CLINICAL OBSERVATION ON LUMBAR INTERVERTEBRAL DISC HERNIATION TREATED BY TRACTION COMBINED WITH ACUPUNCTURE

Objective: To observe the therapeutic effect of traction combined with acupuncture on lumbar intervertebral disc herniation (LIDH). Methods:Eighty-three patients diagnosed as LIDH were randomly divided into treatment group (n=42)and control group (n=41). In the treatment group, besides lumbar traction, electroacupuncture at Jiaji (EX-B 2, L 3～5), Shenshu (BL 23), Qihai (CV 6), Mingmen (GV 4), Huantiao (GB 30), Chengshan (BL 57) and Yanglingquan (GB 34) was added. In the control group, only lumbar traction was applied. Results: In treatment group, the cure plus markedly effective rate was 80.95% with a total effective rate of 92.86%, while in control group, it was 39.02% with a total effective rate of 80.48%. The therapeutic effect in the treatment group was obviously better than that in the control group (P<0.001). Conclusion: Lumbar traction plus EA can effectively alleviate or even eliminate clinical symptoms and signs of lumbar intervertebral disc herniation.

Effects of percutaneous intervertebral foraminal BEIS technique on patients with lumbar disc herniation

Objective:To compare the application effects of percutaneous percutanuous intervertebral foraminal BEIS(Broad Easy Immediate Surgery)technique on patients with lumbar disc herniation.Methods:Eighty-six patients with lumbar disc herniation treated in the Seventh People’s Hospital of Zibo City from Mary 2016 to May 2019 were selected and divided into control group and study group according to the simple randomization of random number table method,with 43 cases in each group.Patients in control group were treated with lamina fenestration while patients in study group were treated with percutanuous intervertebral foraminal BEIS technique.The surgical status and hospital stay,complications,pain[Visual Analogue Scale(VAS)score],Oswestry Disability Index(ODI)score and quality of life[MOS 36-item Short From Health Survey(SF-36)]were compared between the two groups.Results:The surgical time in study group was longer than that in control group,and the incision length was shorter than that in control group,and the fluoroscopy frequency was more than that in control group,and the intraoperative blood loss was less than that in control group,and the hospital stay was shorter than that in control group(P<0.05).There were no significant differences in the incidence rates of postoperative complications between the two groups(P>0.05).There were statistically significant differences in the between-group effects,timepoint effects and interaction effects of VAS pain score(P<0.05),and the VAS pain score in study group at 24 h and 1 w after surgery was significantly lower than that in control group(P<0.05).There were no statistically significant differences in the group-between effects and interaction effects of ODI score(P>0.05),and there were statistically significant differences in the time-point effects(P<0.05).There were statistically significant differences in the betweengroup effects,time-point effects and interaction effects of SF-36 score(P<0.05).The ODI score at 3 months after surgery in study group was lower than that in control group while the SF-36 score was higher than that in control group(P<0.05).Conclusion:Compared with traditional lamina fenestration,percutanuous intervertebral foraminal BEIS technique has the advantages of less trauma and quicker postoperative recovery in the treatment of lumbar disc herniation.Self-made simple locator can reduce the fluoroscopy frequency,improve the accuracy of positioning,further reduce surgical trauma and promote recovery of patients.

Meta-analysis of Huoxue huayu Chinese medicine compound combined with Intervertebral Pore Lens in the treatment of Lumbar Intervertebral Disc Herniation

Objective:A meta-analysis was performed to evaluate the difference of curative effect of Huoxue huayu Chinese medicine compound combined with intervertebral pore lens in the treatment of lumbar disc herniation.Methods:CNKI,VIP,CBM,PubMed and Web of Science were searched by computer and included in the clinical trial data about the treatment of lumbar disc herniation by the Huoxue huayu Chinese medicine compound and intervertebral pore lens.Data were extracted and Cochrane system was used to evaluate the quality of the study.Cochrane system in ReMan 5.1 was used to evaluate the publication bias and Stata 12.0 was used for meta analysis.Results:A total of 1039 patients were included in 16 articles,including 519 patients in the treatment group and 520 patients in the control group.The results showed that the total effective rate of the treatment group was higher than that of the control group(RR=1.20,95%CI(1.11,1.30),P<0.05);The excellent rate of the treatment group was higher than that of the control group(RR=1.20,95%CI(1.08,1.32),P<0.05);The JOA score of the treatment group was higher than that of the control group(MD=3.39,95%CI(1.90,4.87),P<0.00001);the VAS score of the treatment group was lower than that of the control group(MD=-1.13,95%CI(-1.84,-0.42),P=0.002);The ODI score of the treatment group was lower than that of the control group[MD=-3.34,95%CI(-4.49,-2.19),P<0.00001].Conclusion:Huoxue huayu Chinese medicine compound and intervertebral pore lens can improve the clinical effect and is worth popularizing.However,due to the poor quality of the literature,more high-quality double-blind randomized controlled trials with large samples are needed.

