Tuina Therapy of Lumbar Intervertebral Disc Protrusion

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Treatment of Protrusion of Lumbar Intervertebral Disc by Massotherapy under Anesthesia—A Report of 64 Cases

Sixty-four cases of protrusion of lumbarintervertebral disc were treated by massotherapy withheavy manipulations plus blocking therapy underanesthesia from August,1997 to July,1998,withsatisfactory therapeutic results as reported in thefollowing.Clinical DataNinety-four cases in the series were randomlydivided into two groups.All the 94 cases satisfied thecriteria for diagnosis of the disorder,and thediagnosis was confirmed by

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.

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.

Comparison of pain media and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc

Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.

CLINICAL OBSERVATION ON ELECTRO-ACUPUNCTURE TREATMENT OF 51 CASES OF PROTRUSION OF LUMBAR INTERVERTEBRAL DISC

Through electroacupuncture(EA) treatment of 51 cases of protrusion of lumbar interver-tebral disc, it was further demonstrated that the specific action and characteristics of Siyao and Wuyao acupoints were significant and elucidated by using some objective indexes and obvious therapeutic ef-fect, which lays a foundation for the development, research, popularization and application of shu-point and provides an effective and practicable way for treatment of lumbar intervertebral disc.

ELECTROACUPUNCTURE TREATMENT OF 176 CASES OF LUMBAR INTERVERTEBRAL DISC PROTRUSION

In the present paper, 176 cases of lumbar intervertebral disc protrusion are treated with electroacupuncture (EA) and topical heat irradiation. Local tender-point is used as the main acupoint, combined with Tunzhong, Tiaoyue, Weizhong (BL 40) and Yanglingquan (GB 34). The treatment is conducted once daily, with 15 sessions being a therapeutic course. Following treatment, of 176 cases, 46 (26. 1%) are cured, 90 (51. 1%) have prominent improvement, 35 (19.8%) have amelioration and 5 (2.8%) have no apparent changes, with a total effective rate of 97.0%.

SUMMARY OF RESEARCHES ON THE TREATMENT OF PROTRUSION OF LUMBAR INTERVERTEBRAL DISC BY"SHE-BIE" OINTMENT-PARTITION MOXIBUSTION

In the present paper the authors sum up their research results about "She-Bie" (black-tail snake-ground beetle) Ointment-partition moxibustion for treatment of lumbar intervertebral disc protrusion (LIDP). Animal experiments showed that when used externally, "She-Bie" Ointment had striking anti-inflammation and pain-relief actions but had no irritant and no allergic effects to the skin. In the treatment of mild type of LIDP, "She-Bie" Ointment partition moxibustion could work well in improving clinical symptoms; and in the treatment of moderate type of LIDP, it could be used as a supplementary measure and raise the excellent and good rates of the therapeutic effect further. For this reason, "She-Bie" Ointment partition moxibustion deserves being popularized in clinical treatment of LIDP.

TREATMENT OF 247 CASES OF PROLAPSE OF LUMBAR INTERVERTEBRAL DISC WITH COMPREHENSIVE PLUM-BLOSSOM MAGNETIC NEEDLE THERAPY

Objective: To observe the therapeutic effect of comprehensive plum-blossom magnetic needle therapy on prolapse of lumbar intervertebral disc. Methods: 247 cases of prolapse of lumbar intervertebral disc were treated first with manual treatment and then with plum-blossom magnetic needle therapy and effect-increasing pad therapy at specified points and reactive points. Results: After treatment for 2 therapeutic courses,153 cases were cured accounting for 61.94%, 71 cases were markedly effective accounting for 28.75%, 22 cases were improved accounting for 8.91% and the rest one failed,accounting for 0.45%. Conclusion: The comprehensive plum-blossom magnetic needle therapy has a better therapeutic effect on prolapse of lumbar intervertebral disc.

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.

