针刺治疗坐骨神经痛的选穴规律研究

目的:探讨针刺治疗坐骨神经痛在现代临床研究中的选穴规律。方法:通过计算机检索2009年1月—2019年2月中文数据库CNKI、万方、维普中针刺治疗坐骨神经痛的相关文献,归纳分析选穴规律。结果:共纳入合格文献192篇,包含74个腧穴,共使用1494次,经络主要以足太阳膀胱经(54.89%)和足少阳胆经(34.74%)为主;选穴部位以下肢(83.13%)为主;常用穴位依次为环跳(188)、委中(154)、阳陵泉(143)、承山(117)、昆仑(110)、大肠俞(88)、秩边(87)、悬钟(82)、肾俞(78)、承扶(56)。结论:现代针灸治疗坐骨神经痛以循经、局部取穴为主,重视本经配穴及阳经腧穴的应用。     

柚皮苷硬膜外腔注射对髓核致坐骨神经痛大鼠的疼痛行为影响

目的研究柚皮苷硬膜外腔注射对致坐骨神经痛大鼠的疼痛行为学的影响。方法选择雄性SD大鼠28只,制作髓核致坐骨神经痛大鼠模型。随机分为4组,每组7只大鼠。术后第3天开始注药治疗,柚皮苷组每日硬膜外腔注入柚皮苷注射液50μl,地塞米松组每日硬膜外腔注入地塞米松注射液50μl,生理盐水组每日硬膜外腔注入生理盐水50μl,未注药组硬膜外腔无药物注入处理。检测大鼠术前,术后及给药后1、3、7、14d的疼痛行为指标（50％机械性刺激缩足阈值和热刺激缩足反应潜伏期）。结果4组大鼠在术后均对机械刺激产生明显的痛觉过敏,与术前比较差异有显著性（P〈0.05）;柚皮苷组与地塞米松组在提高疼痛行为学指标的作用方面差异无显著性（P〉0.05）。结论硬膜外腔注射柚皮苷可有效改善髓核致坐骨神经痛大鼠的疼痛反应。     

Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica

Background contextGadolinium-enhanced magnetic resonance imaging (Gd-MRI) is often performed in the evaluation of patients with persistent sciatica after lumbar disc surgery. However, correlation between enhancement and clinical findings is debated, and limited data are available regarding the reliability of enhancement findings.PurposeTo evaluate the reliability of Gd-MRI findings and their correlation with clinical findings in patients with sciatica.Study designProspective observational evaluation of patients who were enrolled in a randomized trial with 1-year follow-up.Patients samplePatients with 6- to 12-week sciatica, who participated in a multicentre randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. In total 204 patients underwent Gd-MRI at baseline and after 1 year.Outcome measuresPatients were assessed by means of the Roland Disability Questionnaire (RDQ) for sciatica, visual analog scale (VAS) for leg pain, and patient-reported perceived recovery at 1 year. Kappa coefficients were used to assess interobserver reliability.MethodsIn total, 204 patients underwent Gd-MRI at baseline and after 1 year. Magnetic resonance imaging findings were correlated to the outcome measures using the Mann-Whitney U test for continuous data and Fisher exact tests for categorical data.ResultsPoor-to-moderate agreement was observed regarding Gd enhancement of the herniated disc and compressed nerve root (kappa<0.41), which was in contrast with excellent interobserver agreement of the disc level of the herniated disc and compressed nerve root (kappa>0.95). Of the 59 patients with an enhancing herniated disc at 1 year, 86% reported recovery compared with 100% of the 12 patients with nonenhancing herniated discs (p=.34). Of the 12 patients with enhancement of the most affected nerve root at 1 year, 83% reported recovery compared with 85% of the 192 patients with no enhancement (p=.69). Patients with and without enhancing herniated discs or nerve roots at 1 year reported comparable outcomes on RDQ and VAS-leg pain.ConclusionsReliability of Gd-MRI findings was poor-to-moderate and no correlation was observed between enhancement and clinical findings at 1-year follow-up.     

