Comparison of pain media and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc

Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.

EFFECT OF ACUPUNCTURE ON POST-OPERATIVE FUNCTIONAL RECOV-ERY IN PATIENTS WITH LUMBAR INTERVERTEBRAL DISC PROTRUSION

Objective To observe the influence of acupuncture on the post-operative rehabilitation in patients undergoing vertebral pulp extraction due to lumbar intervertebral disc protrusion （LIDP） so as to evaluate its efficacy in the treatment of lumbago induced by LIDP. Methods A total of 69 patients undergoing vertebral pulp extraction were randomized into acupuncture group （ n = 35） and control group （ n = 34）. Patients of acupuncture group were treated with routine rehabilitation method and electroacupuncture （EA） stimulation on Zhìbiān （秩边 BL54） and Wěizhōng （委中 BL40）, acupuncture on Shènshū （ 肾俞 BL23）, Dàchángshū （大肠俞 BL25）, BL54, BL40, Jiájǐ （夹脊 EX-B 2）, Shàngliáo （上髎 BL31）, etc., and cupping on BL40, with 15 days being a therapeutic course and for average 7. 36 courses. Patients of control group were treated with simple rehabilitation method. Functional recovery state was judged before and after surgery by using the standards of Japanese Orthopedic Association （JOA）. Results The average recovery rates of 3 months, 6 months and one year after surgery were 49.93% ,90.31% and 95.08% separately in acupuncture group, and 26.24% ,63.42% and 71.36% successively in control group. The recovery rates of acupuncture group were significantly higher than those of control group at the same time-points （P〈0. 05）. Conclusion Acupuncture has a definite effect on promoting post-operative functional recovery in LIDP patients undergoing vertebral pulp extraction and spinal fusion.

Tuina Therapy of Lumbar Intervertebral Disc Protrusion

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CLINICAL OBSERVATION ON ELECTRO-ACUPUNCTURE TREATMENT OF 51 CASES OF PROTRUSION OF LUMBAR INTERVERTEBRAL DISC

Through electroacupuncture(EA) treatment of 51 cases of protrusion of lumbar interver-tebral disc, it was further demonstrated that the specific action and characteristics of Siyao and Wuyao acupoints were significant and elucidated by using some objective indexes and obvious therapeutic ef-fect, which lays a foundation for the development, research, popularization and application of shu-point and provides an effective and practicable way for treatment of lumbar intervertebral disc.

Treatment of Protrusion of Lumbar Intervertebral Disc by Massotherapy under Anesthesia—A Report of 64 Cases

Sixty-four cases of protrusion of lumbarintervertebral disc were treated by massotherapy withheavy manipulations plus blocking therapy underanesthesia from August,1997 to July,1998,withsatisfactory therapeutic results as reported in thefollowing.Clinical DataNinety-four cases in the series were randomlydivided into two groups.All the 94 cases satisfied thecriteria for diagnosis of the disorder,and thediagnosis was confirmed by

ELECTROACUPUNCTURE TREATMENT OF 176 CASES OF LUMBAR INTERVERTEBRAL DISC PROTRUSION

In the present paper, 176 cases of lumbar intervertebral disc protrusion are treated with electroacupuncture (EA) and topical heat irradiation. Local tender-point is used as the main acupoint, combined with Tunzhong, Tiaoyue, Weizhong (BL 40) and Yanglingquan (GB 34). The treatment is conducted once daily, with 15 sessions being a therapeutic course. Following treatment, of 176 cases, 46 (26. 1%) are cured, 90 (51. 1%) have prominent improvement, 35 (19.8%) have amelioration and 5 (2.8%) have no apparent changes, with a total effective rate of 97.0%.

SUMMARY OF RESEARCHES ON THE TREATMENT OF PROTRUSION OF LUMBAR INTERVERTEBRAL DISC BY"SHE-BIE" OINTMENT-PARTITION MOXIBUSTION

In the present paper the authors sum up their research results about "She-Bie" (black-tail snake-ground beetle) Ointment-partition moxibustion for treatment of lumbar intervertebral disc protrusion (LIDP). Animal experiments showed that when used externally, "She-Bie" Ointment had striking anti-inflammation and pain-relief actions but had no irritant and no allergic effects to the skin. In the treatment of mild type of LIDP, "She-Bie" Ointment partition moxibustion could work well in improving clinical symptoms; and in the treatment of moderate type of LIDP, it could be used as a supplementary measure and raise the excellent and good rates of the therapeutic effect further. For this reason, "She-Bie" Ointment partition moxibustion deserves being popularized in clinical treatment of LIDP.