TREATMENT OF 29 CASES OF LUMBAR INTERVETEBRAL DISC PROTRUSION WITH GINGER-SEPARATED MOXIBUSTION

: To observe the effect of ginger-separated moxibustion for treatment of lumbar intervertebral disc prolapse. Methods: 29 lumbar intervertebral disc protrusion patients including 21 males and 8 females were treated with ginger-separated moxibustion of Ashi-point and Jiaji (EX-B 2 , the affected region), 5-6 cones every time, once every other day, continuously for 5 times. Then the therapeutic effect was analyzed. Results: After treatment, of the 29 cases, 23(79.3%) were cured, and the rest 6(20.7%) experienced improvement. Conclusion: Ginger-separated moxibustion is fairly effective and safe in treatment of lumbar intervertebral disc protrusion.

80 CASES OF PROLAPSE OF LUMBAR INTERVERTEBRAL DISC TREATED BY ROUND-SHARP NEEDLE

Objective: To observe the therapeutic effect of round-sharp needle for prolapse of lumbar intervertebral disc. Methods: A total of 80 cases of lumbar intervertebral disc prolapse were treated by puncturing Qihaishu (气海俞 BL 24), Guanyuanshu (关元俞 BL 26), etc., with round-sharp needle, once every week, continuously for 4 sessions. Results: After the treatment, of the 80 cases, 56 (70 %) were cured, 16 (20%) improved,and 8 (10)%) failed, with an effective rate of 90%. Conclusion: Round-sharp needle works well in the treatment of prolapse of lumbar intervertebral disc.

CLINICAL OBSERVATION ON TREATMENT OF 80 CASES OF PROLAPSE OF LUMBAR INTERVERTEBRAL DISC BY COMBINATION OF ACUPUNCTURE AND MEDICINE

cases of prolapse of lumbar intervetebral disc were randomly divided into treatment and control groups. 80 cases in treatment group were treated with combination of acupuncture, oral administration of Chinese medicinal herbs, traction, point injection and intravenous drip of energy dehydration mixture; 70 cases in control group were managed by combination of acupuncture, oral administration of herbal medicines, traction, acupoint injection (without energy dehydration mixture). The results showed that the curative rate and the total effective rate of the treatment group were 91.25% and 98.75% separately, while those of the control group 62.86% and 92.86% respectively. Comparison of the curative rate between the 2 groups showed a remarkable significance (P<0.01). The observation demonstrated that combined treatment of prolapse of lumbar intervertebral disc with traditional Chinese and Western medicine is an effective approach.

Diagnostic Significance of Topical Image of Infrared Thermography on The Patients with Lumbar Intervertebral Disc Protrusion AComparative Study on 45 Patients with Manipulative Treatment and 65 Normal Control

Objective: To analyse and explore the diagnostic significance of infrared thermography on the patients with lumbar intervertebral disc protrusion.Methods: Forty-five hospitalized cases under conservative treatment (mainly manipulation) and 65 controls were consecutively selected. Both groups were examined with infrared thermography on lower back and lower extremities as well as physical examination before and after treatment. The study statistically analysed the temperature difference between the involved and healthy parts at different areas; and also compared the variation of the temperature difference after the treatment to the decreasing scores of physical examination afterward. Results: The statistic result showed that the temperature difference between two sides on patient group was significantly higher than those of the control group. The further analysis showed that the temperature difference at posterior femur area in the patients’ group correlated significantly to the severity of clinical signs caused by nerve root irritation.Conclusion: The thermogram was uncertain to the segmental diagnosis of lumbar disc protrusion and could only be considered as a reference in the final diagnosis. Nevertheless, it is helpful to discover the severity of radical signs according to the posterior femoral region of hypo- (hyper-) thermogram.

