Spinal epidural hematoma after spinal manipulation therapy:Report of three cases and a literature review

BACKGROUND Spinal manipulation therapy(SMT)has been widely used worldwide to treat musculoskeletal diseases,but it can cause serious adverse events.Spinal epidural hematoma(SEH)caused by SMT is a rare emergency that can cause neurological dysfunction.We herein report three cases of SEH after SMT.CASE SUMMARY The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT.Her symptoms persisted after 3 d of conservative treatment,and she was admitted to our hospital.Magnetic resonance imaging(MRI)demonstrated an SEH,extending from C6 to C7.The second case was a 55-year-old man with sudden back pain 1 d after SMT,numbness in both lower limbs,an inability to stand or walk,and difficulty urinating.MRI revealed an SEH,extending from T1 to T3.The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT.He was unable to stand or walk and experienced mild back pain.MRI revealed an SEH,extending from T1 to T2.All three patients underwent surgery after failed conservative treatment.The three cases recovered to ASIA grade E on day 5,1 wk,and day 10 after surgery,respectively.All patients returned to normal after 3 mo of follow-up.CONCLUSION SEH caused by SMT is very rare,and the condition of each patient should be evaluated in full detail before operation.SEH should be diagnosed immediately and actively treated by surgery.

Minimally manipulated autologous adherent bone marrow cells (ABMCs):a promising cell therapy of spinal cord injury

Spinal cord injury（SCI）is a devastating ailment that results in drastic life style alterations for the patients and their family members（Mc Donald and Sadowsky,2002）.Damage post injury causes necrosis,edema,hemorrhage and vasospasm.Post injury,secondary damage is caused by ischemia,

The Modernisation of Manipulative Therapy

Research indicates that, despite physiotherapists’ comprehensive training in the basic sciences, manipulative (currently “musculoskeletal”) therapy is still dominated in the clinical setting by its original, now obsolete, structure-based “biomedical” model. This is further inexplicable in the light of evidence that not only the underlying “philosophy” but also several of the fundamental requirements of the clinical process itself which has the structural-mechanical model as its basis, have been shown to be flawed or at least irrelevant. The apparent inability of the profession to fully abandon outmoded “concepts” (and embrace the acknowledged science-based “best practice” biopsychosocial model) may have potentially undesirable consequences for both patients and therapists engaged in the management of (chronic) musculoskeletal pain and disability.

Advances in Research of Simple Obesity and Its Manipulative Therapy in Recent Ten Years

The simple obesity is a common clinical disease and its incidence is increasing year by year.With the increasing pace of work,increasing pressure,and changing eating habits,the incidence of simple obesity tends to be younger.Among the treatment protocols for this disease,TCM manipulative(Tuina)therapy has remarkable curative effect and few adverse reactions,and has been well recognized.Modern research has also proposed a variety of treatment protocols with different characteristics and good curative effects.This paper reviews the related literature on simple obesity and its manipulative therapy in the past ten years,and summarizes its disease name,etiology and pathogenesis,manipulation and related therapies,so as to provide new ideas and new angles for the treatment of the simple obesity.

三维侧凸角定量评估手法治疗腰椎间盘突出症的近期效果

背景:腰椎间盘突出症患者因髓核压迫、力学失衡而出现不同的身体畸形,冯天有教授在此基础上提出“四步腰型”,冯伟教授提出三维侧凸角客观量化“四步腰型”。目的:探讨三维侧凸角在评估新医正骨疗法治疗腰椎间盘突出症患者疗效中的应用价值。方法:纳入149例腰椎间盘突出症患者,其中四步腰型Ⅰ/Ⅱ型96例,Ⅲ/Ⅳ型55例,均进行2周的手法治疗;另纳入10名健康志愿者作为健康对照。利用表面形貌技术测量三维侧凸角,比较四步腰型Ⅰ/Ⅱ型及Ⅲ/Ⅳ型患者三维侧凸角治疗前后的差异,比较患者治疗后与健康受试者的差异,比较Ⅰ/Ⅱ型和Ⅲ/Ⅳ型三维侧凸角治疗变化量的差异,探索三维侧凸角各投影面内在相关性及与常用临床疗效评分的相关性。结果与结论:(1)四步腰型Ⅰ/Ⅱ型与Ⅲ/Ⅳ型患者治疗前后的三维侧凸角差异有显著性意义(P <0.05);(2)Ⅰ/Ⅱ型、Ⅲ/Ⅳ型患者治疗后与健康受试者冠侧凸和横截凸差异有显著性意义(P <0.05),矢侧凸无统计学差异(P> 0.05);(3)三维侧凸角在各个投影面之间两两呈现相关性,与主观量表之间存在相关性;(4)提示三维侧凸角在手法治疗前后脊柱畸形程度定量评估中具有很好的作用,通过定量化的指标能够揭示患者治疗前后病情变化规律;三维侧凸角能反映影响患者生活状态的严重程度,但单一平面参数评估脊柱侧弯有一定局限性。