TREATMENT OF 29 CASES OF LUMBAR INTERVETEBRAL DISC PROTRUSION WITH GINGER-SEPARATED MOXIBUSTION

: To observe the effect of ginger-separated moxibustion for treatment of lumbar intervertebral disc prolapse. Methods: 29 lumbar intervertebral disc protrusion patients including 21 males and 8 females were treated with ginger-separated moxibustion of Ashi-point and Jiaji (EX-B 2 , the affected region), 5-6 cones every time, once every other day, continuously for 5 times. Then the therapeutic effect was analyzed. Results: After treatment, of the 29 cases, 23(79.3%) were cured, and the rest 6(20.7%) experienced improvement. Conclusion: Ginger-separated moxibustion is fairly effective and safe in treatment of lumbar intervertebral disc protrusion.

Epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion

Objective： To investigate epidural fat distribution patterns in patients with lumbar intervertebral disc protrusion. Methods： Medical records were selected randomly from 30 patients whose diagnoses were consistent with the inclusion criteria of the study. Thickness of bilateral fat, the longest length of posterior fat, thickness of bilateral yellow ligament and the hernial distance of lumbar discs were measured by MRI at L3/L4, L4/L5 and L5/S 1 levels. According to clinical symptoms of lumbar intervertebral disc protrusion, the patients were divided into two groups at all space levels. All data were analyzed by statistical software. Results： The longest length of posterior epidural fat at the symptomatic levels was shorter than that at the non-symptomatic levels in each disc space. The symptomatic levels had no effect on the whole thickness of the lateral fat and lateral yellow ligaments. Conclusion： Epidural fat distribution in patients with lumbar intcrvertebral disc protrusion is different from that in normal adults. It is affected by the hernial distance of lumbar discs. The diagnostic criteria for spinal epidural lipomatosis in normal adults may therefore prove to be inappropriate for patients with lumbar intervertebral disc protrusion.

棘突间植入物Coflex与PLIF术式治疗节段性不稳的腰椎间盘突出症的疗效比较

目的:对置入棘突间动态固定装置Coflex与PLIF两种手术方法治疗腰椎间盘突出症合并腰椎不稳的患者分析手术疗效。方法:对18例苏州大学附属第一医院收治确诊为腰椎间盘突出症并伴有腰椎不稳的患者行手术治疗,临床及相关影像学资料相对完整的患者进行随访调查研究,随访时间为2～14个月,平均(5.33±3.69)个月。术前和术后分别用ODI指数、JOA评分评价,并评价两种手术的疗效。结果:术后ODI指数较术前明显下降、JOA评分较术前明显提高(P<0.01),两种手术疗效差异无统计学意义(P>0.05)。结论:两组患者的手术均具有较为满意的疗效,两者间的疗效无明显差异。

Diagnostic Significance of Topical Image of Infrared Thermography on The Patients with Lumbar Intervertebral Disc Protrusion AComparative Study on 45 Patients with Manipulative Treatment and 65 Normal Control

Objective: To analyse and explore the diagnostic significance of infrared thermography on the patients with lumbar intervertebral disc protrusion.Methods: Forty-five hospitalized cases under conservative treatment (mainly manipulation) and 65 controls were consecutively selected. Both groups were examined with infrared thermography on lower back and lower extremities as well as physical examination before and after treatment. The study statistically analysed the temperature difference between the involved and healthy parts at different areas; and also compared the variation of the temperature difference after the treatment to the decreasing scores of physical examination afterward. Results: The statistic result showed that the temperature difference between two sides on patient group was significantly higher than those of the control group. The further analysis showed that the temperature difference at posterior femur area in the patients’ group correlated significantly to the severity of clinical signs caused by nerve root irritation.Conclusion: The thermogram was uncertain to the segmental diagnosis of lumbar disc protrusion and could only be considered as a reference in the final diagnosis. Nevertheless, it is helpful to discover the severity of radical signs according to the posterior femoral region of hypo- (hyper-) thermogram.

中医特色健康管理模式联合中药热敷对腰突症患者疼痛及功能康复的影响

目的研究探讨中医特色健康管理模式联合中药热敷对腰突症患者疼痛及功能康复的影响。方法选取2021年6月—2023年6月本院收治的100例腰突症患者为对象,随机数字表法分为观察组、对照组,每组50例。对照组以常规护理干预结合中药热敷干预,观察组在此基础上增加中医特色健康管理模式干预。评估对比两组中医症状评分、疼痛程度、康复效果、不良事件发生率。结果观察组在干预2、4、8、12周时中医症状评分低于对照组(P<0.05)。观察组在干预2、4、8、12周时视觉模拟评分低于对照组(P<0.05)。观察组在干预2、4、8、12周时日本骨科协会评估治疗评分低于对照组(P<0.05)。观察组不良事件发生率6.00%,低于对照组的22.00%(P<0.05)。结论中医特色健康管理模式联合中药热敷对腰突症效果良好,缓解中医症状和疼痛程度,恢复腰椎功能,降低各种不良事件发生。

