Meta-analysis of Clinical Efficacy of Warm Needling Acupuncture in the Treatment of Lumbar Disc Herniation

[Objectives]To evaluate the efficacy of warm needling acupuncture in the treatment of lumbar disc herniation(LDH)by Meta-analysis.[Methods]Randomized controlled trial of warm needling acupuncture in the treatment of lumbar disc herniation published from January 2000 to December 2021 was searched by Cochrane Library,PubMed,VIP,CNKI and Wanfang.After the quality evaluation of the literature,the Meta-analysis of the literature was carried out by using Review Manager 5.3.[Results]A total of 10 studies were included,involving a total of 980 patients.The results of Meta-analysis showed that warm needling acupuncture in the treatment of lumbar disc herniation could improve the total clinical effective rate,OR=5.38,95%CI(3.40,8.49),P<0.00001;decrease the VAS score,MD=-3.33,95%CI[-4.53,-2.12],z=5.42(P<0.00001);increase the JOA score,MD=-5.63,95%CI[-8.12,-3.14];improve the dysfunction,MD=-5.63,95%CI[-8.12,-3.14],z=4.43(P<0.00001);decrease inflammatory factors,MD=-11.09,95%CI[-13.60,-8.58],z=8.65(P<0.00001).And the recurrence rate was low,OR=0.33,95%CI[0.15,0.70],z=2.86(P=0.004).[Conclusions]Warm needling acupuncture could effectively treat lumbar disc herniation and relieve pain symptoms.However,due to the general poorness of literature quality and the low quality of evidence,high-quality randomized controlled trials are still needed.

DISCUSSION OF MECHANISM ON LUMBAR DISC HERNIATION TREATED WITH BLOODLETTING ON W■IZH■NG(委中BL40)

Objective To observe the changes of sciatic nerve conduction velocity （SNCV） and interleukin-1α （IL-1α）, phospholipase A2 （PLA2） and prostaglandin E2 （PGE2） in neucleus pulposus tissue in experimental rabbits with lumbar disc herniation （LDH） ; and discuss the mechanism of LDH treated with bloodletting on Wěizhōng （委中 BL40）. Methods 40 normal named control group, LDH model group, BL40 group New Zealand rabbits were randomized into 4 groups, and comparative point group. The experimental LDH model was prepared by the self-made LDH animal pathological modeling device. Bloodletting on BL40 or on comparative point was applied for 7 days. BL-410 physiological signal recorder was used to record SNCV. Enzyme-linked immunosorbent assay （ELISA） and radioimmunology methods were used to determine the contents of IL-1α and PLA2 in neucleus pulposus tissue and PGE2 in serum. Results In BL40 group, SNCV was significantly increased after treatment comparing with that before treatment （P〈0. 01 ）, and the difference in SNCV value before and after treatment was significantly bigger than that in model group and comparative point group （P〈0.05）. Bloodletting on BL40 reduced the contents of IL-1α and PLA2 in neucleus pulposus tissue and serum PGE2 in LDH rabbits, which indicated significant difference or very significant results in the comparison with model and comparative point groups （P〈0.01 or 0. 05）. Conclusion Bloodletting speeded up rapidly SNCV and reduced the contents of inflammatory factors, i.e. IL-1α, PLA2 and serum PGE2 in LDH rabbits, which indicated that alleviation of local inflammatory reaction is probably one of the mechanisms on LDH treated by bloodletting on BL40.

