Treatment of Protrusion of the Lumbar Intervertebral Disc by TCM Massage

Protrusion of the lumbar intervertebral disc is a common disorder frequently encountered in clinic. With TCM massage and the maneuver of manual reduction, we have treated 82 cases of protrusion of the lumbar intervertebral disc, with satisfactory therapeutic results reported in the following.……

Treatment of Protrusion of Lumbar Intervertebral Disc by Pulling and Turning Manipulations

The authors treated 62 cases of protrusion oflumbar intervertebral disc by pulling and turningmanipulations from February 1993 to February 1998.Another 50 cases were treated by traction as controls.Statistical data showed that pulling and turningmanipulations had much better therapeuticeffectiveness than traction(P<0.05).

Treatment of Protrusion of the Lumbar Intervertebral Disc by Massotherapy

Clinically, there is a higher incidence of protrusion of the lumbar intervertebral disc. It can cause a terrible pain. The author has treated 66 cases by massotherapy, who were confirmatively diagnosed as having protrusion of the lumbar intervertebral disc by X-ray film and computer-aided tomography, with satisfactory results as reported in the following.Clinical DataAmong the 66 cases in this series, 49 were male and 17 female, ranging in age from 26 to 59 years, averaging 36.2 years. All the patients had got lumbago and unilateral ischialgia, with the left side affected in 37 cases and the right side in 29 cases. The leg pain radiating to lateral malleolus was found in 28 cases, to dorsum of the foot in 24 cases, and to the toes in 14 cases. Intermittent claudication was present in 22 cases, numbness of the affected foot in 16 cases, pain exacerbated when coughing in 35 cases, scoliosis in 21 cases, and positive Lasegue's sign in 48 cases.

Treatment of Protrusion of the Lumbar Intervertebral Disc by Intravertebral Blocking and Massotherapy——A Report of 62 Cases

Protrusion of the lumbar intervertebral disc is adisease commonly encountered in orthopedics andtraumatology clinic.At present removal of thenucleus pulposus to relieve the compression on thenerve root is usually adopted in the treatment of thedisease.From April,1990 to October,1997,theauthor treated 62 cases of protrusion of the lumbarintervertebral disc by massotherapy afterintravertebral blocking,with satisfactory

Effect of siRNA interference on nerve growth factor in intervertebral disc inflammation rats

Objective:To investigate the inhibition effect of siRNA interference on NGF induced by inflammatory factor IL-6,and JUL—1 so as to provide novel targets for clinical treatment of discogenic low back pain.Methods:The intervertebral disc nucleus and annulus fibrosus cells of rats were separated-The cells were co-cultured with different concentrations(10 nmol/L,20nmol/L,50 nmol/L,100 nmol/L)of IL-6 and IL-1β.The NGF-siRNA was leaded into the cocultured cells with its import ability assessed by flow cytometry instrument tests,hefore and after which the NCF mRNA expression was detected by real-time Q-PCR and the NGF content was detected by ELISA.Results:Flow cytometry instrument test results showed that the NGFsiRNA cell conversion rate was 99.8%.Real-time Q-PCR detection results showed that compared with negative control group,the NGF mRNA expression of co-cultured cells treated by 10 nmol/L,20 nmol/L,50 nmol/L,100 nmol/L IL-6 and IL-1βwere respectively raised 3.4,3.7,4.7,3.7 times which were all significantly down-regulated after the import of NGF-siRNA.EILSA detection results showed that compared with negative control group,the NGF content of cocultured medium treated by 10 nmol/L,20 nmol/L,50 nmol/L,100 nmol/L I-L6 and IL-1βwere respectively raised 2.9,3.3,4.5,7.4 times which were all significantly decreased after the import of NGF-siRNA.Conclusions:These molecular biological results suggest that inflammatory factor IL-6 and IL-1βcould stimulate NCF on intervertebral disc cells in vitro culture model and its efficiency is concentration dependent,while siRNA interference can inhibit the stimulation effect of IL-6 and IL-1βon intervertebral disc cell,which provides a new targets for the clinical treatment of discogenic low back pain.

Fifty-six Cases of Protrusion of Lumbar Intervertebral Disc Treated by Penetration and Oral Administration of Chinese Decoction Plus Traction

Fifty-six cases of the protrusion of the lumbar intervertebral disc in the treatment group were treated by drug-penetration and oral administration of traditional Chinese decoction plus traction, and the other 35 cases in the control group by oral administration of Chinese decoction and traction. The results showed that the cure rate in the treatment group was 83.9%, and that in the control group was 57.1%, with a statistically significant difference between the two groups (P<0.01), indicating that the former is a more effective therapy for protrusion of the lumbar intervertebral disc.

