Clinical therapeutic effect of self-prescribed Sanhanchushi Tongbi on lumbar disc herniation

BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a customized prescription.It disperses cold,relieves pain,removes cold from the meridians and viscera,and treats neuropathic pain.However,few studies have investigated its mechanism of pain relief.AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST.METHODS A total of 211 patients with LDH syndrome were divided into two groups:107 patients in the control group were treated with conventional massage combined with traction,and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST.The patients were treated for 4 wk.Indices of traditional Chinese medicine(TCM)syndrome score and serum inflammatory factor levels were measured.RESULTS After therapy,the TCM syndrome score in the observation group was significantly lower than that in the control group(P<0.05).The main symptoms,clinical signs,daily activities,and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy(P<0.05).The levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein were lower in the observation group than in the control group(P<0.05).In the observation group,superoxide dismutase levels were significantly higher,whereas malondialdehyde levels were significantly lower,compared with the control group(P<0.05).The overall efficacy rate in the observation group was 96.15%,which was substantially higher than that in the control group(88.79%;P<0.05).CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.

Research progress of pain catastrophizing in patients with lumbar disc herniation

Pain catastrophization is one of the negative emotional factors and an important psychological factor associated with patients with lumbar disc herniation(LDH).Currently,the concept of pain catastrophization of LDH is relatively mature abroad;however,there are only few research studies on this in China.To understand the status quo of pain catastrophization(PC)in patients with LDH and its influencing factors,the intervention measures of PC and their efficacy were further analyzed.In the present paper,the research status of PC at home and abroad is briefly expounded,and the influencing factors and clinical intervention measures for PC are analyzed.This paper reviews the concept of PC,the assessment tools,influencing factors,and the relevant intervention measures.In order to evaluate the pain degree of patients,understand the incidence of pain in patients,and improve the cure rate and quality of life of patients,the basic situation of patients with pain disaster is summarized to provide reference for medical personnel.

miR-141-3p对腰椎间盘突出症大鼠背根神经节炎症及下肢疼痛的抑制和改善作用

背景:研究表明,胰岛素样生长因子1/血小板源性生长因子有抑制纤维环细胞凋亡的作用。miR-141-3p微小RNA在骨髓基质细胞中随着年龄的增加而增加,且与炎症信号通路的活化存在一定关系,提示其可能成为腰椎间盘突出症的治疗靶点。目的:探究miR-141-3p通过调控胰岛素样生长因子1/血小板源性生长因子对腰椎间盘突出症大鼠背根神经节炎症及下肢疼痛的影响。方法:选取50只SPF级SD雄性大鼠,随机分为正常组、模型组、miR-NC组、miR-141-3p inhibitor组、miR-141-3p mimics组,每组10只。除正常组外,其余大鼠采用自体髓核移植法进行腰椎间盘突出症建模。建模成功后,对miR-NC组、miR-141-3p inhibitor组和miR-141-3p mimics组大鼠鞘内分别注射10μL 20μmol/L miR-NC,miR-141-3p inhibitor,miR-141-3p mimics,均每天注射1次,连续注射28 d;正常组、模型组同期同位置注射同体积生理盐水。采用热缩足潜伏期阈值评价大鼠下肢疼痛,实时荧光定量PCR检测背根神经节组织miR-141-3p mRNA表达,ELISA法检测背根神经节组织炎症因子,免疫印迹法检测背根神经节组织胰岛素样生长因子1/血小板源性生长因子蛋白表达,并分析miR-141-3p与胰岛素样生长因子1/血小板源性生长因子的相关性。结果与结论:miR-NC组各项指标与模型组比较,差异均无显著性意义。①大鼠热缩足潜伏期阈值:模型组明显低于正常组(P<0.05),miR-141-3p inhibitor组明显低于miR-NC组(P<0.05),miR-141-3p mimics组明显高于miR-141-3p inhibitor组(P<0.05)。②背根神经节组织miR-141-3p mRNA表达:模型组明显低于正常组(P<0.05),miR-141-3p inhibitor组明显低于miR-NC组(P<0.05),miR-141-3p mimics组明显高于miR-141-3p inhibitor组(P<0.05)。③背根神经节组织肿瘤坏死因子α、白细胞介素1β、白细胞介素1含量:模型组明显高于正常组(P<0.05),miR-141-3p inhibitor组明显高于miR-NC组(P<0.05),miR-141-3p mimics组明显低于miR-141-3p inhibitor组(P<0.05)。④背根神经节组织胰岛素样生长因子1、血小板源性生长因子蛋白表达:模型组明显低于正常组(P<0.05),miR-141-3p inhibitor组明显低于miR-NC组(P<0.05),miR-141-3p mimics组明显高于miR-141-3p inhibitor组(P<0.05)。⑤胰岛素样生长因子1与miR-141-3p呈正相关(r=0.904,P<0.001),血小板源性生长因子与miR-141-3p呈正相关(r=0.879,P<0.001)。⑥结论:miR-141-3p可显著改善腰椎间盘突出症大鼠下肢疼痛,抑制背根神经节炎症,其机制可能与促进胰岛素样生长因子1/血小板源性生长因子表达有关。

