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.

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.

Clinical Outcome of Percutaneous Endoscopic Lumbar Surgery (PELS) in Treatment of Lumbar Disc Herniation

Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.

Meta-analysis of Clinical Efficacy of Warm Needling Acupuncture in the Treatment of Lumbar Disc Herniation

[Objectives]To evaluate the efficacy of warm needling acupuncture in the treatment of lumbar disc herniation(LDH)by Meta-analysis.[Methods]Randomized controlled trial of warm needling acupuncture in the treatment of lumbar disc herniation published from January 2000 to December 2021 was searched by Cochrane Library,PubMed,VIP,CNKI and Wanfang.After the quality evaluation of the literature,the Meta-analysis of the literature was carried out by using Review Manager 5.3.[Results]A total of 10 studies were included,involving a total of 980 patients.The results of Meta-analysis showed that warm needling acupuncture in the treatment of lumbar disc herniation could improve the total clinical effective rate,OR=5.38,95%CI(3.40,8.49),P<0.00001;decrease the VAS score,MD=-3.33,95%CI[-4.53,-2.12],z=5.42(P<0.00001);increase the JOA score,MD=-5.63,95%CI[-8.12,-3.14];improve the dysfunction,MD=-5.63,95%CI[-8.12,-3.14],z=4.43(P<0.00001);decrease inflammatory factors,MD=-11.09,95%CI[-13.60,-8.58],z=8.65(P<0.00001).And the recurrence rate was low,OR=0.33,95%CI[0.15,0.70],z=2.86(P=0.004).[Conclusions]Warm needling acupuncture could effectively treat lumbar disc herniation and relieve pain symptoms.However,due to the general poorness of literature quality and the low quality of evidence,high-quality randomized controlled trials are still needed.

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.

A meta-analysis of Duhuo Jisheng decoction combined with non-operative therapy on lumbar disc herniation

Objective:To systematically evaluate the cllinical efficacy of Duhuo Jisheng decoction(DHJSD)combined with non-surgical therapy on lumbar disc herniation(LDH).Methods:China Science and Technology Journal Database(VIP),Chinese National Knowledge Infrastructure(CNKI),WanFang Data,PubMed were searched and eligible randomized controlled clinical trials(RCTs)were included.Two reviewers evaluated the quality of the included RCTs and extracted data independently.Then,data analysis was performed with RevMetn 4.2 software.Results:A total of 18 RCTs were enrolled,including 1682 patients.Meta-analysis results showed that the overall response rate of DHJSD combined with non-operative therapy group(treatment group)in the treatment of LDH was better than that of the non-operative therapy group(control group)[OR=4.29,95%CI(3.19,5.76),P<0.001].JOA score of the treatment group was significantly higher than that of control group[OR=3.96,95%CI(3.4,4.52),P<0.001].VAS score was dramatically lower in the treatment group than the control group[OR=-1.58,95%CI(-1.97,-1.18),P<0.001].Conclusion:The clinical efficacy of DHJSD combined with non-surgical therapy is better than that of non-surgical therapy alone.However,due to the low quality of the included literatures,large-scale and high-quality RCTs are still needed for further confirmation.

Analysis of the Application Value of MRI and CT Diagnosis of Lumbar Disc Herniation

Objective:To analyze the application value of MRI and CT diagnosis for those with lumbar disc herniation.Methods:The data of 62 patients with LDH treated in our hospital from January 2019 to December 2019 were analyzed retrospectively.All patients were diagnosed as LDH after operation,and 62 patients were treated with MRI and CT.The accuracy of CT and MRI in the diagnosis was analyzed according to the gold standard of operation results.Results:62 patients were diagnosed as LDH after operation,including 25 cases with intervertebral disc herniation,12 cases with intervertebral disc prolapse,8 cases with intervertebral disc nodule,7 cases with intervertebral disc dissociation as well as 10 cases with intervertebral disc bulge.The accuracy of MRI diagnosis(95.16%)was higher than that of CT(75.81%),and the difference was statistically significant(P<0.05).Conclusion:For the diagnosis of LDH,MRI is more accurate,but CT is faster and cheaper.Both of them have their own advantages can be chosen clinically according to the actual situation of patients on the basis of ensuring the diagnostic accuracy.

