Clinical Observation of the Hot and Humid Compress Therapy of Traditional Chinese Medicine in the Treatment of Qi Stagnation and Blood Stasis Type of Lumbar Disc Herniation

Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis, clinical evidence is limited. Objective: The purpose of this study is to provide high-quality evidence to support the effectiveness of the traditional Chinese hot and humid compress in the treatment of LDH with qi stagnation and blood stasis. Methods: From October 2021 to November 2023, 86 patients with LDH of qi stagnation and blood stasis type were recruited in our hospital and divided into a control (n = 43) and an observation group (n = 43) according to the random number table method. The control group was given routine clinical treatment, and the observation group was treated with the hot and humid compress therapy for two weeks. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, TCM syndrome score, serum interleukin-6 (IL-6), serum interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were observed and compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated. Results: After treatment, the VAS score, TCM symptom score, and serum IL-6, IL-1β, and TNF-α levels decreased in both groups (P P P P P Conclusions: The hot and humid compress of traditional Chinese medicine can effectively relieve pain, restore lumbar function, improve TCM syndromes, reduce the level of inflammatory factors, and have a curative effect in treating LDH.

Clinical Observation of Warm Needling Acupuncture of Mongolian Medicine in the Treatment of Lumbar Disc Herniation

[Objectives]To observe the clinical efficacy of warm needling acupuncture of Mongolian medicine in the treatment of lumbar disc herniation(LDH).[Methods]120 patients with lumbar disc herniation hospitalized in Inner Mongolia International Mongolian Hospital from June 2019 to June 2022 were randomly divided into observation group(n=60)and control group(n=60).The observation group was treated with warm needling acupuncture of Mongolian medicine,and the control group was treated with common acupuncture of Mongolian medicine,with two weeks as a course of treatment.The pain visual analogue scale(VAS)and Japanese orthopaedic association(JOA)score were observed before and after treatment,and the clinical efficacy was evaluated by the changes of clinical symptoms and signs of Mongolian medicine.[Results]The cure rate of the observation group was 71.7%,which was better than that of the control group(53.3%).The difference in the cure rate between the two groups was statistically significant,X 2=4.302,P=0.038.The total markedly effective rate(cured+markedly effective)of the observation group was 90.0%,while that of the control group was 83.3%.There was no significant difference in the total markedly effective rate between the two groups,X 2=1.154,P=0.283.The total effective rate(cured+markedly effective+effective)of the observation group was 100%,while that of the control group was 95.0%.There was no significant difference in the total effective rate between the two groups,and the continuous corrected chi-square value was 1.368 and 0.242.After treatment,the degree of low back pain,lower limb pain and dyskinesia were significantly improved in the two groups,the observation group was better than the control group,and the difference was statistically significant(P<0.05).[Conclusions]The warm needling acupuncture of Mongolian medicine was effective in the treatment of lumbar disc herniation,which is worth popularizing.

Clinical Effect of Transforaminal Endoscopic Surgery in the Treatment of Lumbar Disc Herniation

Objective:Objective to explore the curative effect of transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:From October 2018 to October 2020,36 patients with lumbar disc herniation were randomly divided into group A and group B.the curative effect,pain,lumbar function and quality of life were analyzed.Results:The curative effect of group A was 94.44%,better than that of group B 61.11%,P<0.05;The visual analogue scale(VAS)of group A was lower than that of group B on 3D,5D and 7d after operation(P<0.05);The KSS of group A was higher than that of group B(P<0.05);The score of quality of life in group A was better than that in group B(P<0.05).Conclusion:Lumbar disc herniation patients underwent transforaminal endoscopic surgery,the effect is good,can improve lumbar function,relieve pain,improve the quality of life of patients.

The Clinical Effect of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Low Lumbar Single Segment Disc Herniation

Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.

