针刺治疗下腰痛患者脑功能连接网络的影响

目的 观察针刺治疗下腰痛(LBP)患者的静息态功能磁共振成像(rs-fMRI)的脑功能连接变化,初步探讨针刺治疗LBP的中枢镇痛机制.方法 纳入20例LBP患者,右侧大肠俞和委中穴针刺治疗14天.均于针刺治疗前、后间隔1天行两次静息态数据采集.分析LBP患者的全脑关联模拟图,比较针刺治疗前后的功能连接差异.结果 全脑关...     

耳甲电针治疗复发性抑郁症即刻脑效应的fMRI初步研究

目的:观察耳甲电针[经皮耳迷走神经刺激术(taVNS)]对复发性抑郁症患者静息态fMRI脑功能活动的即刻调节作用.方法:收集30例复发性抑郁症患者(患者组)及30例健康者(健康组),2组性别、年龄及受教育程度相匹配.患者组采用taVNS治疗30 min,并于治疗前后行静息态fMRI扫描;健康组仅行一次静息态fMRI扫描...     

针刺烦躁焦虑患者太冲穴即刻脑功能变化的fMRI研究

目的:观察针刺太冲穴对烦躁焦虑患者脑功能的调节,为针刺太冲穴治疗中医"郁证"提供临床依据.方法:招募中医烦躁焦虑状态受试者24例,随机平均分成针刺组和对照组各12例,对照组接受一次静息态fMRI扫描,针刺组在针刺太冲穴后即刻行一次静息态fMRI扫描.结果:针刺太冲穴即刻针刺组双侧梭状回低频振荡振幅(ALFF)信号较对照...     

慢性腰痛推拿治疗前后默认脑网络功能连接变化研究

目的:探讨慢性腰痛患者推拿治疗前、治疗后静息态下默认脑网络的功能连接变化。方法:收集20例慢性腰痛患者和20名健康对照者的静息态功能磁共振(MRI)数据。采用SPM8软件对脑功能数据进行预处理,并以后扣带回为种子点,分析默认脑网络(DMN)功能连接,比较慢性腰痛组与健康对照组、慢性腰痛组推拿治疗前后DMN功能连接的差异。结果:慢性腰痛人群存在DMN与左侧颞下回、左侧小脑前叶、左恻枕中回、左侧背外恻额上回功能连接异常。推拿治疗后主要变化表现为DMN与左恻背外侧额上回连接恢复,DMN与左侧内侧额上回、后扣带皮质连接增强,DMN与左侧楔前叶、左侧回直肌、中脑功能连接降低。结论:静息状态下腰痛受试者DMN存在特定脑功能异常连接区域,推拿治疗主要影响了慢性腰痛人群的感觉、情绪和认知水平的区域。     

静息态fMRI在帕金森病基线脑活动变化中的初步研究

目的 探讨静息态功能磁共振成像(fMRI)低频振幅(ALFF)方法评价帕金森病(Parkiuson's disease,PD)基线脑活动变化.资料与方法 利用1.5 T MRI系统对PD患者和年龄匹配正常对照组各16例分别进行静息态fMRI.静息态fMRI原始数据采用统计参数图软件(SPM5)预处理和静息态磁共振数据分析工具包(REST)进行ALFF分析,采用SPM5进行t检验统计分析,并用XjView软件确定有统计学意义的脑区解剖位置及MRIcroN软件结果呈现.结果 在静息状态下,相对正常对照组,PD患者以下脑区ALFF增高有统计学意义,这些脑区包括左侧中央后回(BA 5)、左侧顶上小叶(BA 7)、左侧顶下小叶、左侧楔前叶和左侧额上回;右侧枕叶舌回(BA 18);双侧小脑后叶.结论 PD患者静息态下左侧脑默认网络及感觉运动皮质等区域ALFF较对照组明显增高,可能代表了与病情程度及治疗有关的特定病理改变.     

肝性脑病患者静息状态下脑缺省模式网络的改变

目的 利用静息功能磁共振成像(fMRI)观察肝性脑病(hepatic encephalopathy,HE)患者脑缺省模式网络(default-mode network,DMN)的改变.资料与方法 对12例HE患者和14名健康自愿者(对照组)行静息状态下fMRI,利用独立成分分析方法,分离得到各自的脑DMN脑区,各组进行单样本t检验组内分析和两样本t检验组间分析,观察HE患者静息状态下脑DMN的改变.结果 HE患者组经校正后左侧海马功能连接明显下降.与对照组组间分析后,HE患者大部分脑DMN脑区功能连接度降低,包括:双侧内侧前额叶、双侧楔前叶、左侧后扣带回、左侧海马旁回、右侧角回.结论 静息fMRI可用于观察HE患者脑DMN的改变.HE患者大部分脑DMN脑区功能连接度下降,提示HE患者的大脑内源性功能组织发生损伤.     

