Effects of acupotomy on the activity of osteoclasts and osteoblasts in the subchondral bone of rabbits with early and mid-stage knee osteoarthritis models

Objective:To investigate whether acupotomy could inhibit subchondral bone remodeling in knee osteoarthritis(KOA)rabbits by regulating the activity of osteoblasts and osteoclasts.Methods:KOA rabbits were prepared by immobilization for 6 and 9 weeks by Videman method.Nine groups of rabbits(control,6 weeks and 9 weeks model,6 weeks and 9 weeks acupotomy,6 weeks and 9 weeks electroacupuncture,and 6 weeks and 9 weeks drug groups)received acupotomy,electroacupuncture and risedronate sodium intervention,respectively,for 3 weeks.Results:Acupotomy can inhibit the activity of osteoclasts and osteoblasts in subchondral bone by reducing the proteins expression of cathepsin K(CK)and tartrate-resistant acid phosphatase(TRAP)and decreasing the proteins expression of osteocalcin(OCN)and alkaline phosphatase(ALP),to intercept the abnormal bone resorption and bone formation of subchondral bone in 6-week and 9-week immobilization-induced KOA rabbits.Conclusion:These findings indicated that acupotomy may be more advantageous than risedronate sodium intervention in modulating subchondral bone remodeling in KOA rabbits,especially in 9-week immobilization-induced KOA rabbits.

Clinical Study on the Acupotomy for Iliotibial Band Release in the Treatment of Valgus Knee Osteoarthritis

[Objectives]To observe the clinical effect of acupotomy for iliotibial band release in the treatment of valgus knee osteoarthritis.[Methods]Sixty patients with mild valgus knee osteoarthritis who met the inclusion criteria were randomly divided into control group(n=30)and treatment group(n=30).The control group was treated with celecoxib capsule,and the treatment group was treated with acupotomy.The visual analogue score(VAS),modified American knee society score(KSS)and anatomic valgus angulation(AVA)were observed and compared between the two groups before and after treatment to evaluate the curative effect.[Results]Compared with those before treatment,there were significant differences in VAS and KSS between the two groups after treatment(P<0.05).There was no significant difference in AVA between the two groups before and after treatment.There were significant differences in the above-mentioned indexes between the two groups(P<0.05).The comprehensive curative effect of the treatment group was better than that of the control group(P<0.05),and there was significant difference between the two groups one month after treatment(P<0.05).[Conclusions]The acupotomy for iliotibial band release was effective in the treatment of valgus knee osteoarthritis,and it was found to delay the progression of knee valgus deformity through long-term observation.

Ultrasound guided acupotomy in treating rhomboid muscle and serratus posterior superior muscle injury:a case report

Objective:The study intended to show us the effect and safety associated with ultrasound-guidance during acupotomy treatment by a case report.Methods:The research presented a case study using ultrasound-guided acupotomy in back pain.The study took place in the Department of Acupuncture and Moxibustion,China-Japan Friendship Hospital.A 56-year-old woman with paroxysmal right upper back pain for more than 10 years,who was diagnosed as the rhomboid muscle and serratus posterior superior muscle injury.Results:After two acupotomy treatments,the Visual Analogue Score(VAS)of the patient declined from7 to 2.One month later,the pain disappeared and the patient was satisfied with it.Conclusion:Ultrasound guidance can be used to observe the anatomical structures clearly to improve the safety of acupotomy treatment.

Clinical Study of Acupotomy Trinity Lysis on Cervical Spondylotic Myelopathy with Liver and Kidney Deficiency Syndrome

Objective:To compare the therapeutic effects of acupotomy trinity lysis and traditional acupotomy on cervical spondylotic myelopathy.Methods:A total of 205 patients with cervical spondylotic myelopathy of liver and kidney deficiency syndrome were randomly divided into the experimental group(105 cases)and the control group(100 cases).The experimental group was relaxed with acupotomy in three positions:Heaven(tian),Human(ren)and Earth(di).Traditional acupotomy was used to relax Ashi acupoints of the affected vertebra in the control group.One treatment was conducted in one week,and the duration of one course of treatment was three weeks.The VAS,JOA score and NDI index were observed after treatment.Results:Before and after treatment,the total treatment efficiency of the treatment group was 95.23%,and that of the control group was 80.00%,there was significant difference between the two groups,P<0.05;Before operation,there was no significant difference in JOA score,NDI index score,and VAS score between the treatment group and the control group(P>0.05);there was no significant difference after 1 week(P>0.05),but there were significant differences between the two groups 2 weeks and 3 weeks after operation(P<0.05).Conclusion:Acupotomy trinity lysis is a safe,effective and economical treatment for cervical spondylotic myelopathy.

