理筋拔戳揉捻法治疗肱骨外上髁炎的多中心临床研究

目的:探讨理筋拔戳揉捻法治疗肱骨外上髁炎(liater epicondylitis,LE)的临床疗效。方法:自2018年1月至2021年12月采用多中心随机对照研究方法,分别在中国中医科学院望京医院、北京电力医院、北京丰盛骨伤科专科医院收集LE患者192例,采用随机数字表法分为治疗组和对照组。治疗组96例,男36例,女60例;年龄28~60(41.20±5.50)岁;病程1~14(5.24±1.35)d;予理筋拔戳揉捻法配合肘关节练功法治疗,隔日1次,治疗2周。对照组96例,男33例,女63例;年龄26~60(43.35±7.75)岁;病程1~14(5.86±1.48)d,予外用扶他林配合护肘关节固定治疗,治疗2周。分别于治疗前及治疗后第1、3、5、7、11、13天比较疼痛视觉模拟评分(visual analogue scale VAS)、美国特种医院评分系统(Hospital for Surgery Scoring System,HSS)、肘关节旋前及旋后角度、腕关节掌屈及背伸角度、肘关节压痛,并比较治疗前及治疗结束后美国特种医院评分系统2(Hospital for Surgery Scoring System2,HSS2)肘关节评分。结果:所有患者获得随访,时间10~14(12.0±1.6)d。治疗组及对照组治疗前VAS分别为(6.83±1.36)、(6.79±1.58)分,末次治疗后降低至(1.49±1.09)、(2.11±1.81)分,其中治疗后第1、3、5、7、9、11、13天,治疗组VAS较对照组明显降低(P<0.05)。两组治疗前HSS评分分别为(61.73±11.00)、(36.47±12.45)分,末次治疗后提高至(94.42±5.90)、(91.44±9.11)分,其中治疗后第1、3、5、7、9、11、13天,治疗组HSS显著高于对照组(P<0.05)。治疗后第5天,治疗组肘关节外旋角度、内旋角度分别为(66.41±12.69)°、(66.35±13.54)°,对照组为(62.08±16.03)°、(61.77±16.35)°;治疗后第7天,治疗组肘关节外旋角度、内旋角度分别为(69.79±12.64)°、(70.02±13.55)°,对照组为(65.28±15.86)°、(65.09±16.67)°,以上时间点治疗组肘关节活动度大于对照组(P<0.05)。治疗后第5天,治疗组腕关节背伸、掌屈角度为(39.43±15.94)°、(46.68±11.10)°,对照组为(38.51±18.49)°、(44.27±13.58)°;治疗后第7天,治疗组腕关节背伸、掌屈角度分别为(42.52±16.50)°、(49.23±10.96)°,对照组为(41.18±20.09)°、(46.64±14.63)°;治疗组腕关节活动度大于对照组(P<0.05)。治疗后第13天,治疗组HSS2为(93.61±6.32)分,高于对照组(92.06±7.94)分(P<0.05)。两组各时间点肘关节压痛值比较,差异无统计学意义(P>0.05)。结论:扶他林外用联合肘部固定和理筋拔戳揉捻手法均能有效改善LE的症状,理筋拔戳揉捻手法较扶他林外用治疗具有止痛时间长和恢复肘关节功能更好的优势。

基于“动静结合,以动为主”的清宫正骨拔戳揉捻法治疗肱骨外上髁炎临床观察

目的观察基于“动静结合,以动为主”理论的清宫正骨拔戳揉捻法治疗肱骨外上髁炎(LE)的临床疗效。方法选取2020年10月—2021年12月中国中医科学院望京医院就诊的LE患者64例,随机分为手法组和对照组各32例。2组均予宣教和肘部练功法指导,手法组采用清宫正骨拔戳揉捻法治疗,3次/周,治疗4周;对照组采用双氯芬酸二乙胺乳胶剂外用并佩戴护肘制动,1次/d,治疗4周。对比2组在治疗前、治疗结束后即刻以及治疗完成后2个月的视觉模拟评分(VAS)、美国特种外科医院(HSS)评分以及肘部压痛阈值。结果与治疗前比较,2组治疗结束后即刻和完成后2个月的VAS评分、HSS评分、肘部压痛阈值均改善(P<0.05);与对照组比较,手法组治疗结束后即刻和完成后2个月的VAS评分、HSS评分及压痛阈值改善明显(P<0.05)。与治疗结束后即刻比较,手法组治疗完成后2个月的VAS评分差异无统计学意义(P>0.05),HSS评分及压痛阈值下降(P<0.05);对照组治疗完成后2个月的VAS评分升高,HSS评分及压痛阈值下降(P<0.05)。结论与外用非甾体抗炎药治疗比较,基于“动静结合,以动为主”理论的清宫正骨拔戳揉捻法可显著减轻LE患者肘关节疼痛,改善关节活动功能,治疗结束长时间后仍有较好的止痛效果。