A meta-analysis of Duhuo Jisheng decoction combined with non-operative therapy on lumbar disc herniation

Objective:To systematically evaluate the cllinical efficacy of Duhuo Jisheng decoction(DHJSD)combined with non-surgical therapy on lumbar disc herniation(LDH).Methods:China Science and Technology Journal Database(VIP),Chinese National Knowledge Infrastructure(CNKI),WanFang Data,PubMed were searched and eligible randomized controlled clinical trials(RCTs)were included.Two reviewers evaluated the quality of the included RCTs and extracted data independently.Then,data analysis was performed with RevMetn 4.2 software.Results:A total of 18 RCTs were enrolled,including 1682 patients.Meta-analysis results showed that the overall response rate of DHJSD combined with non-operative therapy group(treatment group)in the treatment of LDH was better than that of the non-operative therapy group(control group)[OR=4.29,95%CI(3.19,5.76),P<0.001].JOA score of the treatment group was significantly higher than that of control group[OR=3.96,95%CI(3.4,4.52),P<0.001].VAS score was dramatically lower in the treatment group than the control group[OR=-1.58,95%CI(-1.97,-1.18),P<0.001].Conclusion:The clinical efficacy of DHJSD combined with non-surgical therapy is better than that of non-surgical therapy alone.However,due to the low quality of the included literatures,large-scale and high-quality RCTs are still needed for further confirmation.

Clinical Outcome of Percutaneous Endoscopic Lumbar Surgery (PELS) in Treatment of Lumbar Disc Herniation

Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.

Clinical Observation of Warm Needling Acupuncture of Mongolian Medicine in the Treatment of Lumbar Disc Herniation

[Objectives]To observe the clinical efficacy of warm needling acupuncture of Mongolian medicine in the treatment of lumbar disc herniation(LDH).[Methods]120 patients with lumbar disc herniation hospitalized in Inner Mongolia International Mongolian Hospital from June 2019 to June 2022 were randomly divided into observation group(n=60)and control group(n=60).The observation group was treated with warm needling acupuncture of Mongolian medicine,and the control group was treated with common acupuncture of Mongolian medicine,with two weeks as a course of treatment.The pain visual analogue scale(VAS)and Japanese orthopaedic association(JOA)score were observed before and after treatment,and the clinical efficacy was evaluated by the changes of clinical symptoms and signs of Mongolian medicine.[Results]The cure rate of the observation group was 71.7%,which was better than that of the control group(53.3%).The difference in the cure rate between the two groups was statistically significant,X 2=4.302,P=0.038.The total markedly effective rate(cured+markedly effective)of the observation group was 90.0%,while that of the control group was 83.3%.There was no significant difference in the total markedly effective rate between the two groups,X 2=1.154,P=0.283.The total effective rate(cured+markedly effective+effective)of the observation group was 100%,while that of the control group was 95.0%.There was no significant difference in the total effective rate between the two groups,and the continuous corrected chi-square value was 1.368 and 0.242.After treatment,the degree of low back pain,lower limb pain and dyskinesia were significantly improved in the two groups,the observation group was better than the control group,and the difference was statistically significant(P<0.05).[Conclusions]The warm needling acupuncture of Mongolian medicine was effective in the treatment of lumbar disc herniation,which is worth popularizing.

Analysis of the Application Value of MRI and CT Diagnosis of Lumbar Disc Herniation

Objective:To analyze the application value of MRI and CT diagnosis for those with lumbar disc herniation.Methods:The data of 62 patients with LDH treated in our hospital from January 2019 to December 2019 were analyzed retrospectively.All patients were diagnosed as LDH after operation,and 62 patients were treated with MRI and CT.The accuracy of CT and MRI in the diagnosis was analyzed according to the gold standard of operation results.Results:62 patients were diagnosed as LDH after operation,including 25 cases with intervertebral disc herniation,12 cases with intervertebral disc prolapse,8 cases with intervertebral disc nodule,7 cases with intervertebral disc dissociation as well as 10 cases with intervertebral disc bulge.The accuracy of MRI diagnosis(95.16%)was higher than that of CT(75.81%),and the difference was statistically significant(P<0.05).Conclusion:For the diagnosis of LDH,MRI is more accurate,but CT is faster and cheaper.Both of them have their own advantages can be chosen clinically according to the actual situation of patients on the basis of ensuring the diagnostic accuracy.