Transforaminal Endoscope for the Treatment of Thoracic Disc Herniation

Objective:Transforaminal endoscope was used in the treatment of thoracic disc herniation and the therapeutic effect was discussed.Methods:Sixteen patients with thoracic disc herniation admitted to our hospital from October 2018 to May 2019 were divided into control group and observation group according to the random number table method,with 8 patients in each group.The control group was treated with posterior laminectomy approach,and the observation group was treated with transforaminal endoscope.The surgery-related conditions(intraoperative blood loss,surgery time,and postoperative drainage volume),VAS score,JOA score and postoperative complications were compared and analyzed.Results:There was no statistically significant difference between the two groups in the total effective rate and preoperative VAS score(P>0.05).Compared with the control group,the observation group had shorter surgery time and incision length,less postoperative drainage volume,and higher VAS score 3 days after surgery,JOA score on day 7 after surgery,and JOA score 3 months after surgery,showing statistically significant differences(P<0.05).There was no significant difference in the complications between the two groups(X2=1.067,P=0.833).Conclusions:Transforaminal endoscope had a good clinical effect with small incision and injury in the treatment of patients with thoracic disc herniation.

Observation of early active training effects after the operation for lumber intervertebral disc herniation

Objective To explore the recent and distant effects of early active training after the operation for lumber intervertebral disc herniation.Method 79 patients after the operation for mono segmental lumber intervertebral disc herniation had been divided into early active training group and routine control group randomly, and accepted training, regular re-examination, and follow-up of 1～6 years respedtively.Results The early active training group had better recent and distant objective effect, and more patients (97.6%) were satisfied with the operational effects.Conclusions The early active training after the operation for lumber intervertebral disc herniation is positive significant for operational effects.

Thoraco-Lumbar Junction Disc Herniation and Tight Filum: A Unique Combination?

Purpose: The incidence of both symptomatic thoraco-lumbar junction disc herniation (TLJDH) and tight filum (TF) may be underestimated. Both conditions have a complex clinical presentation that may involve the distal spinal cord, conus medullaris, and/or cauda equina, including upper and/or lower motor neuron impairment, sensory impairment, urological and sexual dysfunction. The coexistence of both conditions has not been previously reported and may be a diagnostic and therapeutic challenge. Methods: We report three teenage girls, a 24-year-old woman, and two middle-aged women who were diagnosed with both conditions and treated at our institution. Results: Disc herniation level was T11-T12 in 2, T12-L1 in 3, and L1-L2 in one. All patients had a fatty filum (n = 5) and/or a low-lying CM (at or above L1-L2 in 2, at or below L2-L3 in 4), and were treated with filum sectioning first. All patients noted marked improvement of preoperative complaints including back pain (n = 5), leg pain and fatigue (n = 4), urological complaints (n = 4), and toe gait (n = 1). One 16-year-old girl successfully underwent a thoracoscopic microdiscectomy for persisting pain at the thoraco-lumbar junction two years after filum sectioning. Conclusions: Thoraco-lumbar junction disc herniation and tight filum both act on the distal spinal cord close to the transition to the cauda equina. Both conditions may coincide and may even act synergistically, the disc herniation acting as a fulcrum, aggravating the deleterious effect of the tethering force (and vice versa). This might explain why both conditions combined may present at a younger age. We suggest filum sectioning as the primary treatment option in all patients, however, more cases and a longer follow-up are needed to better understand their unique combination and interaction. Nevertheless, when confronted with a symptomatic TLJDH especially in young patients we advise to rule out a coinciding TF by careful consideration of all clinical, radiological, and urological data.

Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation

Background The traditional lamina osteotomy replantation method is prone to nerve root injury and low back pain recurrence. Our team has proposed a modified approach that improves the osteotomy site and its fixation procedure. The aim of this study was to evaluate the clinical efficacy of traditional and modified lamina replantation methods in treating unstable lumbar disc herniation. Methods From March 2008 to August 2011, 124 patients with unstable lumbar disc herniation were enrolled and randomly divided into the following two groups according to random digital table： group A （traditional group） consisting of 61 patients who underwent traditional laminectomy replantation, and group B （modified group） consisting of 63 patients who underwent modified lamina replantation. Both surgeries were performed by the same surgeons. The two groups had no significant difference in gender, age, symptoms, time of onset and the prominent segment. Visual analogue scale （VAS）, Oswertry disability index （ODI）, and Japanese Orthopaedic Association （JOA） scores, operative time, blood loss, complication rate, radiographic healing rates, and low back pain recurrence rates were compared between the two groups. Results There were 121 patients followed up for more than one year, and the follow-up rate was 97.6%. Nerve injury occurred in two patients （3.3%） in the modified group and 12 patients （20.0%） in the traditional group. Dural injury occurred in one patient （1.6%） in the modified group and seven patients （11.7%） in the traditional group. Pseudarthrosis occurred in two patients in the modified group and in 18 patients in the traditional group with 1-year fusion rates of 96.7% and 70.0%, respectively. Recurrence of lower back pain after one year was noted in three patients （4.9%） in the modified group, and in 15 （25.0%） in the traditional group. Leg pain recurrence was noted in one patient （1.6%） in the modified group and in three cases （5.0%） in the traditional group. The one-year healing rates of nerve injury, dural injury, replantation lamina and low back pain recurrence rates after one year were significantly different （P〈0.05） between the two groups. At two weeks, three months, six months and one year postoperatively, both groups had significant improvement in VAS, ODI, and JOA scores from their preoperative values （P〈0.05）. No significant difference was detected between the short term postoperative scores between groups A and B （P〉0.05）. However, a significant difference was found one year later （P〈0.05）. Conclusions Compared to the traditional approach, the modified technique for lamina replantation showed lower rates of dural and nerve damage, a higher lamina healing rate, a lower back pain recurrence rate, and better clinical scores. It is a safe and effective operation for lumbar spine surgery.

单侧双通道与经皮椎间孔内镜下治疗腰椎间盘突出症的临床疗效比较

目的比较单侧双通道内镜技术(unilateral biportal endoscopy,UBE)与经皮椎间孔脊柱内镜技术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症的临床疗效。方法回顾性分析2020年3月至2022年3月首都医科大学附属北京朝阳医院脊柱内镜治疗的腰椎间盘突出症患者87例,UBE组39例,PELD组48例。分别记录两组患者的年龄、性别、体质量指数(body mass index,BMI)、住院时间、手术时间、术中透视次数、出血量、手术前后血红蛋白的减少值、随访时间、术后并发症。术前、术后1个月、3个月及12个月随访时进行腰腿痛视觉模拟量表(Visual Analogue Scale,VAS)评分和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估。术后12个月应用改良MacNab标准评价临床疗效。比较两组患者术前、术后12个月硬膜囊面积变化。结果所有患者均顺利完成手术。两组患者的年龄、性别、BMI、住院时间、手术时间、随访时间、术后并发症差异无统计学意义(P>0.05)。UBE组术中出血量较PELD组多(P<0.05),但血红蛋白减少值差异无统计学意义(P>0.05)。UBE组术中透视次数少于PELD组(P<0.05)。两组患者术后1个月、3个月及12个月腰腿痛VAS评分和ODI较术前均明显下降(P<0.05),两组患者各时间点腰腿痛VAS评分及ODI差异均无统计学意义(P>0.05)。术后两组优良率差异无统计学意义(P>0.05)。两组患者术后12个月硬膜囊面积较术前均显著增大(P<0.05),UBE组较PELD组更为明显(P<0.05)。结论UBE与PELD治疗腰椎间盘突出症均可有效缓解疼痛,改善患者生活质量。UBE较PELD出血量略多,但术中透视次数少,硬膜囊面积的改善更优。