张闻东教授循经分证针法治疗腰椎间盘突出症的经验

张闻东教授继承与发扬中医传统疗法根据“经脉所过,主治所及”的思想,结合长期治疗腰椎间盘突出症的临床经验提出了“循经取穴为主,辨证选穴为辅,远治近治相结合,辨经辨证同配伍”的取穴原则,从辨经入手将腰椎间盘突出症分为膀胱经型、胆经型、督脉型和混合型,根据足太阳膀胱经、足少阳胆经和督脉的经脉循行路线,选取近部腧穴与远部腧穴治疗;同时从辨证入手将腰椎间盘突出症分为寒湿证、瘀血证、肾虚证,在治疗时再结合不同的配穴予以针刺,结合艾灸、刺络放血等疗法,在临床取得了很好的临床疗效,值得推广应用。

中西医结合治疗肾虚血瘀型腰椎间盘突出症临床观察

目的:观察六味地黄汤加味联合甲钴胺片和右酮洛芬胶囊治疗肾虚血瘀型腰椎间盘突出症的临床疗效。方法:选取符合纳入标准的腰椎间盘突出症患者60例,采用随机数字表法将其分为两组各30例。对照组予甲钴胺片联合右酮洛芬胶囊,治疗组在对照组基础上加用六味地黄汤加味。2周为1个疗程,治疗2个疗程。比较两组患者治疗前后视觉模拟量表(VAS)评分、日本骨科协会评估治疗分数(JOA)评分、Oswestry功能障碍指数问卷表(ODI)评分。结果:治疗组总有效率为90.00%,高于对照组的66.67%(P<0.05);治疗后,治疗组VAS、JOA、ODI评分均明显改善(P<0.05),且改善程度优于对照组(P<0.05);治疗组复发率为7.40%,低于对照组的25.00%,两组比较差异有统计学意义(P<0.05)。结论:六味地黄汤加味联合甲钴胺片和右酮洛芬胶囊治疗肾虚血瘀型腰椎间盘突出症效果较好,可缓解患者腰部疼痛症状,改善其生活质量。

密集型温针灸斜刺联合腰椎斜扳手法治疗腰椎间盘突出症的疗效观察

目的观察密集型温针灸斜刺联合腰椎斜扳手法治疗腰椎间盘突出症(LDH)的临床疗效。方法选取2022年8月至2023年7月收治的60例LDH患者为研究对象,采用随机数字表法分为2组,对照组30例予常规针刺治疗,治疗组30例予密集型温针灸斜刺联合腰椎斜扳手法治疗。比较2组治疗前后Oswestry功能障碍指数(ODI)评分、血清C反应蛋白(CRP)、血液流变学指标[包括全血黏度(低切)、全血黏度(高切)及血浆黏度]及生活质量综合评定问卷(GQOLI-74)(包括躯体功能、心理功能及社会功能3个维度)评分变化情况。结果治疗组总有效率93.33%(28/30),对照组总有效率73.33%(22/30),治疗组总有效率高于对照组(P<0.05)。与本组治疗前比较,2组治疗后腰椎功能ODI评分均降低(P<0.05),且治疗组治疗后腰椎功能ODI评分低于对照组(P<0.05)。与本组治疗前比较,2组治疗后炎症指标血清CRP水平均降低(P<0.05),且治疗组治疗后血清CRP水平低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血液流变学指标全血黏度(低切)、全血黏度(高切)及血浆黏度水平均降低(P<0.05),且治疗组治疗后血液流变学指标全血黏度(低切)、全血黏度(高切)及血浆黏度水平均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后生活质量GQOLI-74躯体功能、心理功能及社会功能评分均升高(P<0.05),且治疗组治疗后GQOLI-74躯体功能、心理功能及社会功能评分均高于对照组(P<0.05)。结论密集型温针灸斜刺联合腰椎斜扳手法治疗LDH的临床疗效确切,可有效改善患者腰椎功能,消除炎症反应,改善血液流变学指标,提高生活质量。