Early efficacy of endoscopic translaminar and intervertebral foraminal approaches in the treatment of lumbar disc herniation

Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.

Apparent diffusion coefficient in normal and abnormal pattern of intervertebral lumbar discs: initial experience

The aim of the present study was to compare the relationship of morphologically defined non-bulging/herni-ated, bulging and herniated intervertebral lumbar discs with quantitative apparent diffusion coefficient （ADC）. Thirty-two healthy volunteers and 28 patients with back pain or sciatica were examined by MRI. All intervertebral lumbar discs from L1 to S1 were classified according to morphological abnormality and degenerated grades. The ADC values of nucleus pulposus （NP） were measured and recorded. The significant differences about mean ADC values of NP were found between non-bulging/herniated discs and bulging discs as well as herniated discs （P 0.05）, whereas there were no significant differences in ADC values between bulging and herniated discs （P 0.05）. Moreover, statistically significant relationship was found in the mean ADC values of NP between ＂non-bulging/herniated and non-degenerated discs＂ and ＂non-bulging/herniated degenerated discs＂ as well as herniated discs （P 0.05）. Linear regression analysis between ADC value and disc level revealed an inverse correlation （r = -0.18）. The ADC map of the NP is a potentially useful tool for the quantitative assessment of componential and molecular alterations accompanied with lumbar disc abnormalities.

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.

Isolation of <i>Gemella morbillorum</i>in Herniated Intervertebral Disc Tissue in a Lumbar Discectomy Patient: A Case Report

Back pain associated with lumbar disc herniation is a common musculoskeletal disorder that leads to absence at work place worldwide. Studies have proven in addition to the traditional factors, microbes play a role in disc herniation causing chronic back pain. A 34-year-old male who has not involved in any traumatic work but has a family history of disc herniation presented with lower back pain and numbness in his right leg. He had previously undergone lumbar discectomy at L4/L5 ten years back. Magnetic Resonance Imaging (MRI) showed L5/S1 right para central disc herniation impinging on the right S1 and S2 nerve roots. Standard protocols for disinfection of instruments, external skin and all transport media were adhered. Skin scrapings, muscle biopsy and excised disc tissue were obtained for anaerobic and aerobic bacterial cultures. Anaerobic microbial cultures of excised disc tissue following lumbar discectomy showed Gram positive growth. Further anaerobic isolation carried out using RapID ANA ID kit confirmed the growth as Gemella morbillorum. In addition, neither of the control samples (muscle nor skin) had any anaerobic growth indicating the absence of contamination. Aerobic bacterial growth was not present in the skin, muscles and disc cultures. The study findings add to the available literature, on the role of microorganisms in lumbar disc herniation and future treatment regimens with antibiotics.

The Clinical Outcomes of Transforaminal Percutaneous Endoscopic Discectomy in Treating Lumbar Disc Herniation: A Review

Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique started during the late 20th century. This process is done through microscopic view under local anesthesia. There is a growing but still insufficient evidence that lumbar EDS shows slightly better results in terms of minor tissue damage, shorter hospital stay, faster return to ordinary daily activities, and patient satisfaction. Recurrence rate still remains a matter of debate, and is related with the surgical skills of the surgeon. The complication rate seems to be similar in both of the techniques i.e., open and endoscopic. More randomized controlled trials, systematic reviews and meta-analysis are needed to clarify whether lumbar EDS can be considered comparable if not superior to standard open discectomy. In spite of lacking defined clinical evidence, lumbar EDS is without doubt a rapidly expanding PELD and its future developments are incredibly promising. Due to less complication rate this technique can be considered as a gold standard compared to the open discectomy. The surgeons still require more cadaveric practices for learning the curve and to approach the herniated disc area. The main objective of this review article is to show the clinical outcomes of the Transforaminal Percutaneous Endoscopic Discectomy in treating the lumbar disc herniation.

