Clinical Observation of Self-made Four-step Tendon Regulating Manipulation in the Treatment of 30 Cases of Thumb Stenotic Tenosynovitis

[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic tenosynovitis of thumb were treated with four-step tendon manipulation and traditional manipulation respectively, 3 times a week, a total of two weeks. The clinical efficacy, changes of visual analogue scale (VAS) and the recurrence rate after 15 d of follow-up treatment were observed before and after treatment. The differences were statistically significant ( P <0.05). [Results] After treatment, the VAS and the recurrence rate after 15 d of treatment in the observation group were significantly lower than those in the control group ( P <0.05). After treatment, the total effective rate was 73.33% in the control group and 93.33% in the observation group ( P <0.05). [Conclusions] The effect of four-step tendon regulating manipulation in the treatment of thumb stenotic tenosynovitis is ideal. The effect is significantly better than that of traditional Chinese medicine in improving thumb pain and function, which is worthy of clinical promotion.

Clinical observation of sinew-regulating and bone-setting manipulation combined with Xiaoyu Jiegu Powder in treating knee osteoarthritis

Objective:To evaluate the clinical efficacy of sinew-regulating and bone-setting manipulation(SRBSM)combined with Xiaoyu Jiegu Powder(XYJGP)in treating knee osteoarthritis(KOA).Methods:Sixty patients were randomly divided into treatment group(30 cases)and control group(30 cases).The treatment group was treated with SRBSM combined with XYJGP and the control group was given intermediate frequency electrotherapy and XYJGP.Visual Analogue Scale(VAS).The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Flexion range of motion of the knee joint,and surface electromyography(sEMG)were used to evaluate and compare the patients'knee function before and after treatment.The efficacy was observed with diagnosis and efficacy standards of TCM.Results:After treatment,compared with the same group before treatment,muscle fatigue and muscle tension decreased,pain was reduced,range of motion of the knee joint was increased,and motor function was improved(P<0.05).The improvement degree of the treatment group was better than that of the control group(P<0.05).The total effective rate of the treatment group was 96.6%(29/30),higher than that of the control group(80.0%),P<0.05.Conclusion:SRBSM combined with XYJGP can effectively reduce the pain of KOA patients,improve the range of motion of the joints,and improve the quality of life of the patients,and its curative effect is better than that of intermediate frequency electrotherapy combined with XYJGP.

Effect of tendon and bone setting manipulation combined with Kinesio Taping on de Quervain disease

Objective:To observe the effect of the treatment of tendon-regulation and bone-setting manipulation and Kinesio Taping on patients with de Quervain Disease.Methods:60 cases with de Quervain Disease were divided into 30 treatment group and 30 control group according to random number table.The observation group was treated withtendon-regulation and bone-setting manipulation and Kinesio Taping,and the control group was given Votalin emulsion combined with Kinesio Taping.The patients were evaluated and compared according to the VAS before and after treatment,the degree of tenderness,the methods of electric integral value(integral electromyogram,iEMG),the degree of wrist ulnar deviation,and the cooney wrist score,and the curative effect was observed using the diagnostic curative effect criteria of TCM disease(the evaluation process was blinded).Results:Compared with the same group before treatment,after treatment,the pain and tenderness of the two groups were reduced,iEMG value increased,the ulnar deviation of the wrist increased,and the cooney wrist score increased(all P<0.05);the improvement of the treatment group was significantly better.In the control group,the difference was statistically significant(P<0.05)and the total effective rate of the treatment group was 93%higher than that of the control group 80%(P<0.05).Conclusion:The combination of the tendon-regulation and bone-setting manipulation combined with the Kinesio Taping can effectively reduce the pain and tenderness of the patients withde Quervain Disease,increase the ulnar mobility of the wrist joint,and improve the joint function of the wrist joint.

Simulation Modeling of the Motion Control of a Two Degree of Freedom,Tendon Based,Parallel Manipulator in Operational Space Using MATLAB

In this paper a dynamical model of a two degree of freedom,tendon based,parallel manipulator (TBPM) system is proposed. The motion control methods of the TBPM system were designed. Using MATLAB,the motion control simulation of this model TBPM system was implemented in preparation for actual experiments. The results of the simulation demonstrated that the response time of the system was in a reasonable range,the motion behavior of the platform was stable and the tension forces acting on the tendons were in a safe range and acceptable. Furthermore,the parameters of the controllers were optimized using MATLAB and better results for the time response were obtained.