椎间孔镜技术下经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄的近期效果观察

目的探讨椎间孔镜技术下经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄的近期临床疗效。方法2018年7月~2022年12月我院治疗的腰椎间盘突出症合并侧隐窝狭窄病人132例。根据手术方式分为内镜组和传统组,内镜组70例,采用椎间孔镜技术下经椎板间入路治疗,传统组62例,采用传统开放手术治疗,对比两种方法的手术指标、术后病人临床症状缓解情况。结果内镜组的平均手术时间(76.1±7.5)分钟、手术出血量(30.5±8.4)ml、切口长度(0.88±0.12)cm、手术后引流量(24.5±4.4)ml、卧床时间(26.8±4.4)小时、住院时间(5.6±1.8)天,传统组分别为(88.0±9.3)分钟、(103.4±18.6)ml、(6.10±1.04)cm、(208.3±34.0)ml、(32.7±6.6)小时、(9.4±2.0)天,两组比较差异有统计学意义(P<0.05)。两组病人术后3个月、6个月VAS评分较术前均降低,JOA评分增高,差异有统计学意义(P<0.05);内镜组腰椎功能优43例(61.43%)、良15例(21.43%),传统组分别为29例(46.77%)、17例(21.43%),两组比较差异无统计学意义(P>0.05);两组病人手术并发症发生率分别为2.86%、11.29%,两组比较差异无统计学意义(P>0.05)。结论椎间孔镜技术下经椎板间入路治疗腰椎间盘突出症合并侧隐窝狭窄和传统开放手术均可达到较好恢复效果,有效缓解临床症状,其优势在于手术时间更短,创伤更小。

立新七针三联针法联合牵引治疗腰椎间盘突出症临床观察

目的:观察立新七针三联针法联合牵引治疗腰椎间盘突出症的临床疗效。方法:选取符合纳入标准的腰椎间盘突出症患者60例,按随机数字表法分为两组各30例。对照组予常规针刺及腰椎牵引治疗,治疗组予立新七针三联针法及腰椎牵引治疗。2周为1个疗程,每个疗程间隔3天,共治疗3个疗程。比较两组患者治疗前后疼痛视觉模拟评分(VAS)、日本骨科协会评估治疗分数(JOA)评分。结果:治疗组总有效率为93.33%,优于对照组的70.00%(P﹤0.05)。治疗后,两组患者VAS评分较治疗前均明显升高(P﹤0.05),JOA评分较治疗前均明显下降(P﹤0.05),且治疗组的VAS评分及JOA评分改善程度均优于对照组(P﹤0.05)。结论:立新七针三联针法联合牵引治疗腰椎间盘突出患者疗效确切,能明显改善腰椎功能。

温通针法联合桃红四物汤治疗腰椎间盘突出症临床观察

目的:观察温通针法联合桃红四物汤治疗腰椎间盘突出症的临床疗效。方法:选取符合纳入标准的90例腰椎间盘突出症患者,随机分为两组各45例,对照组采用常规治疗,治疗组采用温通针法联合桃红四物汤治疗。以视觉模拟评分(VAS)、Roland-Morris功能障碍调查表(RMQ)、日常生活活动能力评定量表(ADL)及临床疗效作为评价指标。结果:治疗组总有效率95.56%,对照组总有效率77.78%,两组比较差异有统计学意义(P﹤0.05);治疗后,两组VAS评分、RMQ评分均降低,且治疗组低于对照组(P﹤0.05);两组的ADL评分均升高,且治疗组高于对照组(P﹤0.05)。结论:温通针法联合桃红四物汤治疗腰椎间盘突出症可改善疼痛,提高腰椎功能和生活质量。

腰椎间盘突出症辨证分型与MRI影像学表现相关性研究

目的:回顾性分析90例腰椎间盘突出症患者中医辨证分型与MRI影像学表现的关系,探讨腰椎间盘突出症中医辨证分型的MRI影像学依据。方法:分析90例腰间盘突症患者临床资料及中医辨证分型,并观察常规腰椎MRI影像学表现中的椎间盘本身的改变、椎体及附件的改变,研究腰椎间盘突出症患者中医辨证分型与MRI影像学表现的关系。结果:中医辨证分型包括血瘀型22例、寒湿型16例、湿热型14例、肝肾亏虚型38例,肝肾亏虚型发病率42.2%最高;血瘀型多为青年人,肝肾亏虚型多为老年人;血瘀型多为侧后突,寒湿型和湿热型多为侧旁型突出,肝肾亏虚型多为中央型突出;椎间盘突出程度分析:血瘀型最重,肝肾亏虚型最轻;椎体和附件改变情况:肝肾亏虚型最重。结论:腰椎间盘突出症中医辨证分型与椎间盘突出MRI影像学存在相关性,磁共振影像学表现结合临床症状可以较准确地确定腰椎间盘患者的中医分型,为临床治疗椎间盘病变提供客观依据。