Dor radicular causada por nódulo de Schmorl: relato de caso

Schmörl's node is focal herniation of intervertebral disc through the end plate into the vertebral body. Most of the established Schmörl's nodes are quiescent. However, disc herniation into the vertebral marrow can cause low back pain by irritating a nociceptive system. Schmörl's node induced radicular pain is very rare condition. Some cases of Schmörl's node which generated low back pain or radicular pain were treated by surgical methods. In this article, authors reported a rare case of a patient with radicular pain cause by Schmörl's node located inferior surface of the 5 th lumbar spine. The radicular pain was alleviated by serial 5 th lumbar transforamnial epidural blocks. Transforamnial epidural block is suggested as first conservative option to treat radicular pain due to herniation of intervertebral disc. Therefore, non‐surgical treatment such as transforamnial epidural block can be considered first treatment option of radicular pain caused by Schmörl's node.     

Pregabalin and gabapentin for the treatment of sciatica

Whilst pregabalin (PGB) and gabapentin (GBP) are both used to treat neuropathic pain, their relative role in sciatica is unclear. Our aim was to extensively review the roles of PGB and GBP in treating sciatica. The efficacy, side effects (SE) profile and cost of PGB and GBP in neuropathic pain states were reviewed with special reference to sciatica. Eleven articles matched the criteria: seven systematic reviews, one retrospective cross-sectional study, one placebo-controlled-crossover study, one randomized placebo-controlled double-blind study and one case report. GBP and PGB appeared to demonstrate comparable efficacy and SE. However, the amount and quality of evidence was low, and only indirect comparisons were available. Importantly, no direct “head-to-head” study existed. Globally, costs varied widely (by up to 31 times) and unpredictably (PGB cheaper than GBP, or vice versa). Formulary regulator rulings were globally disparate; however, many exclusively favoured the more expensive drug (whether GBP or PGB). No studies assessed PGB-GBP interchange. Weak evidence suggests that efficacy and SE with GBP and PGB are probably similar; however, firm conclusions are precluded. Despite weak data, and having cited minor titration, but definite cost, advantages, UK National Institute for Health and Clinical Excellence favoured PGB over GBP. Given that no evidence supports unhindered PGB-GBP interchange, neither drug should probably be favoured. Prospective “head-to-head” studies are urgently required to provide robust evidence-based knowledge for choice of GBP or PGB in sciatica.     

A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

Purpose

Systematic review comparing biological agents, targeting tumour necrosis factor α, for sciatica with placebo and alternative interventions.

Methods

We searched 21 electronic databases and bibliographies of included studies. We included randomised controlled trials (RCTs), non-RCTs and controlled observational studies of adults who had sciatica treated by biological agents compared with placebo or alternative interventions.

Results

We pooled the results of six studies (five RCTs and one non-RCT) in meta-analyses. Compared with placebo biological agents had: better global effects in the short-term odds ratio (OR) 2.0 (95 % CI 0.7–6.0), medium-term OR 2.7 (95 % CI 1.0–7.1) and long-term OR 2.3 [95 % CI 0.5 to 9.7); improved leg pain intensity in the short-term weighted mean difference (WMD) −13.6 (95 % CI −26.8 to −0.4), medium-term WMD −7.0 (95 % CI −15.4 to 1.5), but not long-term WMD 0.2 (95 % CI −20.3 to 20.8); improved Oswestry Disability Index (ODI) in the short-term WMD −5.2 (95 % CI −14.1 to 3.7), medium-term WMD −8.2 (95 % CI −14.4 to −2.0), and long-term WMD −5.0 (95 % CI −11.8 to 1.8). There was heterogeneity in the leg pain intensity and ODI results and improvements were no longer statistically significant when studies were restricted to RCTs. There was a reduction in the need for discectomy, which was not statistically significant, and no difference in the number of adverse effects.

Conclusions

There was insufficient evidence to recommend these agents when treating sciatica, but sufficient evidence to suggest that larger RCTs are needed.

Electronic supplementary material

The online version of this article (doi:10.1007/s00586-013-2739-z) contains supplementary material, which is available to authorized users.     

