地塞米松穴位注射治疗强直性脊柱炎并发膝关节腔积液体会

目的:观察穴位注射地塞米松治疗强直性脊柱炎并发膝关节腔积液的临床疗效,以期寻找一种疗效可靠、副作用小的治疗手段。方法:选择47例确诊为强直性脊柱炎,自诉膝关节肿痛、活动受限,经B超检查有膝关节腔积液的患者,予以地塞米松5mg分双侧足三里穴位注射,根据患者病情缓解情况,3-5天后减量为4mg,以后每3天减量1mg,减量为2mg注射3天后改为强的松5mg口服,1日2次,1周后改为强的松5mg口服,1日1次,维持两周后停用激素。治疗期间,其他非甾体抗炎药、免疫抑制剂按照常规治疗方案使用。每天记录患者自诉症状,测量患者双膝关节周径。治疗前、第一次地塞米松减量时及激素停用时对患者进行双膝关节B超检查。治疗前后检查血尿常规。结果:所有患者在开始激素治疗后,自诉膝关节肿痛、活动受限等症状有所改善,且又日渐减轻的趋势,肿胀的膝关节周径减少。3-5天后,一般患者自觉症状改善明显,医师检查发现膝关节肿胀明显消退,予以膝关节B超检查,38患者关节腔积液基本消失。到治疗结束时,所有患者未诉膝关节疼痛、活动障碍,医师查体发现,未见膝关节肿胀,测量膝关节周径恢复正常,膝关节B超检查检查,均无关节腔积液。结论:穴位注射地塞米松疗法将激素的治疗作用与经穴的刺激作用结合起来,提高了治疗效果,缩短了疗程,减少口服给药的胃肠道刺激作用。操作简便,易于掌握,病人容易接受,值得推广。

后路长节段经皮置钉内固定术治疗强直性脊柱炎合并胸腰椎骨折患者的效果

目的:观察后路长节段经皮置钉内固定术治疗强直性脊柱炎合并胸腰椎骨折患者的效果。方法:回顾性分析2018年1月至2020年8月该院收治的120例强直性脊柱炎合并胸腰椎骨折患者的临床资料,按不同手术方案分为观察组70例和对照组50例。对照组实施后路长节段切开复位内固定术治疗,观察组实施后路长节段经皮置钉内固定术治疗,比较两组手术时间、术中出血量、术后首次下床活动时间、疗效、视觉模拟评分法(VAS)评分、伤椎Cobb角和并发症发生率。结果:观察组手术时间和术后首次下床活动时间均短于对照组,术中出血量明显低于对照组,差异有统计学意义(P<0.05);两组术后6个月治疗优良率、VAS评分和伤椎Cobb角比较,差异均无统计学意义(P>0.05);两组均未出现并发症。结论:后路长节段经皮置钉内固定术治疗强直性脊柱炎合并胸腰椎骨折患者可减少术中出血量,以及缩短手术时间和术后首次下床活动时间,效果优于后路长节段切开复位内固定术治疗。

鹿瓜多肽注射液对强直性脊柱炎患者血清Vaspin的影响

目的:观察鹿瓜多肽注射液对强直性脊柱炎(AS)患者血清内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(visceraladipose tissue-derived serine protease inhibitor,Vaspin)水平的影响,阐明Vaspin在强直性脊柱炎发生过程中可能的作用机制。方法:采用酶联免疫法测定AS患者鹿瓜多肽注射液治疗前后血清Vaspin水平及炎症因子浓度,并分析血清Vaspin水平与炎症因子间的相互关系。结果:AS组血清Vaspin水平明显高于正常对照组(1.79±0.27vs.0.72±0.08μg/L,P<0.01)。AS组患者血清Vaspin水平与TNF-α及BASDAI呈正相关(r=0.454,P<0.05和r=0.328,P<0.01)。TNF-α是影响空腹血清Vaspin水平的独立相关因素。AS组经鹿瓜多肽注射液治疗后ESR、CRP、TNF-α、BAS-DAI及BASFI均显著降低(均P<0.01),血清Vaspin水平也显著降低(1.79±0.27vs.1.26±0.07μg/L,P<0.01)。结论:鹿瓜多肽注射液能有效抑制致炎性细胞因子产生,控制和延缓疾病活动,同时降低血清Vaspin水平。

Rheumatoid arthritis and ankylosing spondylitis occurring together: a case report

Ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are two different rheumatoid immune diseases. It is not common that the two diseases occur simultaneously in the same patient in clinical practice. Here, we reported a case of meeting the diagnostic criteria for both AS and RA, who was treated with integrated traditional Chinese and Western medicine and received apparent improvement.

