探讨剪切波弹性成像(SWE)评价舒筋利节推拿法治疗慢性非特异性颈痛(CNNP)的临床价值。

本研究为前瞻性随机对照研究。选择2024年2月至2025年12月济宁医学院附属医院康复医学科60例CNNP患者，采用随机数字表法分为推拿组(n＝30)与对照组(n＝30)。两组均给予磁热振疗法联合双氯芬酸二乙胺乳胶剂外用治疗；推拿组在此基础上加用舒筋利节推拿法。于治疗前、治疗后分别对两组行视觉模拟评分法(VAS)、颈椎功能障碍指数(NDI)评估；应用SWE测量两组患者两侧上斜方肌、头半棘肌、头夹肌、颈夹肌的肌肉平均杨氏模量(Y)值。分别采用独立样本t检验及配对样本t检验进行组间及组内比较；采用Pearson相关分析评估治疗前后各肌肉平均Y值下降幅度与VAS、NDI下降幅度的相关性。

治疗前，推拿组与对照组各肌肉平均Y值、VAS及NDI比较，均差异无统计学意义(均P > 0.05)。治疗后，推拿组VAS、NDI及上斜方肌、头半棘肌、头夹肌、颈夹肌平均Y值分别为(1.83±0.79)分、(6.80±1.47)分、(12.50±3.70)kPa、(12.18±4.71)kPa、(9.84±3.39)kPa、(12.40±4.13)kPa；对照组分别为(2.77±0.68)分、(10.20±2.37)分、(17.59±4.28)kPa、(15.31±4.90)kPa、(15.00±3.58)kPa、(15.00±3.79)kPa，均较治疗前减小，均差异有统计学意义(均P<0.01)。两组治疗前后上斜方肌、头半棘肌、头夹肌和颈夹肌的平均Y值、VAS及NDI比较，均差异有统计学意义(均P<0.01)。Pearson相关性分析显示，治疗前后VAS下降幅度与上斜方肌、颈夹肌平均Y值下降幅度呈低强度的正相关(r＝0.356，0.268；均P<0.05)；与头半棘肌、头夹肌平均Y值下降幅度呈中等强度的正相关(r＝0.542，0.480；均P<0.01)。NDI下降幅度与上斜方肌、头半棘肌、头夹肌、颈夹肌平均Y值下降幅度均呈中等强度的正相关(r＝0.465，0.685，0.578，0.540；均P<0.01)。

舒筋利节推拿法可有效降低CNNP患者颈部肌群的肌肉硬度，减轻疼痛。SWE能较好地评价舒筋利节推拿法治疗CNNP的疗效。

To investigate the clinical value of shear wave elastography (SWE) in evaluating the therapeutic effect of Shujin Lijie tuina therapy on chronic nonspecific neck pain (CNNP).

This was a prospective randomized controlled study. A total of 60 patients with CNNP were recruited from the Department of Rehabilitation Medicine, Affiliated Hospital of Jining Medical University between February 2024 and December 2025. The patients were randomly divided into a tuina group (n=30) and a control group (n=30) by the random number table method. Both groups received magneto-thermo-vibration therapy combined with topical diclofenac diethylamine emulsion. On this basis, the tuina group additionally received Shujin Lijie tuina therapy. Visual analogue scale (VAS) and neck disability index (NDI) were assessed before and after treatment. SWE was applied to measure the mean Young modulus (Y) values of bilateral upper trapezius, semispinalis capitis, splenius capitis and splenius cervicis muscles. Independent samples t-tests and paired samples t-tests were used for between-group and within-group comparisons, respectively. Pearson correlation analysis was performed to evaluate the correlations between the reduction magnitude of mean muscle Y values and the reduction magnitudes of VAS and NDI before and after treatment.

Before treatment, no significant differences were observed between the tuina and control groups in the mean Y values of all evaluated muscles, VAS, and NDI (all P > 0.05). After treatment, the VAS scores, NDI, and the mean Y values of the upper trapezius, semispinalis capitis, splenius capitis, and splenius cervicis muscles were (1.83±0.79), (6.80±1.47), (12.50±3.70) kPa, (12.18±4.71) kPa, (9.84±3.39) kPa, (12.40±4 13) kPa in the tuina group, and (2.77±0.68), (10.20±2.37), (17.59±4.28) kPa, (15.31±4.90) kPa, (15.00±3.58) kPa, (15.00±3.79) kPa in the control group, respectively. All these parameters decreased significantly compared with their baseline values in both groups (all P<0.01). Furthermore, significant differences were observed between the two groups after treatment regarding the mean Y values of the four aforementioned muscles, as well as the VAS scores and NDI (all P<0.01). Pearson correlation analysis revealed that the reduction amplitude of VAS was weakly positively correlated with those of mean Y values of upper trapezius and splenius cervicis (r=0.356, 0.268, all P<0.05), and moderately positively correlated with those of semispinalis capitis and splenius capitis (r=0.542, 0.480, all P<0.01). The decrease in NDI was moderately positively correlated with the reduced mean Y values of upper trapezius, semispinalis capitis, splenius capitis and splenius cervicis (r=0.465, 0.685, 0.578, 0.540, all P<0.01).

In conclusion, the Shujin Lijie tuina therapy can effectively reduce muscle stiffness in cervical muscles and alleviate pain in patients with CNNP. Furthermore, SWE serves as a reliable objective tool for evaluating the therapeutic efficacy of this intervention.