脊柱-骨盆矢状位参数与腰椎退行性疾病术后持续性下腰痛的关系

目的 分析脊柱-骨盆矢状位序列参数变化与腰椎退行性疾病(degenerative lumbar disease,DLD)患者术后持续性下腰痛的关系。方法 选取天津市人民医院2019年6月至2022年6月行单节段腰椎融合内固定术治疗的86例DLD患者,根据术后是否发生持续性下腰痛分为腰痛组和非腰痛组。腰痛组34例,男10例,女24例;年龄32~77岁,平均(59.36±8.65)岁。非腰痛组52例,男21例,女31例;年龄30~78岁,平均(56.81±8.03)岁。比较两组患者一般资料、手术前后疼痛视觉模拟评分(visual analogue score,VAS)、日本骨科协会(Japanese orthopaedic association,JOA)腰椎功能评分及脊柱-骨盆矢状位序列参数[腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)]。分析术后持续性下腰痛发生的影响因素,分析手术前后脊柱-骨盆矢状位序列参数变化值与VAS、JOA评分变化值的相关性,分析手术前后脊柱-骨盆矢状位序列参数变化值及相关影响因素预测术后发生持续性下腰痛的价值。结果 腰痛组骨质疏松、术中骨性终板损伤发生率(47.06%、23.53%)高于非腰痛组(15.38%、1.92%);腰痛组术后3个月VAS、PT高于非腰痛组,JOA评分、LL、SS低于非腰痛组,ΔVAS、ΔJOA、ΔLL、ΔPI、ΔPT、ΔSS小于非腰痛组(P<0.05);DLD患者ΔLL、ΔPT、ΔSS均与ΔVAS、ΔJOA间存在正相关关系(P<0.05),ΔPI与ΔVAS、ΔJOA间无明显相关性(P>0.05);骨质疏松、术中骨性终板损伤、ΔLL、ΔPT、ΔSS均为DLD患者术后发生持续性下腰痛的影响因素(P<0.05);ΔLL、ΔPT、ΔSS预测DLD患者术后发生持续性下腰痛的曲线下面积(area under the curve,AUC)分别为0.776、0.825、0.731;与ΔLL、ΔPT、ΔSS单独预测比较,ΔLL、ΔPT、ΔSS联合预测的AUC(0.939)明显增大,净重新分类指数、综合判别改善指数均>0(P<0.05)。结论 脊柱-骨盆矢状位序列参数变化与DLD患者腰椎术后持续性下腰痛的发生有关,且在预测术后发生持续性下腰痛方面具有良好应用价值。

Analgesic effects of balanced acupuncture versus body acupuncture in low-back and leg pain patients with lumbar disc herniation, as assessed by resting-state functional magnetic resonance imaging

Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.