Research Progress on Molecular Mechanism of Moxibustion in the Treatment of Ankylosing Spondylitis

As an important part of traditional Chinese medicine (TCM) nursing technology, moxibustion plays a unique role in improving the symptoms of ankylosing spondylitis (AS). The research on the mechanism of moxibustion intervention in AS mainly focuses on anti-inflammatory effects, immune regulation, bone metabolism regulation, intestinal flora regulation, and so on. Molecular medicine is of great significance to further clarify the mechanism of moxibustion intervention in AS. However, there are still some problems in the research on the molecular mechanism of moxibustion intervention in AS: the existing biomedical research methods only explore from a specific field and lack the exploration of moxibustion-targeted molecules based on biomedical network. In the future, the molecular network effect of moxibustion on AS can be discussed comprehensively and systematically with the help of omics technology and the construction of biological information interaction network between omics. The effect of moxibustion on upstream osteogenic transcription factors and related signaling pathways such as WNT, β-catenin, and BMP/Smads is not yet clear. Future research can focus on the relevant signal targets of bone reconstruction and clarify the mechanism of moxibustion against the new bone formation. In addition, there is a lack of research on the molecular mechanism of moxibustion in the treatment of AS from the perspective of metabolites. It is necessary to further explore the mechanism of moxibustion in the treatment of AS with the help of metabonomics technology.

Moxibustion on Governor Vessel for ankylosing spondylitis due to kidney yang deficiency:a clinical controlled study

Objective： To observe the clinical effect of moxibustion on Governor Vessel for ankylosing spondylitis（AS） due to kidney yang deficiency.Methods： A total of 60 patients of AS due to kidney yang deficiency were randomly divided into a treatment group and a control group by random digital table, 30 cases in each group. Both of the two groups were treated by oral administration of Sulfasalazine tablets. Additionally, the treatment group was given moxibustion on Governor Vessel, and the control group was given sham moxibustion. The treatment was given once every other day, 4 weeks constituted one course, 2 courses in total. Before treatment, after 1-course and 2-course treatments, the quantified scores of traditional Chinese medicine（TCM） syndromes and the symptoms scores recommended by AS International Society [including Bath ankylosing spondylitis disease activity index（BASDAI）, visual analogue scale（VAS）, Bath ankylosing spondylitis functional index（BASFI） and Bath ankylosing spondylitis metrology index（BASMI）] were respectively observed and recorded, and the change of safety item was monitored. Results： After 1-course and 2-course treatments, the quantified scores of TCM syndromes were obviously improved than those before treatment in the two groups（P〈0.05）, and the score was improved better in the treatment group than that in the control group（P〈0.05）. In comparison within the group, there were no statistical differences between the scores after 1-course treatment and 2-course treatment in the two groups（P〈0.05）. After 1-course treatment, the items of the symptoms scores were improved than those before treatment in the two groups（P〉0.05）. After 2-course treatment, the therapeutic effect was more remarkable in the treatment group, with a statistical difference between the two groups（P〈0.05）. During treatment, no obvious abnormality in all safety items was noticed in the two groups. Conclusion： Moxibustion on Governor Vessel can effectively relieve the clinical symptoms of AS patients, without obvious adverse reaction.

Treatment of ankylosing spondylitis by fire-needle therapy plus tuina manipulations

Objective：To observe the clinical effect of fire-needle therapy plus tuina manipulations for ankylosing spondylitis （AS）. 〈br〉 Methods：A total of 49 eligible cases were treated by fire-needle therapy plus tuina manipulations, once every other day. Ten days made one course. After the continuous treatment for six courses, the therapeutic effects were summarized and the changes in the clinical symptoms and signs were observed. 〈br〉 Results：During treatment, 7 cases dropped off. In 42 patients who had completed treatment for six courses, the results showed clinical recovery in 16 cases, remarkable effect in 13 cases, effect in 7 cases and failure in 6 cases. The measurements of the patients were all improved in different degrees than those before treatment. Moreover, no side effect was noticed during treatment. 〈br〉 Conclusion：The therapeutic effect is precise and free of adverse reaction in treatment of AS by fire-needle therapy plus tuina manipulations.