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。

浮针疗法联合口服消髓化核汤治疗腰椎间盘突出症的临床研究

目的:探讨浮针疗法联合口服消髓化核汤治疗腰椎间盘突出症的临床疗效。方法:将60例腰椎间盘突出症患者随机分为联合治疗组和消髓化核汤治疗组,每组30例。联合治疗组采用浮针疗法联合口服消髓化核汤治疗,消髓化核汤治疗组单纯采用口服消髓化核汤治疗。浮针疗法每隔3~4 d进行1次,共治疗5~6次,消髓化核汤连续口服20 d。比较2组患者治疗前和治疗结束后1 d的腰腿部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)及治疗结束后12个月的腰椎间盘突出重吸收率。结果:联合治疗组退出3例、消髓化核汤治疗组退出5例。治疗结束后1 d,2组患者腰腿部疼痛VAS评分、ODI均低于治疗前[(7.07±1.71)分,(2.97±1.81)分,t=27.981,P=0.000;(7.18±1.52)分,(3.99±1.87)分,t=28.198,P=0.000;(33.53±7.60)%,(9.20±6.47)%,t=29.734,P=0.000;(33.40±7.70)%,(14.00±7.62)%,t=29.541,P=0.000];治疗前,2组患者腰腿部疼痛VAS评分、ODI的组间差异无统计学意义(t=0.263,P=0.793;t=0.067,P=0.946);治疗结束后1 d,联合治疗组患者腰腿部疼痛VAS评分、ODI均低于消髓化核汤治疗组(t=2.155,P=0.035;t=2.631,P=0.011)。治疗结束后12个月,联合治疗组患者椎间盘突出重吸收率高于消髓化核汤治疗组[(36.61±15.31)%,(22.47±9.72)%,t=-4.268,P=0.000]。结论:浮针疗法联合口服消髓化核汤治疗腰椎间盘突出症,能够缓解疼痛、改善腰椎功能,促进椎间盘突出重吸收,且疗效优于单纯口服消髓化核汤。

中医特色健康管理模式联合中药热敷对腰突症患者疼痛及功能康复的影响

目的研究探讨中医特色健康管理模式联合中药热敷对腰突症患者疼痛及功能康复的影响。方法选取2021年6月—2023年6月本院收治的100例腰突症患者为对象,随机数字表法分为观察组、对照组,每组50例。对照组以常规护理干预结合中药热敷干预,观察组在此基础上增加中医特色健康管理模式干预。评估对比两组中医症状评分、疼痛程度、康复效果、不良事件发生率。结果观察组在干预2、4、8、12周时中医症状评分低于对照组(P<0.05)。观察组在干预2、4、8、12周时视觉模拟评分低于对照组(P<0.05)。观察组在干预2、4、8、12周时日本骨科协会评估治疗评分低于对照组(P<0.05)。观察组不良事件发生率6.00%,低于对照组的22.00%(P<0.05)。结论中医特色健康管理模式联合中药热敷对腰突症效果良好,缓解中医症状和疼痛程度,恢复腰椎功能,降低各种不良事件发生。