An intraoperative lumbar neurological force monitoring system with high-density flexible pressure sensor array

In the surgery of lumbar disc herniation(LDH),the nerve root retractor is used to pull the nerve root to prevent damage.The traditional medical nerve root retractor cannot quantify the force on the nerve root.In order to improve the nerve root retractor,this paper proposes an intraoperative lumbar neurological force monitoring system.The core module of this system is the improved nerve root retractor equipped with the high density flexible pressure sensor array.The high density microneedle array and multiple pressure detection units are used in the pressure sensor to realise sensitive pressure monitoring in a narrow surgical operation area.The sensing area is 4 mm×17 mm,including 6 detection units.The sensitivity of sensor is 67.30%/N in the range of 0-5 N.This system is used for in vitro animal experiments,which can continuously detect pressure.

归原疏筋合剂治疗腰椎间盘突出症的临床疗效及对血清NF-κB p65表达水平的影响

【目的】探究归原疏筋合剂治疗腰椎间盘突出症(LDH)患者的临床疗效及其可能的作用机制。【方法】将68例气滞血瘀证LDH患者随机分为试验组和对照组,每组各34例。对照组给予塞来昔布及甲钴胺片内服治疗,试验组在对照组的基础上加用归原疏筋合剂内服治疗,疗程为4周。观察2组患者治疗前后腰痛和下肢痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分、改良日本骨科协会(JOA)评分以及血清炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素1β(IL-1β)]和血清核因子κB p65(NF-κB p65)水平的变化情况,并评价2组患者的临床疗效和用药安全性。【结果】(1)脱落情况方面,研究过程中,试验组脱落1例,对照组脱落3例,最终试验组33例、对照组31例纳入疗效统计。(2)疗效方面,治疗4周后,试验组的总有效率为96.97%(32/33),对照组为87.10%(27/31);组间比较(秩和检验),试验组的疗效明显优于对照组(P<0.05)。(3)量表评分方面,治疗后,2组患者的腰痛及下肢痛VAS评分、ODI评分均较治疗前降低(P<0.05或P<0.01),改良JOA评分均较治疗前升高(P<0.01),且试验组对腰痛及下肢痛VAS评分、ODI评分的降低幅度及对改良JOA评分的升高幅度均明显优于对照组(P<0.05或P<0.01)。(4)血清炎症相关指标方面,治疗后,2组患者血清TNF-α、IL-6、IL-1β、NF-κB p65水平均较治疗前降低(P<0.01),且试验组的降低幅度均明显优于对照组(P<0.01)。(5)安全性方面,治疗过程中,试验组的不良事件发生率为2.94%(1/34),对照组为8.82%(3/34),组间比较,差异无统计学意义(P>0.05)。【结论】归原疏筋合剂治疗气滞血瘀证LDH患者疗效确切,可有效缓解患者疼痛症状,改善患者腰椎功能,降低血清炎症因子及NF-κB p65表达水平,其作用机制可能与降低炎症因子水平,抑制NF-κB信号通路的活化有关。

One hundred and twenty-four cases of lumbar disc herniation treated with acupuncture and massage manipulation

Objective To discuss the clinical efficacy on lumbar disc herniation （LDH） treated with acupuncture and massage manipulations. Methods One hundred and twenty-four cases of LDH were treated with acupuncture at Taichong （太冲LR 3）, Neiting （内庭 ST 44）, Zulinqi （足临泣 GB 41）, Yaotongdian （腰痛点 lumbar pain point）, Tuntangdian （臀痛点 buttock pain point） and Zuogushenjingdian （坐骨神经点 sciatic point） and massage manipulations [including gunfa （rolling technique）, yizhichan tuifa （one-finger pushing technique）, qianyin doudong fa （shaking technique under traction）, anyofa （pressing technique） and zuoyou cebanfa （bilateral pulling technique）], once a day, for 3 weeks totally. The lower back pain scoring system of the Japanese Orthopedic Association （JOA） was adopted for the scoring before and after treatment to assess the efficacy. Results At the end of treatment, JOA score was reduced to （0.95±0.32） points as compared with （6.14±0.97） points before treatment （P〈0.01）. Concerning to the efficacy improvement rate, 96 cases were excellent, 12 cases good, 5 cases fair and 3 cases poor. 116 cases received the follow-up visit for 6 months averagely and no case of recurrence was reported. Conclusion Acupuncture combined with massage manipulate can relieve rapidly acute pain in the lumbar region and legs and acts directly on the foci. This therapy is safe and effective, achieves the high clinical curative rate and brings less pain to the patients.

