以吞咽困难为主要表现的弥漫性特发性骨质增生症一例报告

临床资料
　　患者，男，70岁，主诉吞咽不适感伴颈部酸痛2年，加重1个月入院。患者于2年前自感吞咽硬食时咽部不适，于当地医院行胃食管镜检查，未见明显阳性结果。于同期出现颈部酸痛感，偶有双侧手指指端麻木感，无明显上肢放射痛及“踩棉花感”。患者于入院前1个月吞咽不适感明显加重，进食时出现食物咽部“停留”感，仅能进软食或流食。遂就诊于我院门诊，行颈椎X线检查示C2～6多节段融合，C2～6前方巨大骨赘形成。门诊以“食管型颈椎病”收入院。患者既往2型糖尿病史10余年，应用胰岛素治疗；既往高血压病史4年余，血压控制可。查体：患者颈部外观未见明显异常，嘱患者做吞咽动作，轻压甲状软骨可诱发明显咽部不适。颈椎无明显压痛，双上肢肌力及感觉正常，上肢腱反射正常，Hoffman征(-)。余查体未见明显阳性体征。辅助检查：颈椎侧位X线示(图1a)：颈椎前方C2～6“流注样”骨化影，诸椎间盘高度未见明显改变，关节突关节未见明显异常。CT示(图1b)：C2～6椎体前方连续但不规则高密度骨化影。骨化物在C4椎体前方突出明显，压迫前方软组织。颈椎MRI示(图1c)：颈椎前方-气管后缘C2～T1异常信号；未见明显椎管狭窄及脊髓压迫。

颈部疼痛

颈部疼痛通常指非特异性颈痛或单纯颈痛(nonspecific or simple neck pain)[1],是骨科临床上常见的疾病之一.颈痛的发生往往没有外伤史,而是因为姿势原因或机械应力劳损所致,但具体的原因并不明确,更多地认为颈痛的发生是多因素作用的结果.颈痛的发生率仅次于非特异性腰痛(non specific back pain).在西方发达国家,随着现代社会工作方式和生活方式的变化,尤其是电脑的使用和文案工作的普及,颈痛的发生率逐年增加,女性约为17％,男性为14％[2].在我国,虽然缺乏相应的流行病学统计数据,但在城市工作的人群发生率相当高,几乎成为都市白领的职业病,且发生人群有年轻化的趋势.

Objective: To observe the therapeutic effect of acupuncture plus psychological intervention for postpartum depression.
Methods: By random number table, 85 patients with postpartum depression were divided into a treatment group and a control group. Forty-three cases in the treatment group were treated by acupuncture plus psychological intervention, once every day, five sessions per week, and rest at weekend. Forty-two cases in the control group were treated by oral administration of Fluoxetine Hydrochloride, 20 mg, once per day. The two groups were treated continuously for six weeks. The change of the score in Hamilton depression scale (HAMD) was observed and the therapeutic effect was summarized.
Results:The total effective rate was 90.7%in the treatment group and 90.5% in the control group. The difference in the total effective rate between two groups was not statistically significant (P>0.05). In the intra-group comparisons of HAMD scores two, four and six weeks after treatment in both groups with those before treatment, the differences were statistically significant (all P<0.05). In comparison between the two groups at the same time point, the differences in HAMD scores were not statistically significant (all P>0.05). Regarding the adverse events, 5 cases had nausea, 3 cases had dizziness, and 6 cases had poor appetite in the control group; no obvious adverse events happened in the treatment group.
Conclusion:Acupuncture plus psychological intervention for postpartum depression is as same as oral administration of Fluoxetine Hydrochloride in therapeutic effects, but it does not have adverse reaction.

Objective: To observe the clinical effect of tuina combined with auricular point sticking on cervical radiculopathy and evaluate in health economics.
Methods: Using randomized single-blind controlled clinical design, a total of72 cases with cervical radiculopathy were randomly allocated into an observation group or a control group by the ratio of 1:1, 36 in each group. Cases in the observation group were treated with tuina combined with auricular point sticking, whereas cases in the control group were treated with tuina alone. Then the clinical effects in the two groups were observed and the cost of health economics was evaluated.
Results: The drop-out, recovery, improvement and failure cases, recovery rate and total effective rate in the observation group were 1, 15, 20, 0, 42.9% and 100% respectively, versus 2, 6, 23, 5, 17.6% and 85.3% in the control group, showing significant differences in recovery rate and total effective rate (P<0.05). As for health economics, the cost-effect in the observation group was better than that in the control group.
Conclusion: Compared with tuina alone, tuina combined with auricular point sticking can obtain better effect and lower cost in health economics for cervical radiculopathy.

Objective: To observe the therapeutic efficacy of acupuncture combined with hyperbaric oxygenation for cervical spondylosis of nerve root type in acute phase.
Methods: One hundred cases with cervical spondylosis of nerve root type in acute phase were randomly divided into two groups, with 50 patients in each group. The patients in the treatment group were treated by acupuncture combined with hyperbaric oxygenation, and those in the control group only received the same acupuncture therapy as the treatment group. The therapeutic efficacy was evaluated after 2 courses of treatment.
Results: In the treatment group, 27cases were cured, 9 cases showed markedly effective, and 4 cases were invalid, and the recovery rate was 67.5%, the total effective rate was 90.0%; in the control group, 18 cases were cured, 17 cases showed markedly effective, 15 cases were invalid, and the recovery rate was 36.0%, the total effective rate was 70.0%. There were statistically significant differences between two groupsin the recovery rate and the total effective rate (bothP<0.05). The average cure time of the treatment group was (15.56±7.13) d, and that of the control group was (22.13±7.78) d, which also had significant difference between the two groups (P<0.05).
Conclusion: Acupuncture combined with hyperbaric oxygenationhas rapid and reliable effects for cervical spondylosis of nerve root type in acute phase.

Objective:To observe the clinical effect of‘setting fire on the mountain’ manipulation by Lu Shou-yan for cervical radiculopathy as well as the infrared thermographic changes of the cervical area before and after treatment.
Methods:A total of 120 eligible cases with cervical radiculopathy were randomly allocated into an observation group and a control group, 60 in each group. Cases in the observation group were treated with Lu Shou-yan’s ‘setting fire on the mountain’ manipulation, whereas cases in the control group were treated with even reinforcing-reducing manipulation. After two courses of treatment, the infrared thermographic changes and overall therapeutic efficacies in the two groups were compared.
Results: The recovery rate and total effective rate in the observation group were 68.3%and 98.3%respectively, versus 28.3%and 81.7%in the control group, showing statistical differences in recovery rate and total effective rate (both P<0.01). There was between-group statistical significance in comparing the infrared thermography after treatment (P<0.01).
Conclusion:‘Setting fire on the mountain’ manipulation by Lu Shou-yan is better than even reinforcing-reducing manipulation for cervical radiculopathy.