Role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinomaAbstractAIM:Tostudytheroleofneedleknifeassistedampul-

AIM:To study the role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma.METHODS:In this study the authors retrospectively analyzed clinical records of patients with periampullary tumors diagnosed by ampullary biopsy taken after needle knife papillotomy in whom surface ampullary biopsies were non contributory.RESULTS:Between January 2008 and December 2010,38 patients with periampullary tumors were seen by us and initial side viewing endoscopy with surface biopsy from the papilla was positive for malignancy in 25 patients.Thirteen patients with a negative surface biopsy for malignancy underwent a repeat ampullary biopsy following needle knife papillotomy.There were 8(61.5%)males and 5(38.5%)females.The most common presenting symptom was jaundice(100%),followed by fever(46.2%),melena(38.5%),abdominal pain(30.8%)and weight loss(30.8%).All the patients had hyperbilirubinemia with a mean ± SD serum bilirubin of(11.2 ± 1.9)mg/dL(normal value <1 mg%)and the mean ± SD serum alkaline phosphatase was(288.0 ± 94.3)IU/L(normal value < 129 IU/L).Serum CA 19.9 level estimation was done in 11 patients;it was elevated(cut off value > 70.5 IU/L)in all of them with a median of 1200 IU/L(inter quartile range 274-3500).Side viewing endoscopy showed a bulky papilla in all of them.Adequate tissue was obtained in all of the 13 patients for histological evaluation;12 of the 13 patients were reported to have adenocarcinoma while one patient had adenoma.There were no complications from the needle knife papillotomy in any of the patients.CONCLUSION:Needle knife assisted ampullary biopsy appears to be a safe and effective diagnostic modality for periampullary carcinoma.

Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography

BACKGROUND: Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10% of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or fistulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups. RESULTS: A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with difficult biliary cannulation, 43 patients underwent needle-knife cut: the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques: the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Significant differences were observed in cannulation success rate and cannulation time but in complication rate between the two groups.CONCLUSION: The early application of the needle-knife in difficult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.

Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations

AIM: To compare the success rates and adverse events of early needle-knife fistulotomy(NKF) and double-guidewire technique(DGT) in patients with repetitive unintentional pancreatic cannulations.METHODS: From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography(ERCP) at a single tertiary care hospital(Pusan National University Yangsan Hospital, Yangsan, South Korea) between January2009 and December 2012, 134(8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved.RESULTS: The success rates with early NKF andthe DGT were 79.1%(53/67) and 44.8%(30/67)(P< 0.001), respectively. The incidence of post-ERCP pancreatitis(PEP) was lower in the early NKF group than in the DGT group [4.5%(3/67) vs 14.9%(10/67),P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and312 s(P = 0.013), respectively.CONCLUSION: Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.

Endoscopic sphincterotomy with needleshaped knife: report of 476 cases

Objectives: To evaluate endoscopic duodenal sphinc- terotomy and improve its success rate. Methods: Needle-shaped knife was used for endoscop- ic sphincterotomy (EST) in 476 patients with biliary or pancreatic diseases from March 1995 to October 2000. Results: Direct incision was made in 243 patients, papillary fenestration in 89, and opposite incision in 144. The papilla located beside and in the diverticu- lum in 56 and 12 patients, respectively. EST emer- gency was made in 147 patients. ERCP after EST be- cause of the difficulty in intubation was made suc- cessfully in 62 patients. Mild complications occurred in 14 patients (2.94%), all of whom were cured af- ter symptomatic treatment. Conclusions: EST with needle-shaped knife has such advantages as safety in operation and convenience in incision. It is suitable for the papilla with different shape, with a higher success rate.

Endoscopic treatment for pancreatic diseases:Needle-knife-guided cannulation via the minor papilla

AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife.METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulationsvia the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed.RESULTS: Standard methods were successful in79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17(89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%,(79 +17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further(80.6%, 79/98 vs98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods(4.7% vs 10.5%, P = 0.301).CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.

Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth Ⅱ gastrectomy

AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.

Needle knife in the treatment of primary dysmenorrhea: a systematic review and meta-analysis

Objective: The aim of this meta-analysis was to examine the effectiveness and safety ofneedle knives for primary dysmenorrhea. Methods: We searched the electronicdatabases from their inception to May 25, 2022, comprising Cochrane Library, PubMed,Embase, SinoMed, CNKI, VIP and Wanfang databases. Randomized controlled trials(RCTs) investigating the effectiveness of needle knives for people with primarydysmenorrhea were eligible. The risk of bias and the quality of the included literaturewere evaluated. RevMan5.3 software was used for this study. Results: Five articles with313 participants were involved in the review. The cure rate (2.82 (2.01, 3.95), I^(2) = 25%)and total effective rate (1.32 (1.10, 1.57), I^(2) = 65%) of the experimental group werehigher than those of the control group. The dysmenorrhea symptom scores (–1.81(–2.61, –1.01), I^(2) = 69%), TCM symptom scores (–4.19 (–6.06, –2.31), I2 = 0%) andadverse reactions (0.16 (0.05, 0.51), I^(2) = 0%) of the experimental group were lowerthan those of the control group. Conclusions: Needle knives may provide advantages inthe treatment of primary dysmenorrhea. RCTs, including the larger sample, multi-center,high-quality and double-blind research, were required to further verify the efficacy ofneedle knives for primary dysmenorrhea.

Observation on the Clinical Effect of Needle Knife Release Combined with Microporous Decompression in Subchondral Bone Marrow Edema Area for Treatment of Knee Osteoarthritis

Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to March 2020,66 patients with knee osteoarthritis were selected as the research objects,and divided into treatment group and control group according to random nuber table.The treatment group was treated with release with needle knife combined with microporous decompression in bone marrow edema area,while the control group was treated with release with needle knife.Visual analogue scale(VAS),the Western Ontario and Mc Master University composite index(WOMCA)and inflammatory factors were used to evaluate the curative effect of patients before treatment and after treatment.Results:The VAS scores of knee pain in both groups decreased after treatment.The treatment group was lower than the control group.The WOMAC scores of both groups were decreased significantly after treatment,and then gradually decreased with time.The WOMAC scroes of the treatment group were lower than those of the control group after treatment,and there was an interactive effect on time factor.Conclusion:Release with needle knife combined with microporous decompression in bone marrow edema area of subchondral bone has good curative effect in the treatment of knee osteoarthritis;it can relieve the pain of patients,improve the function of joint,reduce inlfammatory reaction,and then delay the pathological progress of KOA,which is worthy of clinical promotion.

TREATMENT OF VERTEBRAL－ARTERY TYPE CERVICAL SPONDYLOPATHY WITH NEEDLE－KNIFE THERAPY

In the present paper, 62 cases of vertebral-artery type cervical spondylopathy were treated with needie-knife therapy (acupotomy). After 2- 6 sessions of treatment, 23 cases (37. 1%) were cured, 19 (30. 7%)showed marked improvement, 15 (24.2%) had some improvement and 5 (8.1 % ) failed in the treatment. The total effective rate was 91.9 %. It indicates that acupotomy therapy is a highly effective remedy for treating vertebral-artery type cervical spndylopathy.