基于浊毒理论针刺结合通滞苏润江胶囊治疗腰椎间盘突出症临床研究

目的:探究浊毒理论针刺结合通滞苏润江胶囊治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床效果。方法:将湿浊瘀阻型LDH患者120例按照随机数字表法分为针药结合组、针刺组、中药组各40例。3组患者均接受常规康复护理训练,在此基础上,针刺组给予《神应经》腰痛十二穴针刺治疗;中药组给予通滞苏润江胶囊;针药结合组给予通滞苏润江胶囊+《神应经》腰痛十二穴针刺,均连续治疗4周。比较3组治疗前后疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科学会评估治疗评分(Japanese orthopaedic association scores,JOA)、Oswestry功能障碍指数(oswestry disability index,ODI)、临床症状及椎间盘退变等级改善率和安全性。结果:针药结合组临床症状改善率为97.50%(39/40),高于针刺组的80.00%(32/40)及中药组的82.50%(33/40)(P<0.05);针药结合组椎间盘退变等级改善率为92.50%(37/40),高于针刺组的75.00%(30/40)及中药组的70.00%(28/40)(P<0.05);治疗后,3组患者VAS、JOA、ODI评分与治疗前比较差异具有统计学意义(P<0.05),针药结合组VAS、ODI评分低于针刺组及中药组(P<0.05),JOA评分高于针刺组及中药组(P<0.05);3组不良反应发生率较低。结论:将基于浊毒理论的针药结合治疗应用于LDH,可有效缓解疼痛,提高患者生活质量及腰椎功能恢复率,改善椎间盘退变程度,且安全性较高。

调督理筋针法联合揿针治疗腰椎间盘突出症的临床观察

【目的】观察调督理筋针法联合揿针治疗腰椎间盘突出症的临床疗效。【方法】将98例腰椎间盘突出症患者随机分为观察组和对照组,每组各49例,对照组给予调督理筋针法治疗,观察组在对照组治疗的基础上,给予揿针治疗。连续治疗1个月。治疗1个月后,评价2组临床疗效,观察2组患者治疗前后日本骨科协会(JOA)评分和疼痛视觉模拟评分法(VAS)的变化情况,以及腰椎活动度和ERK蛋白、ERK mRNA表达的情况。比较2组患者治疗前后β-内啡肽(β-EP)、神经肽Y(NPY)、5-羟色胺(5-HT)、P物质(SP)水平和白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)水平的变化情况。并评价2组的安全性。【结果】(1)观察组总有效率为93.88%(46/49),对照组为79.59%(39/49)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的JOA、VAS评分均明显改善(P<0.05),且观察组在改善JOA、VAS评分方面明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的β-EP、NPY、5-HT、SP水平明显改善(P<0.05),且观察组在改善β-EP、NPY、5-HT、SP水平方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的IL-6、IL-1β、TNF-α水平明显改善(P<0.05),且观察组在改善IL-6、IL-1β、TNF-α水平方面明显优于对照组,差异有统计学意义(P<0.05)。(5)治疗后,2组患者的腰椎前屈、后伸活动度明显改善(P<0.05),且观察组在改善腰椎前屈、后伸活动度方面明显优于对照组,差异有统计学意义(P<0.05)。(6)治疗后,2组患者的ERK蛋白表达、ERK mRNA水平明显改善(P<0.05),且观察组在改善ERK蛋白表达、ERK mRNA水平方面明显优于对照组,差异有统计学意义(P<0.05)。(7)观察组不良反应发生率为8.16%(4/49),对照组为4.08%(2/49),组间比较,差异无统计学意义(P>0.05)。【结论】调督理筋针法联合揿针治疗腰椎间盘突出症,疗效显著,能明显改善患者的疼痛症状,降低血清疼痛介质、炎性因子水平,改善腰椎功能,其作用机制可能与抑制ERK的信号通路相关。