Alopecia treatment using minimally manipulated human umbilical cord-derived mesenchymal stem cells:Three case reports and review of literature

BACKGROUND Alopecia areata(AA)is a common autoimmune disease characterized by hair loss.AA appears in extensive forms,such as progressive and diffusing hair loss(diffuse AA),a total loss of scalp hair(alopecia totalis),and complete loss of hair over the entire body(alopecia universalis).Recently,mesenchymal stem cells(MSCs)have been identified as a therapeutic alternative for autoimmune diseases.For this reason,preclinical and case studies of AA and related diseases using MSCs have been conducted.CASE SUMMARY Case 1:A 55-year-old woman suffered from AA in two areas of the scalp.She was given 15 rounds of minimally manipulated umbilical cord-MSCs(MM-UC-MSCs)over 6 mo.The AA gradually improved 3 mo after the first round.The patient was cured,and AA did not recur.Case 2:A 30-year-old woman,with history of local steroid hormone injections,suffered from AA in one area on the scalp.She was given two rounds of MM-UC-MSCs over 1 mo.The AA immediately improved after the first round.The patient was cured,and AA did not recur.Case 3:A 20-year-old woman,who was diagnosed with alopecia universalis at the age of 12,was given 14 rounds of MM-UC-MSCs over 12 mo.Her hair began to grow about 3 mo after the first round.The patient was cured,and alopecia universalis did not recur.CONCLUSION MM-UC-MSC transplantation potentially treats patients who suffer from AA and related diseases.

Psoriasis treatment using minimally manipulated umbilical cordderived mesenchymal stem cells:A case report

BACKGROUND Psoriasis is a chronic autoimmune disease that usually manifests as a red scaly epidermis,induration,and hyperproliferation of basal keratinocytes.About 2%of the world’s population suffers from psoriasis but there are no clear therapeutics yet.Recently,mesenchymal stem cells(MSCs)have been regarded as a therapeutic alternative for autoimmune diseases,as they possess immunosuppressive effects without risks.Human umbilical cord-derived MSCs effectively regulate immune cells and are characterized by low immunogenicity,which has many advantages in treating immune diseases.CASE SUMMARY The patient was a 47-year-old male,diagnosed with psoriasis in 1995.He had received various treatments for 25 years,but the psoriatic condition was not significantly improved.He was given three rounds of minimally manipulated umbilical cord-derived MSCs over 2 wk.The erythema gradually disappeared.Three months after the 1st round,all erythema completely disappeared,and the psoriasis did not recur.CONCLUSION Minimally manipulated umbilical cord-derived MSC transplantation can potentially treat patients who suffer from psoriasis.

Treatment of acute ischemic stroke by minimally manipulated umbilical cord-derived mesenchymal stem cells transplantation:A case report

BACKGROUND Stroke is one of the major causes of disability and death worldwide.Some treatments for stroke exist,but existing treatment methods have limitations such as difficulty in the regeneration of damaged neuronal cells of the brain.Recently,mesenchymal stem cells(MSCs)have been studied as a therapeutic alternative for stroke,and various preclinical and case studies have been reported.CASE SUMMARY A 55-year-old man suffered an acute stroke,causing paralysis in the left upper and lower limbs.He intravenously transplanted the minimally manipulated human umbilical cord-derived MSCs(MM-UC-MSCs)twice with an 8-d interval.At 65 wk after transplantation,the patient returned to his previous occupation as a veterinarian with no adverse reactions.CONCLUSION MM-UC-MSCs transplantation potentially treats patients who suffer from acute ischemic stroke.

Lateral elbow tendinopathy: Evidence of physiotherapy management

Lateral elbow tendinopathy(LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.