恩再适注射液肌注治疗LDH术后残余神经痛的临床疗效观察

目的：观察恩再适注射液肌注治疗LDH（腰椎间盘突出症）术后残余神经痛的临床疗效。方法：选择年龄于40~59岁之间的LDH患者90例（男女各45例）经正规保守治疗4周无效且VAS≥5分患者，行腰4－5或腰5－骶1髓核摘除、椎间融合术后第2周仍存在下肢疼痛或（和）麻木者，按照完全随机等分法分三组、每组30例：A组（维生素B1＋B12注射液组），B组（注射用腺苷钴胺组），C组（恩再适注射液组），通过上述三组治疗3~6周后，观察恩再适注射液组治疗LDH术后残余神经痛的临床疗效。结果：C组（恩再适注射液组）临床疗效显著优于A、B两组。结论：恩再适注射液可显著改善LDH术后残余神经痛症状，具有显著临床疗效。

平补平泻手法穴位针刺在LDH患者术后残余下肢麻木中的应用

目的:观察平补平泻手法穴位针刺在腰椎间盘突出症(lumber disc herniation,LDH)患者术后残余下肢麻木中的应用效果。方法:选取2017年9月-2021年12月厦门市中医院收治的60例LDH术后残余下肢麻木患者。按照随机数字表法1∶1配对原则将其分为观察组(n=30)和对照组(n=30)。两组均在硬膜外麻醉下行椎间孔镜术。术后对照组给予甲钴胺片,观察组给予甲钴胺片+平补平泻手法穴位针刺。对比两组临床疗效、治疗前及治疗25 d后下肢麻木程度、功能障碍、简明健康调查问卷(SF-36)评分及腰椎功能。结果:观察组总有效率为96.67%,显著高于对照组的73.33%(P<0.05)。治疗25 d后,观察组针刺试验、尼龙绳试验评分均高于对照组,麻木视觉模拟(VAS)评分低于对照组(P<0.05),站立、步行、坐位、提物、睡眠状况、疼痛强度、生活自理评分均低于对照组(P<0.05),生理功能、情感职能、社会功能、总体健康、生理职能、生命活力、心理健康、躯体疼痛评分及日本骨科协会(JOA)评分均高于对照组(P<0.05)。结论:平补平泻手法穴位针刺应用于LDH患者术后残余下肢麻木效果显著,能减轻麻木症状,促进肢体功能恢复。

腰椎间盘突出症患者坐立过程的动力学特征

目的研究腰椎间盘突出症(lumbar disc herniation,LDH)患者在坐立过程中疼痛对腰椎和髋关节力矩的影响。方法应用AMTI测力台采集20例健康对照与20例LDH受试者的动力学数据,通过统计参数映射(statistical parametric mapping,SPM)分析两组受试者坐立任务中腰椎与髋关节在矢状面和冠状面的力矩差异。结果与健康对照组相比,LDH受试者从站立回到坐位过程中腰椎最大屈曲力矩与髋关节最大内收力矩明显增高(P<0.05)。SPM分析显示,在站立初期阶段(37%~42%),LDH组髋关节外展力矩大于健康对照组,存在统计学差异(P=0.007)。结论LDH受试者在坐立过程中腰椎骨盆不够稳定,尤其站立静止阶段,难以使身体达到平衡状态,需增加髋关节外展力矩来维持骨盆稳定。在临床评估治疗中应重点关注脊柱与骨盆的稳定功能。

基于“颈腰同治”理论探讨正骨手法联合冲击波对腰椎间盘突出症患者的干预作用

【目的】探讨基于“颈腰同治”理论运用正骨手法联合冲击波治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。【方法】将80例LDH患者随机分为观察组和对照组,每组各40例。对照组患者给予腰部正骨手法治疗,观察组患者给予颈、腰部正骨手法及冲击波治疗,2组患者均每周治疗2次,连续治疗4周。观察2组患者治疗前后Oswestry功能障碍指数(ODI)评分、疼痛视觉模拟量表(VAS)评分、腰椎功能日本骨科协会(JOA)评分以及血清前列腺素E2(PGE2)、白细胞介素6(IL-6)、白细胞介素23(IL-23)、肿瘤坏死因子α(TNF-α)水平的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗4周后,观察组的总有效率为92.50%(37/40),对照组为80.00%(32/40);组间比较(秩和检验),观察组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)量表评分方面,治疗后,2组患者的VAS、ODI评分均较治疗前明显降低(P<0.05),JOA评分均较治疗前明显提高(P<0.05),且观察组对ODI、VAS评分的降低作用和对JOA评分的提高作用均明显优于对照组,差异均有统计学意义(P<0.05)。(3)血清炎症因子方面,治疗后,2组患者血清TNF-α、PGE2、IL-23、IL-6水平均较治疗前明显降低(P<0.05),且观察组对血清TNF-α、PGE2、IL-23、IL-6水平的降低作用均明显优于对照组,差异均有统计学意义(P<0.05)。【结论】基于“颈腰同治”理论运用正骨手法联合冲击波治疗LDH疗效确切,能够降低患者血清炎症因子水平,缓解疼痛症状并改善腰椎功能,表明该治疗方法对LDH具有较高的临床可行性。