微创髓核成形术叠加氧-臭氧混合物治疗腰椎间盘突出症(英文)

[目的]探讨应用髓核成形术叠加氧-臭氧混合物治疗腰椎间盘突出症的治疗机理及其临床疗效。[方法]2005年6月～2006年6月对62例腰椎间盘突出症患者行叠加术治疗,其中男34例,女28例;年龄32～76岁,平均53.4岁,病程3～56个月,平均1.3年。椎间盘突出类型为L3、4及L4、513例,L4、532例,L4、5及L5S18例,L5S19例。对其疗效进行随访分析。[结果]术后经过25～35个月随访,按照改良MacNab评估,优50例、良8例、可2例、差2例,优良率达到93.5%。[结论]应用髓核成形术叠加氧-臭氧混合物疗法的优势互补技术是一种行之有效的微创治疗方法,从而使治疗效果达到最大化,使局部损伤降低到最小,拓展了适应证,扩大了微创技术在腰椎间盘突出症治疗中的应用空间。

机器人辅助下Endo-PLIF与PLIF治疗腰椎间盘突出症的近期疗效比较

目的探讨机器人辅助下经皮内镜下腰椎融合术(endoscopic lumbar interbody fusion,Endo-PLIF)与后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗腰椎间盘突出症的近期疗效。方法纳入2019年7月~2021年3月行腰椎减压融合手术治疗的50例腰椎间盘突出症患者,其中行机器人辅助下Endo-PLIF手术24例(Endo-PLIF组),PLIF手术26例(PLIF组),分析两组患者的近期疗效。结果Endo-PLIF组的术中失血量和住院时间均显著少于PLIF组,但Endo-PLIF组的手术时间显著长于PLIF组,差异均有统计学意义(P<0.05)。两组术后3 d、3个月及6个月随访时的VAS评分、ODI指数均有显著改善,其中,Endo-PLIF组术后3个月、6个月的两项指标均显著低于PLIF组,差异有统计学意义(P<0.05)。结论与传统PLIF手术比较,机器人辅助下Endo-PLIF手术显著减少了患者术中失血量,缩短了住院时间,加速了患者康复。

脊-盆-髋调正手法配合银杏叶提取物腰椎间孔注射对腰椎间盘突出症患者血清IL-1β和TNF-α水平的影响

目的观察脊-盆-髋调正手法配合银杏叶提取物腰椎间孔注射对腰椎间盘突出症患者治疗前后血清中白介素1β(IL-1β)及肿瘤坏死因子α(TNF-α)的变化。方法 105例腰椎间盘突出症患者随机分为3组,治疗组(脊-盆-髋调正手法配合银杏叶提取物注射液腰椎间孔注射治疗)、对照Ⅰ组(脊-盆-髋调正手法治疗)、对照Ⅱ组(银杏叶提取物注射液腰椎间孔注射治疗),比较3组患者治疗前后血清中IL-1β、TNF-α水平的变化。结果治疗后3组患者血清中IL-1β和TNF-α的含量较治疗前均有显著下降,(P<0.05);治疗2疗程后,治疗组与对照Ⅰ组与对照Ⅱ组比较,差异有统计学意义(P<0.05)。结论脊-盆-髋调正手法配合银杏叶提取物注射液腰椎间孔注射治疗能显著降低患者血清中IL-1β和TNF-α的含量,且效果优于单纯手法或单纯椎间孔注射疗法。