“Tong Guan Li Qiao” Acupuncture Therapy on Post-Stroke Dysphagia

The differences between the“Tong Guan Li Qiao”acupuncture therapy and the conventional and current other acupuncture methods for poststroke dysphagia are as follows:first,it adheres to the basic idea of "Xing Nao Kai Qiao"acupuncture therapy in selecting and combining acupoints,centers on the brain,and combines the dysphagia symptoms of the mouth,tongue,and throat-related orifices with the root cause of"brain";second,thereare strictand standard requirements intheacupuncture operation,that is,manipulation quantification.In addition to standardized twirling,lifting,and thrusting,the techniques of deep needling on the acupoints in the neck region,blood-letting puncturing at the posterior wallof the pharynx,and theneedling sensation of"like a fishbone getting stuck in the throat"are all unique.

中药透皮术配合穴位手法治疗外阴色素减退性疾病的临床研究

目的 探讨中药透皮术联合穴位手法对外阴色素减退性疾病临床疗效。方法 将90例就诊于长春中医药大学附属医院妇产诊疗中心门诊,并符合纳入标准的外阴色素减退性疾病患者随机分为治疗组和对照组。治疗组采用中药透皮术配合穴位手法治疗,对照组采用竹红菌素软膏外涂。对2组的临床有效率与复发率进行详细比较。结果 治疗组的整体临床有效率高达95.56%,相比之下,对照组的总有效率仅为73.33%。通过比较2组数据可以发现,在有效性方面,治疗组优于对照组,差异具有统计学意义(P<0.05)。后续对2组患者进行为期一个月的随访,随访结果表明,治疗组的复发率相较于对照组更低。结论 中药透皮术配合穴位手法治疗外阴色素减退性疾病,其方法切实可行,疗效显著,复发率低,为中医治疗本病提供了新依据、新思路。

Three heavy manipulations therapy at Dàzhuī (大椎 GV 14) for difficult diseases

With introduction of three heavy manipulations therapy at Dazhui （大椎 GV 14） for unclear enunciation case of acute cerebral infarction, acute attack case of chronic asthmatic bronchitis, amyotrophic lateral sclerosis case of motor neuron disease, ankylosing spondylitis case and chronic fatigue syndrome case, it is confirmed thatDazhui （大椎 GV 14） combined with three heavy manipulations therapy of blood-letting acupuncture, cupping and moxibust-ion has efficacy for external and endogenous wind, promoting and tonifying yang- qi, strengthening the body timely, removing wind and dampness, and relieving the pain and spasm in the clinical practice.

“乎井术”针刺疗法治疗慢性非萎缩性胃炎临床研究

目的:观察长桑君脉法“乎井术”针刺疗法对缓解慢性非萎缩性胃炎临床症状的临床疗效。方法:回顾分析2020年6月—2022年10月到广州中医药大学顺德医院顺峰山门诊和三门诊就诊,且治疗方案采用了长桑君脉法“乎井术”针刺疗法的慢性非萎缩性胃炎患者资料。比较患者治疗前后的中医证候积分,并统计临床疗效、症状缓解时间及不良反应。结果:治疗后患者腹痛、腹胀、胸胁胀痛、烧心、呃逆、恶心等中医证候积分均降低(P<0.05)。临床治疗总有效率91.71%。不良反应发生率0.55%。治疗后患者各不适症状均在2~4 min左右可得到缓解。结论:“乎井术”针刺治疗能迅速缓解患者临床症状,解除患者痛苦,操作简便,安全有效。

推拿手法联合冲击波治疗腰椎间盘突出症的临床效果

目的探讨推拿手法联合冲击波治疗腰椎间盘突出症的临床效果.方法选取2019年10月—2022年10月扬州友好医院收治的62例腰椎间盘突出症患者为研究对象,随机分为对照组与观察组,每组31例.对照组采用推拿手法治疗,观察组在此基础上采用冲击波治疗.比较两组患者的疼痛程度、腰痛症状改善情况、腰椎关节活动度及腰椎功能.结果治疗3周后,观察组的疼痛视觉模拟评分为(2.86±1.19)分,低于对照组的(4.41±1.25)分,日本骨科协会评估治疗分数为(25.03±3.42)分,高于对照组的(21.38±3.72)分,组间差异有统计学意义(P<0.05).治疗3周后,观察组的腰椎前屈、后伸、向左侧弯、向右侧弯活动度均大于对照组,组间差异有统计学意义(P<0.05).治疗3周后,观察组的功能独立性评测量表中行进、转移、括约肌控制、自理活动评分均高于对照组,组间差异有统计学意义(P<0.05).结论腰椎间盘突出症患者采用推拿手法联合冲击波治疗,可明显减轻腰痛程度,改善腰椎功能.

