针灸治疗腰痛的国内外研究评述

本研究回顾2005年至今国内外针灸治疗腰痛的研究,发现国内外研究的侧重点不同。国内研究侧重于某个穴位或某种针刺方法治疗腰痛效果,而国外学者研究的重点是针刺是否有效。通过对国内外研究的分析,提出增加样本量、明确纳入标准、采用适当和充足的针刺治疗方法、延长随访时间等建议,希望对今后的针灸治疗腰痛研究有所帮助。     

射频热凝术结合臭氧治疗椎间盘源性腰痛的临床效果

目的 探讨射频热凝术联合臭氧治疗椎间盘源性腰痛患者的临床效果。 方法 收集 2013 年 10 月— 2015 年 10 月在我院采用射频热凝术联合臭氧治疗的 120 例腰椎间盘突出症患者的临床资料。 手术前后疼痛情况采用疼痛视觉模拟（VAS）评分（于患者术前和术后 1 周, 1、3、6、12 个月给予）, 健康调查简表（SF-36）评分（于患者术前及术后 6 个月给予）。 疗效评定采用改良 MacNab 标准。 结果 患者 VAS 评分术前为 7.02±0.64, 术后 1 周, 1、3、6、12 个月时分别为 3.13±0.32、2.11±0.67、2.62±0.89、2.37±0.34、2.31±0.50, 术后均较术前降低（P < 0.05）。 患者术前SF-36 评分为 48.32±7.46, 术后 6 个月（82.03±5.89）较术前增加（P < 0.05）。 术后 6 个月改良 MacNab 标准评定结果显示患者优良率为 89.17%。 结论 射频热凝术联合臭氧治疗椎间盘源性腰痛是一种有效、可靠的方法。     

颊针治疗慢性非特异性下腰痛的临床疗效

目的 观察颊针治疗慢性非特异性下腰痛(NLBP)的临床疗效.方法 慢性NLBP患者100例,随机分为两组,每组50例.A组采用颊针治疗,根据痛点和肌肉挛缩或硬结处靶点位置在人体面颊部的相应穴位分布实施单侧或双侧颊针治疗,留针20～40 min,每3天1次,5次1个疗程;B组采用体外冲击波治疗作为对照.记录治疗前(T0)...     

穴位皮内针联合腰痛宁胶囊治疗老年慢性腰腿痛的临床疗效观察

目的 探讨穴位皮内针联合腰痛宁胶囊治疗老年慢性腰腿痛的临床疗效。方法 选取 2019年5月至2020年12月于费县人民医院中医科接收的老年慢性腰腿痛患者120例作为研究对象, 采用随机数字表法对半分为对照组与观察组,每组各 60 例。对照组男 28 例、女 32 例,年龄（68.42± 6.09）岁;观察组男 26例、女 34例,年龄（68.05±6.26）岁。对照组在生活指导与运动指导基础上,口服腰痛宁胶囊治疗;观察组在对照组基础上实施穴位皮内针治疗,2周为1个疗程,1个疗程后评价疗效。 比较两组患者的疗效及治疗前后的疼痛数字评分法（NRS）评分、日本骨科协会（JOA）腰椎评分。计数资料组间比较采用 χ2 检验,计量资料组间比较采用独立样本 t 检验,组内采用配对 t 检验。结果 观察组治疗总有效率为91.67%（55/60）,高于对照组76.67%（46/60）,差异有统计学意义（χ2 =5.065,P< 0.05）。两组治疗后腰部、腿部NRS评分均低于治疗前,且观察组治疗后的腰部、腿部NRS评分分别为 （2.95±0.73）分、（3.03±0.78）分,均低于对照组的（3.54±0.92）分、（3.69±0.95）分,差异均有统计学意义 （均P<0.05）。两组患者治疗后JOA腰椎评分中主观症状、临床体征、日常活动受限度及膀胱功能评分均高于治疗前,且观察组治疗后的JOA腰椎评分中主观症状、临床体征、日常活动受限度及膀胱功能评分分别为（6.30±0.65）分、（5.25±1.04）分、（11.08±1.54）分、（-1.02±0.21）分,均高于对照组的（5.63± 0.74）分、（4.76±0.93）分、（9.81±1.61）分、（-1.33±0.28）分,差异均有统计学意义（均P<0.05）。结论 穴位皮内针联合腰痛宁胶囊在老年慢性腰腿痛患者治疗可降低疼痛感,提升腰椎功能,提升治疗有效率。     

针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征的可行性及安全性

目的：探讨针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征的可行性及安全性。方法选取本院2012年10月~2013年11月收入院的慢性腰腿疼痛综合征患者605例,随机分为观察组305例和对照组300例,观察组采用针灸联合腰腿痛丸治疗,对照组采用腰腿痛丸治疗,比较两组的临床疗效、关节疼痛评分及疼痛综合评分。结果观察组总有效率明显高于对照组,差异有统计学意义（P〈0.05）。观察组治疗后的关节疼痛评分明显低于对照组,疼痛综合评分明显高于对照组,差异有统计学意义（P〈0.05）。两组治疗后的关节疼痛评分低于治疗前,差异有统计学意义（P〈0.05）。结论采用针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征,可明显缓解患者疼痛,疗效显著,安全可靠,值得推广应用。     

Controlled trial of a back support ('Lumbotrain') in patients with non-specific low back pain.