运动疗法通过机械-化学偶联治疗慢性非特异性下背痛

背景:目前运动疗法是非药物治疗腰痛的有效方法,运动疗法可通过骨骼和肌肉之间的机械-化学偶联维持腰椎的稳定,但目前尚无关于运动疗法通过机械-化学偶联缓解慢性非特异性下背痛之间研究进展及最佳治疗方案的明确阐述。目的:综述运动疗法时椎旁肌通过机械-化学偶联影响腰椎稳定性进而缓解慢性非特异性下背痛的相关研究进展,以及目前运动疗法治疗慢性非特异性下背痛的最佳方案。方法:在万方数据库、中国知网、维普、Web of Science和PubMed数据库进行文献检索,以“慢性非特异性下背痛,腰椎稳定,椎旁肌,运动疗法”为中文检索词,以“chronic nonspecific low back pain,lumbar stabilization,paravertebral muscle,exercise therapy”为英文检索词,检索各数据库建库至2024年1月发表的相关文献,最终纳入93篇文献进行归纳总结。结果与结论:运动疗法可以通过适当的机械刺激作用于椎旁肌和骨骼并使其产生相应的变化。运动疗法主要通过机械-化学偶联方式来提高椎旁肌的质量,进而维持腰椎稳定,从而更好地缓解慢性非特异性下背痛,是慢性非特异性下背痛的重要干预措施。但是,对于运动疗法通过腰椎稳定来治疗慢性非特异性下背痛的确切有效方案尚无明确报道。个体化运动方案的制定对于慢性非特异性下背痛的治疗和预后尤为重要。同一个体的肌肉质量与骨骼质量是密切相关的,影像学评估椎旁肌的质量和体积对于疾病的发现和干预具有重要意义。

Potential sex differences in activation of pain-related brain regions in nonhuman primates with a unilateral spinal nerve ligation

The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present study examined stimulus-evo ked brain activation with functional magnetic resonance imaging in male and female cynomolgus macaques following unilateral L7 spinal nerve ligation and the effects of clinical analgesics pregabalin,duloxetine,and morphine on brain activation in these macaques.A modified straight leg raise test was used to assess pain severity in awake animals and to evo ke regional brain activation in anesthetized animals.The potential effects of clinical analgesics on both awake pain behavior and regional brain activation were examined.Following spinal nerve ligation,both male and female macaques showed significantly decreased ipsilateral straight leg raise thresholds,suggesting the presence of radicula rlike pain.Morphine treatment increased straight leg raise thresholds in both males and females whereas duloxetine and pregabalin did not.In male macaques,the ipsilateral straight leg raise activated contralateral insular and somatosensory cortex(Ins/SII),and thalamus.In female macaques,the ipsilateral leg raise activated cingulate cortex and contralateral insular and somatosensory cortex.Straight leg raises of the contralateral,unligated leg did not evoke brain activation.Morphine reduced activation in all brain regions in both male and female macaques.In males,neither pregabalin nor duloxetine decreased brain activation compared with vehicle treatment.In females,however,pregabalin and duloxetine decreased the activation of cingulate cortex compared with vehicle treatment.The current findings suggest a diffe rential activation of brain areas depending on sex following a peripheral nerve injury.Diffe rential brain activation observed in this study could underlie qualitative sexual dimorphism in clinical chronic pain perception and responses to analgesics.Future pain management approaches for neuropathic pain will need to consider potential sex differences in pain mechanism and treatment efficacy.

血清TNF-α、IL-17表达预测腰椎间盘突出症患者术后残留疼痛的价值

目的探讨血清肿瘤坏死因子(TNF-α)、白细胞介素-17(IL-17)表达预测腰椎间盘突出症患者术后残留疼痛的价值。方法回顾性收集2020年1月至2023年1月郑州大学第二附属医院收治的165例腰椎间盘突出症患者的临床资料,根据患者术后6个月时残留疼痛情况分为残留疼痛组(19例)和未残留疼痛组(146例)。术前检测患者血清TNF-α、IL-17水平,分析血清TNF-α、IL-17对腰椎间盘突出症患者术后残留疼痛的预测价值。结果两组纤维环损伤、TNF-α、IL-17水平差异有统计学意义(P<0.05);经logistic回归分析,结果显示,血清TNF-α、IL-17水平、纤维环损伤是腰椎间盘突出症患者术后残留疼痛发生的危险因素(OR>1,P<0.05);绘制受试者工作特征(ROC)曲线,结果显示,血清TNF-α、IL-17以及联合预测腰椎间盘突出症患者术后残留疼痛的曲线下面积(AUC)均>0.7,具有一定预测价值,且联合预测价值更高。结论血清TNF-α、IL-17高表达是腰椎间盘突出症患者术后残留疼痛的影响因素,且具有一定预测价值。

Ultrasound, Fluoroscopic-Guided Caudal, Lumbar Epidural Steroid Injections and Blinding Paraspinal Lumbosacral Steroid Injections in Patients with Low Back Pain with Radiculopathy

Background and Aims: Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. Patients and Methods: This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. Results: In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). Conclusion: US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.

