中、西医疗法治疗腰椎间盘突出症对照研究

目的：比较中医、西医、中西医结合疗法治疗腰椎间盘突出引起的急性腰腿痛的疗效、安全性和耐受性。方法：将90例患者随机分成西医组、中医组及中西医组，每组30例，分别接受西医药物及局部理疗、中医药物及针刺拔罐、中西医方法联合治疗，并于治疗开始后第7天和第30天对患者的疼痛、活动度、肌紧张等指标进行监测。结果：治疗7天后中西医组在腰骶痛和下肢放射痛VAS评分两方面指标改善优于中医组，但无统计学差异；中西医组在腰骶痛和下肢放射痛VAS评分、直腿抬高试验、脊柱活动度（Schober试验和指尖-地面距离）等方面指标改善明显优于西医组（P〈0．05）。治疗30天后3组疗效比较差异无统计学意义。3组患者对治疗均耐受良好，未发现严重不良反应。结论：中西医结合疗法治疗腰椎间盘突出引起的急性腰腿痛在缓解疼痛、改善活动度方面起效快、疗效肯定。     

Clinical Observation on Treatment of Lumbar Intervertebral Disc Herniation with Electroacupuncture on Jiaji （Ex-B 2） Points plus Traction： A Clinical Report of 30 Cases

目的探讨夹脊电针配合三维牵引治疗腰椎间盘突出症的临床疗效.方法将90例腰椎间盘突出症患者随机分为3组,分别采用三维牵引、夹脊电针和综合治疗(夹脊电针加三维牵引),采用临床症状积分和临床疗效进行治疗前后比较.结果治疗4星期后综合组在临床症状积分和临床疗效均优于其他两组.结论夹脊电针配合三维牵引治疗腰椎间盘突出症的疗效肯定.     

Treatment of Lumbar Intervertebral Disk Herniation with Electric Acupuncture

目的对电针治疗腰椎间盘突出症的疗效进行客观评价.方法采用随机对照的研究方法,将200例患者分为两组,观察组100例,采用电针疗法进行治疗;对照组100例,采用口服莫比可药物治疗.结果观察组治疗腰突症的总有效率为86.5%,对照组总有效率为75.0%,两组间差异存在显著性意义(P＜0.01).结论电针疗法治疗腰突症疗效显著,安全性高.     

小关节内侧缘入路注射臭氧与胶原酶治疗巨大型腰椎间盘突出症

目的研究应用小关节内侧缘入路,联合注射臭氧与胶原酶,治疗巨大型(突出物长径>5 mm)腰椎间盘突出症的效果、并发症及不良反应。方法36例腰椎间盘突出症患者,于CT引导下穿刺,穿刺针经小关节内侧缘进入硬膜外间隙、突出物内及椎间盘中后1／3处,在盘内注射浓度为60μg/ml的臭氧10 ml,突出物内注入胶原酶600 U水溶液1 ml和浓度为60μg／ml的臭氧5 ml,硬膜外间隙神经根旁注入浓度为40μg／ml的臭氧10 ml和得保松7 mg。结果治疗3个月后进行随访,按照改良Macnab方法进行评定,优20(55．6％)例,良14(38．9％)例,差2(5．5％)例,有效率94．4％。治疗过程全部患者无严重疼痛及症状加重,无脊髓、硬膜囊、血管、神经等重要脏器损伤。结论该方法在CT引导下操作,定位准确,穿刺顺利,成功率100％,无不良反应及严重并发症,是一种安全有效的对巨大型腰椎间盘突出症的治疗方法。同时为髂骨翼较高、横突肥大的L5-S1椎间盘突出症患者,行侧后方盘内穿刺进针困难者,提供了一种更安全、更方便的进针入路。     

深刺夹脊穴治疗腰椎间盘突出症的疗效观察

目的观察长毫针深刺夹脊穴治疗腰椎间盘突出症的临床疗效。方法88例患者随机分为治疗组44例(深刺腰部夹脊穴)与对照组44例(常规刺夹脊穴)。结果治疗组总有效率为95.46%,对照组总有效率为77.27%,治疗组疗效明显优于对照组(P<0.01)。结论深刺腰部夹脊穴治疗腰椎间盘突出症有较好疗效。     

脊柱侧凸顶椎区椎间盘纤维环中多聚蛋白多糖的表达及意义

目的：探讨脊柱侧凸患者顶椎区椎间盘纤维环中多聚蛋白多糖的表达及其意义。方法：采集2003年7月至2004年9月间行前路松解或矫形手术的40例脊柱侧凸患者侧凸顶椎区椎间盘组织。青少年特发性脊柱侧凸患者（adolescent idiopathic scoliosis，AIS）25例，胸椎椎间盘11例，腰椎椎间盘14例；先天性脊柱侧凸患者（congenital scoliosis，CS）15例，胸椎椎间盘6例，腰椎椎间盘9例。利用RT—PCR扩增多聚蛋白多糖（Aguecan），琼脂糖凝胶电泳，在UVP（紫外光测定法）成像系统进行扫描．GelWork图像分析系统中进行灰度测定半定量分析。分别计算AIS组和CS组凹侧、凸侧纤维环中Aggrecan含量，并对CS组和AIS组胸椎和腰椎以及椎间盘的凹侧和凸侧进行比较。结果：AIS组和CS组椎间盘凹侧纤维环中Aggrecan含量低于凸侧．差异有显著性（P〈0．01），胸椎椎间盘纤维环中Aggrecan的含量低于腰椎，但无统计学差异。AIS组Aggrecan的含量和CS组相应部位Aggrecan的含量无明显差别。结论：AIS椎间盘纤维环凹凸侧存在Aggrecan代谢差异．并且可能是脊柱侧凸所致的继发改变．但也可能是脊柱侧凸发生、发展中的重要因素。     

Molecular signaling in intervertebral disk development.

