早期功能锻炼配合穴位按摩在腰椎间盘突出症经皮全脊柱内镜术后的应用价值

目的:探讨早期功能锻炼配合穴位按摩在腰椎间盘突出症经皮全脊柱内镜术后的应用价值。方法:选取2020年3月-2022年3月宿迁市第一人民医院收治的行经皮全脊柱内镜技术治疗的腰椎间盘突出症患者120例为观察对象,采用随机数字表法分为对照组与观察组,各60例。对照组采用常规护理干预,观察组采用早期功能锻炼配合穴位按摩护理干预。比较两组患者疼痛缓解情况、腰椎功能[Oswstry功能障碍指数(ODI)]、生活质量。结果:术后6~12 h、12~18 h、24~48 h,观察组疼痛评分低于对照组,差异有统计学意义(P<0.05);术后1、3个月,两组患者ODI评分均降低,观察组低于对照组,差异有统计学意义(P<0.05);观察组精力、社会功能、躯体功能、精神健康评分高于对照组,差异有统计学意义(P<0.05)。结论:对腰椎间盘突出症经皮全脊柱内镜术后患者进行早期功能锻炼配合穴位按摩,可缓解患者术后疼痛,改善腰椎功能障碍,提高患者的生活质量。

182例腰椎间盘突出症CT分析

目的：CT对腰椎间盘突出症的诊断。方法：对182例腰椎间盘突出症行CT检查，将其结果进行比较分析。结果：本组182例中，中央型95例，外侧型65例，远外侧型22例。结论：CT检查腰椎间盘突出症可显示椎间盘后缘向椎管内限局性突出的软组织块影，并有大小，形态不一的钙化，Sehmort结节形成，硬膜囊，神经根受压变形，椎管骨性狭窄以及黄韧带钙化。

APLD术后椎间盘炎的问题探讨

目的:探讨自动经皮腰椎间盘切吸术(AutoPercutaneousLumberDiscectomy,APLD)术后并发椎间盘炎的病因、诊断、治疗和预防;方法:采用大剂量抗生素静脉滴注,同时尽早再次APLD减压冲洗、抽吸;结果:7例均再次行APLD后症状明显好转并较快治愈;结论:APLD术后并发椎间盘炎以预防为主,治疗方法首选尽早再次行APLD。

MED椎间盘镜治疗腰椎间盘突出症

腰椎间盘突出症是常见病、多发病，传统的开放式手术损伤大，出血多，卧床时间长，且破坏了脊柱正常的生物力学关系。选择一种创伤小，脊柱生物力学破坏少且疗效好的治疗方法，是骨科医生追求的目的。我院2004年5月起应用MED椎间盘镜手术系统对29例腰间椎盘突出症患者进行了腰椎间盘摘除手术，现报告如下：

易误诊为腰椎间盘突出症的腰骶部疾患(附13例报告)

易误诊为腰椎间盘突出症的腰骶部疾患（附１３例报告）浙江省东阳市人民医院（３２２１００）张永进单军标腰椎间盘突出症（下简称腰突症）手术已在基层医院普遍开展，由于其创伤小，手术效果良好，受到了病人的欢迎。但误诊误治时有发生，自１９９３年至１９９５年，本院...

DISCUSSION OF MECHANISM ON LUMBAR DISC HERNIATION TREATED WITH BLOODLETTING ON W■IZH■NG(委中BL40)

Objective To observe the changes of sciatic nerve conduction velocity （SNCV） and interleukin-1α （IL-1α）, phospholipase A2 （PLA2） and prostaglandin E2 （PGE2） in neucleus pulposus tissue in experimental rabbits with lumbar disc herniation （LDH） ; and discuss the mechanism of LDH treated with bloodletting on Wěizhōng （委中 BL40）. Methods 40 normal named control group, LDH model group, BL40 group New Zealand rabbits were randomized into 4 groups, and comparative point group. The experimental LDH model was prepared by the self-made LDH animal pathological modeling device. Bloodletting on BL40 or on comparative point was applied for 7 days. BL-410 physiological signal recorder was used to record SNCV. Enzyme-linked immunosorbent assay （ELISA） and radioimmunology methods were used to determine the contents of IL-1α and PLA2 in neucleus pulposus tissue and PGE2 in serum. Results In BL40 group, SNCV was significantly increased after treatment comparing with that before treatment （P〈0. 01 ）, and the difference in SNCV value before and after treatment was significantly bigger than that in model group and comparative point group （P〈0.05）. Bloodletting on BL40 reduced the contents of IL-1α and PLA2 in neucleus pulposus tissue and serum PGE2 in LDH rabbits, which indicated significant difference or very significant results in the comparison with model and comparative point groups （P〈0.01 or 0. 05）. Conclusion Bloodletting speeded up rapidly SNCV and reduced the contents of inflammatory factors, i.e. IL-1α, PLA2 and serum PGE2 in LDH rabbits, which indicated that alleviation of local inflammatory reaction is probably one of the mechanisms on LDH treated by bloodletting on BL40.