Applied anatomy of intrusive operations of lumbar intervertebral foramen

Objective:To provide anatomical datum for intrusive operations of lumbar intervertebral foramen,especially that using acupuncture-knife as intrusive tool.Methods:To dissect 10 antisepsis cadavers and observe the exposed blood vessels,ligaments,nerves and their adjacent relations in L1/2~L5/S1intervertebral foramen.Results:Lumbar intervertebral foramen exit zones were almost sealed by nerves and blood vessels.There were two zones with relatively no blood vessel and nerve(triangular working zones)located in the midpoint of the distance between two adjacent roots of transverse processus,and clung to lamina of vertebral arch,and they were also found upon the margo superior of the root of transverse processus,but the ascending lumbar vein or(and)the rami anastomoticus between the remi inferior of intervertebral vein and lumbar veins were observed in 12%triangular working zones upon the margo superior of root of transverse processus.Conclusions:"Triangular working zone"was relatively avascular zone.Pay attention to the possibilty of presence of blood vessels on the entrance passage of intrusive operations on lumbar side rear.The needlepoint should be pierced at the midpoint of the distance between two adjacent roots of transverse processus and cling to the outer edge of lamina of vertebral arch when doing the foraminal lumbar puncture.As lumbar intervertebral foramina exit zone was almost sealed by nerves and blood vessels,blind incising and debonding with acupuncture-knife in this area was relatively much more dangerous.

经皮椎间孔镜技术治疗腰椎固定术后邻近节段椎间盘突出症

目的 评价经皮椎间孔镜技术治疗腰椎固定术后邻近节段椎间盘突出症的临床疗效。方法 2014年3月~2019年7月,采用经皮椎间孔镜技术治疗腰椎固定术后邻近节段椎间盘突出症患者26例,其中男18例,女8例;年龄21~72岁,本次手术距离腰椎固定术后3~15年。手术节段:L_(3-4)3例,L_(4-5)12例,L_(5-S1)11例;均采用经皮椎间孔镜技术治疗。术后即刻、1 d、1个月、3个月和2年进行VAS评分,术后2个月以Oswestry功能障碍指数评估腰椎功能,采用改良MacNab标准判定疗效。结果 26例患者获随访,随访时间24~36个月。患者术后较术前症状明显改善,腰痛及下肢疼痛减轻,术后即刻、1 d、1个月、3个月以及术后2年的VAS评分较术前显著降低(P<0.01),术后2年时ODI指数显著低于术前(P<0.05)。末次随访时,采用改良MacNab评分标准评定手术疗效:优21例,良4例,可1例,优良率96%。结论 经皮椎间孔镜技术治疗腰椎固定术后邻近节段椎间盘突出症,对脊柱稳定性结构破坏小,减压彻底,术后患者恢复快,疗效满意。

扶阳罐循经温推联合益肾活血汤治疗腰椎间盘突出症的临床研究

目的观察扶阳罐循经温推联合益肾活血汤治疗腰椎间盘突出症的临床疗效。方法选取2019年9月至2020年5月收治的138例腰椎间盘突出症患者为研究对象,按照随机数字表法分为2组,对照组69例采用常规推拿治疗,治疗组69例予扶阳罐循经温推联合益肾活血汤治疗。2组均治疗10天后统计疗效,比较2组治疗前后疼痛症状[分别用日本骨科学会(JOA)下腰痛评分及疼痛视觉模拟评分法(VAS)评分进行评定]及炎症因子[包括白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)及IL-4]水平变化情况,比较2组治疗期间不良反应发生状况。结果与本组治疗前比较,2组治疗后JOA下腰痛评分均升高(P<0.05),疼痛VAS评分均降低(P<0.05),且治疗组治疗后JOA下腰痛评分高于对照组(P<0.05),疼痛VAS评分低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血清炎症因子IL-6、TNF-α水平均降低(P<0.05),IL-4水平均升高(P<0.05),且治疗组治疗后IL-6、TNF-α水平均低于对照组(P<0.05),IL-4水平高于对照组(P<0.05)。治疗组不良反应总发生率4.3%(3/69),对照组不良反应总发生率7.2%(5/69),2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论扶阳罐循经温推联合益肾活血汤治疗腰椎间盘突出症疗效确切,可有效改善患者疼痛症状,抑制炎症反应,临床应用安全可靠。