腰椎间盘突出症外周血TNF-α表达水平的临床研究

目的探讨外周血肿瘤坏死因子(TNF-α)水平与腰椎间盘突出症(LDH)的关系。方法46例LDH患者按核磁共振(MRI)影像学表现分为膨突型、脱出型,采用放免法(RIA)检测外周血TNF-α水平。结果LDH膨突组、脱出组、正常对照组外周血TNF-α比较,前两者较后者增高,脱出组增高更明显,且各组间差异显著。结论LDH存在外周血TNF-α水平异常,不同影像学类型LDH外周血TNF-α水平有差异。

Fas/FasL/Caspase-9凋亡基因多态性和环境危险因素的交互作用与腰椎间盘突出症的关系

目的探讨凋亡相关基因、环境危险因素及其交互作用在腰椎间盘突出症（LDH）中的病因学角色。方法采用病例-对照研究方法,选取128例住院的LDH患者和132例年龄和性别与之匹配的正常对照者,采集外周静脉血样并提取DNA。利用基质辅助激光解吸附电离飞行时间质谱分析法检测Fas-1377G/A rs2234767、Fas-670G/A rs1800682、Fas rs2147420、Fas rs2296603、Fas rs7901656、Fas rs1571019、FasL-844C/T rs763110、CASP-9-1263A〉G rs4645978,CASP-9-712C〉T rs4645981三个基因9个多态性位点基因型。采用非条件Logistic回归模型分析Fas、FasL和CASP-9基因的多态性与LDH患病风险的相关性。采用多因素Logistic回归模型评价腰椎负荷、睡床类型、业余运动、业余活动等环境危险因素与凋亡相关基因的交互致病效应。结果年龄、性别在病例组和对照组中的分布差异无统计学意义,均衡性较好;而腰椎负荷、体重指数、睡床类型、业余运动、业余活动在病例组和对照组中差异存在统计学意义（P〈0.05）。关联分析发现,FasL-844C/T（rs763110）、CASP-9-1263A〉G（rs4645978）的多态性和LDH存在显著关联,FasL-844C/T TT基因型、CASP-9-1263A〉G GG基因型可能是腰椎间盘突出症的高风险基因型。环境-基因交互作用分析发现,FasL-844TT基因型和腰椎负荷3-4级交互作用机制在LDH发生中为超相乘模型,CASP-9-rs4645978GG基因型和腰椎负荷3-4级交互作用机制在LDH发生中为次相乘模型。结论 FasL、CASP-9基因和腰椎负荷及其交互作用在LDH发病机制中发挥重要作用。提示LDH的患病风险可能由环境危险因素和遗传易感基因共同决定,不同基因型和同一环境因素或不同环境因素的交互作用机制不同。

中医综合疗法对肾虚血瘀型腰椎间盘突出症患者疗效及血清PGE2、5-HT、SOD水平的影响

【目的】探讨中医综合疗法对肾虚血瘀型腰椎间盘突出症患者临床疗效及血清前列腺素E2(PGE2)、5-羟色胺(5-HT)、超氧化物歧化酶(SOD)水平的影响。【方法】将81例肾虚血瘀型腰椎间盘突出症患者随机分成试验组41例和对照组40例。对照组给予骨盆牵引联合体外冲击波(取夹脊和大肠俞等穴)治疗,治疗组在对照组的基础上给予正骨手法及补阳还五汤口服治疗,疗程为2周。观察2组患者治疗前后疼痛视觉模拟量表(VAS)评分、腰椎功能日本骨科协会(JOA)评分、中医证候积分及血清PGE2、5-HT、SOD水平的变化情况,并评价2组患者的临床疗效。【结果】(1)76例患者完成随访,其中试验组39例,对照组37例。(2)治疗2周后,试验组的总有效率为92.31%(36/39),对照组为70.27%(26/37);组间比较,试验组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的VAS评分和中医证候积分均较治疗前明显降低(P<0.05),JOA评分较治疗前明显升高(P<0.05),且试验组对VAS评分和中医证候积分的降低作用及对JOA评分的升高作用均明显优于对照组,差异均有统计学意义(P<0.01)。(4)治疗后,2组患者血清PGE2、5-HT水平均较治疗前明显降低(P<0.05),血清SOD水平均较治疗前明显升高(P<0.05),且试验组患者对血清PGE2、5-HT水平的降低作用和对血清SOD水平的升高作用均明显优于对照组,差异均有统计学意义(P<0.01)。【结论】中医综合治疗肾虚血瘀型腰椎间盘突出症疗效确切,不仅能降低患者体内炎症水平,减少炎症因子表达,还能提高血清SOD水平,减轻自由基对椎间盘的损伤,从而改善患者疼痛症状及腰椎活动功能。