Clinical Study of Acupotomy Trinity Lysis Combined with Rehabilitation Training for Spastic Paralysis after Stroke

Objective:To study the clinical efficacy of acupotomy trinity lysis combined with rehabilitation training in the treatment of spastic paralysis after stroke,and to provide guidance for clinical diagnosis and treatment.Methods:From July 2019 to November 2020,119 patients with post-stroke spastic paralysis who were admitted to our hospital's encephalopathy department were selected as the research objects,and 61 patients were divided into acupuncture combined with rehabilitation training group as the observation group by random number table method.58 patients were divided into the rehabilitation training group as the control group.After 21 days of treatment,they passed the modified Ashworth Spasm Scale(MAS)grading scale score,Clinical Spasm Index(clinical spasm index,CSI)assessment,Fugl,Meyer exercise function scale(FMA)Score,Modified Barthel Index Score,and compare the clinical efficacy after treatment.Results:After treatment,the total effective rate of the observation group(95.08%)was higher than that of the control group(86.21%),and the difference was statistically significant(P<0.05);Before treatment,the contrast difference of MAS,FMA,CSI scores and modified Barthel index scores of the two groups of patients is not statistically significant;After treatment,the MAS scores and CSI scores of the elbow and knee joints of the observation group[(1.52±0.81)(1.46±0.83)(5.87±2.12)]were significantly lower than those of the control group[(2.17±0.68)(2.03±0.79)(8.36±2.41)];FMA upper limb and lower limb scores and modified Barthel index[(51.87±4.41)(30.21±5.05)(72.41±5.81)]of the observation group were significantly higher than those of the control group[(44.26±4.78)(28.45±4.23)(68.65±6.09)],the difference was statistically significant(P<0.05).Conclusion:Acupotomy trinity lysis combined with rehabilitation training is effective in treating patients with post-stroke spastic paralysis.It provides a safe,reliable and clinically effective new program,which is worthy of popularization and application.

Effect of ultrasound-guided acupotomy vs electro-acupuncture on knee osteoarthritis:a randomized controlled study

OBJECTIVE:To investigate the effect of acupotomy on knee osteoarthritis(KOA),compared to electro-acupuncture(EA).METHODS:Sixty KOA patients were randomly divided into 2 groups:ultrasound-guided acupotomy group and EA group;each had 3 weeks' therapy.After the treatment,by contrast before and after therapy,by comparing curative effects among groups,we looked into disease improvement degree through activities of daily living score(ADL),hospital for special surgery index(HSS),visual analogue scales score(VAS) and knee joint's infrared thermal imaging detection.RESULTS:Graded by ADL,the excellent rate in acupotomy group was much higher than EA group;both acupotomy group and EA group had obviouschanges in HSS index before and after the therapy(P < 0.01).And there was remarkable difference in HSS index variation between the groups(P < 0.01).Acupotomy group and EA group showed big difference in pain index before and after treatment(P <0.01).Apparent difference also existed in the comparison among groups(P < 0.01).Both acupotomy group and EA group had apparent changes in infrared thermal imaging detection before and after the treatment(P < 0.01).CONCLUSION:Acupotomy and EA both have significant effects in KOA treatment;the former is better than the latter in relieving pain and improving knee functions.