Reduction in nerve root compression by the nucleus pulposus after Feng's Spinal Manipulation

Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng＇s Spinal Manipulation, hot fomentation, and bed rest （treatment group）. The remaining 46 patients were treated with hot fomentation and bed rest only （control group）. After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng＇s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.

Modeling and motion control simulation of tendon based parallel manipulator translation mechanism for sensor based high value waste processing

A novel sorting system based on one degree of freedom (DOF) tendon based parallel manipulator (TBPM) for high value waste processing was presented and designed. In order to control the motion of loads, nonlinear state feed forward control algorithm in the tendon length coordinate was used. Considering the system redundancy and actuation behavior, algorithms of optimal tension distribution and forward kinematics were designed. Then, the simulation experiments of motion control were implemented. The results demonstrate that the proposed TBPM translation system performs robust capacities. It can transfer the loads 1 m away within 1.5 s. With further optimization, the translation duration can be further reduced to be about 1 s and the optimized translation is followed with 43.59 m/s2 maximum acceleration. The translation errors at the aim position remain below 0.4 mm.

基于筋骨理论对青少年颈痛的临床新思考

青少年颈痛症状类似于成人颈椎病,但其病理改变并不完全符合颈椎椎间盘退变。因此,应积极探索更符合其临床特点的病因学和病理学理论,实现临床对青少年颈痛的有效诊断与治疗。在石氏伤科百年治伤临床经验和最新科学研究认识的基础上,探讨青少年颈痛的诊断名称和基于“筋骨合和”理论的病因病机,并针对颈部“筋出槽、骨错缝”核心病机建立“四以相和”的诊治策略。

基于“筋、节、骨、髓”分型探讨神经根型颈椎病的手法治疗

神经根型颈椎病(CSR)是一种由于颈椎间盘和椎间关节退变引起的疾病,主要表现为颈部、肩部及上肢神经支配区域的疼痛、感觉异常和运动障碍。传统中医的筋骨辨证在治疗该病时存在概念不清、辨证分型不一等问题。岐黄学者林定坤教授在筋骨辨证的基础上,结合现代解剖学提出了颈椎“筋”“节”“骨”“髓”4大分型。该文通过总结林定坤教授对CSR筋骨辨证学术思想,总结手法治疗该病的作用靶点,提出基于筋劳、节错、骨变和髓损等4种病损分型,采用理筋、调节、护髓和治骨4种手法治疗,以期完善骨伤科手法治疗CSR的辨证施治体系,为临床提供参考。

李盛华教授运用陇中正骨手法治疗“骨错缝、筋出槽”病例报告

陇中正骨学术流派第三代传人李盛华教授批判性吸纳各家流派治疗“骨错缝、筋出槽”患者的方法,并在陇中正骨学术流派学术思想“整体辨证、筋骨并重、内外兼治、动静互补、精准微创”的指导下,在治疗“骨错缝,筋出槽”过程中提出“稳、准、轻、巧”四字法则,同时还强调“心身同治”的理念,恰到好处的手法可有效整复“骨错缝、筋出槽”,恢复关节功能。此外,他根据不同的损伤部位,选择相应的手法进行复位,即可缓解患者的疼痛、功能障碍,使其效果立竿见影,充分发挥了中医骨伤治疗骨伤疾病“简、便、效、廉”的优势。

基于骨正筋柔理论应用棍点理筋正骨手法治疗急性腰扭伤的临床效果

目的探讨棍点理筋正骨手法在急性腰扭伤疾患中的临床效果。方法将广西中医药大学附属贺州市中医医院骨科及推拿科2020年7月至2022年12月收治的60例急性腰扭伤患者随机分为观察组和对照组,每组各30例。观察组采用棍点理筋正骨手法治疗,对照组患者采用常规推拿手法治疗。比较两组治疗后的总有效率、显效率;比较两组治疗前后疼痛视觉模拟评分法(VAS)评分和腰椎功能障碍指数(ODI)评分情况。结果观察组总有效率为93.33%,高于对照的76.67%,但差异无统计学意义(P>0.05);观察组显效率为73.33%,高于对照组的46.67%,差异有统计学意义(P<0.05)。治疗前两组VAS、ODI评分比较,差异无统计学意义(P>0.05)。治疗1周后,观察组的VAS、ODI评分均低于对照组,差异有统计学意义(P<0.05)。结论在急性腰扭伤疾病的治疗中,对患者的疼痛缓解以及腰椎功能的改善方面棍点理筋正骨手法要优于传统推拿手法,且疗效更佳,是一种安全可行的治疗方法,值得推广。