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.

腰痹通胶囊联合浮针对腰椎间盘突出症患者腰椎活动度及腰背肌表面肌电信号的影响

【目的】探讨腰痹通胶囊联合浮针针刺治疗对腰椎间盘突出症(LDH)患者腰椎活动度及腰背肌表面肌电信号的影响。【方法】将80例LDH血瘀证患者随机分为研究组和对照组,每组各40例。对照组给予服用腰痹通胶囊治疗,研究组在对照组基础上给予浮针针刺治疗,疗程为2周。观察2组患者治疗前后腰椎活动度、疼痛程度视觉模拟量表(VAS)评分、改进汉化的Oswestry功能障碍指数(ODI)评分、Roland-Morris腰椎功能障碍问卷(RMDQ)评分及腰背肌表面肌电信号的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗2周后,研究组的总有效率为97.50%(39/40),对照组为80.00%(32/40),组间比较(χ^(2)检验),研究组的临床疗效明显优于对照组(P<0.05)。(2)腰椎活动度方面,治疗后,2组患者的腰椎屈伸、旋转活动度均较治疗前明显改善(P<0.05),且研究组对腰椎屈伸、旋转活动度的改善幅度均明显优于对照组(P<0.05或P<0.01)。(3)腰椎功能评分方面,治疗后,2组患者的ODI评分和RMDQ评分均较治疗前明显下降(P<0.05),且研究组对ODI评分和RMDQ评分的下降幅度均明显优于对照组(P<0.01)。(4)疼痛程度评分方面,研究组治疗1周、2周和1个月后及对照组治疗2周和1个月后的疼痛程度VAS评分均较治疗前明显下降(P<0.05),且研究组在治疗1周、2周和1个月后对疼痛程度VAS评分的下降幅度均明显优于对照组(P<0.01)。(5)腰背肌表面肌电参数方面,治疗后,2组患者的腰背肌表面肌电信号积分肌电值(IEMG)和平均功率频率(MPF)均较治疗前明显升高(P<0.05),且研究组对腰背肌表面肌电信号MPF和IEMG的升高幅度均明显优于对照组(P<0.01)。【结论】腰痹通胶囊联合浮针针刺治疗可显著提升LDH患者的疗效,改善患者腰椎活动度,提高腰背肌群表面肌电信号,缓解肌肉疲劳和疼痛症状。

针刺疗法联合中医定向透药治疗腰椎间盘突出症临床研究

目的:观察针刺疗法联合中医定向透药治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:选择上海市崇明区城桥镇社区卫生服务中心中医科2020年8月至2021年12月门诊就诊的LDH患者90例,按照随机数字表法分为针刺药透组、单纯针刺组、单纯药透组,每组各30例。单纯针刺组给予针刺疗法治疗,单纯药透组给予中医定向透药治疗,针刺药透组给予针刺疗法联合中医定向透药治疗。观察3组患者治疗前后疼痛视觉模拟评分(visual analogue score,VAS)、腰椎功能障碍指数量表(the oswestry disability index,ODI)评分、日本骨科学会下腰痛量表(Japanese orthopaedic association waist disorders,JOA)评分、血清代谢物(β-隐黄素、柠檬酸、丙酮酸、赖氨酸)变化情况及临床疗效、不良反应发生情况。结果:针刺药透组治疗2周后、治疗4周后、治疗后2周VAS评分、ODI评分均低于单纯针刺组、单纯药透组,差异均有统计学意义(P<0.05)。针刺药透组治疗2周后、治疗4周后、治疗后2周JOA评分高于单纯针刺组、单纯药透组,差异有统计学意义(P<0.05)。单纯针刺组有效率为73.33%,单纯药透组有效率为76.67%,针刺药透组有效率为96.67%,针刺药透组有效率高于单纯针刺组、单纯药透组,差异有统计学意义(P<0.05)。针刺药透组治疗后β-隐黄素、柠檬酸、丙酮酸、赖氨酸水平均高于单纯针刺组、单纯药透组,差异有统计学意义(P<0.05)。结论:针刺疗法联合中医定向透药治疗LDH,可减轻患者疼痛程度,改善腰椎功能。

