基于数据挖掘的黄有荣教授治疗腰椎间盘突出症用药规律分析

目的应用数据挖掘的方法总结和分析黄有荣教授治疗腰椎间盘突出症的用药规律,为临床中医药治疗腰椎间盘突出症提供参考。方法收集、整理黄有荣教授首诊治疗腰椎间盘突出症的病例,对符合纳入标准的病例中使用的中药进行统计分析,运用SPSS20.0 for Windows统计软件对中药的频数、聚类规则进行分析,运用SPSS Modeler 14.1统计软件对药物用药规律进行数据挖掘。结果共有263份病例符合纳入标准,共使用中药210味,总计出现频次3582次,分析得出使用高频次药物有当归、牛膝、甘草、杜仲等33味中药;高频次药物组合主要包含当归与赤芍、当归与桃仁、牛膝与党参、当归与川芎等;治疗腰椎间盘突出症用药以补虚药、活血化瘀药、祛风湿药类药物为主,药物归经主要归肝、肾、脾经。结论黄有荣教授治疗腰椎间盘突出症以补益肝肾、活血化瘀为主,辅以祛风湿,通络止痛为治疗原则,独活寄生汤是其治疗的基础方剂,数据挖掘客观反映了黄有荣教授临床用药规律。     

健康宣教联合心理护理在腰椎间盘突出症患者围术期的应用效果分析

目的探讨健康宣教联合心理护理在腰椎间盘突出症(LDH)患者围术期的应用效果。方法选取我院2018年6月至2019年6月实施手术治疗的90例LDH患者,随机分为观察组(n=45)和对照组(n=45)。对照组采用常规围术期护理,观察组在对照组基础上采用健康宣教联合心理护理。比较两组患者的SDS、 SAS、 VAS、 JOA评分以及护理满意度。结果护理7d后,观察组的SDS、 SAS评分均显著低于对照组(P <0.05);术后3个月,观察组的VAS评分显著低于对照组,JOA评分显著高于对照组(P均<0.05)。观察组的护理满意度显著高于对照组(P <0.05)。结论健康宣教联合心理护理应用于LDH患者围术期,能够减少患者的焦虑和抑郁情绪,缓解疼痛,提升护理满意度。     

Is T9-11 the true thoracolumbar transition zone?

ObjectiveDegenerative thoracic stenosis has been shown to most frequently involve the lower thoracic segments (T9-T12) where there is greater mobility and vulnerability due to flexion, extension and rotation of the spine. The thoracolumbar junction is considered anatomically to be T12-L1; the anatomical transition between the relatively immobile thoracic spine and relatively mobile lumbar spine. From anecdotal experience at our institution, we hypothesise that the true thoracolumbar junction is higher, at T10-11; the point of transition from floating to false ribs resulting in increased mobility at T10-11.Methods and materialsA retrospective review was performed of MRI lumbar and whole spine performed on patients aged 10–40 years in our institution over a 5-year period. Patients with previous surgery, chronic spinal disorders and congenital abnormalities were excluded from the study. Intervertebral discs from T8-9 to L1-2 were assessed for evidence of degeneration using the Pfirrmann grading system. Data obtained from a study using computer-based models to assess mean resultant loads in flexion, sitting and standing from T8-9 to L1-2 on patients aged 18–35 years was also analysed. The mean load gradients between two consecutive discs from T8 to L2 were analysed. Statistical analysis was performed with SPSS (p < 0.05 was considered statistically significant).ResultsThree-hundred and twenty-two MRI studies were reviewed. Mean Pfirrmann grade was highest at T8-9 and T9-10 (1.35 ± 0.99 and 1.32 ± 0.93 respectively).Pfirrmann grade differed significantly at each level (χ² = 45.137 p = 0.001). Difference in mean load gradient from T9 to T11 was significantly higher than mean load gradient across T11 to L1 in both sitting and standing (0.095 ± 0.062 vs 0.050 ± 0.044 kN; p = 0.007, and 0.101 ± 0.061 kN vs 0.040 ± 0.054 kN; p = 0.007).ConclusionThe changes in segmental loads and more severe disc degeneration at T9-11 compared to T11-L1 support our hypothesis that the true thoracolumbar transition is higher than expected, at T10-11; where the rib cage transitions from floating to false ribs.     