Current Usage of Terminologies Related to Acupotomy: A Literature Research and Standardization Suggestion

Objective: To investigate the current usage of terminologies related to acupotomy through systematic search and analyze the pros and cons of each for proposing a standard terminology. Methods: Seven medical journal databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, KoreaMed, and Korean studies Information Service System using 10 candidate terminologies as searching terms. All studies published from their inception to July 26, 2017 were collected. Articles were included if the title stated one of the 10 candidate terminologies consistent with the definition of acupotomy. Priorly established frequency and consistency of each candidate terminology from medical databases were calculated and evaluated. Moreover, the pros and cons of each were analyzed to propose a standard terminology. Results: A total of 112 studies in English databases, 1,129 studies in Chinese database, and 44 studies in Korean databases were included. The most frequently used terminologies were needle knife(35.71%), acupotomy(48.54%) and acupotomy(90.90%) in English, Chinese and Korean database, respectively. Overall, acupotomy and needle knife were the most frequently used. Others like acupotomology, needle scalpel, miniscalpel acupuncture and miniscalpel needle were used within 10% of the total searched literature. Acupotome, stiletto needle, sword like needle, and Xiaozhendao were rarely used. Acupotomy had the advantages of high frequency and consistency but lacked representativeness. Needle knife also showed a high frequency, but the consistency was poor. Though miniscalpel acupuncture and miniscule needle were used less frequently, they had advantages of inclusiveness and clarity. Conclusions: A debate for standardization of the terminology is necessary. This preliminary research can provide a basic outline for the standardization consensus process, and we believe it is noteworthy to discuss miniscalpel needle and miniscalpel acupuncture along with acupotomy and needle knife on the subject.

Safety of acupotomy in a real-world setting:A prospective pilot and feasibility study

Objective:Acupotomy is a modern acupuncture method that includes modern surgical methods.Since acupotomy is relatively more invasive than filiform acupuncture treatment,it is important to establish the safety profile of this practice.To justify further large-scale prospective observational studies,this preliminary study was performed to assess the feasibility of the approach and investigate the safety profile and factors potentially associated with adverse events(AEs).Methods:This was a prospective pilot study that assessed the feasibility of a large-scale forthcoming safety study on acupotomy treatment in a real-world setting.The feasibility(call response rate,dropout rate,response rate for each variable and recruitment per month)and safety profile(incidence,type,severity and causality of AEs,and factors potentially associated with AEs)were measured.Results:A total of 28 participants joined the study from January to May 2018.A follow-up assessment was achieved in 258(1185 treatment points)out of 261 sessions(1214 treatment points).The response rate via telephone on the day after treatment was 87.3%.There were 8 systemic AEs in all the sessions(8/258;3.11%)and 27 local AEs on the total points treated(27/1185;2.28%).Severe AEs did not occur.Total AE and local AE occurrence were associated with blade width and the number of needle stimulations per treatment point.Conclusion:The findings suggest that it could be feasible to analyze the safety of acupotomy in a realworld setting.Moreover,the primary data on some relevant AEs could be determined.We are planning large-scale prospective studies based on these findings.Trial registration:Clinical Research Information Service(CRIS)KCT0002849(https://cris.nih.go.kr/cris/search/detailSearch.do/11487).

Applied anatomy of intrusive operations of lumbar intervertebral foramen

Objective:To provide anatomical datum for intrusive operations of lumbar intervertebral foramen,especially that using acupuncture-knife as intrusive tool.Methods:To dissect 10 antisepsis cadavers and observe the exposed blood vessels,ligaments,nerves and their adjacent relations in L1/2~L5/S1intervertebral foramen.Results:Lumbar intervertebral foramen exit zones were almost sealed by nerves and blood vessels.There were two zones with relatively no blood vessel and nerve(triangular working zones)located in the midpoint of the distance between two adjacent roots of transverse processus,and clung to lamina of vertebral arch,and they were also found upon the margo superior of the root of transverse processus,but the ascending lumbar vein or(and)the rami anastomoticus between the remi inferior of intervertebral vein and lumbar veins were observed in 12%triangular working zones upon the margo superior of root of transverse processus.Conclusions:"Triangular working zone"was relatively avascular zone.Pay attention to the possibilty of presence of blood vessels on the entrance passage of intrusive operations on lumbar side rear.The needlepoint should be pierced at the midpoint of the distance between two adjacent roots of transverse processus and cling to the outer edge of lamina of vertebral arch when doing the foraminal lumbar puncture.As lumbar intervertebral foramina exit zone was almost sealed by nerves and blood vessels,blind incising and debonding with acupuncture-knife in this area was relatively much more dangerous.

