辨证治疗痹证42例疗效观察

目的 观察中医辨证治疗痹证的临床疗效.方法 42例痹证患者按随机数字表法分为两组各21例,对照组采用西医常规疗法治疗,治疗组采用中医辨证分型治疗,治疗结束后比较两组患者的临床疗效.结果 治疗组总有效率为85.7%,对照组为66.7%,两组总有效率比较,差异有统计学意义(χ~2=3.126,P＜0.05).结论 中医辨证治疗痹证疗效优于西医常规治疗.     

中药离子导入法治疗膝关节骨性关节炎的临床观察

目的观察专利中药处方作中药离子导入治疗膝关节骨性关节炎寒湿型患者的临床疗效。方法选取60例患者随机分为两组,分别以中频治疗仪和药物离子导入治疗。结果药导治疗组的总有效率为93.3%,优于中频组80.0%(P0.05)。结论中药离子导入法治疗膝关节骨性关节炎临床疗效优于单纯中频治疗。     

温针灸与小针刀联合推拿治疗气滞血瘀、肝肾阴虚膝骨关节炎随机平行对照研究

[目的]观察温针灸与小针刀联合推拿治疗气滞血瘀、肝肾阴虚膝骨关节炎疗效。[方法]使用随机平行对照方法,将64例住院患者按就诊顺序编号简单随机分为两组。对照组32例推拿1推法:以大鱼际自关节上方由近及远平推;2揉法:拇指点揉肌肉结节和内侧韧带;3推髌:拇指刮揉患者髌骨两侧缘,轻推髌骨;4点穴:点压膝关节部位穴位,如膝眼、血海、足三里等;5屈伸:使患者被动屈伸膝关节,逐渐加大幅度以患者能耐受为度。治疗组32例温针灸1双膝下垫枕以避免膝关节悬空;2取膝眼、血海、阴陵泉、阳陵泉、足三里、鹤顶针刺,得气后留针;3将一段2cm左右的艾条插在针柄上,点燃艾条;4待艾条燃尽后去除灰烬,取针;1次/d,连续6d;小针刀,治疗第7日,患者取仰卧位,明确压痛点,取1~3个进针点,小针刀刺入皮肤,平行进刀,小针刀尖端贴紧欲剥离组织,横向剥离后,纵向切割,以横向链接的纤维组织松懈剥离为度,术中避开大血管和神经,出针按压,覆盖创面;推拿治疗同对照组。连续治疗7d为1疗程。观测临床症状、膝关节功能、疼痛程度VAS评分、生存质量SF-36问卷、不良反应。治疗1疗程(7d),判定疗效。[结果]治疗组临床控制12例,显效11例,有效7例,无效2例,总有效率93.75%。对照组临床控制6例,显效8例,有效9例,无效9例,总有效率71.88%。治疗组疗效优于对照组(P0.05)。膝关节功能两组均有改善(P0.01),治疗组优于对照组(P0.01);疼痛程度两组均有改善(P0.01),治疗组优于对照组(P0.01);生存质量两组均明显改善(P0.01,P0.05),治疗组优于对照组(P0.01)。[结论]温针灸与小针刀联合推拿治疗气滞血瘀、肝肾阴虚膝骨关节炎,疗效满意,无副作用,值得推广。     

Arthralgia induced by endocrine treatment for breast cancer: A prospective study of serum levels of insulin like growth factor-I,its binding protein and oestrogens

BackgroundAromatase inhibitors (AIs) frequently induce or enhance musculoskeletal problems (AI-induced musculoskeletal syndrome (AIMSS)) which sometimes are debilitating. Apart from low oestrogen levels, underlying mechanisms are unknown and likely multiple. We previously hypothesised a role for the growth hormone/insulin like growth factor-I (IGF-I) axis. Here, we report the effect of tamoxifen and AI on IGF-I, IGF binding protein-3 (IGFBP-3) and oestrogen levels from a prospective study.Materials and methodsPostmenopausal women with an early breast cancer scheduled to start adjuvant endocrine therapy with an AI or tamoxifen were recruited. A rheumatologic questionnaire was completed and serum was collected for assessment of IGF-I, IGFBP-3 and oestrogen levels. Re-evaluation was done after 3, 6 and 12 months of therapy.Results84 patients started on tamoxifen (n = 42) or an AI (n = 42). 66% of the latter group experienced worsening of pre-existing or de novo complaints in joint and/or muscle, compared to 29% of tamoxifen-treated patients. AI therapy resulted in elevated IGF-I levels with a statistically significant increase at 6 months (p = 0.0088), whereas tamoxifen users were characterised by a decrease in IGF-I levels at all follow-up times (p < 0.0004). No effect on IGFBP-3 was seen in the latter group. AI-users, however, showed decreased IGFBP-3 levels at 12 months (p = 0.0467). AIMSS was characterised by a decrease in IGFBP-3 levels (p = 0.0007) and a trend towards increased IGF-I/IGFBP-3 ratio (p = 0.0710).ConclusionThese findings provide preliminary evidence that AI-induced musculoskeletal symptoms are associated with changes in the growth hormone (GH)/IGF-I axis.     