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.

CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE PLUS ATOMIZED HERBAL MEDICINE IN THE TREATMENT OF LUMBAR INTERVERTEBRAL DISC PROTRUSION

Objective To observe the therapeutic effect of acupuncture combined with atomized herbal medicine in the treatment of protrusion of lumbar intervertebral disc. Methods A total of 211 patients with lumbar intervertebral disc protrusion were randomized into two groups, with 106 cases being in trealment group and 105 in control group. The treatment was given once everyday, 12 days as one course of treatment. After two courses of treatment, the results were analyzed. Results The curative rate was 97.1% in the treatment group and 81.0% in the control group. Conclusion Acupuncture together with herbal medicine for the protrusion of lumbar intervetebral disc was better in effect than acupuncture only.

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.

Application of Huangqi Guizhi Wuwu Decoction in Orthopaedics and Traumatology

The Huangqi Guizhi Wuwu Decoction(HQGZWWT)is composed of Huangqi(Astragali Radix),Shaoyao(Paeoniae Radix Alba),Guizhi(Cinnamomi Ramulus),Shengjiang(Zingiberis Rhizoma Recens),and Dazao(Jujubae Fructus)which has various pharmacological anti-inflammatory,analgesic,antioxidant,antitumor,lipid-lowering,and immunity-regulating activities.It has certain advantages in the treatment of orthopaedic diseases,such as cervical spondylosis,scapulohumeral periarthritis,lumbar disc herniation,knee osteoarthritis,rheumatoid arthritis,myofascial pain syndrome,etc.,with outstanding clinical efficacy,few adverse reactions,and high patient compliance.However,modern pharmacological researches on the whole prescription of HQGZWWT are insufficient and the therapeutic targets are not clear which needs further exploration.Besides,this prescription cannot treat ll orthopaedic diseases,so we should adhere to the thinking of four diagnostics in traditional Chinese medicine(TCM),select prescriptions based on syndrome differentiation,closely follow the pathogenesis,innovate and expand its scope of application,reflect the application advantages of this prescription in orthopaedics and traumatology and improve the total clinical efficiency.

Observation of efficacy on prolapse of lumbar intervertebral disc treated with body acupuncture and wrist-ankle acupuncture

Objective To observe the clinical effects of body acupuncture and wrist-ankle acupuncture on prolapse of lumbar intervertebral disc, Methods One hundred and eighty cases of prolapse of lumbar intervertebral disc were randomly divided into body acupuncture and wrist-ankle acupuncture group （observation group） and simple body acupuncture group （control group）, 90 cases in each one. In observation group, body acupuncture was applied on Ahshi points of lumbar region, lumbar Jiájǐ （夹脊EX-B 2）, Dàchángshú（大肠俞 BL 25）, etc. and wrist-ankle acupuncture was applied on lower No. 4, 5 and 6 regions. In control group, simple body acupuncture was applied on the same points as observation group. Results The lumbar vertebral function and pain scale were improved in either group in comparison before and after treatment （P〈0.05）. Concerning pain improvement, the total effective rate was 95.6% in observation group, which was superior to that （86.7%） in control group （P〈0.05）. Concerning the improvement of lumbar vertebral function, the total effective rate was 90.0% in observation group and 93.3% in control group, without significant difference between two groups （P〉0.05）. Conclusion Combined therapy of body acupuncture and wrist-ankle acupuncture demonstrates apparent analgesia in prolapse of lumbar intervertebral disc.

One hundred and twenty-four cases of lumbar disc herniation treated with acupuncture and massage manipulation

Objective To discuss the clinical efficacy on lumbar disc herniation （LDH） treated with acupuncture and massage manipulations. Methods One hundred and twenty-four cases of LDH were treated with acupuncture at Taichong （太冲LR 3）, Neiting （内庭 ST 44）, Zulinqi （足临泣 GB 41）, Yaotongdian （腰痛点 lumbar pain point）, Tuntangdian （臀痛点 buttock pain point） and Zuogushenjingdian （坐骨神经点 sciatic point） and massage manipulations [including gunfa （rolling technique）, yizhichan tuifa （one-finger pushing technique）, qianyin doudong fa （shaking technique under traction）, anyofa （pressing technique） and zuoyou cebanfa （bilateral pulling technique）], once a day, for 3 weeks totally. The lower back pain scoring system of the Japanese Orthopedic Association （JOA） was adopted for the scoring before and after treatment to assess the efficacy. Results At the end of treatment, JOA score was reduced to （0.95±0.32） points as compared with （6.14±0.97） points before treatment （P〈0.01）. Concerning to the efficacy improvement rate, 96 cases were excellent, 12 cases good, 5 cases fair and 3 cases poor. 116 cases received the follow-up visit for 6 months averagely and no case of recurrence was reported. Conclusion Acupuncture combined with massage manipulate can relieve rapidly acute pain in the lumbar region and legs and acts directly on the foci. This therapy is safe and effective, achieves the high clinical curative rate and brings less pain to the patients.