A randomized, controlled, parallel-group clinical trial was carried out in general practice to assess the clinical efficacy of a new back support ('Lumbotrain') compared with 'standard therapy' of advice on rest and lifestyle in the treatment of patients with non-specific low back pain. A total of 216 patients entered this study (111 'Lumbotrain' group, 105 control group). All patients were allowed to take 1 g paracetamol up to 4-times daily if necessary for control of pain. Self-assessments were made daily by patients, over a period of 21 days, of pain levels at rest, on activity, at night, and limitation of activity using visual analogue scales. Details were also recorded of their ability to work or not, and the number of doses of paracetamol taken. At the end of the study period, patients assessed their overall response to treatment and those in the 'Lumbotrain' group were questioned on the comfort and ease of use of the back support. A clinical examination was carried out by the doctor at the start and end of the study period and an assessment made of the total range of active and passive back movement. Analysis of the daily diary records showed there were progressive, significant reductions in mean scores for all the pain and activity criteria in both groups and these were significantly greater in the 'Lumbotrain' group from Day 7 onwards. The times taken for reduction of symptom scores to 10% of initial values were significantly less in the 'Lumbotrain' group, such a degree of recovery occurring 2 to 4 days more rapidly than in the control group. A significantly higher proportion of patients in the 'Lumbotrain' group became able to work normally. After 3 weeks, 85% of patients in the 'Lumbotrain' group could work normally, as compared with 67% in the control group (p less than 0.02). Total analgesic consumption during the trial was significantly lower (p less than 0.0001) in the 'Lumbotrain' group (median 24.5 doses) than in the control group (median 51 doses). Overall clinical assessment scores were significantly superior in the 'Lumbotrain' group (p less than 0.002). Improvement was seen in 106 (95%) of 111 patients in the 'Lumbotrain' group, as compared with 79 (77%) of 103 of those in the control group (p less than 0.0002).(ABSTRACT TRUNCATED AT 400 WORDS)     

针刀治疗慢性下腰痛患者的临床疗效

目的：探讨针刀治疗慢性下腰痛的应用及疗效。方法：将147例慢性下腰痛患者分为两组。治疗组72例,依据关键性治疗点,采用针刀治疗,1次/7 d,3次为1个疗程,共2个疗程。对照组75例采用电针联合特定电磁波谱治疗,1次/2 d,10次为1个疗程,共2个疗程。对两组疗效进行比较。结果：治疗组治疗前与治疗近期和远期（4个月）的VAS差值分别为（4.14＆#177;0.98）分和（3.56＆#177;1.06）分,对照组则分别为（3.12＆#177;1.34）分和（2.47＆#177;1.28）分,组间差异有统计学意义（P〈0.01）。结论：针刀治疗慢性下腰痛有较好的临床疗效,明显优于电针联合特定电磁波谱治疗。     

盘源性下腰痛患者CT腰椎间盘造影与MRI相关性研究

目的 基于CT腰椎间盘造影术（CTD）诱发的一致性疼痛,研究盘源性下腰痛与MRI改变的相关性.方法 对盘源性下腰痛76例行MRI检查后实施CT腰椎间盘造影术,共计造影209个腰椎间盘,分析CTD分型、对比剂注射剂量、诱发的一致性疼痛与MRI改变的相关性.结果 在完成CTD检查的209个椎间盘中,83个诱发一致性疼痛;其CTD分型、对比剂注射剂量与诱发一致性疼痛具有相关性,腰椎间盘的MRI改变与造影诱发的一致性疼痛有明显的相关性.结论CT腰椎间盘造影术能定性诊断腰椎间盘内破裂,进一步确定责任椎间盘.盘源性下腰痛的病因可能与腰椎间盘MRI改变：Ⅳ～Ⅴ级退变、局限性高信号（HIZ）的出现、软骨终板及终板下骨髓信号异常（modic变性）相关.     

腰背痛患者520例人类白细胞抗原-B27检测及亚型分型

目的探讨人类白细胞抗原B27(HLA-B27)的检测及其亚型分型。方法采用流式细胞术(FCM)及聚合酶链反应-序列特异性引物(PCR-SSP)法对520例腰背痛患者外周血HLA-B27及其亚型进行检测。结果在520例腰背痛患者中,FCM阳性率为55.4%,PCR-SSP法阳性率为56.7%。两者的阳性率差异无统计学意义(χ2≈3.79,P>0.05)。PCR-SSP法检出HLA-B2704、HLA-B2705、HLA-B2705/07、HLA-B2702、HLA-B2704/05、HLA-B2705/02、HLA-B2704/02、HLA-B2704/05/07等亚型,分别占42.0%、29.2%、23.1%、1.4%、0.7%、0.7%、0.3%。结论 FCM与PCR-SSP法是目前常用的检测HLA-B27的方法,两者阳性率差异无统计学意义,但PCR法可进行亚型分型,这些亚型与强直性脊柱炎等疾病的诊断、治疗及预后判断相关。     

Managing acute low back pain

Back pain is very common. In the UK, there were about 14 million GP consultations for back pain in 1993 and around 60-80% of the population will have had it at some time during their lives. Many attacks resolve quickly but some patients go on to develop chronic back pain and a few develop severe, long-term disability. Here we discuss the natural history, diagnosis and management of acute low back pain, focusing on simple low back pain, in which the pain is uncomplicated by nerve root involvement or serious spinal pathology.