Systematic evaluation and meta-analysis of acupuncture treatment for residual pain after lumbar disc herniation

Objective:To systematically evaluate the effectiveness and safety of acupuncture in the treatment of postoperative residual pain in lumbar disc herniation,and to provide evidence for its clinical treatment.Methods:A randomized controlled trial(RCT)of all acupuncture treatments for postoperative lumbar disc herniation in PubMed,CBM,CNKI,Wanfang,VIP,E mbase,and Cochrane libraries was published by May 2019,followed by RevMan5.3 software for meta-analysis.Results:11 randomized controlled trials were included in 855 patients,including 428 in the experimental group and 427 in the control group,with a ratio of 1:1.The results of the meta-analysis showed that the overall effective rate of the experimental group[RR=1.22,95%CI(1.15,1.29),P<0.00001],visual analogue pain(VAS)score[MD=1.59,95%CI(1.22,1.95),P<0.00001],Japanese Orthopaedic Association evaluation treatment score(JOA)[MD=5.66,95%CI(2.58,8.74),P=0.0003],the incidence of adverse hair loss[RR=0.35,95%CI(0.18,0.71),P=0.003]were significantly better than the control group,the difference was statistically significant.Conclusion:Acupuncture has obvious advantages in the treatment of residual pain after lumbar disc herniation,which can significantly relieve postoperative pain and improve quality of life.However,the conclusions of this study need to be further verified by the large sample and high quality literature.

Standardizing MI-TLIF, a Proposal for a Reproducible Technique

Background: Minimally invasive transforaminal lumbar interbody fusion (MI TLIF) is a widely known and performed technique, however its versatility among different physicians continues to hinder its replication and results. Therefore, this study aimed to provide a step-by-step surgical guide to perform a safe MI-TLIF, based on the results obtained in patients operated on by a single surgeon over a period of 12 years. Patients and methods: A retrospective, single center, longitudinal, and observational cohort study was conducted with 931 patients who underwent MI TLIF by a single surgeon between 2010 and 2022 using the technique described on this paper, each with a minimum follow-up of 12 months. Criteria included Schizas classification, listhesis according to Meyerding classification, number of levels treated, cage size, and complications (screw repositioning or cerebrospinal fluid leak). Patient clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pre- and postoperative radicular pain. Thin slice CT scans were used to assess the progression of the fusion using the Bridwell classification. In the statistical analysis, percentages, median, and interquartile range (IQR) were calculated. Results: Nine hundred and thirty one patients underwent MI TLIF using the technique described, eight hundred and eighty (94.5%) had a single level treated and fifty one (5.5%) had a 2 level procedure (982 levels), an 8mm cage was placed on five hundred and seventeenlevels (52.7%), six hundred and sixty three levels(67.6%) achieved grade I fusion, two hundred and sixty six levels (27.1%) achieved grade II fusion, 52 levels (5.3) achieved grade III fusion and one level (0.1) achieved a grade IV fusion or non-union. Revision surgery was performed on 3 patients (0.3%) for screw repositioning, cerebrospinal fluid leak was present on 2 patients during surgery and treated before closure. VAS scores and ODI were improved at 12 months postop (VAS from 8.70 to 2.30 and ODI from 34.2 to 14.1, (p = 0.001). Conclusions: The MI TLIF technique described could be a safe and easy to replicate way to achieved lumbar interbody fusion, providingclinical and radiological benefits.