基于比率低频振幅方法初步探索针刺治疗腹泻型肠易激综合征的潜在神经机制

目的:探索针刺治疗腹泻型肠易激综合征(IBS-D)潜在的中枢神经机制.方法:纳入27例IBS-D患者,采用调神健脾针法对其连续治疗6周,3次/周,采用严重程度评分(IBS-SSS)和生活质量量表(IBS-QOL)评价病情及针刺疗效;采用静息态fMRI技术和比率低频振幅(fALFF)方法观察针刺对患者内源性脑活动的影响,...     

基于fMRI的五输穴针刺机制研究进展

通过分析近年来运用fMRI研究五输穴针刺中枢效应机制的文献,对五输穴的针刺效应机制进行整理,分析该领域整体趋向,为临床应用五输穴及今后研究提供参考。通过文献总结可知,针刺五输穴的fMRI研究主要包括静息态fMRI与任务态fMRI,研究的腧穴包括五输穴单穴和五输穴配伍。五输穴属于特定穴,其配伍应用具有特殊疗效。五输穴配伍的作用机制是通过多个脑区形成复杂协调的功能网络达到治疗效果,而不是几个单穴脑激活区的简单叠加。针刺五输穴在治疗脏腑、运动、情志等方面的病症上发挥着重要作用。     

重度吸烟依赖者脑局部一致性静息态功能MRI研究

目的 基于脑静息态功能MRI(fMRI)研究重度吸烟依赖者(HS)脑局部一致性(ReHo),探讨HS自我觉醒机制.方法 选取30例HS(HS组)和年龄、性别匹配的31名无酒精烟草滥用健康志愿者(对照组)行3.0T静息态fMRI采集,采用统计参数图(SPM)5软件进行数据预处理,Rest软件计算ReHo值,HS组和对照组间ReHo值比较采用两样本t检验,最终获得ReHo值有统计差异的功能图.结果(1)与对照组比较,静息态下HS组ReHo值减低脑区包括两侧楔前叶、额上回、前额叶内侧及右角回、额下回、枕下回、小脑和左额中回等.(2)与对照组比较,静息态下HS组ReHo值增高脑区包括两侧岛叶、海马旁回、顶叶白质、桥脑及左侧顶下小叶、舌回、丘脑、额下眶回、额颞叶白质、小脑等,且呈左侧化趋势.结论 HS静息态脑默认模式网络活动减低;活动增强脑区组成吸烟成瘾静息态网络,并呈左侧化趋势,反映HS自我觉醒机制.     

基于fMRI研究经筋疗法对健康人脑网络拓扑结构的影响

目的：使用静息态BOLD-fMRI结合图论方法,分析健康志愿者经筋治疗前后功能脑网络的拓扑结构,以揭示经筋疗法对脑神经网络的调控机制。方法：招募41例健康志愿者,随机分为理筋伴针刺组21例和单纯理筋组20例,采集治疗前后简单反应时间测试、舒尔特方格测试、颅脑MRI3D-T₁WI及BOLD数据。使用GRETNA软件构建功能脑网络、计算拓扑参数,并行治疗前后组内及组间比较。结果：治疗后2组反应力和注意力均显著提高;理筋伴针刺组的全局效率(E_glob)和小世界属性(σ)提高,聚类系数(Cp)和特征路径长度(Lp)降低,而理筋组仅E_glob提高和Lp降低;理筋伴针刺组发现一神经回路连接强度减弱,包括86条连边和73个节点。相关性分析示E_glob、标准化聚类系数(γ)和σ分别与舒尔特方格时间呈负相关,而Lp与舒尔特方格时间呈正相关。结论：经筋治疗能重塑功能脑网络、优化其信息处理模式,进而增强志愿者的反应力和注意力,这种重塑作用可能是其治未病疗效的作用基础。而针刺松解筋结点作为经筋疗法的重要组成部分,对功能网络...     

Wiltse入路椎弓根螺钉固定治疗腰椎间盘突出症的疗效观察

目的比较Wiltse入路（肌间隙入路）椎弓根螺钉固定融合术（A组）与传统腰椎后正中入路椎间融合术（B组）治疗腰椎间盘突出症（Lumbar disc herniation,LDH）的临床疗效。方法 285例腰椎间盘突出症接受手术治疗的患者分为两组,A组120例,B组165例。比较两种手术入路术中出血量、手术时间、术后并发症,术后卧床时间、融合率,术前、术后随访均应用腰痛和腿痛视觉模拟（Visual analogue pain score,VAS）评分、Oswestry功能障碍指数（oswestry disability index,ODI）评分、下腰痛（Japanese Orthopaedic Association,JOA）评分估计患者的恢复情况,并进行统计分析。结果 A组在术中出血量、手术时间、术后并发症、术后卧床时间、末次随访腰痛VAS评分及JOA评分方面明显优于B组（P〈0.05）,但A组末次随访腿痛VAS评分、ODI评分、融合率与B组相比无显著性差异（P＆gt;0.05）。两组末次随访腰腿痛VAS评分、ODI评分及JOA评分与术前比较有显著性改善（P〈0.05）。结论 Wiltse入路椎弓根螺钉固定减压融合术与传统腰椎后正中入路固定减压融合术治疗腰椎间盘突出症均能取得满意的临床疗效,但前者具有出血少、创伤小、手术时间短、术后并发症发生率及腰痛残留率低,并能早期起床减少卧床并发症的发生等优点。     