CT导引下腰神经根周围抗炎治疗坐骨神经痛探讨

目的 探讨CT引导下经皮穿刺治疗腰椎间盘突出引起坐骨神经痛的疗效。方法 CT、MR检查发现有腰椎间盘突出伴明确临床体征90例，CT引导下经皮穿刺至相应椎间孔附近注射得宝松、维生素B12和利多卡因混合药，使药液均匀分布椎管内硬膜外。结果 CT引导下经皮穿刺注药成功率100％。经3个月随访观察，在1、2、3个月止痛有效率分别为92．22％、87．77％、80．00％。结论 CT引导治疗腰椎间盘突出引起坐骨神经痛是一种安全、可靠、有效的新疗法，其远期疗效有待进一步观察。     

破裂型椎间盘突出动物模型中自身免疫反应的实验研究

目的:从动物实验的角度探讨破裂型椎间盘突出动物模型中的自身免疫反应.方法:20只SD大鼠分为两组,实验组采用自体髓核移植于坐骨神经旁的方法建立破裂型椎间盘突出动物模型(坐骨神经痛模型);对照组大鼠手术方法同实验组,但不放置髓核.术前及术后1、2、3周时采用爬坡实验及后肢机械缩爪阈值测定评估大鼠造模前后后肢运动能力及痛觉过敏的变化.术后3周时处死动物应用透射比浊法检测大鼠血清中免疫球蛋白IgG、IgM的含量,ELISA法测定血清中TNF-α、IL-6、IL-12的含量;采用免疫组化染色观察移植髓核中抗原抗体复合物沉积情况;应用BCA蛋白定量法观察坐骨神经中磷脂酶A2(PLA2)的活性.结果:所有大鼠模型建立前爬坡试验结果均为Ⅳ级,造模后对照组爬坡试验仍为Ⅳ级,实验组在造模后1、2及3周时爬坡试验均为Ⅲ级.实验组大鼠造模后1、2、3周时的后肢机械缩爪阈值分别为67.2±8.4、41.3±5.2及40.7±5.3mmHg,较术前(90.4±5.0mmHg)及对照组明显降低(P＜0.01),出现较为明显的痛觉过敏.术后3周实验组大鼠血清中IgG含量4.98±0.96g/L及IgM含量1.45±0.37g/L较对照组(4.31±0.77g/L及0.79±0.35g/L)明显上升(P＜0.05);血清中TNF-α、IL-6、IL-12的含量(205.77±46.32pg/L,186.4±87.3pg/L,69.23±27.46pg/L)较对照组(11.01±2.53pg/L,85.0± 13.2pg/L,21.65±11.93pg/L)均明显升高(P＜0.05).实验组大鼠移植髓核中出现抗原抗体复合物阳性沉积,阳性率为80％,明显高于对照组(P＜0.01);其坐骨神经中PLA2活性为0.0766±0.0039μmoL/(min·L),较对照组0.0006±0.0010μmoL/(min·L)明显升高(P＜0.05).结论:破裂型椎间盘突出动物模型中存在着由移植髓核引起的全身及局部异常的自身免疫反应,这可能是导致其疼痛的主要原因.     

前列腺素E2在突出腰椎间盘中的表达及其与坐骨神经痛的关系

目的探讨前列腺素(PG)E2在突出腰椎间盘组织中的表达及其在坐骨神经痛发病机制中的作用。方法 42个突出椎间盘标本取自42例腰椎间盘突出并有坐骨神经放射性疼痛症状的手术治疗患者,其中膨隆型12例,破裂型15例,游离型15例,取材部位为紧贴神经根突入椎管的椎间盘组织(A部位)和椎间隙内残存的椎间盘组织(B部位)。术前采用视觉模拟评分(VAS)对所有患者坐骨神经痛严重程度进行评分。应用酶联免疫吸附试验(ELISA)检测PGE2含量。结果 A部位PGE2含量自膨隆型、破裂型至游离型逐渐升高,差异有显著性(P<0.01);A部位PGE2含量高于B部位(P<0.01);PGE2含量与患者坐骨神经痛VAS评分存在明显相关性(r=0.848,P<0.01)。结论 PGE2参与了腰椎间盘退变、突出的发病机制,PGE2含量与坐骨神经痛程度呈正相关性。