椎间融合术治疗腰椎间盘突出症术后复发的临床研究

目的:探究不同椎间融合器(cage)治疗术后复发的腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:回顾性分析2019年1月至2021年1月142例行单纯椎间盘髓核摘除术后复发的LDH患者,均采用通道下联合固定并椎间融合术治疗,根据植入cage类型及数目不同分为单枚解剖组、2枚解剖组和单枚香蕉组。单枚解剖组51例,男29例,女22例;年龄39~65(53.74±5.68)岁;身体质量指数(body mass index,BMI)18.62~28.13(22.08±2.15)kg·m-2;手术与复发间隔时间0.5~4.0(2.7±0.8)年;L3,45例,L4,535例,L5S111例;植入单枚解剖型cage。2枚解剖组46例,男25例,女21例;年龄37~66(54.15±6.02)岁;BMI为18.25~28.44(21.74±1.83)kg·m-2;手术与复发间隔时间0.5~5.0(2.7±0.9)年;L3,44例,L4,532例,L5S110例;植入2枚解剖型cage。单枚香蕉组45例,男22例,女23例;年龄38~65(54.49±6.45)岁;BMI为18.85~28.20(21.63±1.59)kg·m-2;手术与复发间隔时间0.5~5.0(2.6±1.0)年;L3,43例,L4,536例,L5S16例;植入单枚香蕉型cage。观察并比较3组手术时间、术中出血量、切口长度、术后切口引流量、住院时间、并发症等情况;比较手术前后椎间隙高度、前凸曲度及术后椎间融合情况;分别于术前、术后1和6个月采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)对腰部疼痛程度、腰椎功能进行临床疗效评价。结果:3组患者均获得至少6个月随访,无病例脱落。3组手术时间、术中出血量、切口长度、术后切口引流量、住院时间比较,差异无统计学意义(P>0.05)。2枚解剖组、单枚香蕉组术后6个月融合节段椎间隙高度[(11.08±1.78)mm、(10.95±1.62)mm]、前凸曲度[(12.05±1.86)°、(11.63±1.57)°],高于单枚解剖组(10.14±1.54)mm、(10.92±1.45)°,差异有统计学意义(P<0.05);2枚解剖组、单枚香蕉组术后6个月椎间融合率(95.65%、95.56%),高于单枚解剖组(78.43%);3组术后1、6个月腰部VAS、ODI较术前下降(P<0.05);3组并发症比较,差异无统计学意义(P>0.05)。结论:3种融合器治疗LDH术后复发均能取得显著效果,但植入2枚解剖型cage和单枚香蕉型cage更有助于维持LDH术后复发患者椎间隙高度、前凸曲度,可获得良好椎间融合效果。

A Study on Extension－Flexion Dynamic Lumbar Spine Radiographsin Patients with Lumbar Intervertebral Disc Herniation

The study has collected a set of clinical materials such as extension-flexion dynamic lum-bar spine radiographs and computerized x-ray tornography of lumbar spine and quantified physical exami-nation from 32 patients with lumbar intervertebral disc herniation, who had gone through a suocessful con-servative treatment. The collection was conducted twice before and after the treatment. With the help oft-test and linear correlation analysis, the study suggests that extensionflexion radiograph of lumbar spineis of important clinical significance in weighing the clinical state of an individual patient, especially forthose who receive conservative treatment. The study emphasizes that the biomechanical disturbance oflumbar spinal column may be from another important pathological element along with the irritation of thenerve root by herniated disc tissue in the pathomechanics of lumbar disc herniation. There is also somediscussion of the computerized X-ray tomography diagnosis in this study. Above all, the author provides anew angle of viewing the trouble by one of the soul principles of traditional Chinese medicine: concept ofholistics .