中医外治法治疗肩周炎的研究进展

肩周炎是一种导致关节囊增厚、纤维化、关节挛缩和关节体积减小的疾病。中医外治法治疗肩周炎对患者危害相对较小,在减轻疼痛、改善肩关节运动障碍方面具有独特优势,但各种治疗方案存在疗效差异。本文就近5年肩周炎的中医外治法内容进行综述,探讨不同外治方案的疗效与治疗特点,为临床治疗肩周炎提供参考。

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。

减肥膏联合推拿手法治疗脾虚湿阻型单纯性肥胖病临床观察

[目的]观察减肥膏联合推拿手法治疗脾虚湿阻型单纯性肥胖病的临床效果。[方法]将62例脾虚湿阻型单纯性肥胖病患者随机分为对照组和治疗组各31例,对照组患者予自制中药减肥膏涂抹、健康饮食和运动宣教;治疗组患者在对照组治疗的基础上联合推拿手法。两组均隔天治疗1次,10次为1个疗程。治疗2个疗程后评价两组临床疗效,观察两组患者的体质量、腰围、体质量指数(BMI)、中医证候积分、血脂水平[血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]变化。[结果]治疗组总有效率为93.55%,高于对照组的70.97%(P<0.05)。治疗后,两组患者的体质量、腰围、BMI、TC、TG、LDL-C、中医证候积分等指标水平均较治疗前显著降低,HDL-C水平较治疗前升高(均P<0.05),且治疗组体质量、腰围、TC、TG、HDL-C、LDL-C治疗前后差值均大于对照组(均P<0.05),BMI、中医证候积分水平均低于对照组(P<0.05)。[结论]减肥膏联合推拿手法治疗脾虚湿阻型单纯性肥胖病疗效满意,具有临床推广价值。

郑氏“颈四步”手法辅助微针刀治疗神经根型颈椎病

目的探究郑氏“颈四步”手法辅助微针刀治疗神经根型颈椎病的临床治疗效果。方法前瞻性随机选取本院在2020年5月-2023年5月间收治的80例神经根型颈椎病患者纳入研究,将其用随机数字法分成对照组和观察组,各40例。对照组予以微针刀治疗,观察组予以郑氏“颈四步”手法辅助微针刀治疗。比较2组临床疗效、中医症状、疼痛改善、颈椎活动度、血液流变学水平。结果观察组总有效率95.00%高于对照组75.00%(P<0.05)。治疗后,观察组颈项疼痛、颈项拘挛、上肢疼痛、活动不利、手指麻木评分低于对照组(P<0.05)。观察组治疗7 d后、14 d后视觉模拟评分法(VAS)评分低于对照组(P<0.05)。观察组左旋转、右旋转、左侧屈、右侧屈活动度均高于对照组(P<0.05)。观察组血浆黏度、全血高切黏度、全血低切黏度均低于对照组(P<0.05)。结论对神经根型颈椎病患者予以郑氏“颈四步”手法辅助微针刀治疗,可明显提升疗效、改善症状,同时有效减轻疼痛、提升颈椎活动度、改善血液流变,促进颈椎功能恢复。

龙氏手法联合施罗斯疗法在特发性脊柱侧弯患者中的应用效果

目的:探讨龙氏手法联合施罗斯疗法对特发性脊柱侧弯患者竖直肌表面肌电、Cobb角及躯干畸形程度的影响。方法:选择2021年11月—2022年12月新余市中医院康复科收治的80例特发性脊柱侧弯患者为研究对象,采用硬币抛掷法分为联合组(n=42)与对照组(n=38)。对照组接受施罗斯疗法,联合组接受龙氏手法联合施罗斯疗法,两组患者治疗6个月。比较两组竖脊肌表面肌电相关指标、Cobb角、躯干畸形程度、总有效率及生活质量。结果:治疗后,联合组凹凸两侧竖脊肌中位频率(MF)、平均功率频率(MPF)及平均肌电值(AEMG)均明显高于对照组,差异均有统计学意义(P<0.05);治疗后,联合组Cobb角、躯干倾斜角(ATI)、躯干旋转角度(ATR)均明显小于对照组,差异均有统计学意义(P<0.05);联合组总有效率及治疗后健康调查量表36(SF-36)各维度评分均明显高于对照组,差异均有统计学意义(P<0.05)。结论:对特发性脊柱侧弯患者行龙氏手法联合施罗斯疗法能显著改善竖脊肌协调性与稳定性,使Cobb角降低,有助于恢复脊柱形态,改善躯干畸形,疗效显著,且能提升生活质量。

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。