神经阻滞疗法治疗颈性疼痛疗效及安全性的系统评价_《中国循证医学杂志》

作者：

许菁 , 贾功伟 , 谭波涛 ,  虞乐华

1. 重庆医科大学附属第二医院康复医学科（重庆 400010）;

关键词：

神经阻滞疗法颈性疼痛系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20120230

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价神经阻滞疗法治疗颈性疼痛的疗效及安全性。
方法　计算机检索The Cochrane Library、PubMed、Ovid、ISI、EBSCO、CBM和CNKI数据库，检索时限均从建库至2011年11月，并辅以文献追溯、手工检索的方法，收集国内外公开发表的关于神经阻滞疗法治疗颈性疼痛的疗效及安全性的随机对照试验。由2位研究者按照纳入和排除标准筛选文献、提取资料并评价纳入研究的方法学质量后，采用RevMan 5.0 软件进行Meta分析。
结果　最终纳入10个RCT，共625例患者。定性分析结果显示神经阻滞治疗颈性疼痛的短期疗效明显优于安慰剂组、认知疗法组以及经皮电神经刺激组；联合神经阻滞治疗的短期疗效明显优于单一神经阻滞。Meta分析结果显示枕大神经阻滞与C2/3椎旁阻滞的短期疗效［SMD=–0.13，95%CI（–0.58，0.32），P=0.58］及中期疗效［SMD=–0.01，95%CI（–0.46，0.44），P=0.98］差异无统计学意义；注射液中是否添加激素的短期疗效［SMD=0.16，95%CI（–0.13，0.44），P=0.28］及长期疗效［SMD=0.27，95%CI（–0.02，0.55），P=0.07］差异无统计学意义。
结论　现有临床证据显示神经阻滞治疗颈性疼痛安全性好，且短期疗效有一定优势，联合阻滞疗效可能更佳，但阻滞液中是否添加激素及不同阻滞方法的选择对疗效无明显影响。受纳入研究质量和数量限制，且总体样本量少，上述结论尚需开展更多高质量、大样本研究加以验证。

引用本文： 许菁,贾功伟,谭波涛,虞乐华. 神经阻滞疗法治疗颈性疼痛疗效及安全性的系统评价. 中国循证医学杂志, 2012, 12(12): 1497-1502. doi: 10.7507/1672-2531.20120230 复制

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7.	刘兵, 梁新梅. 颈源性头痛及其神经阻滞疗法. 中国疼痛医学杂志, 2009, 15(6): 363-365.
8.	谭冠先. 神经阻滞疗法. 见: 谭冠先, 主编. 疼痛诊疗学. 第2版. 人民卫生出版社, 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.	郑宝森, 史可梅, 邓迺封, 等. 神经阻滞与经皮电刺激治疗颈源性头痛的对照研究. 天津医科大学学报, 2002, 8(3): 344-346.
17.	王威, 王保国, 刘延青, 等. 不同神经阻滞方法治疗颈源性头痛的疗效观察. 中国康复医学杂志, 2005, 20(8): 585-588.
18.	申颖, 白莺, 金旭, 等. 甘油果糖复合神经阻滞治疗颈源性头痛的临床观察. 中国康复理论与实践, 2008, 14(6): 506-507.
19.	庄志刚, 王秀岩. 椎旁神经阻滞治疗颈源性头痛对比观察. 中国实用神经疾病杂志, 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. 刘兵, 梁新梅. 颈源性头痛及其神经阻滞疗法. 中国疼痛医学杂志, 2009, 15(6): 363-365.
8. 谭冠先. 神经阻滞疗法. 见: 谭冠先, 主编. 疼痛诊疗学. 第2版. 人民卫生出版社, 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. 郑宝森, 史可梅, 邓迺封, 等. 神经阻滞与经皮电刺激治疗颈源性头痛的对照研究. 天津医科大学学报, 2002, 8(3): 344-346.
17. 王威, 王保国, 刘延青, 等. 不同神经阻滞方法治疗颈源性头痛的疗效观察. 中国康复医学杂志, 2005, 20(8): 585-588.
18. 申颖, 白莺, 金旭, 等. 甘油果糖复合神经阻滞治疗颈源性头痛的临床观察. 中国康复理论与实践, 2008, 14(6): 506-507.
19. 庄志刚, 王秀岩. 椎旁神经阻滞治疗颈源性头痛对比观察. 中国实用神经疾病杂志, 2011, 14(4): 12-13.

《中国循证医学杂志》

神经阻滞疗法治疗颈性疼痛疗效及安全性的系统评价

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《中国循证医学杂志》

神经阻滞疗法治疗颈性疼痛疗效及安全性的系统评价

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