中药单体促髓核细胞自噬缓解椎间盘退变的研究进展

椎间盘退变是临床常见疾病,髓核与髓核细胞是椎间盘中主要的病变组织与细胞类型。髓核细胞受病理因素影响而加速衰老或出现代谢障碍时,髓核稳态被破坏,这导致了椎间盘退变的发生发展。自噬是细胞在病理环境下降解受损细胞器与异常蛋白质以维持正常生理功能的途径之一,能促进细胞自我调节以抵御致病因素影响。椎间盘退变时,髓核细胞处于应力失衡与代谢障碍的异常环境中,促进髓核细胞自噬可清除有害代谢产物累积、延缓细胞老化,这有助于维持髓核与椎间盘的健康生理状态。随着中医药治疗椎间盘退变疾病相关研究的不断深入,大量提取自传统中草药的单体成分被发现可以促进髓核细胞自噬以缓解椎间盘退变。根据最新的研究进展,讨论了髓核细胞的自噬与椎间盘退变的关联,共获取了14种在促进髓核细胞自噬以缓解椎间盘退变领域展现出潜力的中药单体,并将其作用机制归纳为以下4种:促自噬抑制髓核细胞凋亡、促自噬拮抗髓核细胞氧化应激、促自噬抑制髓核细胞外基质降解和促自噬促进髓核细胞外基质大分子合成,以期为中药单体调节髓核细胞自噬从而缓解椎间盘退变的研究提供新的思路与参考。

巨大游离椎间盘硬膜外后移位致椎管占位1例

患者,男,59岁,2022年9月14日无明显诱因出现腰痛伴左大腿外侧及小腿外侧麻木、疼痛,左足背麻木。症状逐渐加重,2022年9月21日出现右大腿外侧及小腿外侧麻木、疼痛,双下肢疼痛剧烈,难以入睡,行走约20 m后双下肢麻木、疼痛加重,休息后未见明显缓解,疼痛视觉模拟评分为9分。于2022年9月28日入院。查体:腰椎生理曲度可,活动度严重受限。腰骶部压痛明显,未引出放射痛。双下肢皮肤感觉正常,双下肢肌力Ⅴ级,肌张力正常。双侧直腿抬高试验阴性,左侧股神经牵拉试验强阳性,右侧股神经牵拉试验阳性。双侧膝腱反射正常,双侧跟腱反射未引出,髌阵挛、踝阵挛阴性,巴氏征阴性。

基于六经辨证的热敏灸联合肌内效贴治疗腰椎间盘突出症临床观察

目的探究基于六经辨证的热敏灸联合肌内效贴治疗腰椎间盘突出症(LDH)的临床效果。方法选取2020年1月—2021年10月南方医科大学南方医院赣州医院收治的88例LDH患者,以随机数字表法分为观察组和对照组,各44例。对照组采用常规热敏灸联合肌内效贴(KT)治疗,观察组则采用基于六经辨证的热敏灸联合KT治疗。观察2组疼痛情况、情绪状态、腰痛症状、腰椎活动度、临床疗效和血清相关指标的差异。结果治疗后,观察组疼痛视觉模拟量表(VAS)评分、汉密尔顿抑郁量表(HAMD)评分和血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及单核细胞趋化蛋白-1(MCP-1)含量均显著低于对照组(P<0.05);观察组日本骨科协会腰痛评价量表(JOA)评分、腰椎前屈和后伸的活动度均显著高于对照组(P<0.05)。观察组临床总有效率为93.18%(41/44),高于对照组的81.82%(36/44)。结论基于六经辨证的热敏灸相对于常规热敏灸疗法,在联合KT治疗腰LDH时,具有更佳的临床效果,值得推广应用。

消肿止痛膏治疗气滞血瘀型腰椎间盘突出症临床观察

目的观察消肿止痛膏治疗气滞血瘀型腰椎间盘突出症(LDH)的临床疗效。方法选取气滞血瘀型LDH患者60例,随机分为对照组(30例)采用常规治疗;试验组(30例)在对照组基础上联合消肿止痛膏治疗,均治疗18 d,评估2组治疗效果。结果治疗后,试验组总有效率高于对照组(P<0.05);试验组JOA评分、中医证候评分、VAS评分、TNF-α和IL-1β改善均优于对照组(P<0.05);2个月后随访,试验组复发率低于对照组(P<0.05)。结论消肿止痛膏可有效减轻患者腰部疼痛,治疗效果显著,安全性高,复发率低,值得临床进一步推广运用。