腰椎立体定位斜扳法与传统腰椎斜扳法对椎间盘及关节突关节软骨影响的有限元分析

目的:分析腰椎立体定位斜扳法与传统腰椎斜扳法对椎间盘及关节突关节软骨的影响。方法:选取1例成年男性L_(4-5)椎间盘突出症患者(椎间盘向左后方突出),采用西门子Light Speed 64排螺旋CT进行腰椎和骨盆扫描,层厚0.5 mm。基于CT扫描数据,应用三维有限元建模软件建立腰椎-骨盆三维有限元模型,通过与文献数据比较验证模型有效性后,分析腰椎立体定位斜扳法与传统腰椎斜扳法作用下腰椎-骨盆整体应力、L_(4-5)椎间盘应力和位移、L_(4-5)关节突关节软骨应力和位移、L_(4-5)上下关节突表面中心点相对空间距离。结果:①腰椎-骨盆三维有限元模型建立及验证结果。建立的腰椎-骨盆三维有限元模型共有550215个节点、344359个单元,高度模拟了腰椎-骨盆的结构与材料特性。在模拟加载条件下,L_(4-5)节段屈伸、侧屈、轴向旋转活动范围与文献中的既往研究结果基本相同。②模型整体应力。实施传统腰椎斜扳法时,腰椎-骨盆三维有限元模型最大应力为5.31 MPa,主要集中于L_(1)、L_(2)、L_(4)、L_(5)椎体;实施腰椎立体定位斜扳法时,腰椎-骨盆三维有限元模型最大应力为29.30 MPa,主要集中于L_(1)、L_(2)椎体及L_(3)、L_(4)、L_(5)椎弓根。③L_(4-5)椎间盘应力及位移。实施传统腰椎斜扳法时,L_(4-5)椎间盘纤维环平均等效应力为1.12 MPa,纤维环整体向左、向前、向下发生位移,平均位移分别为0.36 mm、0.20 mm、0.05 mm;髓核平均等效应力为0.02 MPa,髓核整体向左、向前、向下发生位移,平均位移分别为0.35 mm、0.24 mm、0.06 mm。实施腰椎立体定位斜扳法时,L_(4-5)椎间盘纤维环平均等效应力为1.14 MPa,纤维环整体向左、向前、向下发生位移,平均位移分别为0.39 mm、1.30 mm、0.05 mm;髓核平均等效应力为0.02 MPa,髓核整体向左、向前、向下发生位移,平均位移分别为0.38 mm、1.30 mm、0.07 mm。④L_(4-5)关节突关节软骨应力及位移。实施传统腰椎斜扳法时,L_(4-5)左侧和右侧关节突关节软骨平均等效应力分别为2.46 MPa、3.18 MPa,平均位移分别为1.10 mm、0.21 mm;实施腰椎立体定位斜扳法时,L_(4-5)左侧和右侧关节突关节软骨平均等效应力分别为2.70 MPa、3.22 MPa,平均位移分别为1.46 mm、0.65 mm。⑤L_(4-5)上下关节突表面中心点相对空间距离。实施传统腰椎斜扳法时,L_(4-5)左、右侧上下关节突表面中心点相对空间距离分别为0.75 mm、0.34 mm;实施腰椎立体定位斜扳法时,L_(4-5)左、右侧上下关节突表面中心点相对空间距离分别为0.81 mm、0.23 mm。结论:腰椎立体定位斜扳法与传统腰椎斜扳法均能使腰椎间盘突出症患者病变节段椎间盘及关节突关节软骨产生一定的应力和位移;相较于传统腰椎斜扳法,腰椎立体定位斜扳法能使病变节段椎间盘和关节突关节软骨产生更大的应力和位移,这也可能是腰椎立体定位斜扳法比传统腰椎斜扳法治疗腰椎间盘突出症疗效更佳的原因。

小针刀联合补肾活血祛痛方治疗腰椎间盘突出症临床观察

目的 探讨小针刀联合补肾活血祛痛方治疗腰椎间盘突出症(LDH)的临床效果。方法 选取2016年7月—2018年4月沈阳市中医院收治的135例患者作为研究对象,将所有患者随机分为甲组(小针刀联合补肾活血祛痛方)、乙组(补肾活血祛痛方)和丙组(小针刀),观察与对比3组患者的腰痛分级、治疗前后视觉模拟量表(VAS)评分和总体效果。结果 甲组总有效率为97.78%(44/45),高于乙组的88.89%(40/45)、丙组的82.22%(37/45),差异具有统计学意义(P<0.05);甲组治疗后VAS评分下降程度明显大于乙组和丙组;甲组治疗后Denis腰痛分级明显优于乙组和丙组,差异具有统计学意义(P<0.05)。结论对LDH患者进行小针刀联合补肾活血祛痛方治疗可以有效缓解患者的疼痛程度、缩短患者的住院时间、提升患者的生活质量,同时患者腰椎功能可以得到快速恢复,值得临床应用与推广。