超声引导下不同型号针刀联合复方倍他米松注射液治疗扳机指的疗效对比

目的:观察超声引导下不同型号针刀松解联合复方倍他米松注射液治疗扳机指的临床效果与安全性。方法:选取2020年5月至2023年5月江苏大学附属医院疼痛科诊断为扳机指患者111例为研究对象,将患者按随机数字表法进行简单随机化分为超声引导+复方倍他米松注射液组(Ⅰ组)36例、超声引导+复方倍他米松注射液+平口型针刀组(Ⅱ组)37例、超声引导+复方倍他米松注射液+V型针刀组(Ⅲ组)38例,随访为期6个月。记录3组治疗前(T1)、治疗后次日(T2)、治疗后3周(T3)、治疗后6个月(T4)的视觉模拟评分(VAS)和改良Quinnell分级,记录治疗6个月时整体改善状况(PGII)和复发率,以及手术操作时间和治疗期间不良反应。结果:①VAS评分比较:在T2时间点,Ⅱ组和Ⅲ组评分明显高于Ⅰ组(P<0.001),Ⅱ组评分明显高于Ⅲ组(P<0.05);在T3和T4时间点,Ⅱ组和Ⅲ组均明显低于Ⅰ组(P<0.05和P<0.001),Ⅱ组和Ⅲ组间无统计学差异(P>0.05)。②改良Quinnell分级比较:在T2、T3、T4时间点,Ⅱ组和Ⅲ组分级均明显低于Ⅰ组(P<0.05和P<0.001)、Ⅱ组和Ⅲ组间无统计学差异(P>0.05)。③治疗6个月PGII总体改善评分比较:Ⅱ组和Ⅲ组评分均明显高于Ⅰ组(P<0.001),Ⅱ组和Ⅲ组间无统计学差异(P>0.05)。④复发率比较:Ⅱ组和Ⅲ组均明显低于Ⅰ组(P<0.05),Ⅱ组和Ⅲ组间无统计学差异(P>0.05)。⑤操作时间比较:Ⅱ组和Ⅲ组均明显长于Ⅰ组(P<0.001),Ⅱ组时间明显长于Ⅲ组(P<0.05)。⑥3组均未见明显不良反应。结论:超声引导下针刀松解联合复方倍他米松注射液治疗扳机指效果优于单纯复方倍他米松注射液,V型针刀松解优于平口型针刀。

Effect of Small Needle Knife on Autophagy and TGF-β in Synovial Fluid of KOA Rats

Objective:To explore the effects of small needle knife on the autophagy function of synovium and the expression of TGF-βin synovial fluid of KOA rats,so as to provide a new theoretical basis for the treatment of KOA.Methods:48 SD rats were randomly divided into blank control group,model group,drug group and acupotomy group.The blank control group maintained the original feeding without any intervention,the model group adopted the sodium monoiodoacetate injection method to prepare the KOA rat model without any intervention,the drug group prepared the KOA rat model and then treated with tripterine by gavage,and the needle knife group treated the KOA rat model with small needle knife.The expression levels of autophagy-related proteins in synovial tissues were detected by immunohistochemistry and Western blotting,and the content of TGF-βin synovial fluid was measured by ELISA.Results:Compared with the blank control group,Beclin-1,Caspase-3 and Bax were up-regulated and m TOR was down-regulated in the model group.Beclin-1,m TOR,Caspase-3 and Bax were up-regulated in the drug group.There was no significant difference in the expression of autophagy-related proteins Beclin-1(0.28±0.09)and m TOR(0.45±0.12)between the acupotomy group and the blank control group,while Caspase-3(0.17±0.03)and Bax(0.30±0.01)were up-regulated.The expression level of TGF-βin synovial fluid in the small needle knife group was(0.29±0.09),which was similar to that in the blank control group,and was significantly higher than that in the model group.Conclusion:Small needle knife treatment can promote the recovery of synovial autophagy in KOA rats,and reduce the level of TGF-βin synovial fluid,and can play a clinical role in the treatment of KOA by regulating the expression of synovial autophagy and TGF-β.