腰椎间盘突出症患者坐立过程的动力学特征

目的研究腰椎间盘突出症(lumbar disc herniation,LDH)患者在坐立过程中疼痛对腰椎和髋关节力矩的影响。方法应用AMTI测力台采集20例健康对照与20例LDH受试者的动力学数据,通过统计参数映射(statistical parametric mapping,SPM)分析两组受试者坐立任务中腰椎与髋关节在矢状面和冠状面的力矩差异。结果与健康对照组相比,LDH受试者从站立回到坐位过程中腰椎最大屈曲力矩与髋关节最大内收力矩明显增高(P<0.05)。SPM分析显示,在站立初期阶段(37%~42%),LDH组髋关节外展力矩大于健康对照组,存在统计学差异(P=0.007)。结论LDH受试者在坐立过程中腰椎骨盆不够稳定,尤其站立静止阶段,难以使身体达到平衡状态,需增加髋关节外展力矩来维持骨盆稳定。在临床评估治疗中应重点关注脊柱与骨盆的稳定功能。

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。

腰痹通胶囊联合浮针对腰椎间盘突出症患者腰椎活动度及腰背肌表面肌电信号的影响

【目的】探讨腰痹通胶囊联合浮针针刺治疗对腰椎间盘突出症(LDH)患者腰椎活动度及腰背肌表面肌电信号的影响。【方法】将80例LDH血瘀证患者随机分为研究组和对照组,每组各40例。对照组给予服用腰痹通胶囊治疗,研究组在对照组基础上给予浮针针刺治疗,疗程为2周。观察2组患者治疗前后腰椎活动度、疼痛程度视觉模拟量表(VAS)评分、改进汉化的Oswestry功能障碍指数(ODI)评分、Roland-Morris腰椎功能障碍问卷(RMDQ)评分及腰背肌表面肌电信号的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗2周后,研究组的总有效率为97.50%(39/40),对照组为80.00%(32/40),组间比较(χ^(2)检验),研究组的临床疗效明显优于对照组(P<0.05)。(2)腰椎活动度方面,治疗后,2组患者的腰椎屈伸、旋转活动度均较治疗前明显改善(P<0.05),且研究组对腰椎屈伸、旋转活动度的改善幅度均明显优于对照组(P<0.05或P<0.01)。(3)腰椎功能评分方面,治疗后,2组患者的ODI评分和RMDQ评分均较治疗前明显下降(P<0.05),且研究组对ODI评分和RMDQ评分的下降幅度均明显优于对照组(P<0.01)。(4)疼痛程度评分方面,研究组治疗1周、2周和1个月后及对照组治疗2周和1个月后的疼痛程度VAS评分均较治疗前明显下降(P<0.05),且研究组在治疗1周、2周和1个月后对疼痛程度VAS评分的下降幅度均明显优于对照组(P<0.01)。(5)腰背肌表面肌电参数方面,治疗后,2组患者的腰背肌表面肌电信号积分肌电值(IEMG)和平均功率频率(MPF)均较治疗前明显升高(P<0.05),且研究组对腰背肌表面肌电信号MPF和IEMG的升高幅度均明显优于对照组(P<0.01)。【结论】腰痹通胶囊联合浮针针刺治疗可显著提升LDH患者的疗效,改善患者腰椎活动度,提高腰背肌群表面肌电信号,缓解肌肉疲劳和疼痛症状。