腰椎间盘突出症患者手术前后血清MMP-2和MMP-9水平的变化及其对疼痛感知的影响

目的探讨腰椎间盘突出症(LDH)患者手术前后血清基质金属蛋白酶-2(MMP-2)和金属蛋白酶-9(MMP-9)水平的变化及其对疼痛感知的影响。方法选择2021年1月~2022年6月在该院接受手术的78例LDH患者作为研究组,抽取同期在该院健康体检的78例受试者作为对照组。观察两组患者血清MMP-2、MMP-9、金属蛋白酶组织抑制因子(TIMP)-1、TIMP-2水平,观察LDH患者术前、术后1个月、术后3个月时的MMP-2、MMP-9、TIMP-1、TIMP-2水平,观察患者MMP-2、MMP-9、TIMP-1、TIMP-2水平与McGill疼痛问卷(SF-MPQ)得分的相关性。结果研究组术前MMP-2、TIMP-2水平均高于对照组(P<0.05),两组MMP-2/TIMP-2水平差异无统计学意义(P>0.05)。研究组术前MMP-9/TIMP-1水平低于对照组,TIMP-1水平高于对照组,差异均有统计学意义(P<0.05)。术前、术后3个月时,研究组MMP-2、TIMP-2、MMP-2/TIMP-2、MMP-9、TIMP-1、MMP-9/TIMP-1水平与患者腰痛视觉模拟评分(VAS-B)、腿痛视觉模拟评分(VAS-L)、PRI、PPI评分均不存在显著相关性(P>0.05)。研究组患者术后1个月、3个月时MMP-2、TIMP-1、TIMP-2水平均高于术前(P<0.05),术后1个月、3个月时MMP-2/TIMP-2水平和MMP-9/TIMP-1水平均低于术前(P<0.05);研究组患者术后1个月、3个月时MMP-9水平差异无统计学意义(P>0.05)。结论MMP-2和MMP-9水平不能解释LDH患者的疼痛及术后疼痛缓解作用,MMPs作为LDH患者疼痛治疗潜在靶点的价值应谨慎考虑。

A Study on the Effect of Exercise Intervention on Function and Pain in Patients with Low Back Pain

Lower back pain(LBP)has a relatively high incidence across various age groups,characterized by discomfort in the lumbosacral and iliosacral regions above the gluteal striatum and within the region below the costal margins.Some patients also experience varying degrees of leg pain,with many experiencing prolonged and recurrent symptoms.International consensus confirms that exercise intervention is an effective treatment method for lower back pain,offering safe and efficient physical therapy.Extensive practical experience suggests that Pilates exercises can effectively regulate the strength of muscle tissue in the peripheral region of the spine,improve muscle endurance,and alleviate low back pain caused by muscular factors.This study analyzes the effects of exercise intervention on the function and pain of patients with lower back pain.It explores various exercise modalities,utilizes SPSS26 statistics to gather data,and draws conclusions with the aim of providing theoretical references for exercise interventions in patients with lower back pain.

小针刀联合热敏灸治疗腰大肌损伤性腰腿痛患者的疗效及对其JOA评分、血清白细胞介素-17、白细胞介素-18水平的影响

目的探讨小针刀联合热敏灸治疗腰大肌损伤性腰腿痛患者的疗效及对其日本骨科学会(JOA)评分、血清白细胞介素17(Interleukin-17,IL-17)、白细胞介素-18(Interleukin-18,IL-18)水平的影响。方法选取2020年10月—2022年10月期间赣州市人民医院中医科门诊收治的100例腰大肌损伤性腰腿痛患者,根据患者入院单双号分为小针刀组和联合组,每组各50例。分别给予小针刀治疗和小针刀联合热敏灸治疗,连续治疗1周,共治疗两周。观察比较两组患者临床疗效、腰腿功能评价[JOA量表和Oswestry功能障碍指数问卷表(ODI)]、血清炎性指标[白细胞介素-17(interleukin-17,IL-17)、白细胞介素-18(Interleukin-18,IL-18)、白细胞介素-1β(Interleukin-1β,IL-1β)]、疼痛递质[血清神经肽Y(Neuropeptide Y,NPY)、5-羟色胺(5-Hydroxytryptamine,5-HT)及P物质(Substance P,SP)]水平。结果治疗后联合组临床总有效率94.00%(47/50)明显高于小针刀组78.00%(39/50),差异有统计学意义(P<0.05)。治疗后两组患者JOA量表评分均较治疗前升高,ODI量表评分均较治疗前降低,差异有统计学意义(P<0.05);且联合组JOA量表评分明显高于小针刀组,ODI量表评分明显低于小针刀组,差异有统计学意义(P<0.05)。治疗后两组患者IL-17、IL-18、IL-1β水平均较治疗前降低,差异有统计学意义(P<0.05);且联合组炎性因子水平明显低于小针刀组,差异有统计学意义(P<0.05)。治疗后两组患者NPY、5-HT、SP水平均较治疗前降低,差异有统计学意义(P<0.05);且联合组疼痛递质水平明显低于小针刀组,差异有统计学意义(P<0.05)。结论小针刀联合热敏灸不仅能够促进腰大肌损伤性腰腿痛患者的功能恢复,对于减轻炎症反应,抑制神经疼痛递质也效果显著。