运用蛋白质组学技术探讨针刀抗KOA兔软骨细胞凋亡的作用机制

ObjectiveTo elucidate the mechanism underlying the inhibitory effect of acupotomy on chondrocyte apoptosis in rabbits with knee osteoarthritis (KOA) through screening, analysis, and verification of apoptosis-related differentially expressed proteins via proteomics.MethodsThirty New Zealand white rabbits were randomly divided into the normal, model, and acupotomy groups, with 10 rabbits in each group. The Vidman method was used to prepare KOA models in the model and acupotomy groups. In the acupotomy group, acupotomy was performed at the midpoints of the patellar ligament and medial and lateral collateral ligaments on the left knees once a week for three weeks. Rabbit articular cartilage protein was quantified in each group, and the proteins with differential expression were profiled via proteomics. The apoptosis-related proteins were further screened, and differentially expressed proteins common among the normal, model, and acupotomy groups were collected for cluster analysis. Pathological changes in chondrocytes were observed via HE staining, and chondrocyte apoptosis was observed under an electron microscope. Quantitative real-time PCR (RT-PCR) and western blot were performed to determine the mRNA and protein expression levels, respectively, of the common apoptosis-related proteins in the three groups.ResultsWestern blot and RT-PCR showed that the protein and mRNA expression levels of TXN, CAP1 and FABP3 were lower (all P < 0.05), whereas that of LTF, SCIN and IL-10 were higher (all P < 0.01) in the acupotomy group than that in the model group.ConclusionThe antiapoptotic effect of acupotomy on chondrocytes in KOA rabbits may be achieved by modulating the protein and mRNA expression of differentially expressed apoptosis-related proteins (TXN, CAP1, FABP3, LTS, SCIN, and IL-10).

不同针法分期治疗肩关节周围炎90例

Objective:To observe the clinical efficacy of different acupuncture modalities in the treatment of adhesive capsulitis a tthrough different clinical stages.Methods:Ninety patients of adhesive capsulitis weregraded in three different stages based on clinical presentations.Patients in painful stage were treated with silver needles once every 5 to 7 days for two courses;patients in adhesive stage were given acupotomy treatment every 7 to 10 days for two courses;while patients in recovery stage were treated with acupuncture with warm needles by moxibustion on tendon knots,once a day 10 times in a course,for two courses of treatment.The disease scores were compared between all groups before and after the treatment,and clinical efficacy was evaluated after the treatment.Results:The disease scores in patients of all three stages were higher after treatment,and the differences were statistically significant(all P<0.05).Among 90 patients with adhesive capsulitis,32 cases were clinically under controlled,37 cases claimed remarkably effective,18 were effective,and 3 ineffective cases,thus the total effective rate for this stage-based treatment is 96.7%.Conclusion:For adhesive capsulitis,different acupuncture modalities targeting patients in different clinical stages were feasible and effective,the disease scores of patients were significantly improved.

整体分层针刀疗法对KOA患者下肢功能及滑囊液MMP1、MMP13的影响——随机临床试验

Objective:To observe the differences in clinical effect on knee osteoarthritis(KOA)between the holistic stratification acupotomy and the joint injection with sodium hyaluronate so as to provide a safe and effective treatment for KOA.Methods:A total of 100 KOA patients were randomly divided into an acupotomy group and a sodium hyaluronate group,50 patients in each one.In the acupotomy group,the holistic stratification acupotomy was adopted.In the sodium hyaluronate group,sodium hyaluronate injection was applied in the joints.The index of Western Ontario and McMaster University(WOMAC)and the expressions of MMP1 and MMP13 in bursal fluid of the patients were compared before and after treatment in the patients between two groups before and after treatment,and the clinical therapeutic effect was observed.Results:After treatment,WOMAC score of each dimension and the concentrations of MMP1 and MMP13 in bursal fluid of the patients of either group were all lower than those before treatment(all P<0.05).After treatment,WOMAC score of each dimension and the concentrations of MMP1 and MMP13 in bursal fluid in the acupotomy group were lower than the sodium hyaluronate group(all P<0.05).The total effective rate in the acupotomy group was higher than that of the sodium hyaluronate group(P<0.05).Conclusion:Both the holistic stratification acupotomy and the joint injection with sodium hyaluronate are effective on KOA in this trial.However,the therapeutic effect of holistic stratification acupotomy is remarkable,which is probably related to the improvements in inflammatory response.