不同体位肩袖和肩峰下空间关系的相关性研究

目的　检测正常肩关节在不同体位时肩峰和锁骨外侧点至肱骨头之间最短距离是否会发生变化 ,并分析其意义。方法　对肩关节处于 6个不同外展体位的 15例正常志愿者进行肩关节MR冠状面薄层扫描 ,观察、测量肩峰外侧点到肱骨头之间的最短距离 (A H)、锁骨外侧点到肱骨头之间的最短距离 (C H)、肩峰下空间和肩袖的位置关系。结果　A H值和C H值在肩关节处于 6 0°、90°、12 0°、15 0°外展体位时 (A H值分别是 1 0 5 1、1 0 84、0 96 1和 0 95 0cm ;C H值分别为 1 5 4 8、1 5 4 8、1 5 2 9和 1 4 96cm)明显小于 0°、30°外展体位时 (A H值分别为 1 2 6 1和 1 2 5 7cm ;C H值分别为 1 96 3和 1 930cm) (F值分别为 8 76和 15 5 1,P值均 <0 0 1) ;而 0°与 30°体位间A H及C H值比较 ,以及 6 0°、90°、12 0°、15 0°体位间A H及C H值两两比较 ,P值均 >0 0 5。 15例肩关节处于6 0°、90°、12 0°外展体位时 ,肩袖 (主要是冈上肌肌腱 )刚好从肩峰和肱骨头之间穿过。结论　肩关节处于 6 0°、90、12 0°外展体位时 ,肩峰下空间缩小 ,且肩袖刚好从中穿过 ,两者关系密切     

The influence of bariatric surgery on hip and knee joint pain: a systematic review

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI’s Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.     

热痹颗粒剂治疗类风湿关节炎湿热痹阻证临床疗效分析

目的:观察热痹颗粒剂治疗类风湿关节炎(RA)湿热痹阻证的临床疗效,为临证用药提供科学的依据。方法:将60例辨证属于湿热痹阻证的活动期RA患者,采用随机、阳性药平行对照的方法分组。实验组口服热痹颗粒剂每次2.0g,1日3次;对照组口服乐松,每次60mg,1日3次。两组疗程均为4周。结果:实验组与对照组均能改善主要症状,体征及理化指标,两组疾病疗效和中医证候疗效比较差异无显著性意义。结论:热痹颗粒剂能消肿、止痛、改善关节功能,且无明显毒副作用。     

肝豆状核变性骨密度测定与骨关节症状的研究

目的 探讨肝豆状核变性(HLD)骨密度测定及临床骨关节症状。方法 216例HLD中内脏型63例、脑型102例、脑-内脏型51例，分析各型骨密度值、血钙、24h尿钙及骨关节病变。结果 99例(45.83％)骨密度减低，51例(23．61％)有骨关节症状，20例(9．26％)以骨关节症状首发。结论 HLD可出现继发性骨质疏松症，骨密度测定可较早期地发现骨关节损害，有助于预防和减少骨关节变形和骨折。     

Cervical facet joint injections in the neck and shoulder pain

The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared. The patients were diagnosed originally as myofascial pain syndrome (MPS), cervical herniated nucleus pulposus (HNP), and whiplash-associated disorders (WAD). Patients with the zygapophyseal joints pain of C5-6 and C6-7 were classified by their pain origin as MPS, HNP, and WAD. All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide. The therapeutic effects were compared with reduction of numeric rating scale (NRS) of pain before and immediately after blockade and symptom-free periods in each group after 12 months. Symptom durations before injections were 16.1+/-9.6, 4.6+/-1.9 and 4.1+/-1.1 months in each MPS, HNP, and WAD groups. The reductions of NRS immediately after the blockade among the three groups were not different. However, the symptom-free duration after blockade lasted longer in the HNP group than the other two groups. In patients with cervical zygapophyseal pain syndromes, the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD.     

综合灸疗法治疗痹证150例

采用灸盒灸肾俞、关元穴区和温针灸输穴、郄穴为主,配合局部痛点小艾炷隔姜灸及毛刺加艾条悬灸治疗痹证150例,经1－10个疗程,显效105例,好转41例,无效4例,总有效率97．3％,结论：综合灸疗法适合于各种痹证,标本兼治,对迅速缓解症状和控制病情发展疗效满意。