Heat-sensitive moxibustion for lumbar disc herniation:a meta-analysis of randomized controlled trials

OBJECTIVE:To assess the efficacy and safety of heat-sensitive moxibustion in the treatment of lumbar disc herniation(LDH).METHODS:Randomized controlled trials(RCTs) involving heat-sensitive moxibustion in the treatment of LDH were retrieved from the Chinese Biological Medical Literature database(1978-20011),Weipu database(1989-2011),Wanfang digital journal(1998-2011),China National Knowledge Internet(1979-2011),PubMed(1966-2011),EMBASE(1980-2011),and Cochrane Library(Issue 1,2011).Hand-search of the relevant journals from the Library of Jiangxi University of Traditional Chinese Medicine was also adopted for the collection of data.Data were extracted and evaluated by two reviewers independently with a specially designed extraction form.The Cochrane Collaboration's RevMan 5.0.20 software was used for data analyses.RESULTS:A total of 6 trials involving 580 patients were included.Meta-analysis showed that the total effectiveness rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.19,95% CI [1.06,1.33)] and diclofenac sodium [RR=1.47,95% CI [1.17,1.85)],but similar to that of acupuncture.The cure rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.58,95% CI(1.04,2.40)] and diclofenac sodium [RR=1.91,95% CI(1.01,3.60)],but similar with that of acupuncture.In terms of the Japanese Orthopaedic Association scores,significant differences were noted in subjective indices,objective indices,and daily life subscales.Two trials reported that there were no adverse events over the duration of treatment.CONCLUSION:Compared with conventional moxibustion,acupuncture,and diclofenac sodium,heat-sensitive moxibustion in the treatment of LDH is superior in efficacy.Further large-scale trials are required to define the role of heat-sensitive moxibustion in the treatment of this disease.

Forty-six cases of postoperative pain in the waist and leg of lumbar disc herniation treated by warming needle moxibustion and electroacupuncture

Objective To explore therapeutic efficacy of warming needle moxibustion and electroacupuncture for postoperative pain in the waist and leg of lumbar disc herniation. Methods Forty-six cases were treated with warming needle moxibustion at Yaotu （腰突, extra point, the same segment of injured disc herniation）, regular acupuncture at Yaoyan （腰眼 EX-B 7）, Zhibian （秩边BL 54）, Huantiao （环跳 GB 30）, Weizhong （委中BL 40）, Yanglingquan （阳陵泉 GB 34） and electroacupuncture at Yaoto （腰突）, Zhibian （秩边 BL 54）, Yanglingquan （阳陵泉 GB 34）. The treatment was given once a day, 10 treatments made up one session, and the therapeutic effect was assessed after 2 sessions of treatment. Results After the treatment, 31 cases （67.4%） were cured, 14 cases （30.4%） were effective and i case （2.2%） was failed. The total effective rate was 97.8%. Conclusion The warming needle moxibustion combined with electroacupuncture has obvious therapeutic effect on postoperative pain in the waist and leg of lumbar disc herniation.

Effect of scraping therapy on Interleukin-1 in serum of rats with lumbar disc herniation

OBJECTIVE:To explore the effect of scraping therapy on the Interleukin-1 (IL-1) levels of rats with lumbar disc herniation (LDH). METHODS: Fifty male rats were devided into a blank group (A), a sham operation group (B), a model group (C), a scraping group (D), and a drug group (E). The rats in the group B were treated with sham operation, and groups C, D and E were made into the LDH model by operation. After operation group C were treated with no interventions, D were given scraping and E were fed with azathioprine Then the IL-1 levels of different groups were detected by enzyme-linked immuno sorbent assay method. And the transplanted coccygeal vertebra discs were observed by pathological section. RESULTS: The IL-1 levels in the groups C, D, and E were significantly higher than those in the groups A and B (all P<0.01), which proved the operationwas successful.The IL-1 levels in the groups D and E at different periods had statistical significance (F= 414.158, P<0.01). The treatment periods and interventions have interation (F=46.613, P<0.01). Multiple comparison results showed that the IL-1 levels in the groups D and E was significantly lower than that in the group C (P<0.01), while the IL-1 levels between the groups D and E had no statistical significance (P>0.05). Moreover, pathological section indicated that immuno-inflammatory response was hardly found in coccygeal vertebra discs in the groups A and B, while local immuno-inflammatory responses of the groups D and E were much lighter than that of the group C. CONCLUSION: Scraping therapy could inhibit the immuno-inflammatory responses in the rats with LDH caused by transplantation of autologous nu cleus pulposus.