Electroacupuncture at jiājǐ(夹脊 EX-B2) for lumbar intervertebral disc herniation:A randomized controlled trial

Objective： To compare the effect differences of electroacupuncture（EA） at Jiajǐ（夹脊 EX-B2） and conventional acupoints for lumbar intervertebral disc herniation（LIDH） and the factors influenced the effect during the way of data mining.Methods： A total of 160 patients of LIDH were randomly assigned into the EX-B2 group and the conventional acupoints group, 80 cases in each one. The patients in the EX-B2 group received EA at the symmetrical 2 acupoints of the bilateral EX-B2 on the lesion part. The patients in the conventional acupoints group received EA at the tender point of the lesion part, Zhibian（ 秩边BL54）, Huantiao（环跳 GB30）,weǐzhōng（委中BL40）, Chéngshān（承山BL57） and Fúyáng（跗阳BL59） on the affected side. The retain time of the needles is both 45 min. The treatment of the two groups is 3 times a week and for a connective 20 times. The modified Assessment Criteria for Low Lumbar Pain of Japanese Orthopedic Association（JOA）,Visual Analogue Scale（VAS） were evaluated before and after the treatment and at the 6-month follow up.Results：（1） Effective outcomes. JOA score： The JOA score of the patients in the EX-B2 group after treatment was（20.89 士 3.43）, and was（19.35 ±4.02） on the follow-up. Compared with the JOA score（12.35 ±4.42） in the same group before the treatment, there were statistical significant higher（both P0.05）. The JOA score in the EX-B2 group after treatment and on the follow-up were both higher than that of the conventional acupoints group at the same time point（both P0.05）. VAS score： The VAS score of the patients in the EX-B2 group on the 24 h after the first treatment was（4.09 ± 1.81）, and was（2.11 ± 1.30） after the treatment. Compared with the VAS score（4.09 ± 1.81） in the same group before the treatment, there were statistical significant lower（both P0.05）. The VAS score in the EX-B2 group on the 24 h after the first treatment and after treatment showed no statistical differences than that of the conventional acupoints group at the same time point（both P0.05）.（2）Related results from data mining： The middle-aged people and disease duration less than six months, their effect of the immediate treatment was the best. According to JOA score, EA at EX-B2 was better than EA conventional acupoints,either in the process of treatment effect, or in pertinence of the treatment, which were superior to EA conventional acupoints therapy; The best curative effect time of EA at EX-B2 was the first treatment after24 h, and the best curative effect of the conventional acupoints was after the first treatment. The age and disease duration also affected curative effect.Conclusion： The effect of EA at EX-B2 was superior to the conventional acupoints in treating LIDH.

循经按摩治疗气滞血瘀型腰椎间盘突出症临床研究

目的:观察循经按摩治疗气滞血瘀型腰椎间盘突出症的临床疗效。方法:将120例气滞血瘀型腰椎间盘突出症患者随机分为常规组、推拿组和循经按摩组,每组40例。常规组给予桃红四物汤加减、中药热奄包、腰背肌力训练、中医辨证施护,推拿组在常规组治疗的基础上行常规推拿手法治疗,循经按摩组在常规组治疗的基础上行循经按摩治疗。观察3组患者治疗前后日本骨科学会(Japanese orthopedic association,JOA)下腰痛评分、数字评分法(numeric rating scale,NRS)、Oswestry功能障碍指数问卷表(Oswestry disability index,ODI)评分变化情况及临床疗效。结果:循经按摩组、推拿组治疗后JOA评分均高于常规治疗组,循经按摩组治疗后JOA评分高于推拿组,差异有统计学意义(P<0.05);循经按摩组、推拿组治疗后NRS评分、ODI评分均低于常规治疗组,循经按摩组治疗后NRS评分、ODI评分低于推拿组,差异有统计学意义(P<0.05);循经按摩组愈显率为85.0%,推拿组愈显率为72.5%,常规组愈显率为32.5%,循经按摩组优于推拿组、常规组,差异有统计学意义(P<0.05)。结论:循经按摩能有效改善腰椎间盘突出症患者症状、腰椎功能,减轻疼痛、功能障碍。