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis

Objective:To observe the efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in ankylosing spondylitis(AS).Methods:A total of 60 patients with hip involvement in AS were randomly divided into a control group and an observation group,with 30 cases in each group.The patients in the control group were given an intra-articular injection of sodium hyaluronate,once a week.The patients in the observation group were given additional warm needling moxibustion,once a day,with a 2-day interval after five consecutive days of treatment.After 5 weeks,changes in such indicators as visual analog scale(VAS)score,Harris score,Bath ankylosing spondylitis disease activity index(BASDAI),Bath ankylosing spondylitis functional index(BASFI),serum cartilage oligomeric matrix protein(COMP),interleukin(IL)-17 were observed,and the efficacy was evaluated.Six months after treatment,Bath ankylosing spondylitis radiology index-hip(BASRI-hip)was evaluated.Results:After treatment,the total effective rate in the observation group was higher than that in the control group(P<0.05).After treatment,the VAS scores in both groups were lower than those before treatment(P<0.05),and the score of the observation group was lower than that of the control group(P<0.05).After treatment,the Harris scores of both groups were higher than those before treatment(P<0.05),and the score of the observation group was higher than that of the control group(P<0.05).Six months after treatment,the BASRI-hip score of the control group was higher than that before treatment(P<0.05),while the score of the observation group was not significantly different from that before treatment(P>0.05)and was lower than that of the control group(P<0.05).After treatment,the scores of BASDAI and BASFI of both groups were lower than those before treatment(P<0.05),and the scores of the observation group were lower than those of the control group(P<0.05).After treatment,the levels of serum COMP and IL-17 of both groups were lower than those before treatment(P<0.05),and the levels of the observation group were lower than those of the control group(P<0.05).Conclusion:The efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for hip involvement in AS is better than the intra-articular injection of sodium hyaluronate alone.This combined approach can alleviate hip pain,improve hip functions,delay the destruction of the hip,prevent AS development,and reduce the levels of serum COMP and IL-17.

Clinical Observation on Long Snake Moxibustion for Ankylosing Spondylitis

Objective： To observe the clinical effect of long snake moxibustion for ankylosing spondylitis （AS）. Methods： A total of 58 AS cases were randomized into a long snake moxibustion group and a Western medication group, 29 in each group. The cases in the former group received long snake moxibustion and Western medication, whereas cases in the latter group received Western medication alone. Results： The total effective rate in the long snake moxibustion group was 93.1%, versus 62.1% in the Western medication group, showing a statistical significance （P〈0.01）; after the treatment, the scores of Bath Ankylosing Spondylitis Disease Activity Index （BASDAI） and Bath Ankylosing Spondylitis Function Index （BASFI） were improved in both groups; however, the improvements of BASDAI and BASFI results in the long snake moxibustion group were more significant than those in the Western medication group （P〈0.05）. Conclusion： Long snake moxibustion and Western medication can significantly improve the clinical effect on AS, coupled with a remarkable effect in enhancing the patients＇ functions.

Effects of acupuncture plus spinal manipulations on physical functioning and biochemical indicators in patients with ankylosing spondylitis

Objective To observe the effects of acupuncture plus spinal manipulations on the physical functioning and levels of alkaline phosphatase(ALP),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and osteoprotegerin(OPG)in patients with ankylosing spondylitis(AS).Methods A total of 128 AS cases were allocated into a control group and an observation group using random number table method,with 64 cases in each group.Patients in both groups took sulfasalazine and meloxicam.Patients in the observation group received additional acupuncture plus spinal manipulations.The efficacy,Bath AS functional index(BASFI),Bath AS disease activity index(BASDAI),and the levels of ALP,ESR,CRP and OPG were compared between the two groups after eight weeks of treatment.Results After treatment,the symptom scores of traditional Chinese medicine in both groups were decreased(all P<0.05),and these scores in the observation group were significantly lower than in the control group(all P<0.05);the VAS,BASFI and BASDAI scores in both groups were decreased(all P<0.05),and these scores in the observation group were significantly lower than in the control group(all P<0.05);and the ALP,ESR,CRP and OPG levels in both groups were decreased(all P<0.05),and these levels in the observation group were significantly lower than in the control group(all P<0.05).The total efficacy rate was 92.2%in the observation group,versus 78.1%in the control group,presenting a statistical significance(P<0.05).Conclusion Conventional medication combined with acupuncture and spinal manipulations can improve clinical symptoms,accelerate the recovery of physical functioning,and reduce the ALP,ESR,CRP and OPG levels.

Clinical development of tumor necrosis factor-alpha inhibitors for ankylosing spondylitis

There is no radical cure for ankylosing spondylitis,a chronic inflammation in joint,till now.Tumor necrosis factor-alpha（TNF-α） inhibitors can block the cascade in inflammatory chain and improve clinical symptom.Among these biological agents,three of them are marketed in China：etanercept,infliximab and adalimumab.Some of the research progresses between 2014 and 2016 are summarized including treatment application,side effects of drugs,and comprehensive research of TNF-α inhibitors.

Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis

Objective： To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis （AS） and the effect of combined anterior and posterior operation. Methods： Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel＇s score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. Results： There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a longterm complication in follow-up. Conclusions： The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.