腰椎间盘突出症临床分型与经皮椎间孔镜手术疗效关系研究

目的:探究腰椎间盘突出症(LDH)临床分型与经皮椎间孔镜手术疗效关系。方法:选取2021年11月—2022年11月安阳市第三人民医院接受经皮椎间孔镜手术治疗的125例不同临床分型LDH患者作为研究对象。比较不同临床分型LDH患者手术相关指标评估手术安全性;选用视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会评估治疗分数(JOA)比较不同分型患者手术疗效。结果:在经皮椎间孔镜手术治疗下,侧弯型患者手术时间、术中出血量、住院时间明显低于其他分型的患者,足下垂型患者手术时间、术中出血量、住院时间明显高于其他分型的患者;经皮椎间孔镜手术后1个月随访,不同临床分型LDH患者VAS、ODI及JOA评分均较治疗前显著改善。结论:对不同临床分型LDH患者实施经皮椎间孔镜手术治疗疗效较好,患者术后疼痛逐渐减轻、腰椎功能和神经功能恢复良好,且所有患者手术时间、出血量及住院时间指标良好,但其中侧弯型患者临床效果最佳、足下垂型患者疗效稍差。

腰椎间盘突出症患者椎间盘和血液中趋化因子和炎性细胞因子表达的相关性分析

目的探讨腰椎间盘突出症(lumbar disc disease,LDH)患者的椎间盘(intervertebral disc herniation,IVD)和血液中趋化因子和炎性细胞因子表达的相关性。方法选择2020年1月~2022年6月在该院接受手术治疗的73例LDH患者作为研究对象,所有患者手术当日抽取空腹静脉血,检测血液标本和术中切除IVD组织中的C-C趋化因子配体20(C-C motif chemokine ligand 20,CCL-20)、C-C受体6(C-C-motif receptor 6,CCR6)、白细胞介素(interleukin,IL)-1、IL-6、IL-1β、IL-17、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)mRNA表达水平,观察IVD组织和血液标本中上述因子的相关性,并对IVD和血清表达存在相关性的因子采用多元线性回归分析,以排除性别、年龄、体质量指数、病程、MPG分级、病变节段等混杂因素的影响。结果改良Pfirrmann分级(modified Pfirrmann grade,MPG)6~8级患者的IVD组织中CCL20、CCR6、IL-6、IL-1β、IL-17和TNF-αmRNA表达水平均显著高于MPG 2~5级患者(P<0.05)。MPG 6~8级患者血液标本中CCL20、CCR6、IL-6、IL-1β、IL-17和TNF-αmRNA表达水平均显著高于MPG 2~5级患者(P<0.05)。IVD标本中的CCL20、IL-1β、IL-17、TNF-α与血液标本中无显著相关性(r=0.203、0.242、0.189、0.228,P均>0.05);IVD标本中的CCR6和IL-6水平与血液标本中存在显著相关性(r=0.413、0.463,P<0.05)。多元线性回归分析,结果显示,CCR6和IL-6与视觉模拟评分(visual analogue scale,VAS)呈正相关(P<0.05),与椎间盘高度(average intervertebral disc height,AVDH)不存在相关性(P>0.05)。结论IL-6和CCR6基因表达水平在IVD组织和血液样本中相关,且血液样本的IL-6和CCR6表达水平与疼痛呈正相关。

圆针椎间孔外口松解术治疗腰椎间盘突出症的临床效果及安全性

目的:探究圆针椎间孔外口松解术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床效果及安全性。方法:选取2020年12月—2022年12月江阴市中医院针灸科收治的80例LDH患者。根据随机数表法将其分为对照组及治疗组,各40例。对照组给予针刺治疗,治疗组在对照组基础上给予圆针椎间孔外口松解术。比较两组临床疗效,治疗前后腰椎功能、疼痛程度及安全性。结果:治疗组总有效率为92.50%,明显高于对照组的72.50%,差异有统计学意义(P<0.05)。治疗后,两组Oswestry功能障碍指数(Oswestry disability index,ODI)评分降低,日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)评分升高,治疗组ODI评分低于对照组,JOA评分高于对照组,差异有统计学意义(P<0.05)。治疗后,两组视觉模拟评分法(visual analogue scale,VAS)评分降低,治疗组VAS评分低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:圆针椎间孔外口松解术治疗LDH能减轻患者疼痛,改善腰椎功能,提高生活质量,且安全性好。