中药有效成分及复方调控巨噬细胞治疗腰椎间盘突出症研究进展

腰椎间盘突出症(lumbar disc herniation,LDH)多由风寒湿热邪侵袭或年老失养,肝肾亏虚;或因跌扑损伤,气血凝滞,经脉不利所致。故病机总属本虚标实,治疗应注重祛风除湿散寒、清热利湿、活血通络治其标,补益肝肾、强筋壮骨治其本。巨噬细胞极化在LDH发生进展中占有重要地位,能改善局部炎性微环境状态,发挥镇痛作用,是治疗LDH的潜在靶点。LDH中巨噬细胞相关的信号通路有:核因子-κB信号通路、NOD样受体热蛋白结构相关蛋白3炎症小体信号通路、丝裂原活化蛋白激酶信号通路、Notch信号通路等。中药有效成分及复方能够通过多途径调节巨噬细胞极化状态,恢复促炎/抗炎因子平衡,减缓LDH的进展。中药提取有效成分有:芦荟中的芦荟醇,骨碎补中的柚皮苷,姜黄中的姜黄素,秦艽、威灵仙中的木兰花苷,黄连中的小檗碱等。三痹汤、宣痹汤、血府逐瘀汤、独活寄生汤等为治疗LDH的代表复方。中药具有多靶点、多机制、疗效高、质优价廉、副作用少等的特点,靶向调控巨噬细胞极化,恢复腰椎间盘突出物局部炎症微环境平衡,可能是未来治疗LDH的潜在方向。目前,中药有效成分及其复方靶向调控巨噬细胞治疗LDH的研究中,对其作用机制的研究还非常有限,缺乏深层标准化的临床前证据与基础实验。因此,在未来的研究中,需加强中药有效成分与复方对调控巨噬细胞极化的研究,明确中药复方调控巨噬细胞治疗LDH的具体作用机制,为研制延缓腰椎间盘退变的新型药物,以及中医药更好的应用提供可靠依据。

经皮椎间孔镜椎间盘切除联合纤维环缝合修复治疗腰椎间盘突出症的临床研究

目的分析经皮椎间孔镜椎间盘切除(PTED)联合纤维环缝合修复治疗腰椎间盘突出症(LDH)的临床疗效。方法回顾性分析2020年7月-2023年2月在山西华晋骨科医院进行PTED治疗的LDH患者117例,根据患者PTED术后是否进行纤维环缝合修复术分成2组,对照组(59例)予以单纯PTED治疗,观察组(58例)予以PTED联合纤维环缝合修复术治疗。比较两组围术期相关指标、腰腿痛改善、腰椎功能、并发症、术后恢复情况。结果观察组手术时间较对照组延长(P<0.05)。术后1周、3个月时,两组腰腿疼痛视觉模拟(VAS)评分均较术前逐渐下降,差异有统计学意义(P<0.05)。术后6、12个月时,两组日本骨科协会评估治疗分数(JOA)较术前逐渐上升,Qswestry功能障碍指数(ODI)、Qswestry功能障碍指数(ODI)评分较术前逐渐下降,差异均有统计学意义(P<0.05)。术后,两组责任椎管面积及腰椎前凸角均较术前升高,差异有统计学意义(P<0.05);与观察组相比,对照组责任椎间隙高度降低,差异有统计学意义(P<0.05)。观察组复发率低于对照组,差异有统计学意义(P<0.05)。结论PTED和PTED联合纤维环缝合修复术用于LDH临床治疗均有促进术后腰椎功能恢复及疼痛缓解的效果,且PTED联合纤维环缝合修复术可维持椎间隙高度,降低术后复发率。