基于经筋理论的膝骨关节炎患者“筋结点”超声解剖学特征分析与针刀治疗的疗效评价研究

目的:借助可视化肌骨超声深入剖析膝骨关节炎患者膝关节局部经筋病灶点的病理特征,并综合评价弓弦平衡针刀法与常规针刺法治疗膝骨关节炎的疗效差异,为今后针刀精准辨位定点及安全入路研究提供客观参考依据。方法:将120例膝骨关节炎患者随机分为针刀治疗组和针刺对照组,每组60例。针刀治疗组进行弓弦平衡针刀法治疗,每周2次;针刺对照组选取犊鼻、内膝眼、阳陵泉、梁丘、鹤顶,及局部阿是穴进行针刺,同时根据不同的证型进行配穴加减,每周3次。2组均以3周为1个疗程,治疗3个疗程。根据肌骨超声下“筋结点”的精确定位、层次解剖、回声特点深入剖析经筋病灶点的超声影像学特征,采用股直肌羽状角、肌纤维横断面积、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)综合评价2组疗效差异。结果:治疗后,2组患者WOMAC评分、股直肌羽状角、平均肌纤维厚度、弹性应变率、IL-1β、TNF-α水平,及膝关节疼痛程度、僵硬、日常活动能力方面较治疗前均显著改善(P <0.05);其中,针刀治疗组在提升股直肌羽状角、增加肌纤维厚度、降低弹性应变率、降低致炎致痛因子水平方面优于针刺对照组,差异有统计学意义(P <0.05);与正常膝关节超声解剖结构相比,患者膝关节各针刀松解点(筋结点)处呈现出不同程度回声增强,同时伴有滑膜增厚、增生、关节腔积液、滑囊积液等典型超声影像学特征。结论:肌骨超声能够精准呈现膝骨关节炎患者膝关节经筋病灶点的解剖位置、解剖层次等超声病变特征,证实弓弦平衡针刀法的安全性和有效性,为针刀医学的标准化、规范化研究提供重要参考依据。

小针刀联合桂枝加葛根汤治疗肩关节周围炎临床观察

目的 观察小针刀联合桂枝加葛根汤治疗肩关节周围炎(以下简称肩周炎)的临床疗效。方法 将136例肩周炎患者按照随机数字表法分为2组,对照组68例予小针刀治疗,治疗组68例在对照组治疗基础上予桂枝加葛根汤口服治疗,2组疗程均为3个月。比较2组治疗前后疼痛视觉模拟评分(VAS)、美国肩肘外科协会评分(ASES)评分及肩关节活动度,统计2组疗效,随访1年记录肩周炎复发情况。结果 治疗组总有效率97.06%(66/68),对照组总有效率88.24%(60/68),治疗组临床疗效优于对照组(P<0.05)。2组治疗后疼痛VAS均较本组治疗前降低(P<0.05),且治疗组治疗后低于对照组(P<0.05)。2组治疗后ASES疼痛和功能评分均较本组治疗前升高(P<0.05),且治疗组治疗后均高于对照组(P<0.05)。2组治疗后肩关节的各方向活动度均较本组治疗前升高(P<0.05),且治疗组治疗后均高于对照组(P<0.05)。随访1年,治疗组复发率2.94%(2/68),对照组复发率13.23%(9/68),治疗组复发率低于对照组(P<0.05)。结论 小针刀联合桂枝加葛根汤治疗肩周炎疗效肯定,显著优于单用小针刀治疗,能缓解肩周疼痛,改善临床症状,复发率较低。

小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者的效果

目的:分析小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者的效果。方法:选取2020年3月—2023年2月福建中医药大学附属第二人民医院收治的100例肩周炎患者。根据随机数表法将其分为研究组与参考组,各50例。参考组给予关节腔注射玻璃酸钠治疗,研究组在参考组基础上给予小针刀治疗。比较两组治疗前后肩关节功能、疼痛程度及临床疗效。结果:治疗后,研究组总有效率显著高于参考组,两组活动度、功能、肌力、症状评分均升高,研究组上述指标均高于参考组,研究组视觉模拟评分法(VAS)评分低于参考组,差异有统计学意义(P<0.05)。结论:小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者可以有效减轻疼痛程度,改善肩关节功能。