TCM Treatment for 50 Cases of Acute Protrusion of the Lumbar Intervertebral Disc

From January 1998 to August 2000, the author has treated 50 cases of acute protrusion of the lumbar intervertebral disc by Chinese herbs, massotherapy, and functional exercise with satisfactory therapeutic results reported in the following.

Protrusion of Lumbar Intervertebral Disc Treated by Ultra Short Wave and the Point Injection in 40 Cases

Since 1996,the author has treated 40 cases of protrusion of lumbar intervertebral disc with ultra short wave and the point injection,and obtained good therapeutic effects.This is reported as follows.

Treatment of 150 Cases of Lumber Intervertebral Disk Displacement by Acupuncture plus Traction

Needling Point Jiaji (Ex-B 2), Dachangshu (BL 25), Huantiao (GB 30), Weizhong (BL 40), and Yanglingquan (GB 34) etc with the cooperation of traction, treated lumbar intervertebral disk displacement. The effective rate was 91.3%. Key Words Lumbar Vertebrae - Intervertebral Disk Displacement - Acupuncture Therapy - Traction Translator: WU Xue-fei

益肾强骨汤联合一指禅推拿治疗急性期腰椎间盘突出症疗效观察

目的:探讨益肾强骨汤联合一指禅推拿治疗急性期腰椎间盘突出症的临床疗效。方法:将120例急性期腰椎间盘突出症患者随机分为对照组和观察组各60例。对照组采用塞来昔布口服联合一指禅推拿治疗,观察组采用益肾强骨汤联合一指禅推拿治疗。观察两组患者临床疗效、日本骨科协会评分(Japanese orthopaedic association scores JOA)及血清炎症因子[白细胞介素1β(Interleukin-1β,IL-1β)、白细胞介素6(Interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)]水平。结果:观察组总有效率为93.33%(56/60),高于对照组的83.33%(50/60)(P<0.05);治疗后观察组JOA评分高于对照组(P<0.05);治疗后两组患者IL-1β、IL-6、TNF-α水平均降低,观察组降低更明显(P<0.05)。结论:益肾强骨汤联合一指禅推拿可降低急性期腰椎间盘突出症患者血清IL-1β、IL-6、TNF-α水平,改善患者腰椎功能。

脊柱内镜下磨钻扩大腹侧空间治疗重度游离型腰椎间盘突出的可行性

目的:应用脊柱内镜技术治疗重度游离型腰椎间盘突出症,探讨使用镜下磨钻扩大腹侧空间的可行性和应用价值,评估临床疗效。方法:收集2019年4月至2021年3月应用脊柱内镜技术治疗的重度游离型腰椎间盘突出患者30例,男19例,女11例;年龄19~76(44.03±16.92)岁;患者均为单一节段病变且髓核脱出,其中L2,33例,L3,43例,L4,515例,L5S19例。术中用镜下磨钻磨除椎体部分后缘骨质及椎弓根切迹,增大腹侧操作空间,显露游离的髓核并完整摘除。记录术中出血量、手术时间、住院时间及术后神经并发症,比较术前、术后2 d、3个月及1年的日本骨科协会(Japanese Orthopaedic Association,JOA)评分,Oswestry功能障碍指数(Oswestry disability index,ODI),疼痛视觉模拟评分(visual analogue scale,VAS),并根据腰椎功能Macnab标准评定疗效。结果:所有患者顺利完成手术,游离髓核取出完整,术后当天腰腿痛明显缓解,2例患者术后出现下肢一过性疼痛麻木,无严重神经损伤并发症发生。术后各时间点的ODI及VAS均较术前显著降低(P<0.01);JOA评分较术前明显升高(P<0.01)。术后第2天、3个月、1年时根据Macnab标准评定疗效,优良率分别为66.67%(20/30)、83.33%(25/30)和90.00%(27/30)。结论:重度游离型腰椎间盘突出,使用镜下磨钻扩大腹侧空间,能够顺利取出游离髓核,避免了神经损伤发生。