中医针推治疗腰椎间盘突出症的临床疗效分析

目的分析中医针推治疗腰椎间盘突出症的临床疗效。方法选取100例腰椎间盘突出症患者作为研究对象,收治时间为2022年2月—2023年2月。采用随机数字表法将患者分为两组:对照组和观察组,每组均为50例。观察组患者接受中医针推治疗;对照组患者接受常规药物治疗。对比两组临床疗效。结果经过治疗,观察组治疗总有效率、VAS评分、JOA评分、TNF-α、hsCRP、-6(IL-6)均显著优于对照组,组间差异显著(P<0.05)。结论中医针推治疗腰椎间盘突出症具有显著的疗效,优于常规药物治疗。它能够快速缓解疼痛,改善患者的症状和体征,提高生活质量。因此,中医针推治疗应作为腰椎间盘突出症的首选治疗方法之一。

经皮激光椎间盘减压术联合熥敷颈腰痛砂治疗腰椎间盘突出症临床观察

目的观察PLDD联合熥敷颈腰痛砂治疗LDH的临床疗效。方法采用随机数字表法将68例患者分为治疗组(PLDD+熥敷颈腰痛砂)、对照组(单纯PLDD治疗)各34例。组内及组间比较两组受试者治疗前及治疗后1周、1个月、2个月、6个月后的视觉模拟疼痛评分(VAS)、日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)及改良MacNab疗效的优良率,并进行安全性评价。结果两组治疗前VAS、ODI、JOA比较,差异无统计学意义(P>0.05)。与本组治疗前比较,两组经治疗后VAS、ODI、JOA均明显改善(P<0.05);术后1周、术后1个月、术后2个月治疗组在疼痛缓解程度上优于对照组,差异有统计学意义(P<0.05);治疗组患者术后1周、术后1个月、术后2个月、术后6个月JOA疼痛评分、ODI评分均优于对照组,差异有统计学意义(P<0.05);两组患者术后2个月、术后6个月的有效率比较,差异无统计学意义(P>0.05);治疗组患者术后2个月、术后6个月优良率分别为94.1%、97.1%,优于对照组术后2个月、术后6个月的优良率,差异有统计学意义(P<0.05)。结论PLDD联合熥敷颈腰痛砂治疗LDH疗效显著,能有效缓解下腰痛、下肢放射痛症状,明显改善腰椎活动功能。

推拿联合塞来昔布治疗腰椎间盘突出症的疗效观察

目的:观察推拿手法联合塞来昔布治疗腰椎间盘突出症的临床疗效,为临床应用提供可靠循证医学证据。方法:选取2021年3月至2022年1月上海中医药大学附属岳阳中西医结合医院推拿科就诊的腰椎间盘突出症患者80例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组40例。观察组采用推拿联合塞来昔布治疗;对照组单纯口服塞来昔布治疗,干预周期为4周。测量的结果变量包括视觉模拟评分(VAS)、简化McGill疼痛问卷简表(SF-MPQ)和Oswestry残疾指数(ODI)。结果:观察组有效率显著高于对照组(P<0.01);2组都能显著降低患者疼痛评分(P<0.001),但观察组疗效更优(P<0.001);2组都能显著降低患者ODI功能障碍指数(P<0.01),观察组疗效更优(P<0.01)。结论:推拿手法结合塞来昔布治疗腰椎间盘突出症在缓解腰部疼痛、改善腰椎功能方面,优于单纯口服塞来昔布治疗。

针刺治疗对颈椎间盘突出症微创手术后疗效的影响

目的:探讨针刺治疗对颈椎间盘突出症(cervical disc herniation,CDH)微创手术(minimally invasive surgery,MIS)后疗效的影响。方法:回顾性分析2019年1月1日至2020年12月31日浙江省人民医院疼痛科住院行MIS的CDH病人。采用视觉模拟评分法(visual analogue scale,VAS)评分、颈椎功能障碍指数(neck disability index,NDI)评分和改良MacNab标准分别评估术后1个月、6个月和1年的疼痛程度、颈椎功能和临床疗效。比较接受针刺治疗和未接受针刺治疗病人的临床特点。结果:211名病人被纳入队列,其中102人接受针刺治疗,未接受针刺治疗病人109例。针刺治疗的病人较未接受针刺治疗的病人术后1个月、6个月和1年的VAS和NDI评分更低(P<0.001)。针刺治疗与治疗后6个月和1年时更低的改良MacNab标准评分相关(P<0.001)。多因素logistic回归显示,针刺治疗是MIS术后1年良好结果的独立因素(P<0.001,OR=9.282,95%CI:3.469-24.836)。结论:针刺治疗对MIS后CDH病人的临床结果有益,是MIS后CDH病人的一种有效的辅助治疗方法。