不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效研究

目的:分析不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效,以及对血清骨特异性碱性磷酸酶(BALP)、Ⅰ型胶原羧基肽β特殊序列(β-CTX)水平的影响。方法:选取我院2020年1月-2022年6月收治的120例行微创椎弓根钉内固定术联合小针刀术干预治疗的胸腰椎创伤性骨折患者,随机分为三组。A组(40例)选择经皮入路,B组(40例)选择经Wiltse入路,C组(40例)选择经后正中入路。记录并比较三组伤椎有效性指标:Oswestry功能障碍指数(ODI)、后凸Cobb角和前缘高度比;视觉模拟疼痛(VAS)评分、血清BALP、β-CTX水平和围手术期指标(手术时间、术中出血量和术后引流量)。结果:三组患者术后7 d、30 d的伤椎ODI、后凸Cobb角和前缘高度比均优于术前,差异有统计学意义(P <0.05),但三组间伤椎ODI、后凸Cobb角和前缘高度比差异无统计意义(P>0.05);三组患者术后VAS评分均显著下降,差异有统计学意义(P <0.05),且三组术后1 d、7 d的VAS评分比较差异有统计意义(P <0.05);三组患者术后血清BALP水平均明显上升,血清β-CTX水平均明显下降,差异均有统计学意义(P <0.05),且三组术后7 d的血清BALP及β-CTX水平比较差异有统计意义(P <0.05);三组手术时间、术中出血量和术后引流量关系为A组<B组<C组,差异有统计学意义(P <0.05)。结论:经皮入路和经Wiltse入路微创椎弓根钉内固定术联合小针刀术干预治疗能有效改善胸腰椎创伤性骨折患者伤椎有效性及骨代谢水平,而传统后正中入路的有效性及对骨代谢水平的改善作用相对较差,临床可结合患者情况在经皮入路和经Wiltse入路二者之间酌情选择入路方式,并结合小针刀术进行干预治疗。

基于小针刀治疗颈椎病的VR系统设计

虚拟手术可以建立一个具有视觉、触觉、听觉等多种感觉的环境,它对改变传统的医学模式和提高工作人员的专业性具有重要作用。但是其在针刀手术中应用还未普及。鉴于此,研究采用AnyBody和Hill模型对头颈椎骨肌进行多体动力学分析,并基于FDK算法实现椎间盘载荷计算。此外,为了较好地模拟颈椎颈椎软组织与针刀的交互作用过程,研究设计了一种包含图像渲染、碰撞检测的虚拟手术仿真系统。结果显示,研究所提模型在整个针刀运动过程中没有间断,且随着针刀与颈椎软组织的分离操作的结束能够减小至0。这表明该模型在分离中避免组织穿透情况效果良好。在椎间盘压力预测上,研究所提模型在前屈、后伸、侧弯以及旋转运动中产生的压力均值均在50-150N之间,这表明压力值符合日常活动压力范围。因此,研究所提模型在模拟和预测颈椎力学特征上具备有效性。

王海东治疗强直性脊柱炎经验

强直性脊柱炎是一种慢性,进行性关节炎症性疾病。王海东教授从事风湿病治疗30余年,对AS的治疗积累了丰富的经验,形成了以中药方剂补肾强督、扶助正气,配合经筋理论指导下的针刀疏经通络、调和阴阳的独特治疗体系,在临床取得良好的效果,值得推广。