辨证施护对保守治疗腰椎间盘突出症患者病情恢复及护理满意度的影响

目的:观察辨证施护对保守治疗腰椎间盘突出症患者病情恢复及护理满意度的影响。方法:选取保守治疗的腰椎间盘突出症患者168例,采用随机数字表法分为对照组和观察组,每组84例。对照组采用常规护理干预,观察组在此基础上给予辨证施护。比较两组患者的疼痛程度、证候积分、生活质量、临床疗效及护理满意度。结果:干预后观察组疼痛视觉模拟评分、证候积分均明显低于对照组(P<0.05),生活质量评分明显高于对照组(P<0.05);观察组总有效率[91.67%(77/84)]及护理满意度[95.24%(80/84)]明显高于对照组总有效率[79.76%(67/84)]及护理满意度[84.52%(71/84)](P<0.05)。结论:辨证施护可促进行保守治疗的腰椎间盘突出症患者的病情恢复,提高护理满意度和生活质量。

基于3D打印技术的腰椎间盘突出症康复支具的临床应用初步观察

目的:分析3D打印个性化腰椎支具对腰椎间盘突出症患者腰部疼痛及腰椎功能的改善效果。方法:选取2018年10月至2021年5月收治的初次确诊为腰椎间盘突出症60例患者,将其分为观察组和对照组,每组30例。其中观察组男18例,女12例;年龄24~56(45.23±6.07)岁;病程1~24(6.25±0.82)个月,佩戴3D打印个性化腰椎支具实施康复治疗;对照组男19例,女11例;年龄25~57(42.78±7.58)岁;病程1~24(6.72±1.36)个月,佩戴传统腰椎护具实施康复治疗。分别于治疗前及治疗1个疗程(3周)后采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估治疗效果,比较两组腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)及视觉模拟评分(visual analogue scale,VAS)。结果:治疗前两组JOA、ODI、VAS比较,差异均无统计学意义(P>0.05)。治疗1个疗程(3周)后,两组JOA评分与治疗前比较均有提高(P<0.05),ODI、VAS与治疗前比较均有降低(P<0.05);观察组治疗后JOA评分高于对照组(P<0.05),ODI、VAS低于对照组(P<0.05)。两组均无不良事件发生。结论:应用3D打印个性化腰椎支具能够有效减轻腰椎间盘突出症患者的疼痛,改善患者腰椎功能。

基于分期指导的“导引固肾法”功能锻炼在腰椎间盘突出症中的应用效果

目的:观察分期指导“导引固肾法”功能锻炼在腰椎间盘突出症患者中的应用效果。方法:将120例腰椎间盘突出症患者依据数字表法随机分为观察组、对照1组和对照2组各40例。观察组根据患者疾病分期,对应指导患者行“导引固肾法”功能锻炼;对照1组行一般功能锻炼;对照2组功能锻炼动作同观察组,但不按疾病分期对应锻炼。出院后继续随访并指导3组患者行相应功能锻炼至3个月。分别在功能锻炼第2周及随访3个月时评估患者腰痛视觉模拟量表(visual analog scale,VAS)评分,于第2周时评估腰椎JOA评分及其改善率、显效率和1年内复发率,同时观察治疗前后炎症因子水平。结果:功能锻炼第2周VAS评分观察组为(1.79±0.33)分,低于对照1组的(2.26±0.52)分和对照2组的(2.10±0.37)分,3个月后VAS评分观察组为(0.73±0.40)分,低于对照1组的(1.25±0.43)分和对照2组的(0.94±0.47)分;2周后JOA评分观察组为(24.35±2.64)分,高于对照1组的(19.88±4.55)分和对照2组的(22.50±3.21)分;2周后总显效率观察组为92.5%(37/40),高于对照1组的57.5%(23/40),对照2组的75.0%(30/40);1年内复发率观察组为7.5%(3/40),低于对照1组的35.0%(14/40),对照2组的15%(6/40);观察组治疗后炎症因子水平低于对照组(P<0.05)。结论:腰椎间盘突出症患者按疾病分期行“导引固肾法”功能锻炼,临床疗效优于一般功能锻炼与不按疾病分期的锻炼,并能降低复发率。