The purpose of this investigation is to identify and study the expression pattern of pertinent molecular factors involved in the differentiation of the intervertebral disk (IVD). It is likely that hedgehog genes and the BMP inhibitors are key factors involved in spinal joint formation. Radioactive in situ hybridization with mRNA probes for pax-1, SHH, IHH and Noggin gene was performed on mouse embryo and adult tissue. Immunohistochemistry was performed to localize hedgehog receptor, "patched" (ptc). From 14.5 dpc until birth pax-1 mRNA was expressed in the developing anulus fibrosus (AF). During the same developmental period Noggin mRNA is highly expressed throughout the spine, in the developing AF, while ptc protein and SHH mRNA were expressed in the developing nucleus pulposus (NP). IHH mRNA was expressed by condensing chondrocytes of the vertebral bodies and later becomes confined to the vertebral endplate. We show for the first time that pax-1 is expressed in the adult intervertebral disk. Ptc expression in the NP is an indicator of hedgehog protein signaling in the developing IVD. The expression pattern of the BMP inhibitor Noggin appears to be important for the normal formation of the IVD and may prove to play a role in its segmental pattern formation.     

The effect of N-ethylmaleimide on transmitter release from the skeletal neuromuscular junction of Bufo marinus

N-ethylmaleimide (NEM) has been used extensively in biochemical assays as an inhibitor of the NEM sensitive fusion protein (NSF). However, examination of the effect of NEM on transmitter release in more physiologically relevant preparations has proved inconclusive. In the present study, we have examined the effect of low concentrations of NEM on synaptic transmission in intact nerve-muscle preparations from toads (Bufo marinus). Under conditions of low transmitter release probability (0.3 mM calcium, 1 mM magnesium), treatment with NEM (10 microM) caused a significant increase in the amplitude of stimulus-evoked endplate potentials (EPPs) and a significant increase in the frequency of spontaneously occurring miniature EPPS (MEPPS) without affecting the amplitude of MEPPs. When the calcium concentration in the bath was raised to 4 mM, 10 microM NEM had no effect on EPP amplitude. Under these conditions, NEM treatment reduced paired pulse facilitation and increased depression during stimulus trains. Treatment with NEM also resulted in a significant decrease in the synaptic delay. The effects of NEM on transmitter release in the present study were not due to inactivation of G-proteins. The results of the present study show a calcium-dependent facilitation of stimulus-evoked transmitter release by NEM. These results are discussed in terms of the possible sites of NEM action leading to the observed changes in transmitter release.     

The relation of clinical symptoms and anti-ganglioside antibodies to MEPPs frequency increase in 8 cases of variant type Guillain-Barré syndrome

Many patients with variant forms of Guillain-Barré syndrome (vGBS) associated with anti-ganglioside antibodies, including Miller Fisher syndrome (MFS), sometimes exhibit miniature endplate potential (MEPP) frequency increases (MFI, described as alpha-latrotoxin-like effects in a previous report) and the factor to produce this effect is present in their sera. MFI-positive sera increase the frequency of MEPPs, then block neuromuscular transmission at the mouse neuromuscular junction. A connection between this effect at the neuromuscular junction and some vGBS symptoms is suspected. We measured MFI directly at several points during the clinical course of 8 vGBS patients who had various symptoms and courses. Six patients had confirmed MFI and this activity decreased with convalescence. In 3 clinically mild cases, we were able to elicit MFI using normal serum to supply complement after exposure to the patient's serum. The anti-GQ1b/GT1a IgG titer, the extent of ophthalmoplegia and the extent of MFI were significantly correlated. They did not correlate with the severity of limb weakness or the occurrence of respiratory failure. These results support the hypothesis that MFI caused by anti-ganglioside antibodies is the pathogenic mechanism responsible for ophthalmoplegia in vGBS; different mechanisms or antibodies may explain limb weakness and respiratory failure. Furthermore, MFI may be an important indicator of how serum injures the nerve terminals. The symptoms of vGBS may result from multiple pathogenic factors.     

白细胞介素1对椎间盘细胞软骨特异性基因Sox9 mRNA的调节作用

目的探讨白细胞介素1（interleukin-1,IL-1）对人椎间盘细胞软骨特异性基因Sox9和Ⅱ型胶原基因表达的调节作用。方法应用RT—PCR技术检测IL-1对培养的椎间盘细胞中软骨特异性基因so西和Ⅱ型胶原基因mRNA表达的调节作用。结果在IL-1浓度为0．1ng／ml、1ng／ml和10ng／ml培养24h时,其对椎间盘细胞Sox9和Ⅱ型胶原基因mRNA可起到显著的负向调控作用;10ng／ml的IL-1随着培养时间的延长对椎间盘细胞中Sox9和Ⅱ型胶原基因mRNA出现显著的负向调控作用。结论IL-1可以按照剂量及时间依赖方式负向调节椎间盘细胞Sox9和Ⅱ型胶原基因的表达。