弧刃针45°腱鞘切开松解术与传统针刀松解术治疗中重度拇指屈指肌腱狭窄性腱鞘炎临床研究

目的研究弧刃针治疗中重度拇指屈指肌腱狭窄性腱鞘炎的安全性及有效性。方法收集符合纳入标准的中重度拇指屈指肌腱狭窄性腱鞘炎患者62例,采用随机数字表法将患者1∶1分配至弧刃针组与针刀组,其中弧刃针组31例,采用弧刃针治疗,针刀组31例,给予传统针刀松解术治疗。两组均治疗1次。记录患者治疗前、治疗后各时期(1周、2周、4周)及24周后随访时的疼痛数字评分(Numberal rating scale,NRS)、指间关节活动度(Range of motion,ROM)、Quinell分级以及疾病的疗效评分(Wangxuechang diease efficacy score,WDES),评估治疗效果。结果62例患者治疗后24W随访时,两组病人Quinell分级对比,弧刃针组优于针刀组(P<0.05);疾病的疗效评分(WDES)总有效率:弧刃针组96.77%,针刀组83.87%,弧刃针组的临床总有效率优于针刀组(P<0.05);治疗后,两组疼痛数字评分(NRS)、关节活动度(ROM)均明显改善,且随时间进展,改善程度越大(P<0.05);且治疗后1周、2周、4周及24周时间点的组间比较显示,弧刃针在改善疼痛、关节活动度方面优于针刀组(P<0.05)。结论弧刃针45°腱鞘切开松解术与传统针刀松解术治疗中重度拇指屈指肌腱狭窄性腱鞘炎均有效,但弧刃针45°腱鞘切开松解术在改善疼痛、指间关节活动度和安全性方面优势明显。

超声引导下针刀松解黄韧带对兔退变腰椎间盘整合素α5、β1表达的影响

背景:针刀松解黄韧带可有效改善腰椎退行性患者的症状,超声引导可增加针刀松解的精准性,但针刀松解黄韧带后对退变椎间盘的具体影响及可能的机制尚待明确。目的:探讨超声引导下针刀松解黄韧带对兔腰椎间盘退变的作用。方法:取24只新西兰兔,采用随机数字表法分为对照组(n=6)与造模组(n=18)。造模组采用横断L5/6、L6/7节段棘上、棘间韧带并保持站立姿势对腰椎施加轴向载荷的方式建立兔腰椎间盘退变模型,造模成功后再随机分为模型组、超声针刀组、假针刀组,每组6只,超声针刀组在超声引导下使用针刀松解L7/S1右侧黄韧带,假针刀组针刀入路同超声针刀组,但不松解黄韧带,1次/周,共4次。针刀干预后30 d,利用MRI观察L7/S1椎间盘髓核信号强度变化,苏木精-伊红染色观察L7/S1椎间盘形态变化,免疫组化染色检测L7/S1椎间盘髓核内Ⅰ,Ⅱ型胶原表达,RT-PCR、Western Blot检测L7/S1椎间盘中整合素α5、β1、p38、核因子κB的表达。结果与结论:①MRI成像显示,模型组兔椎间盘髓核呈灰-黑色,髓核灰度值明显低于对照组(P<0.01);超声针刀组兔椎间盘髓核亮度较模型组升高,髓核灰度值高于模型组(P<0.01);②苏木精-伊红染色显示,模型组髓核形状不规则,髓核细胞数量减少,细胞外基质被压缩,纤维环破裂,终板结构与边界不清,软骨细胞排列紊乱;与模型组相比,超声针刀组髓核细胞数量增多,纤维环破裂情况有改善,软骨终板细胞排列较为规则;③免疫组化染色显示,与对照组比较,模型组髓核内Ⅰ型胶原阳性表达增加(P<0.01),Ⅱ型胶原阳性表达减少(P<0.01);与模型组比较,超声针刀组髓核内Ⅰ型胶原阳性表达减少(P<0.01),Ⅱ型胶原阳性表达增加(P<0.01);④RT-PCR、Western Blot检测显示,与对照组比较,模型组兔椎间盘中整合素α5、整合素β1、p38、核因子κB的mRNA与蛋白表达均升高(P<0.01);与模型组比较,超声针刀组兔椎间盘中整合素α5、整合素β1、p38、核因子κB的mRNA与蛋白表达均降低(P<0.01);⑤结果表明,超声引导下针刀松解黄韧带可改善兔腰椎间盘退变程度,该作用与通过调控整合素α5、β1表达、抑制p38和核因子κB表达有关。