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.

Tuina Therapy of Lumbar Intervertebral Disc Protrusion

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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.

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%.

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.

The comparison of different medication project of continuous epidural analgesia for the patient after lumbar vertebra operation

Objective Comparing different medication pro ject of continuous epidural analgesia for the patient after lumbar verte bra opera-tion,to decrease the complications and promote analgesia effects.Methods150cases with ASAⅠ～Ⅱgrade,lumbar intervertebral disc e x-tirpation and /or vertebral canal decompression,were divided into 5gro ups.A group:0.0625%bupivacaine;B group:0.125%bupiva-caine;C group:0.0625%bupivacaine and 1mg morphine;D group:0.125%bupivacaine and 1mg morphine;E group:n o analgesia.Record the occurrence of RR,MAP,HR,VAS score and side effects.Results The analgesia effects of all groups were satisfying,but the oc-currence of urine retention increased in B,C,D group,and the occurrence of nausea and vomit increased obviou sly in C,D group.Conclusions The continuous epidural analgesia w ith simple 0.0625%for patients afte r lumbar vertebral operation is best.

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.

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

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 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.

脊柱-骨盆矢状位参数与腰椎融合术预后相关性的研究进展

腰椎融合术是腰椎退行性疾病常用的外科干预、治疗手段之一。腰椎融合术后少部分患者仍然留有或出现下腰痛等并发症。脊柱-骨盆参数与腰椎融合术后患者并发症的发生紧密相关。该文回顾了常用腰椎内固定融合手术技术和主流脊柱-骨盆矢状位参数,并综述了脊柱-骨盆矢状位参数与包括下腰痛在内的多种术后并发症关系的相关研究进展及现状。

Comparison of biomechanical effect between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position for lumbar intervertebral disc herniation

Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Methods： A three-dimensional finite element model of L3-S1 was developed to carry out a comparative study between oblique Ban-pulling manipulation and lumbar erection and rotation manipulation in sitting position. The disc protrusion was assumed to be on the rear left of L4 disc, and the manipulations were performed on the right side. The loading process was simulated by two steps, in the first step, only the compression loading was imposed, and in the second step, both the compression loading and axial rotation moment were imposed. The displacement and stress distribution in L4 disc were investigated. Results： The values of stress and displacement in the second step were lower than those in the first step in each manipulation. The stress and displacement differences between the two steps were respectively 1.79 times and 3.03 times larger in oblique Ban-pulling manipulation than those in lumbar erection-rotation manipulation in sitting position. Conclusion： Oblique Ban-pulling manipulation may result in a better biomechanical effect than lumbar erection-rotation manipulation in sitting position for LIDH.

Clinical Observation on Treatment of 67 Cases with Lumbar Intervertebral Disc Herniation with Abdomen Acupuncture

Objective： To compare the clinical efficacy of abdomen acupuncture with body acupuncture for treating lumbar intervertebral disc protrusion. Methods： One hundred and thirty three patients were randomly allocated to a treatment group of 67 cases and a control group of 66 cases. The patients in the treatment group received abdomen acupuncture and those in the control group, body acupuncture. The improvements in the symptoms were compared after treatment. Results： The efficacy rate was 95.5% in the treatment group and 86.4% in the control group; there was a statistically significant difference between the two groups （P〈0.05）. The cure rate after one course of treatment was significantly higher in the treatment group than in the control group （P〈0.05）. Conclusion： Abdomen acupuncture has a good effect on lumbar intervertebral disc protrusion with a short course of treatment.

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。

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。

双能量CT虚拟去钙成像诊断腰椎间盘突出症的价值

目的 探讨双能量CT(DECT)虚拟去钙(VNCa)成像在腰椎间盘突出症诊断中的应用价值。方法 选取因临床拟诊腰椎间盘突出症而接受腰椎DECT和MRI检查的患者55例,对DECT数据进行后处理,获得常规CT灰阶图像和VNCa伪彩图像。根据2014年北美脊柱外科协会《腰椎间盘命名法(2.0版)》对MR图像、CT灰阶图、VNCa伪彩图所显示椎间盘突出进行分类。以MRI检查结果作为参考标准,对CT灰阶图和VNCa伪彩图在腰椎间盘突出症(膨出、突出、脱出)中的诊断效能进行分析。结果 CT灰阶图与MRI诊断结果具有较好的一致性(Kappa=0.720),VNCa伪彩图与MRI诊断结果具有很好的一致性(Kappa=0.942)。VNCa伪彩图诊断3种腰椎间盘突出类型(膨出、突出、脱出)的敏感性、特异性和准确性均高于CT灰阶图,差异均有统计学意义(P<0.05)。结论 DECT-VNCa成像在腰椎间盘突出症诊断中具有较高的应用价值。

经椎间孔入路经皮内窥镜下椎间盘切除术后类脊髓高压综合征伴代谢性酸中毒1例报告并文献复习

腰椎椎间盘突出症(LDH)是骨科常见病,其病因复杂,主要与遗传、椎间盘退行性变、发育异常、腰部外伤、姿势不当等因素相关^([1])。其发生率呈增长趋势,并呈年轻化,给患者个人、家庭和社会带来了巨大的经济和医疗负担,严重影响患者日常生活及工作^([2])。约85%的LDH患者伴有坐骨神经痛^([3]),部分患者甚至出现二便失禁^([4])。LDH首选药物、物理治疗等非手术治疗方式,但非手术治疗疗效不佳的情况下需考虑手术治疗。

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。