腰痹汤配合拨筋调督手法治疗退行性腰椎管狭窄症的效果观察

目的:探讨腰痹汤配合拨筋调督手法治疗退行性腰椎管狭窄症的临床效果。方法:选取2019年12月—2021年12月北京市昌平区中西医结合医院收治的60例腰椎管狭窄症患者作为研究对象,根据随机数字表法分为对照组和观察组,各30例。对照组采用常规西药治疗,观察组采用腰痹汤配合拨筋调督手法治疗。比较两组临床疗效、疼痛情况、中医证候积分、腰椎功能。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.001)。治疗前,两组视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);治疗后,两组VAS评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组中医证候积分比较,差异无统计学意义(P>0.05);治疗后,两组中医证候积分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组日本骨科学会腰痛疗效评价标准(JOA)评分比较,差异无统计学意义(P>0.05);治疗后,两组JOA评分高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:腰痹汤配合拨筋调督手法治疗退行性腰椎管狭窄症的临床效果显著,可缓解患者疼痛,改善临床症状,提升腰椎功能。

理筋手法调控兔骨骼肌损伤修复中瘢痕形成的作用机制

背景:理筋手法能够促进骨骼肌修复,治疗骨骼肌损伤。但骨骼肌损伤在修复过程中的纤维化形成、瘢痕组织增生等与损伤修复质量密切相关。开展理筋手法对纤维化形成、瘢痕组织增生的调控作用研究,有利于阐述理筋手法提高骨骼肌损伤修复质量的相关机制。目的:探索理筋手法提高兔骨骼肌损伤后修复质量的作用机制,为临床治疗提供科学依据。方法:45只健康成年日本大耳白兔随机分为空白组、模型组、理筋组,每组15只。其中模型组和理筋组均进行腓肠肌打击造模;造模后理筋组于第3天开始进行理筋手法干预,1次/d,15 min/次。各组在造模后的第7,14,21天分别处死5只兔进行观察。苏木精-伊红染色法观察腓肠肌形态及炎性细胞量,Masson染色法观察腓肠肌胶原纤维量,ELISA法检测腓肠肌白细胞介素6和白细胞介素10的表达量,Western blot和RT-PCR检测配对盒基因7、成肌分化因子、肌细胞生成素、肌动蛋白α、转化生长因子β1、Ⅰ型胶原蛋白的蛋白及mRNA表达,免疫组织化学法检测Ⅰ型胶原蛋白的表达。结果与结论:①苏木精-伊红染色及Masson染色结果显示,与模型组比较,理筋组各观察点炎性细胞浸润减少,胶原纤维量减少(P<0.01),肌纤维逐渐愈合;②ELISA结果显示,与模型组比较,理筋组白细胞介素6表达持续降低(P<0.05),而白细胞介素10在造模后第7天时升高(P<0.05),随后呈下降趋势(P<0.05);③Western blot和RT-PCR结果显示,与模型组比较,理筋组造模后第14天配对盒基因7、成肌分化因子、肌细胞生成素的蛋白及mRNA表达量均显著升高(P<0.05),而第21天时却较之前下降(P<0.05);理筋组各观察点肌动蛋白α、转化生长因子β1、Ⅰ型胶原蛋白的蛋白及mRNA表达量相较于模型组均显著降低(P<0.05);④免疫组化结果显示,理筋组各观察点Ⅰ型胶原蛋白的表达量相较于模型组均显著降低(P<0.05);⑤结果表明,理筋手法能够通过抑制炎症、促进肌卫星细胞的增殖分化、减少纤维化的生成,从而提高兔骨骼肌损伤的修复质量。

理筋正骨手法治疗颈型颈椎病临床观察

目的观察理筋正骨手法结合运动锻炼治疗颈型颈椎病的临床疗效。方法将60名颈型颈椎病患者随机分为治疗组和对照组,每组30例;治疗组采用理筋正骨手法结合运动锻炼,对照组采用牵引疗法联合运动锻炼;分别于治疗前后采用手持式压痛仪检测患者颈部疼痛部位压痛阈值,关节角度尺测量颈椎关节活动度,采集颈部肌肉表面肌电积分肌电值(integral electromyogram,iEMG),计算颈椎前屈、后伸、侧屈的肌肉协同收缩率(co-contraction ratio,CCR),采用颈部功能障碍指数(neck disability index,NDI)评价功能改善程度,并进行疗效评价。结果与治疗前比较,两组患者治疗后疼痛减轻,颈椎活动度增加,颈部肌肉CCR下降,NDI降低(P<0.05);治疗组疼痛、颈椎关节活动度、颈部肌肉CCR、NDI改善程度均优于对照组(P<0.05)。治疗组临床疗效优于对照组(P<0.05)。结论理筋正骨手法结合运动锻炼可有效减轻颈型颈椎病患者的疼痛,改善关节活动度,提高颈部肌肉协调性,改善患者颈椎功能,其疗效优于牵引疗法结合运动锻炼。