海桐皮汤提取膏经皮给药对小鼠抗炎镇痛作用及机制研究

目的:探讨海桐皮汤提取膏经皮给药后对小鼠镇痛、抗炎作用的影响及其机制。方法:应用热板法、醋酸扭体实验以验证海桐皮汤提取膏对疼痛模型小鼠的镇痛作用;采用二甲苯致耳廓肿胀模型、角叉菜胶致右足肿胀模型,结合ELISA法测定小鼠血清中肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白介素1β(interleukin-1β,IL-1β)、白介素6(interleukin-6,IL-6)的水平,观察海桐皮汤提取膏对炎症模型小鼠的抗炎作用。结果:在镇痛方面,与模型组比较,工艺1组、工艺2组均可明显延长小鼠的热板痛阈值及扭体反应潜伏期(P<0.05),显著减少小鼠扭体的次数(P<0.001),且工艺1组的效果更明显(P<0.05);在抗炎方面,与空白组比较,模型组小鼠右后足肿胀度及肿胀率均明显增高(P<0.01),表明小鼠急性炎症造模成功。与模型组比较,工艺1组、工艺2组均能明显降低小鼠的足肿胀度和肿胀率(P<0.05),并降低小鼠的耳廓肿胀度,提升其肿胀抑制率(P<0.05),且工艺1组有效作用更显著(P<0.05)。与模型组相比,工艺1组可明显降低TNF-α、IL-1β的含量(P<0.01),与工艺2组相比,工艺1组可明显降低IL-1β含量(P<0.05)。结论:两种不同工艺制备的海桐皮汤提取膏经皮给药后对小鼠具有较好镇痛、抗炎作用,其作用机制可能与减少体内TNF-α、IL-1β、IL-6等促炎性细胞因子表达有关,且工艺1组抗炎镇痛效果优于工艺2组,可能与中药挥发油的单独提取、储存保证了挥发油较长时效的药理活性有关。

腰椎管狭窄所致神经性跛行的非手术干预:2021美国疼痛研究协会指南解读

腰椎管狭窄症(lumbar spinal stenosis,LSS)是引起神经源性跛行(neurogenic claudication,NC的主要原因,在老年人中较为常见,且发病率有增加的趋势。为了提供更加有效的LSS所致NC的非手术疗法,美国疼痛研究协会(United States Association for the Study of Pain)于2021年发布了新版循证临床实践指南。在充分研读最新版指南的基础上,结合临床新进展,并与2011年北美脊柱学会(North American Spine Society,NASS)指南(以下简称2011指南)和2019年丹麦卫生管理局(Danish Health Authority,DHA)指南(以下简称2019指南)进行比较,对LSS所致NC的临床诊治进行评述并提出建议。

Effect and Mechanism of Hai Tong-pi Decoction Ointment on Antiinflammation and Analgesia by Transcutaneous Administration in Mice

Objectve:To investigate the effect and mechanism of Hai Tongpi decoction ointment on analgesic and anti-inflammatory effects in mice after transdermal administration.Methods:The hot plate method and the acetic acid writhing experiment were used to verify the analgesic effect of Hai tong-pi extract on pain model mice;the xylene-induced auricular swelling model and the carrageenan-induced right foot swelling model were used,combined with the ELISA method to determine the analgesic effect.The levels of TNF-α,IL-1βand IL-6 in the serum of mice were observed.Anti-inflammatory effect of Haitongpi Tang decoction ointment on inflammation model mice.Results:In terms of analgesia,compared with the model group,both the treatment group 1 and the treatment group 2 can significantly prolong the hot plate pain threshold and the latency of the writhing response(P<0.05),and significantly reduce the writhing in the mice.The number of times(P<0.001),and the effect of process 1 is more obvious(P<0.05);In terms of antiinflammatory,compared with the blank group,the swelling degree and swelling rate of the right hind paw of the mice in the model group were significantly increased(P<0.01),indicating that the acute inflammation model was successfully established in the mice.Compared with the model group,both the process group 1 and the process group 2 can significantly reduce the swelling degree and swelling rate of the mice feet(P<0.05),and reduce the auricle swelling degree of the mice,and increase the swelling inhibition rate(P<0.05),and the effective effect of process 1 group was more significant(P<0.05).At the same time,compared with the blank group,the contents of TNF-α,IL-1βand IL-6 in the model group were significantly increased(P<0.01).Compared with the process group 2,the process group 1 had a more significant decrease in the content of IL-1β(P<0.05),and IL-6 content of the two had no statistical difference(P>0.05).Conclusion:The Hai tong-pi decoction ointment prepared by two different processes have good analgesic and antiinflammatory effects on mice after transdermal administration.inflammatory cytokine expression.The anti-inflammatory and analgesic effect of process group 1 was better than that of process group 2,which may be related to the separate extraction and storage of volatile oil of traditional Chinese medicine,which ensured the long-term pharmacological activity of volatile oil.