手术后和物理治疗后颈椎疾病患者的颈部相关头痛：前瞻性随机研究的 1 年随访。
Neck-Related Headache in Patients With Cervical Disc Disease After Surgery and Physiotherapy: A 1-Year Follow-up of a Prospective Randomized Study.
机构信息
Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden.
Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden.
出版信息
Spine (Phila Pa 1976). 2020 Jul 15;45(14):952-959. doi: 10.1097/BRS.0000000000003430.
STUDY DESIGN
A prospective randomized multicenter trial.
OBJECTIVE
To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain.
SUMMARY OF BACKGROUND DATA
The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging-verified disc disease is unknown.
METHODS
One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively.
RESULTS
Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups. Post-hoc tests showed a significant difference between baseline and 6 weeks (P ≤ 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, β = 0.40).
CONCLUSION
There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity.
LEVEL OF EVIDENCE
研究设计
前瞻性随机多中心试验。
目的
探讨术后结构性物理治疗与标准术后方法对颈椎病患者颈部相关头痛的影响。其次，探讨颈部相关头痛变化与颈部肌肉耐力、颈部活动度或颈部疼痛变化之间的关系。
背景资料摘要
由于磁共振成像证实的椎间盘疾病导致颈椎神经根病手术后接受物理治疗对颈部相关头痛患者的影响尚不清楚。
方法
共纳入 106 例颈部相关头痛且参与评估颈椎神经根病手术后物理治疗附加疗效的随机对照试验的患者。患者术前随机分为结构性术后物理治疗组（n = 51）或标准术后组（n = 55）。主要结局指标为头痛强度和颈部疼痛强度、颈部肌肉耐力和颈部活动度。术前及术后 6 周、3 个月、6 个月和 1 年均进行测量。
结果
两组患者的头痛强度均从基线显著改变至术后 1 年（P < 0.001）。事后检验显示，6 周时与基线相比有显著差异（P ≤ 0.05）。组间差异无统计学意义（P > 0.05），组间随时间变化的差异也无统计学意义（P > 0.05）。当前头痛强度随时间的变化与当前颈部疼痛强度随时间的变化相关（P = 0.003，β = 0.40）。
结论
颈椎病伴颈部相关头痛患者术后 1 年头痛强度显著改善，但组间随时间变化无差异。当前头痛强度的变化仅与当前颈部疼痛强度的变化相关。
证据等级
2。
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