李盛华教授运用陇中正骨手法治疗踝关节滑膜嵌顿临证经验撷英

介绍李盛华教授运用陇中正骨手法治疗踝关节滑膜嵌顿的临床经验,对其治疗该病的临床思路及手法进行系统总结。李盛华教授以“顺于自然、手稳法巧、筋骨相通、内外兼治、身心并重”的理论体系为中心治则,运用“拔、揉、摇、落”的正骨手法技巧,达到“筋脉归位,骨正筋柔”的治疗目的。

柔筋养精手法联合中药膏膜治疗膝骨关节炎疼痛

目的探讨柔筋养精手法联合中药膏膜治疗膝骨关节炎(KOA)疼痛的临床应用。方法选取2022年3月-2023年3月安徽中医药大学第二附属医院收治的膝骨关节炎患者84例,根据随机数表法分为研究组与对照组,各42例。研究组采用柔筋养精手法联合中药膏膜治疗,对照组口服塞来昔布胶囊,比较2组疼痛情况、关节功能及血清白细胞介素-1β(IL-1β)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平。结果治疗后研究组膝关节内侧点、外侧点、中心点疼痛阈值高于对照组(P<0.05),简版McGill疼痛问卷调查(SF-MPQ)评分低于治疗前及对照组(P<0.05);治疗后研究组膝关节损伤与骨关节炎评分(KOOS)评分高于治疗前及对照组(P<0.05);治疗后研究组血清IL-1β、TNF-α、CRP水平低于对照组(P<0.05);研究组膝骨关节炎患者治疗总有效率(95.24%,40/42)高于对照组(76.19%,30/42)(P<0.05)。结论柔筋养精手法联合中药膏膜治疗可以有效缓解膝骨关节炎患者疼痛症状,降低膝骨关节炎患者关节炎症反应,改善关节功能,提高临床治疗效果。

手法松解术联合几丁糖治疗肩周炎

目的观察手法松解术联合医用几丁糖治疗冻结期肩周炎的临床疗效。方法选择102例肩周炎患者,随机分为对照组和观察组。对照组采用针灸、推拿治疗,观察组采用手法松解术联合医用几丁糖治疗,2组治疗前、治疗1天、1周、1个月、3个月、6个月后,分别记录视觉模拟评分(VAS)、Constant肩关节评分(CMS)、肩关节活动度、总有效率及复诊率。结果治疗1天、1周、1个月、3个月、6个月后,2组VAS评分、CMS、肩关节活动度均有不同程度改善,且观察组明显优于对照组(P<0.05);观察组临床疗效总有效率(98%,49/50)高于对照组(78%,39/50)(P<0.05),复诊率低于对照组(P<0.05)。结论在“筋主骨从”理论指导下手法松解术联合医用几丁糖治疗冻结期肩周炎可以明显降低患者的疼痛程度、改善肩关节功能障碍、提高肩关节活动度、降低复诊率,在改善患者功能障碍方面优势明显。

基于“筋骨平衡”理念的陇中正骨手法治疗早期膝骨性关节炎探讨

从陇中正骨手法的发展历程、陇中正骨手法-膝关节调衡手法、陇中正骨手法治疗膝骨性关节炎(knee osteoarthritis,KOA)3方面探讨基于“筋骨平衡”理念的陇中正骨手法治疗早期KOA的理论机制,指出陇中正骨调衡手法在传统手法的基础上注重“筋骨平衡”理念,在治疗KOA的过程中融入动静结合、筋骨并重的思想,重在纠正筋骨力学失衡,达到筋骨并调的目的,为手法治疗早期KOA提供了新策略。