石氏伤科腰椎间盘突出症辨治规范(三)——L5-S1巨大椎间盘突出后重吸收医案1则

通过介绍L_5-S_1巨大椎间盘突出后重吸收医案,简要论述腰椎间盘突出症的临床诊断和分期治疗方法。认为应重视椎间盘突出髓核重吸收的研究;临床诊治腰椎间盘突出症时应将问诊、触诊、望诊、影像资料有机结合,充分评估患者病症以明确致病病因病理,严格把握保守治疗与手术治疗最佳适应证。     

温针灸联合推拿治疗腰椎间盘突出症临床观察

目的:观察温针灸联合推拿治疗腰椎间盘突出症的临床疗效。方法:100例按随机数字表法分为两组各50例。对照组行腰椎牵引治疗,观察组行温针灸联合推拿治疗。结果:观察组总有效率、JOA评分高于对照组(P<0.05),治疗后VAS评分、IL-1β、IL-8、TNF-α、MMP-3指标低于对照组(P<0.05)。结论:温针灸联合推拿治疗腰椎间盘突出症可降低VAS评分及炎症因子水平,提高JOA评分,改善症状及预后。     

甘露醇在腰椎间盘突出症术后“反跳痛”治疗中的应用

目的：探讨甘露醇注射液在腰椎间盘突出症术后"反跳痛"治疗中的临床疗效。方法：收集2014年3月到2017年3月在我院行椎间盘镜下髓核摘除术的患者共82例，将所有患者随机分为3组，其中对照组27例，甘露醇组30例，地塞米松组25例。术前记录患者下肢痛的视觉模拟评分（VAS评分），腰椎日本骨科协会评估治疗分数（JOA评分）。术后甘露醇组使用20%甘露醇注射液125 mL静脉滴注，每8小时一次，连用一周。地塞米松组使用20 mg地塞米松磷酸钠注射液加入葡萄糖注射液，3 d后地塞米松减量为10 mg，连用一周。记录术后下肢痛的VAS评分和腰椎JOA评分，以及是否有下肢"反跳痛"及其VAS评分和持续时间。结果：3组患者手术前后VAS评分和JOA评分没有显著性差异（P>0.05）。3组患者术后下肢"反跳痛"的发生率没有显著性差异（P>0.05）。地塞米松可减少术后下肢痛的VAS评分，甘露醇无此效果，差异有显著性差异（P<0.05）。结论：甘露醇不能减少术后下肢"反跳痛"的发生率，疼痛程度和持续时间。     

Therapeutic effects of cell therapy with neonatal human dermal fibroblasts and rabbit dermal fibroblasts on disc degeneration and inflammation

BACKGROUND CONTEXT

Increasing evidence suggests transplanting viable cells into the degenerating intervertebral disc (IVD) may be effective in treating disc degeneration and back pain. Clinical studies utilizing autologous or allogeneic mesenchymal stem cells to treat patients with back pain have reported some encouraging results. Animal studies have shown that cells injected into the disc can survive for months and have regenerative effects. Studies to determine the advantages and disadvantages of cell types and sources for therapy are needed.

利用微信平台延续性护理对老年腰椎间盘突出症术后患者康复及生活质量的影响

目的探讨微信平台延续性护理对老年腰椎间盘突出症术后患者康复及生活质量的影响。方法选取2015年6月—2018年5月在郑州市骨科医院接受手术治疗的老年腰椎间盘突出症患者96例进行研究。对照组行常规延续性护理,观察组行微信平台延续性护理。对比两组康复效果、治疗依从性及生活质量。计数资料采用卡方检验分析,计量资料采用t检验分析。结果观察组有效率为95.83%,明显高于对照组的81.25%。观察组总依从率为91.67%,明显高于对照组的77.08%。干预前两组生活质量量表得分相当,治疗后两组生活质量均有明显改善,但观察组改善程度更为明显。结论微信平台延续性护理相比传统延续性护理可明显提高老年腰椎间盘突出症患者康复效果、提高治疗依从性和改善生活质量。     

针灸联合推拿治疗对腰椎间盘突出症患者疼痛及功能恢复的影响

目的:探究针灸联合推拿治疗对腰椎间盘突出症患者疼痛及功能恢复的影响。方法:选取2017年8月-2018年6月于我院治疗的90例腰椎间盘突出症患者,采用随机数字表法分为两组,各45例。对照组给予常规治疗,观察组采用针灸联合推拿治疗。对比两组临床疗效、治疗前后中医证候积分、疼痛评分(Visual Analogue Scale,VAS)及功能恢复评分(Japanese Orthopaedic Association Scores,JOA)。结果:相较于对照组观察组的治疗总有效率较高,差异有统计学意义(P<0.05);观察组治疗后各中医证候积分分别为(1.05±0.64)分、(1.12±0.87)分、(1.01±0.62)分、(0.94±0.12)分,VAS评分为(1.84±0.22)分均低于对照组(2.57±0.81)分、(2.63±0.91)分、(2.94±0.68)分、(1.38±0.36)分、(3.24±0.36)分,JOA评分为(21.33±2.46)分高于对照组(18.57±2.24)分,差异有统计学意义(P<0.05)。结论:针灸联合推拿在治疗腰椎间盘突出症中获得较好的临床效果,患处疼痛感有效缓解,腰椎功能明显改善,值得推广应用。