椎间孔镜下髓核摘除术和靶点射频热凝术治疗包容型腰椎间盘突出症的疗效比较

目的:观察不同年龄段经皮椎间孔镜下髓核摘除术(percutaneous endoscopic transforaminal discectomy,PETD)和靶点射频热凝术(coblation nucleoplasty,CN)对包容型腰椎间盘突出症(lumbar disc herniation,LDH)的疗效,为临床制定精准化、个体化的治疗方案提供依据。方法:对2018年1月至2021年6月采用PETD和CN治疗的腰椎间盘突出症219例患者进行回顾性分析,其中PETD治疗107例,CN治疗112例,依据年龄将两种不同手段治疗的患者分为青年组(≤45岁)、中年组(>45岁且<60岁)和老年组(≥60岁)。于治疗前,治疗后3 d及1、6个月评价疼痛视觉模拟评分(visual analogue scale,VAS),日本骨科学会(Japanese Orthopaedic Association,JOA)腰痛评分,红外热成像温差值(△T)及腰椎活动度(range of motion,ROM),比较不同年龄段之间两种治疗手段的疗效差异。结果:VAS和JOA评分观察:(1)同年龄段组内比较。①同年龄段、同一治疗方法、不同时刻的VAS和JOA评分与治疗前比较差异有统计学意义(P<0.05),治疗后均有明显改善;②同年龄段、不同治疗方法,老年组PETD治疗后VAS较CN治疗后低、JOA评分较CN后高(P<0.05),青年组及中年组患者中两种治疗方法之间差异无统计学意义(P>0.05)。(2)不同年龄段组间比较。①PETD治疗、不同年龄段、同一时刻比较,VAS和JOA评分差异无统计学意义(P>0.05);②CN治疗、不同年龄段、同一时刻比较,治疗后1、6个月老年组VAS均高于青年组和中年组(P<0.05),JOA评分均低于青年组和中年组低(P<0.05)。红外热成像温差和腰椎活动度观察:(1)同年龄段组内比较。①同年龄段、同一治疗方法△T和ROM都较治疗前显著改善(P<0.05);②同年龄段、不同治疗方法,PETD和CN治疗后△T的差异均无统计学意义(P>0.05),青年组和中年组ROM的差异无统计学意义(P均>0.05),老年组内PETD治疗后的ROM较CN治疗后高(P<0.05)。(2)不同年龄段组间比较。①PETD治疗、不同年龄段、同一时刻比较,△T和ROM的差异均无统计学意义(P>0.05);②CN治疗、不同年龄段、同一时刻比较,治疗后△T差异无统计学意义,但老年组ROM小于青年和中年组(P<0.05)。结论:PETD和CN治疗包容型LDH均有较好的疗效,术后6个月内老年患者接受PETD治疗的疗效收益大于CN,CN更适用于青、中年人。

腰椎间盘突出症的非手术疗法研究进展

从卧床休息及牵引、针灸、手法、物理、药物与综合治疗等方面综述近10年关于腰椎间盘突出症(lumbar disc herniation,LDH)的非手术治疗相关文献,非手术治疗以改善局部组织微循环、消除神经根水肿、解除肌肉痉挛、纠正小关节紊乱、调节腰椎力学平衡、缓解腰腿疼痛及麻木症状为主。今后当制定统一的疗效评定标准,通过大样本、多中心、多学科的发病机制理论研究为临床治疗提供参考。

基于可穿戴式惯性传感器对中医综合疗法治疗气滞血瘀型腰椎间盘突出症的疗效评价研究

背景临床中,中医保守治疗对腰椎间盘突出症(LDH)患者有明确疗效,其起效机制和生物力学效应是目前研究的热点。目的应用可穿戴式惯性传感器对气滞血瘀型LDH患者治疗前后的步态进行分析,通过生物力学的方法验证中医综合疗法的作用优势。方法纳入2020年6月—2021年12月在长春中医药大学附属医院推拿科住院治疗且入院诊断为LDH的40例患者为研究对象,采用中医综合治疗方法进行治疗。收集患者的年龄、性别、下肢疼痛侧、基线BMI、住院时间、患者治疗前后的腰痛相关量表评分,并于治疗前后采用可穿戴式惯性传感器收集步态分析相关参数。结果40例患者中,男18例,女22例,18例下肢疼痛侧在左侧,8例下肢疼痛侧在右侧,14例下肢疼痛侧为双侧。患者平均年龄(52.3±15.2)岁,平均BMI(25.2±4.2)kg/m2,平均住院时间(17.5±6.2)d。治疗后共35例有效或显效,5例无效,总体有效率为87.5%。与治疗前相比,患者治疗后疼痛视觉模拟评分、腰椎Oswestry功能障碍指数降低,日本骨科协会评估治疗分数升高(P<0.05);患者治疗后步频、步速、步幅、步行周期、摆动相占比、胫骨和足底冲击力升高,支撑相占比降低(P<0.05);患者治疗后髋关节内收外展、髋关节旋转、膝关节内外翻、膝关节旋转、踝关节旋转活动度下降(P<0.05);患者治疗后骨盆侧倾指数、骨盆侧斜指数、髋关节内收外展指数、髋关节屈伸指数、髋关节旋转指数、膝关节旋转指数、踝关节内外翻指数、踝关节屈伸指数、踝关节旋转指数升高(P<0.05)。40例LDH患者经中医综合治疗后,未出现不良反应及毒副作用,在随访过程中有5例患者症状反复或再次入院治疗。结论中医综合疗法可明显改善气滞血瘀型LDH患者的疼痛、功能障碍,增加步行状态中的动态稳定性,是安全有效的保守治疗方案。