理筋手法减轻兔损伤骨骼肌纤维化的作用机制

背景:理筋手法能够减少纤维化瘢痕增生,促进骨骼肌修复。但不恰当的激活Wnt/β-catenin信号通路,能加剧损伤骨骼肌纤维化,对骨骼肌修复过程产生不利影响。开展理筋手法对Wnt/β-catenin信号通路的调控作用研究,有利于阐述理筋手法减少纤维化瘢痕增生、促进骨骼肌损伤修复的相关机制。目的:探讨理筋手法促进兔骨骼肌损伤修复的作用机制。方法:45只普通级健康成年日本大耳兔随机分为空白组、模型组和理筋组,每组15只。模型组和理筋组均进行腓肠肌打击造模,理筋组于造模后第3天开始进行理筋手法治疗,1次/d,15 min/次。各组在造模后第7,14,21天分别取5只进行取材。苏木精-伊红染色观察腓肠肌一般形态结构,Masson染色观察腓肠肌胶原纤维含量,Western blot检测腓肠肌Wnt3a、β-catenin、GSK3β、p-GSK3β、TCF、Ⅰ型胶原蛋白、Ⅲ型胶原蛋白表达,RT-PCR检测腓肠肌Wnt3a、β-catenin、TCF mRNA表达,免疫荧光法检测腓肠肌β-catenin的表达,免疫组化法检测腓肠肌Ⅰ型胶原蛋白、Ⅲ型胶原蛋白的表达。结果与结论:①苏木精-伊红染色及Masson染色结果显示:与模型组比较,理筋组各观察点炎性细胞浸润减少,胶原纤维量减少(P<0.001),肌纤维逐渐愈合;②Western blot结果显示:与模型组比较,理筋组各观察点Wnt3a、β-catenin、TCF、Ⅰ型胶原蛋白、Ⅲ型胶原蛋白的蛋白表达量均显著降低(P<0.05),而p-GSK3β/GSK3β比值较模型组则明显升高(P<0.05);③RT-PCR结果显示:与模型组比较,理筋组各观察点Wnt3a、β-catenin、TCF的mRNA表达量均显著降低(P<0.001);④免疫荧光结果显示:与模型组比较,理筋组各观察点β-catenin核表达荧光强度明显降低,且逐渐与空白组相近(P<0.001);⑤免疫组化结果显示:理筋组各观察点Ⅰ型胶原蛋白、Ⅲ型胶原蛋白的表达量相较于模型组均显著降低(P<0.01)。结果表明:理筋手法能够抑制Wnt/β-catenin信号通路的异常激活,减少纤维化瘢痕增生,从而达到促进损伤骨骼肌修复的目的。

罗素兰教授运用罗氏正筋八法治疗踝关节扭伤经验撷英

对罗素兰教授应用罗氏正筋八法治疗踝关节扭伤的经验进行总结,指出其操作步骤及手法原理包括复贴松解、分推拔正、环转拖拉、舒筋持顺,后期康复包括固定、中药熏洗等。罗素兰教授提出的正筋八法体系操作简便,手法轻、见效快,可广泛应用于各种急慢性筋伤疾患。

以手法为主要干预措施的随机对照试验在样本量估计方面的常见问题分析

目的:分析以手法为主要干预措施的随机对照试验(randomized controlled trial,RCT)在样本量估计方面存在的问题。方法:应用计算机检索PubMed、Embase和Cochrane Library中以手法为主要干预措施的RCT,检索时限均为2017年1月至2024年6月。依据文献检索及筛选方案筛选出符合要求的文献后,由2名经过培训的研究人员独立提取是否报告样本量估计、假设检验类型、Ⅰ类错误概率α、把握度(1-β)、预期效应量、单侧或双侧检验、最小临床重要性差值(minimal clinically important difference,MCID)、脱落率、样本量计算工具、主要结局指标及多重检验等信息,以频数和百分比的形式进行描述性分析。结果:共检索到48688篇文献,去除重复文献后随机抽取20%的文献,通过筛选最终纳入274篇文献。在纳入的274项研究中,192项(70.07%)报告了样本量估计。在报告了样本量估计的192项研究中,16项(8.33%)报告了假设检验类型,146项(76.04%)报告了Ⅰ类错误概率α,164项(85.42%)报告了把握度(1-β),98项(51.04%)报告了预期效应量,88项(45.83%)报告了单侧或双侧检验,81项(42.19%)报告了MCID,156项(81.25%)报告了脱落率,167项(86.98%)报告了样本量计算工具,131项(68.23%)报告了主要结局指标。16项报告了假设检验类型的研究均为优效性试验,其中9项采用单侧检验,7项采取双侧检验;37项报告了2个及以上主要结局指标的研究中,8项(21.62%)调整了Ⅰ类错误概率α;23项报告了多个组别比较的研究中,1项(4.35%)调整了Ⅰ类错误概率α。结论:以手法为主要干预措施的RCT在样本量估计方面,存在未报告样本量估计、样本量估计参数缺失或不明、样本量估计方法与假设检验类型及主要结局指标不对应、多重检验时未调整Ⅰ类错误概率α等问题。