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.

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。

电针夹脊穴对压力诱导退变椎间盘纤维环的影响

目的:探讨电针夹脊穴对压力诱导退变椎间盘纤维环形态结构的影响。方法:随机将20只成年雄性新西兰大白兔分为正常组、假手术组、模型组和电针组,每组5只。通过外置轴向加压器械诱导腰椎间盘退变(IVDD)模型,轴向加压28 d后使用MRI评估造模效果。电针组在造模成功后第1天开始电针双侧夹脊穴治疗28 d。电针干预结束后观察记录4组实验兔的精神状态、饮食、活动和对外界的刺激情况并评分;使用MRI观察各组椎间盘的信号强度并行Pfirrmann分级评估;采用HE染色和透射电镜比较4组椎间盘纤维环组织形态及亚细胞结构;采用免疫组化染色检测各组实验兔椎间盘纤维环细胞中的血小板反应蛋白解整合素金属肽酶-5(ADAMTS-5)抗体阳性表达。结果:与假手术组比较,模型组实验兔的综合反应评分降低(P<0.01),椎间盘信号消失,Pfirrmann分级明显升高,纤维环组织结构破坏,细胞排列紊乱,纤维软骨细胞增多,胶原纤维组织内的纤维细小,排列紊乱,纤维环细胞中ADAMTS-5抗体阳性表达明显增多(P<0.01);与模型组比较,电针组实验兔的综合反应评分升高(P<0.01),椎间盘信号改善,Pfirrmann分级降低,纤维环结构和胶原纤维形态改善,纤维环细胞中ADAMTS-5抗体阳性表达明显降低(P<0.01)。结论:轴向加压刺激能明显破坏纤维环细胞形态及组织结构,并引起纤维环细胞外基质的降解,而电针能在一定程度上改善退变的纤维环,进而延缓IVDD。

椎间盘源性腰痛射频热凝+臭氧减压辅助腰背肌 锻炼的疗效探讨

目的研究椎间盘源性腰痛射频热凝+臭氧减压辅助腰背肌锻炼的疗效。方法非随机选取深圳精诚医疗集团如皋医院于2021年1月—2024年1月收治的94例椎间盘源性腰痛患者作为研究对象,按治疗方法不同进行分组,每组47例,对照组应用射频热凝联合臭氧减压辅助物理康复牵引方案治疗,观察组应用射频热凝联合臭氧减压辅助腰背肌锻炼方案治疗。对比两组临床疗效、疼痛程度和腰椎功能指标水平。结果观察组临床总有效率为97.87%(46/47),高于对照组的85.11%(40/47),差异有统计学意义(χ^(2)=4.919,P<0.05);观察组Oswestry功能障碍指数、疼痛评分均低于对照组,日本骨科协会评分高于对照组,差异有统计学意义(P均<0.05)。结论于椎间盘源性腰痛患者的临床治疗中,射频热凝、臭氧减压辅助腰背肌锻炼联合应用展现出显著的临床效果。

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。

Influence of degenerative changes of intervertebral disc on its material properties and pathology

Objective： To investigate the material properties of normal and degenerated intervertebral discs （IVDs） and examine the effect of degenerative changes on IVD pathology. Methods： A computer-based online search was undertaken to identify English articles about material properties of IVDs published from January 1950 to 2011 in PubMed database. The retrieved keywords included material properties, intervertebral disc and degeneration. Based on the principles of reliability, advancement and efficiency, the obtained data were primarily examined, and the original source was retrieved to read the full-text. Repetitive articles were excluded. The data of material properties of normal and degenerated IVDs were summarized and analyzed by meta-analysis. Results： The data of Young＇s modulus, Poisson＇s ratio, shear modulus, hydraulic permeability and intradiscal pres- sure of normal and degenerated 1VDs were obtained. Com- pared with normal IVDs, the Young＇s modulus and shear modulus of annulus fibrosus and nucleus pulposus werehigher in degenerated IVDs, the Poisson＇s ratio was lower while the hydraulic permeability and intradiscal pressure were higher. Besides, the degeneration-related alterations in IVDs had an influence both on itself and other spinal structures, leading to diseases such as bulging disc, discogenic pain and spinal stenosis. Meanwhile, the heavy mechanical loading and injury indicated important pathways to IVD degeneration. Conclusions： To a certain extent, the degenerative changes of IVD influence its material properties. And the degeneration-related alterations of composition can cause structural failure oflVDs, leading to injuries and diseases.

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。

MR体素内不相干运动弥散加权成像评估腰椎间盘退变程度

目的观察MR体素内不相干运动-弥散加权成像(IVIM-DWI)定量评估腰椎间盘退变程度的价值。方法对90例下腰痛患者采集共450个腰椎间盘常规MRI及IVIM-DWI,评估各椎间盘Pfirrmann分级,比较不同Pfirrmann分级椎间盘之间IVIM-DWI定量参数表观弥散系数(ADC)、慢速弥散系数(D)、快速弥散系数(D*)及灌注分数(f)的差异;采用有序logistic回归分析及受试者工作特征(ROC)曲线评价IVIM-DWI定量参数诊断腰椎间盘退变Pfirrmann分级的效能。结果450个椎间盘中,21个PfirrmannⅠ级,168个Ⅱ级,152个Ⅲ级,87个Ⅳ级,22个Ⅴ级。PfirrmannⅠ与Ⅱ级之间髓核ADC、D值及前纤维环ADC,Ⅱ与Ⅲ级间髓核ADC、D和f值及前、后纤维环ADC、D值,Ⅲ与Ⅳ级间髓核ADC、D、f值、前纤维环ADC、D值及后纤维环ADC,Ⅳ与Ⅴ级间髓核ADC、D值及后纤维环D值差异均有统计学意义(P均<0.05);相邻Pfirrmann分级间其余IVIM-DWI定量参数差异均无统计学意义(P均>0.05)。髓核ADC(OR=1.879)及D值(OR=2.212)均为腰椎间盘退变Pfirrmann分级的相关因素(P均<0.001)。髓核ADC及D值评估Pfirrmann分级的曲线下面积为0.80~0.92。结论IVIM-DWI可有效定量评估椎间盘退变程度。

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。