基于磁共振成像参数和临床特征分析腰椎间盘突出症经皮椎间孔镜椎间盘切除术疗效的影响因素

目的 基于磁共振成像(MRI)参数和临床特征分析腰椎间盘突出症(LDH)经皮椎间孔镜椎间盘切除术(PTED)疗效的影响因素。方法 选取2019年12月-2022年5月浙江中医药大学附属温岭市中医院和浙江金华广福肿瘤医院收治的302例LDH患者为研究对象,均接受PTED治疗,具备1年随访资料。其中,疗效为优良的272例纳入预后良好组,疗效可的30例纳入预后不良组。回顾性收集研究对象一般资料、MRI参数和临床特征。通过单因素分析和多因素Logistic回归分析法,分析影响LDH患者PTED疗效的因素。结果 随访1年,302例LDH患者,优205例,良67例,30例疗效为可,0例疗效为差,预后不良率为9.93%。与预后良好组比较,预后不良组吸烟和椎间盘退变Ⅳ级比例更高,手术时间更长,腰大肌横截面面积(CSA)差值绝对值和多裂肌CSA差值绝对值更大,椎间孔面积更小,差异均有统计学意义(P <0.05);两组患者年龄、体重指数(BMI)、性别、饮酒、糖尿病、高血压、高血脂、纤维环破裂、病变段、Lee分区、Modic改变、术中出血量、切口长度、手术入路和关节镜型号比较,差异均无统计学意义(P> 0.05);多因素Logistic分析结果显示:吸烟(OR=4.179,95%CI:1.035~16.865)、椎间盘退变Ⅳ级(OR=6.863,95%CI:2.049~22.983)、腰大肌CSA差值绝对值> 1.63 cm^(2)(OR=19.084,95%CI:3.566~102.130)和多裂肌CSA差值绝对值> 1.02 cm^(2)(OR=482.525,95%CI:19.538~12 137.347)为LDH患者PTED预后不良的危险因素,差异均有统计学意义(P <0.05);椎间孔面积> 118.31 mm^(2)(OR=0.750,95%CI:0.721~0.862)为LDH患者PTED预后不良的保护因素,差异有统计学意义(P <0.05)。结论 吸烟、椎间盘退变Ⅳ级、腰大肌CSA差值> 1.63 cm^(2)和多裂肌CSA差值绝对值> 1.02 cm^(2)是LDH患者PTED预后不良的危险因素,椎间孔面积> 118.31 mm^(2)是LDH患者PTED预后不良的保护因素。临床可筛选预后不良的高危患者,并采取相应的干预对策。

归原疏筋合剂治疗腰椎间盘突出症的临床疗效及对血清NF-κB p65表达水平的影响

【目的】探究归原疏筋合剂治疗腰椎间盘突出症(LDH)患者的临床疗效及其可能的作用机制。【方法】将68例气滞血瘀证LDH患者随机分为试验组和对照组,每组各34例。对照组给予塞来昔布及甲钴胺片内服治疗,试验组在对照组的基础上加用归原疏筋合剂内服治疗,疗程为4周。观察2组患者治疗前后腰痛和下肢痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、改良日本骨科协会(JOA)评分以及血清炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素1β(IL-1β)]和血清核因子κB p65(NF-κB p65)水平的变化情况,并评价2组患者的临床疗效和用药安全性。【结果】(1)脱落情况方面,研究过程中,试验组脱落1例,对照组脱落3例,最终试验组33例、对照组31例纳入疗效统计。(2)疗效方面,治疗4周后,试验组的总有效率为96.97%(32/33),对照组为87.10%(27/31);组间比较(秩和检验),试验组的疗效明显优于对照组(P<0.05)。(3)量表评分方面,治疗后,2组患者的腰痛及下肢痛VAS评分、ODI评分均较治疗前降低(P<0.05或P<0.01),改良JOA评分均较治疗前升高(P<0.01),且试验组对腰痛及下肢痛VAS评分、ODI评分的降低幅度及对改良JOA评分的升高幅度均明显优于对照组(P<0.05或P<0.01)。(4)血清炎症相关指标方面,治疗后,2组患者血清TNF-α、IL-6、IL-1β、NF-κB p65水平均较治疗前降低(P<0.01),且试验组的降低幅度均明显优于对照组(P<0.01)。(5)安全性方面,治疗过程中,试验组的不良事件发生率为2.94%(1/34),对照组为8.82%(3/34),组间比较,差异无统计学意义(P>0.05)。【结论】归原疏筋合剂治疗气滞血瘀证LDH患者疗效确切,可有效缓解患者疼痛症状,改善患者腰椎功能,降低血清炎症因子及NF-κB p65表达水平,其作用机制可能与降低炎症因子水平,抑制NF-κB信号通路的活化有关。