The Clinical Study Of Cervical Spondylotic Radiculopathy Recurrence And It's Related Factors

At present, cervical spondylosis (CS) incidence rate is 3.8%-17.5%, in which cervical spondylotic radiculopathy (CSR) is accounting for 60%. The treatment of CS can be divided into surgical and non-surgical therapy (drugs, traction, manipulation, physical therapy, exercise, etc). Most of CSR patient become recover after treated by non-surgical therapy. And there are many advantages in non-surgical therapy, which is a variety and curative effect, simple, inexpensive, safe and so on. However, there are some deficiencies in non-surgical therapy, which is backward research methods, lacking standardization, low effective rate, high recurrence rate and so on. We take the national study projects in the Tenth Five-year Plan and the national study projects in the Eleventh Five-year Plan, establish operating norms of rotation-traction manipulation and Traditional Chinese Medicine combined therapy program, verify their efficacy and safety. In this study, CSR patients were followed up from 2006-2009, we observe CSR recurrence standard and it's related factors, and set up control programme of CSR recurrence.We hope to make probe by two clinical studies:①to set up CSR recurrence standards;②to analyze CSR recurrence related factors;③to set up cervical rehabilitation gymnastics;④to put forward lifestyle instructor of CSR patient.Clinical data1 Case sourceTo chose 210 cases of CSR patient were up to the study, who were divided into two groups:testing group (106 cases) and control group (104 cases) and treated for 2 weeks.164 effective patients (97 cases of testing group,67 cases of control group) were followed up in 1 month after treatment,3 months,6 months,3 years.2 General Information 164 cases of CSR patient be up to the study mustard, male 72, female 92; patients'age from 45 years to 65 years; patients'course of disease from 15 days to 5 years.3 Cases of selectDiagnosis of CSR according to CS diagnostic standards of Second National academic conference about CS in 1992. And setting up selected standards of case, excluded standards of case, falled off standards of case, eliminateed standards of case, stoped standards of case, qiuted standards of case,.Research Methods1 RandomizedWith the central random arrangement,210 cases of CSR patient were divided into two groups:testing group (106 cases) and control group (104 cases). Two groups of There are not significant difference between two groups'patients on gender, age, course of disease and so no.2 TreatmentsTesting Group (group A) were treated with rotation-traction manipulation, control group (group B) was treated with neck traction.3 To set up CSR recurrence form of patients self-evaluation4 Symptoms and signs score, effect assessmentWith CSR assessment system (35 score value method).5 Follow-upCSR patients filled in CSR recurrence form of patients'self-evaluation, which wre tightly closed. Patients were reserved to clinic, researchers evaluated the patient condition and filled in the CSR assessment system (35 score value method).6 Statistical analysisThe data was analysised and processed with SPSS for Windows Release 13.0 statistical package. Experimental data was indicated with mean±standard deviation (x±s), P<0.05 was considered significant statistical significance. Count data was tested byχ2 test, measurement data was tested by t test, ranked data was tested by Wilcoxon rank sum test. Related factors were tested by Logistic regression analysis.Result1 Clinical response after treatment The effective rate of test group is 91.51%, the effective rate of control group is 64.42%. There are statistically significant difference by Wilcoxon rank sum test, Z= 41.48, P= 0.000 <0.01. No adverse reactions'happened in two groups. Excluding invalid cases,164 effectual cases were evaluated on recurrence:testing group (97 cases) and control group (67 cases).2 Recurrent self-evaluation of testing group and control groupFollowing up in 1 month,3 months,6 months,3 years, CSR patients filled in CSR recurrence form of patients self-evaluation, there are statistically significant difference on recurrence rate at each time between the two groups, the two groups and the total at all time statistics, byχ2 test, P＜0.05.3 Recurrent self-evaluation of the different efficacy groupFollowing up in 1 month,3 months,6 months,3 years, CSR patients filled in CSR recurrence form of patients self-evaluation, there are statistically significant difference on recurrence rate at each time between the different efficacy group, the different efficacy group and the total at all time statistics, byχ2 test, P<0.05. The recurrence rate is higher in patients of markedly effective group and effective group. The recurrence rate is lower in patients recovery group, only one patient was precurrence within 3 years.4 According to CSR assessment system decreased recurrence assessedAccording to cervical nerve root ganglion segment examination, there were 5 patients (lin 6 months,4 in 3 years) different segments of the original disease on cervical nerve root ganglion segment. They are new cases of other nerve root ganglion segments CSR, but are not recurrence case. So, there are 43 recurrence cases in 6 months,60 in 3 years, and recurrence rates were 26.22%,36.59%.After treatment, effective CSR patients who have clinical manifestation on the same cervical nerve root ganglion segment during follow-up period, and efficacy index decreased by 10%,20%,30%,40%,50%,60%,70%,80%,90%,100% than the efficacy index at the end of the last course of treatment, are confirmed as recurrence CSR. To evaluate the recurrence rates in 3 years, the standard of efficacy index decreased by 30% than the efficacy index at the end of the last course of treatment, can distinguish recurrence or non-recurrence distinguish the most by receiver operator characteristic curve (ROC curve).5 The validity evaluation of the recurrence standard in efficacy