经皮脊柱内镜腰椎间盘摘除术后手术部位感染的临床特点及防治策略

目的总结经皮脊柱内镜腰椎间盘摘除(percutaneous endoscopic lumbar discectomy,PELD)术后手术部位感染(surgical site infection,SSI)的诊治经验。方法回顾性分析2016年1月~2022年12月11例PELD术后SSI的病例资料。PELD术后均出现剧烈腰背部或下肢疼痛,视觉模拟评分(Visual Analogue Scale,VAS)7~9分,平均8.1分。红细胞沉降率(ESR)17~114 mm/h,平均54.4 mm/h,C反应蛋白(CRP)8~151 mg/L,平均56.5 mg/L。MRI均提示术区椎间隙炎症信号改变。PELD术后2~17 d(平均9.5 d)确诊SSI。均采用抗生素治疗(经验性抗生素治疗4例,敏感抗生素7例),其中8例联合手术,包括经皮内镜病灶清除、置管冲洗引流4例,后路病灶清除2例,后路病灶清除联合内固定2例。结果随访14~75个月(平均36.8月)。根据改良MacNab标准,优5例,良4例,可2例。结论PELD术后SSI以发病急、再发剧烈腰背部或下肢疼痛、炎性指标升高及特征性影像学表现为临床特点,规范化的抗生素治疗辅以手术可以取得良好疗效。

系统针刀疗法治疗腰椎间盘突出症临床经验

腰椎间盘突出症是纤维环破裂后髓核突出压迫神经根造成以腰腿痛为主要表现的疾病,是临床常见病、多发病。针刀治疗严重的、病变范围较广的腰椎间盘突出症尚在探索中,笔者在经筋、筋骨系统理论指导下,充分利用中医整体观念,结合近20年的系统针刀疗法治疗重症腰椎间盘突出症较为成熟的临床经验,形成了上海金山“系统针刀疗法”治疗腰椎间盘突出症的特色诊疗方法。此文从对针刀疗法的认识、常规针刀疗法入手,阐述系统针刀疗法治疗腰椎间盘突出症的理论基础、穴位探究、具体方案,并结合典型案例分析系统针刀疗法治疗腰椎间盘突出症的辨证思路和治疗特点,以期丰富腰椎间盘突出症的临床治疗方案。

经皮内镜下椎间孔椎间盘切除术治疗L_(5)-S_(1)腰椎间盘突出症及髂嵴高度对其临床疗效的影响

目的分析L_(5)-S_(1)腰椎间盘突出症(LDH)应用经皮内镜下椎间孔椎间盘切除术(PETD)治疗的效果,并探讨髂嵴高度对其疗效的影响。方法择取2019年2月至2022年2月收治的行PETD治疗LDH(L_(5)-S_(1)节段)患者86例,基于髂嵴高度与L_(4-5)椎弓根位置关系进行分组,将髂嵴最高点位于L_(5)椎弓根上边缘下方的48例患者纳入为A组、髂嵴最高点位于L_(4)椎弓根下缘与L_(5)椎弓根上边缘之间的33例患者纳入为B组、髂嵴最高点位于L_(4)椎弓根下缘上方的5例患者纳入为C组。比较3组手术情况及手术前后不同时点[术前(T_(0))、术后1周(T_(1))、术后1、6、12个月(T_(2)、T_(3)、T_(4))]视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果3组手术手术时间、术中出血量差异无统计学意义(P>0.05)。T_(0)时,三组VAS评分、ODI比较差异无统计学意义(P>0.05);T_(1)-T_(4)时,3组VAS评分、ODI均低于T_(0)时,A、B组均低于C组(P<0.05),但A、B组间差异无统计学意义(P>0.05)。结论PETD治疗L_(5)-S_(1)节段LDH临床疗效显著,髂嵴高度是否高于L_(4)椎弓根下缘水平线会对其临床疗效造成影响。