腰椎间盘突出症术后低颅压致短暂性失明1例

患者,男,52岁,因“腰背部疼痛3年,加重伴左下肢疼痛、麻木3 d”为主诉于2020年7月9号收住入院。患者诉3年无明显诱因出现腰背部疼痛,自备膏药贴服(具体药物用法用量不详),休息后症状可缓解,未做系统诊疗。入院前3 d因干农活后病情加重,出现左下肢疼痛、麻木伴活动受限。患者无特殊既往病史,入院完善相关检查,轮椅推入病房,腰椎活动度疼痛受限。

基于p38MAPK信号通路分析咪达唑仑对腰椎间盘突出症模型大鼠疼痛的影响

目的:探究基于p38MAPK信号通路分析咪达唑仑对腰椎间盘突出症模型大鼠疼痛的影响。方法:选取50只SPF级别SD健康大鼠,雌雄各半,随机分为正常组,模型组,低、中、高剂量组,模型组和低、中、高剂量组先建立腰椎间盘突出症模型。正常组、模型组大鼠腹腔注射生理盐水,低、中、高剂量组大鼠腹腔注射咪达唑仑,分别按30、60、90 mg/kg给药。采用酶联免疫吸检测大鼠血清中白细胞介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、5-羟色胺(5-hydroxytryptamine,5-HT)、β-内啡肽(β-endorphin,β-EP)、P物质(substance P,SP)、神经肽Y(neuropeptide Y,NPY)水平,采用Western blot检测各组大鼠组织中p38 MAPK,基质金属蛋白酶3(matrix metalloproteinase-3,MMP3)蛋白表达。结果:模型组大鼠TNF-α、IL-1β、β-EP水平较正常组高,5-HT水平低于正常组(P<0.05);低、中、高剂量组大鼠TNF-α、IL-1β、β-EP水平较模型组下降、5-HT水平升高(P<0.05)。模型组大鼠较正常组SP、NPY水平上升(P<0.05);低、中、高剂量组较模型组大鼠SP、NPY水平下降(P<0.05)。模型组较正常组大鼠p38 MAPK、MMP-3表达上升(P<0.05),低、中、高剂量较模型组大鼠p38 MAPK、MMP-3表达下降(P<0.05)。结论:咪达唑仑可以改善腰椎间盘突出症模型大鼠的免疫炎症反应,可能是通过p38MAPK信号通路调控来实现的。

股骨头坏死12例临床误诊分析

目的探讨股骨头坏死误诊为腰椎间盘突出症的原因及防范措施。方法回顾分析2016年4月—2021年3月收治的误诊为腰椎间盘突出症的股骨头坏死12例的病例资料。结果12例均有不同程度的腰骶部、大腿周围酸痛不适和僵硬感,伴左侧下肢疼痛6例、右侧下肢疼痛4例、双侧下肢疼痛2例,以夜间疼痛明显,伴轻度跛行10例,休息后可缓解;单侧患病10例(左侧6例、右侧4例),双侧患病2例。12例病程3~10个月;诱发因素:大量饮酒4例,长期大量使用糖皮质激素3例,髋部外伤史2例,原因不明3例。12例CT检查示椎间盘均有轻微膨出。12例据上述症状体征及影像学检查结果,诊断为腰椎间盘突出症,经牵引、按摩、针灸等治疗后症状无明显减轻且逐渐加重。转院后查体发现疼痛侧髋关节活动范围缩小,患髋叩击痛均(+),8例“4”字试验(+);MRI检查均发现股骨头缺血坏死征象。遂确诊为股骨头坏死,Ficat分期:Ⅲ期8例、Ⅳ期4例。误诊时间2~5个月。8例Ⅲ期患者行股骨头保护性手术治疗,4例Ⅳ期患者行髋关节置换术。术后随访2年,预后良好。结论股骨头坏死早期患者症状体征不典型,部分患者以腰臀部疼痛或下肢疼痛为主要症状就诊,髋部症状缺如,在未行髋部MRI检查前极易误诊为腰椎间盘突出症;详细询问患者有无相关诱发因素,仔细髋部查体,及早行髋部MRI检查,认真鉴别诊断,有利于本病的早期诊治。