冻结肩中喙突疼痛针刀治疗不同技法临床疗效观察

Objective:To explore the manipulation techniques of acupotomy in treatment of coracoid pain of frozen shoulder.Methods:A total of 60 patients with coracoid pain of frozen shoulder were collected.The randomized double-blind controlled method was adopted.Using random number table,the patients were divided into two groups,named a treatment group and a control group,30 cases in each one.In the treatment group,the pricking technique of acupotomy was adopted.In the control group,the traditional dissection technique of acupotomy was used.The duration of treatment was 5 weeks.Acupotomy was given once a week.At the end of treatment,pain index(visual analogy scale,VAS)and the therapeutic effect index were used to evaluate the therapeutic effect.Results:Before treatment,the average VAS score was 8.31±0.84 in the treatment group and it was 8.14±0.24 in the control group.After treatment,the average VAS score was 0.01±0.89 in the treatment group and it was 0.10±1.01 in the control group.The difference was significant before and after treatment in the patients of the two group(both P<0.05).The difference before and after treatment was not significant between the two groups.The effective rate was 100%and the remarkably effective rate was100%in either the treatment group or the control group.Conclusion:The pricking technique of acupotomy achieves the same therapeutic effect on coracoid pain of frozen shoulder as compared with the dissection technique,which suggests that the dissection technique is not the indispensable manipulation in the treatment of the disease.The pricking technique of acupotomy brings a smaller wound,less medical damage in,less suffering in patients and quicker recovery of wound,as well as quicker remission of pain after acupotomy.Such modified method of acupotomy is more significant in practice.However,a further research is suggested for the pathological mechanism of frozen shoulder.

Clinical Efficacy and Safety of Miniscalpel-Needle Treatment for Tension-Type Headache:A Systematic Review and Meta-Analysis

Objective:To investigate the clinical efficacy and safety of miniscalpel-needle(MSN)treatment for tension-type headache(TTH).Method:Seven medical databases were searched to identify randomized controlled trials(RCTs)evaluating the effect and safety of MSN treatment.All articles published up to November 15,2018 were retrieved.A meta-analysis was conducted for the included studies,and the risk of bias was assessed.Primary outcomes were visual analogue scale(VAS)or numeric rating scale(NRS)score.Secondary outcomes were clinical effective rates including total effective rate(TER),markedly effective rate(MER),and totally cured rate(TCR)determined by improvement in clinical symptoms or VAS scores,the frequency of adverse events(AEs)that occurred during the study,and participant quality of life(QOL).Results:Seven RCTs involving 724 participants were included.MSN treatment showed significantly higher MER and TCR[relative risk(RR)1.27,95%confidence interval(Cl)1.01 to 1.61;RR 1.31,95%Cl 1.09 to 1.57,respectively],but not TER(RR 1.03,95%Cl 0.96 to 1.10)compared to acupuncture.MSN treatment plus conventional treatment showed significant lower VAS and higher TER,MER,and TCR(mean difference-3.54,95%Cl-3.80 to-3.28;RR 1.14,95%Cl 1.06 to 1.23;RR 2.31,95%Cl 1.50 to 3.58;RR 3.01,95%Cl 2.25 to 4.02,respectively)compared to conventional treatment.Conclusions:According to current evidence,MSN treatment as a monotherapy or as an adjunctive treatment to other existing treatments might have benefits on treating TTH.However,since the number and the sample size of studies included were both small and the methodological quality was poor,the findings of this review should be interpreted with great caution,and our confidence in the results is low.A high quality RCT using objective outcomes should be performed on this topic.