血清SIRT1、TGF-β1表达与退行性腰椎管狭窄症患者功能障碍指数及疼痛评分的相关性分析

目的分析血清沉默信息调节因子(SIRT1)、转化生长因子β1蛋白(TGF-β1)表达与退行性腰椎管狭窄症(DLSS)患者功能障碍指数及疼痛评分的相关性。方法选取2020年10月—2023年10月山西省汾阳医院创伤与脊柱科收治的DLSS患者86例作为DLSS组,依据Oswestry腰痛功能障碍指数(ODI)将患者分为轻中度功能障碍亚组(n=50)及重度功能障碍亚组(n=36);同期医院健康体检者85例作为健康对照组。收集2组临床资料,测量所有受检者总无脂肪多裂肌横截面积(TFCSA)、总多裂肌横截面积(TCSA),并计算TFCSA/TCSA比值;采用酶联免疫吸附法(ELISA)检测受检者血清SIRT1、TGF-β1、皮质醇、促肾上腺皮质激素(ACTH)水平;采用ODI评估受检者腰痛功能障碍;采用视觉模拟疼痛评分(VAS)评估受检者疼痛程度;Spearman法相关性分析血清SIRT1、TGF-β1水平与ODI指数及VAS评分的相关性;多因素Logistic回归分析DLSS发生的影响因素。结果DLSS组患者TFCSA、TFCSA/TCSA及血清SIRT1、TGF-β1水平显著低于健康对照组(t/P=8.696/<0.001、6.669/<0.001、38.323/<0.001、22.313/<0.001),皮质醇、ACTH、ODI指数、VAS评分均高于健康对照组(t/P=57.280/<0.001、58.495/<0.001、48.583/<0.001、53.355/<0.001);与轻中度功能障碍亚组比较,重度功能障碍亚组血清SIRT1、TGF-β1、TFCSA、TFCSA/TCSA水平降低(t/P=13.834/<0.001、4.684/<0.001、3.520/0.001、5.418/<0.001),皮质醇、ACTH、ODI指数、VAS评分升高(t/P=6.168/<0.001、2.355/0.021、15.784/<0.001、11.004/<0.001);相关性分析显示,血清SIRT1、TGF-β1水平与ODI指数及VAS评分呈负相关(r=-0.534、-0.577,-0.602、-0.556,P均<0.001);血清SIRT1高、TGF-β1高水平是DLSS发生的保护因素[OR(95%CI)=0.687(0.491~0.961),0.547(0.401~0.746)],皮质醇高、ACTH高、ODI指数高、VAS评分高是DLSS发生的危险因素[OR(95%CI)=2.468(1.200~5.077)、2.673(1.162~6.148)、3.345(1.165~9.602)、3.123(1.457~6.694)]。结论DLSS患者血清SIRT1、TGF-β1水平降低,与ODI指数及VAS评分呈负相关,是DLSS发生的影响因素。

右美托咪定静脉泵注在腰-硬联合麻醉剖宫产手术中对产妇止痛效果的影响

目的分析并探究剖宫产手术中采用右美托咪定静脉泵注腰-硬联合麻醉后产妇的止痛效果。方法选择2021年2月至2023年2月进行剖宫产的98例产妇作为研究对象,对其随机分组后,参照组采用生理盐水与罗哌卡因进行麻醉,实验组通过罗哌卡因联合右美托咪定进行静脉泵注麻醉,两组均采取腰-硬联合麻醉的方式。观察两组产妇不同时段[麻醉前(T1)、麻醉后5min(T2)、麻醉后20min(T3)、胎儿娩出时(T4)]血流动力学指标[心率(HR)、平均动脉压(MAP)]、产后各时段(6h、12h、24h、48h)疼痛程度(VAS评分)、新生儿分娩2min、5min后阿氏(Apgar)评分与产妇不良反应发生情况。结果两组产妇T1时段HR、MAP指标、T2时段MAP指标、产后6h的VAS评分、新生儿分娩后2min、5min的Apgar评分、不良反应发生率差异比较均不明显(P>0.05),但实验组产妇T2时段HR指标、T3、T4时段HR、MAP指标与参照组相比较高,产后12h、24h与48hVAS评分相较于参照组则较低,各组数值对比差异明显(P<0.05)。结论在剖宫产手术中产妇采用右美托咪定静脉泵注腰-硬联合麻醉,不但对产妇术中血流动力学影响较小,产后止痛效果良好,还不易引发不良反应,具有较高的麻醉安全性,适合用于临床推广。

脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及对手术疗效的评估价值

目的:探究脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及评估手术疗效的价值。方法:回顾性分析2019年10月至2020年10月采用后路腰椎椎体间融合术治疗的95例双节段腰椎滑脱患者,其中男31例,女64例;年龄41~63(52.10±4.35)岁;病变程度,Ⅰ度47例,Ⅱ度48例。术后3个月根据Oswestry功能障碍指数(Oswestry dysfunction index,ODI)改善率评定手术疗效,ODI改善率≥50%为良好,<50%为不良。95例根据手术疗效分为疗效良好组(74例)和疗效不良组(21例)。比较两组患者的临床资料,包括性别、年龄、身体质量指数、病程、病变程度、手术时间、术中出血量、合并症;观察术前及术后3个月脊柱-骨盆矢状面参数,包括脊柱骶骨角(spino-sacral angle,SSA),T1骨盆角(T1 pelvic angle,TPA),腰椎前凸角(lumbar lordosis,LL),骨盆投射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS);采用视觉模拟评分法(visual analogue scale,VAS)和ODI对临床症状进行评定;并分析手术前后脊柱-骨盆矢状面参数变化值与VAS、ODI变化值的相关性,评价术后3个月脊柱-骨盆矢状面参数评估双节段腰椎滑脱症患者手术疗效的价值。结果:疗效不良组病程、手术时间长于疗效良好组,病变程度高于疗效良好组(P<0.05);疗效良好组术前、术后3个月SSA、TPA、LL、SS均高于疗效不良组,PT低于疗效不良组(P<0.05);疗效良好组手术前后SSA、TPA、LL、PT、SS变化值均大于疗效不良组(P<0.05)。两组术后3个月VAS、ODI均低于术前,且疗效良好组低于疗效不良组(P<0.05);疗效良好组手术前后VAS、ODI变化值均大于疗效不良组(P<0.05)。手术前后SSA、TPA、LL、PT、SS变化值与VAS、ODI变化值呈正相关(P<0.05);术后3个月SSA、TPA、LL、PT、SS评估双节段腰椎滑脱症患者手术疗效为不良的获取曲线下面积(area under the curve,AUC)分别为0.868、0.797、0.875、0.822、0.853,各指标联合评估的AUC最大,为0.927,最佳评估敏感度、特异度分别为90.50%、91.89%。结论:双节段腰椎滑脱症患者手术前后脊柱-骨盆矢状面参数SSA、TPA、LL、SS呈升高趋势,PT呈降低趋势,PI无明显变化,且SSA、TPA、LL、SS、PT变化值与患者疼痛程度、腰椎功能改善情况密切相关,可作为评估手术疗效的参数。

Management of lumbar zygapophysial (facet) joint pain

AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.

A double-network hydrogel for the dynamic compression of the lumbar nerve root

Current animal models of nerve root compression due to lumbar disc herniation only assess the mechanical compression of nerve roots and the inflammatory response. Moreover, the pressure applied in these models is static, meaning that the nerve root cannot be dynamically compressed. This is very different from the pathogenesis of lumbar disc herniation. In this study, a chitosan/polyacrylamide double-network hydrogel was prepared by a simple two-step method. The swelling ratio of the double-network hydrogel increased with prolonged time, reaching 140. The compressive strength and compressive modulus of the hydrogel reached 53.6 and 0.34 MPa, respectively. Scanning electron microscopy revealed the hydrogel's crosslinked structure with many interconnecting pores. An MTT assay demonstrated that the number of viable cells in contact with the hydrogel extracts did not significantly change relative to the control surface. Thus, the hydrogel had good biocompatibility. Finally, the double-network hydrogel was used to compress the L4 nerve root of male sand rats to simulate lumbar disc herniation nerve root compression. The hydrogel remained in its original position after compression, and swelled with increasing time. Edema appeared around the nerve root and disappeared 3 weeks after operation. This chitosan/polyacrylamide double-network hydrogel has potential as a new implant material for animal models of lumbar nerve root compression. All animal experiments were approved by the Animal Ethics Committee of Neurosurgical Institute of Beijing, Capital Medical University, China(approval No. 201601006) on July 29, 2016.

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.