基于累积求和法分析后路单通道内镜治疗单节段腰椎间盘突出症的学习曲线及短期疗效

目的探讨后路单通道内镜治疗单节段腰椎间盘突出症(LDH)的学习曲线和短期临床疗效。方法对2019年11月至2022年12月我院收治的111例LDH病人进行回顾性分析:应用累积求和(cumulative summation,CUSUM)法分析手术学习曲线并将病人划分为技术学习组和熟练掌握组;比较两组病人的手术时间、Oswestry功能障碍指数(ODI)、腰部及下肢疼痛视觉模拟量表(VAS)评分、术后并发症及手术满意度(改良MacNab评分)。结果根据CUSUM的拐点将111例病人分为技术学习组(46例)和熟练掌握组(65例)。两组病人性别、年龄、术前身体质量指数(BMI)、糖尿病及高血压病史、吸烟及饮酒史、手术节段之间差异无统计学意义(P>0.05)。手术时间从技术学习组的(105.52±15.62)min减少到熟练掌握组的(69.19±9.68)min,差异有统计学意义(P<0.05)。两组术前及术后各随访节点的腰痛及腿痛VAS评分、ODI指数、手术满意度比较,差异均无统计学意义(P>0.05);且两组在术后各随访时间节点的VAS评分、ODI指数均显著低于术前(P<0.05)。技术学习组的并发症发生率明显高于熟练掌握组(P<0.05),前者并发症发生率为19.57%(9/46),其中5例为腰椎间盘突出复发,2例为硬膜损伤,2例为神经根损伤;后者并发症发生率为4.62%(3/65),其中2例为腰椎间盘突出复发,1例为硬膜损伤。结论本研究应用CUSUM分析后路单通道内镜治疗单节段LDH的学习曲线,从技术学习期到熟练掌握期所需的手术例数为46例。当手术例数达到学习曲线平台期后,手术时间将明显缩短。单通道内镜技术是治疗单节段LDH的有效微创手段。

加味独活寄生合剂联合体外冲击波对腰椎间盘突出症患者的临床疗效及其对NF-κB信号通路的影响

目的观察加味独活寄生合剂联合体外冲击波对寒湿痹阳型腰椎间盘突出症的临床疗效,及对NF-κB信号通路的影响。方法将湖南中医药大学第一附属医院68例寒湿痹阻型腰椎间盘突出症患者按入组顺序随机分为试验组与对照组,每组34例。对照组予体外冲击波治疗,试验组在体外冲击波的基础上给予加味独活寄生合剂治疗,两组均治疗2周。采用疼痛视觉模拟(visual analogue scale,VAS)评分、Oswestry功能量化指数(oswestry disability index,ODI)评分及日本骨科协会评分(Japanese orthopaedic association,JOA)评估两组患者的疗效;用ELISA检测治疗前后血清NF-κB信号通路指标(p50、p65)、白细胞介素-8(Interleukin-8,IL-8)、白细胞介素-10(Interleukin-10,IL-10)、肿瘤坏死因子-α(Tumor Necrosis Factor-alpha,TNF-α)表达含量。结果治疗后,两组患者NF-κB信号通路指标(p50、p65)、IL-8、TNF-α与治疗前比较均降低(P<0.01),IL-10明显升高(P<0.01)。治疗后,两组患者JOA评分、ODI评分与治疗前比较均显著改善(P<0.01);且试验组效果优于对照组(P<0.01)。两组患者VAS评分差异无统计学意义(P>0.05)。结论加味独活寄生合剂联合体外冲击波治疗腰椎间盘突出症可能通过抑制NF-κB信号通路的激活从而影响下游炎症因子表达,减轻LDH患者异常炎症反应,改善腰椎功能。