index decreased by 30%Sensitivity (Sen)= 91.67%. Sen was 91.67%, indicating to efficacy index decreased by 30% as the recurrence standard of CSR, which can diagnose correctly recurrence better.Specific rate (Spe)= 92.31%. Spe was 92.31%, indicating to efficacy index decreased by 30% as the recurrence standard of CSR, which can exclude non-recurrence better.Positive likelihood ratio (+LR)= sensitivity/(1-specificity)= 11.92Negative likelihood ratio (-LR)= (1-sensitivity)/specificity= 0.09+LR= 11.92> 10,-LR= 0.09＜0.10, efficacy index decreased by 30% as the recurrence standard of CSR, that is higher diagnostic value.6 The reliability evaluation of the recurrence standard in efficacy index decreased by 30%Agreement= 92.07%, Adjusted agreement=90.90%Those shows efficacy index decreased by 30% as the recurrence standard of CSR is high reliability.Observed agreement (Po)= 92.07%, Chance agreement (Pc)=53.11%Potential agreement beyond changce= 1-Pc= 46.89%Actual agreement beyond changce= Po-Pc= 38.96%Kappa value (K)= 83.09> 0.75.Those datas show efficacy index decreased by 30% as the recurrence standard of CSR could keep together better with patients self-evaluation.7 Analysis of the recurrence related factorsTo analyze the recurrence related factors by Logistic regression analysis, showing long bow desk work, a long time computer operation, driving time, pillow height, sitting, neck and shoulder exposure to cold, weight lifting, neck injury, myopia, emotional stress, physical exercise were selected the recurrence related factors.Conclusion1 There is significant effect in treating CSR by rotation-traction manipulation (markedly effective rate of 40.57%, efficiency 91.51%).2 The CSR recurrence rate of test group and control group is higher as longer time. And there is significant difference between the two groups.3 The recurrence rate is higher in patients of markedly effective group and effective group. The recurrence rate is lower in patients'recovery group. So, it's suggested that patients with clinical remission should continue treat in order to achieve recovery, reducing the recurrence rate.4 After treatment, effective CSR patients who have clinical manifestation on the same cervical nerve root ganglion segment during follow-up period, and efficacy index decreased by 30% than the efficacy index at the end of the last course of treatment, are confirmed as recurrence standard. It has a higher diagnostic value, high validity and reliability.5 Long bow desk work, a long time computer operation, driving time, pillow height, sitting, neck and shoulder exposure to cold, hand weights, neck injury, myopia, emotional stress, physical exercise were selected the recurrence related factors.Clinical data1 Case sourceTo chose 78 cases of CSR patient were up to the study, which were divided into two groups:testing group (39 cases) and control group (39 cases) and treated for 2 weeks. And they were follow up in 1 month after treatment,3 months,6 months.2 General Information78 cases of CSR patient be up to the study mustard, male 36, female 42; patients'age from 45 years to 65 years; patients'course of disease from 5 days to 5 years.3 Cases of select (the same with study one)Research Methods1 RandomizedWith the central random arrangement,78 cases of CSR patient were divided into two groups:testing group (39 cases) and control group (39 cases). Two groups of There are not significant difference between two groups'patients on gender, age, course of disease and so no.2 TreatmentTesting Group (group A) were treated with rotation-traction manipulation+Jingtong keli+ Cervical rehabilitation gymnastics, control group (group B) was treated with neck traction+Diclofenac Sodium Sustained Release Tablets+neck band.3 Symptoms and signs score, effect assessment (the same with study one)4 Follow-up (the same with study one)5 CSR life guidance6 Quality control during follow-up7 Statistical analysis (the same with study one)Result1 Clinical response after treatmentThe effective rate of test group is 94.87%, the effective rate of control group is 79.49%. There are statistically significant difference by Wilcoxon rank sum test, Z=-3.872, P= 0.000 <0.01. No adverse reactions happened in two groups. Excluding invalid cases,68 effectual cases were evaluated on recurrence:testing group (37 cases) and control group (31 cases).2 The recurrence rate of testing group and control groupFollowing up in 1 month,3 months,6 months, according to recurrence standard of CSR to judge recurrence rate of two group. There are statistically significant difference on recurrence rate at each time between the two groups, the two groups and the total at all time statistics, byχ2 test,P＜0.05.3 Analysis of CRG and CSR life guidanceAfter treatment, patients in two groups were followed up at 1 month,3 months,6 months. The patients of test group kept doing CRG well. The patients of two groups kept CSR life guidance well at the beginning, but kept CSR life guidance declinly later, and there are statistically significant difference in two groups.4 The relation recurrence and CRG,CSR life guidance during follow up timeThe recurrence patients of testing group focused on cases who kept CRG worse, and there were no recurrence patients in who kept CRG more 5 times per-week during 6 months follow-up period. The recurrence patients of control group focused on cases who kept CSR life guidance worse. Because of fewer cases, it was not statistically analyzed. Conclusion1 Cervical rehabilitation gymnastics can significantly improve the efficacy and reduce the recurrence rate, with strong scientificalness and feasibility.2 CSR life guidance include CSR recurrence-related factors comprehensive. CSR recurrence-related factors can assist prevention and cure CSR, with strong scientificalness and feasibility.3 The CSR prognosis study is important, but there are many problem, such as have many varieties influencing factor, low controllability, need further in-depth scientific study.