针刺疗法联合中医定向透药治疗腰椎间盘突出症临床研究

目的:观察针刺疗法联合中医定向透药治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:选择上海市崇明区城桥镇社区卫生服务中心中医科2020年8月至2021年12月门诊就诊的LDH患者90例,按照随机数字表法分为针刺药透组、单纯针刺组、单纯药透组,每组各30例。单纯针刺组给予针刺疗法治疗,单纯药透组给予中医定向透药治疗,针刺药透组给予针刺疗法联合中医定向透药治疗。观察3组患者治疗前后疼痛视觉模拟评分(visual analogue score,VAS)、腰椎功能障碍指数量表(the oswestry disability index,ODI)评分、日本骨科学会下腰痛量表(Japanese orthopaedic association waist disorders,JOA)评分、血清代谢物(β-隐黄素、柠檬酸、丙酮酸、赖氨酸)变化情况及临床疗效、不良反应发生情况。结果:针刺药透组治疗2周后、治疗4周后、治疗后2周VAS评分、ODI评分均低于单纯针刺组、单纯药透组,差异均有统计学意义(P<0.05)。针刺药透组治疗2周后、治疗4周后、治疗后2周JOA评分高于单纯针刺组、单纯药透组,差异有统计学意义(P<0.05)。单纯针刺组有效率为73.33%,单纯药透组有效率为76.67%,针刺药透组有效率为96.67%,针刺药透组有效率高于单纯针刺组、单纯药透组,差异有统计学意义(P<0.05)。针刺药透组治疗后β-隐黄素、柠檬酸、丙酮酸、赖氨酸水平均高于单纯针刺组、单纯药透组,差异有统计学意义(P<0.05)。结论:针刺疗法联合中医定向透药治疗LDH,可减轻患者疼痛程度,改善腰椎功能。

中药有效成分及复方调控巨噬细胞治疗腰椎间盘突出症研究进展

腰椎间盘突出症(lumbar disc herniation,LDH)多由风寒湿热邪侵袭或年老失养,肝肾亏虚;或因跌扑损伤,气血凝滞,经脉不利所致。故病机总属本虚标实,治疗应注重祛风除湿散寒、清热利湿、活血通络治其标,补益肝肾、强筋壮骨治其本。巨噬细胞极化在LDH发生进展中占有重要地位,能改善局部炎性微环境状态,发挥镇痛作用,是治疗LDH的潜在靶点。LDH中巨噬细胞相关的信号通路有:核因子-κB信号通路、NOD样受体热蛋白结构相关蛋白3炎症小体信号通路、丝裂原活化蛋白激酶信号通路、Notch信号通路等。中药有效成分及复方能够通过多途径调节巨噬细胞极化状态,恢复促炎/抗炎因子平衡,减缓LDH的进展。中药提取有效成分有:芦荟中的芦荟醇,骨碎补中的柚皮苷,姜黄中的姜黄素,秦艽、威灵仙中的木兰花苷,黄连中的小檗碱等。三痹汤、宣痹汤、血府逐瘀汤、独活寄生汤等为治疗LDH的代表复方。中药具有多靶点、多机制、疗效高、质优价廉、副作用少等的特点,靶向调控巨噬细胞极化,恢复腰椎间盘突出物局部炎症微环境平衡,可能是未来治疗LDH的潜在方向。目前,中药有效成分及其复方靶向调控巨噬细胞治疗LDH的研究中,对其作用机制的研究还非常有限,缺乏深层标准化的临床前证据与基础实验。因此,在未来的研究中,需加强中药有效成分与复方对调控巨噬细胞极化的研究,明确中药复方调控巨噬细胞治疗LDH的具体作用机制,为研制延缓腰椎间盘退变的新型药物,以及中医药更好的应用提供可靠依据。