilisation for neck pain: A Cochrane Review. Manual Therapy, 2010, 15(4): 315-333.
6. Langevin P, Lowcock J, Nolan M, et al. Botulinum toxin for subacute/chronic neck pain(Review). Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD008626. DOI: 10.1002/14651858.CD008626.pub2.
7. 劉兵, 梁新梅. 頸源性頭痛及其神經阻滯療法. 中國疼痛醫學雜志, 2009, 15(6): 363-365.
8. 譚冠先. 神經阻滯療法. 見: 譚冠先, 主編. 疼痛診療學. 第2版. 人民衛生出版社, 2010. 44-44.
9. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache, 1990, 30(11): 725-726.
10. Inan N, Ceyhan A, Inan L, et al. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol, 2002, 16(3): 239-243.
11. Gale G, Nussbaum D, Rothbart P, et al. A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain. Pain Res Manag, 2003, 7(4): 185-189.
12. Naja ZM, El-Rajab M, Al-Tannir MA, et al. Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Practice, 2006, 6(2): 89-95.
13. Manchikanti L, Singh V, Falco F J, et al. Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine, 2008, 33(17): 1813-1820.
14. Manchikanti L, Cash KA, Pampati V, et al. Cervical epidural injections in chronic discogenic neck pain without disc herniation or radiculitis: preliminary results of a randomized, double-blind, controlled trial. Pain Physician, 2010, 13(4): E265-278.
15. Manchikanti L, Singh V, Falco FJ, et al. Comparative outcomes of a 2-year follow-up of cervical medial branch blocks in management of chronic neck pain: a randomized, double-blind controlled trial. Pain Physician, 2010, 13(5): 437-450.
16. 鄭寶森, 史可梅, 鄧迺封, 等. 神經阻滯與經皮電刺激治療頸源性頭痛的對照研究. 天津醫科大學學報, 2002, 8(3): 344-346.
17. 王威, 王保國, 劉延青, 等. 不同神經阻滯方法治療頸源性頭痛的療效觀察. 中國康復醫學雜志, 2005, 20(8): 585-588.
18. 申穎, 白鶯, 金旭, 等. 甘油果糖復合神經阻滯治療頸源性頭痛的臨床觀察. 中國康復理論與實踐, 2008, 14(6): 506-507.
19. 莊志剛, 王秀巖. 椎旁神經阻滯治療頸源性頭痛對比觀察. 中國實用神經疾病雜志, 2011, 14(4): 12-13.

《中國循證醫學雜志》

神經阻滯療法治療頸性疼痛療效及安全性的系統評價

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《中國循證醫學雜志》

神經阻滯療法治療頸性疼痛療效及安全性的系統評價

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