电针、推拿结合牵引治疗慢性腰痛疗效观察

目的:回顾性分析比较电针、推拿结合牵引与单纯电针、推拿治疗慢性腰痛的疗效。方法:以本院2010年1月之后应用电针、推拿结合牵引治疗的100例慢性腰痛患者为A组,之前采用电针、推拿治疗的100例患者为B组。两组治疗前后均采用改良JOA腰痛问卷评分、疼痛视觉评分(VAS)以及指地距离(FFD)评定疗效。同时以治愈率、好转率和未愈率三个等级计算两组临床治疗总有效率,并对比二组疗效。结果:治疗后两组JOA问卷评分较治疗前均显著提高(P<0.05),且A组显著高于B组(P<0.05);治疗后两组VAS及FFD指标较治疗前均显著降低(P<0.05),且A组显著低于B组(P<0.05);A组临床治疗总有效率显著高于B组(P<0.05)。结论:两种治疗方法均可有效改善慢性腰痛患者功能障碍,缓解症状,电针、推拿结合牵引治疗法效果优于单纯电针、推拿治疗。     

椎间孔镜下改良环锯技术部分切除增生上关节突治疗腰神经根卡压综合征的效果

目的 评估椎间孔镜下改良环锯技术部分切除增生上关节突(superior articular process,SAP),治疗SAP增生引起的腰神经卡压综合征(lumbar nerve root entrapment syndrome,LNRES)的效果.方法 选择2015-04至2019-07医院收治的LNRES患者10...     

银质针疗法联合骶管阻滞治疗腰椎间盘突出症临床观察

目的 观察银质针疗法结合骶管阻滞治疗腰椎间盘突出症的临床疗效。方法 将60例腰椎间盘突出症患者随机分为3组,A组（n=20）采用银质针疗法,B组（n=20）采用骶管阻滞疗法,C组（n=20）采用银质针联合骶管阻滞治疗,在治疗前及治疗后1天、1周、1个月,分别采用视觉模拟评分法（VAS）进行疗效分析。结果 A、B、C 3组患者在治疗后不同时期VAS评分均低于治疗前,且C组在治疗后不同时期VAS评分均明显低于A、B组。结论 银质针疗法联合骶管阻滞能够迅速缓解疼痛,是治疗腰椎间盘突出症的有效方法。     

内灸式激光针灸针治疗寒湿腰痛的疗效观察

目的观察内灸式激光针灸针治疗寒湿腰痛的临床疗效。方法寒湿腰痛患者68例,随机分为试验组和对照组,每组34例。试验组采用内灸式激光针灸针治疗;对照组采用传统针刺法治疗。治疗后应用疼痛视觉模拟量表（visual analogue scale,VAS）和Oswestry功能障碍指数（oswestry dability index,ODI）评估疗效。结果 （1）VAS评分：两组患者治疗后与治疗前比较,VAS评分均显著下降（P〈0.05）;第1次治疗后两组VAS评分分别为：试验组（3.95±1.89）分;对照组（4.94±2.05）分,两组比较差异有显著意义（P〈0.05）。治疗10次后两组的VAS评分分别为：试验组（3.50±1.18）,对照组（3.69±1.27）分,两组比较差异无显著意义（P〉0.05）。（2）ODI评分：第1次治疗后两组患者ODI评分分别为：试验组（16.28±7.82）分,对照组（16.14±7.18）分,两组比较差异无显著意义（P〉0.05）。治疗10次后两组患者的Oswestry评分均显著下降,与治疗前比较差异有显著意义（P〈0.05）,组间比较差别无显著意义（P〉0.05）。结论内灸式激光针灸针法治疗寒湿腰痛即时止痛效果优于传统针刺疗法,但治疗1次对提/携物、坐、行走各项功能无明显改善;治疗1个疗程后两种疗法皆可止痛及改善各种功能。     

Percutaneous Ozone Treatment for Herniated Lumbar Discs: 1-Year Follow-up of a Multicenter Pilot Study of a Handheld Disposable Ozone-Generating Device

PurposeTo evaluate the safety and efficacy of oxygen-ozone treatment delivered via a novel, handheld ozone-generating device for improving pain and function in herniated disc patients.Materials and MethodsA total of 39 patients with contained herniated lumbar discs received oxygen-ozone treatment at 1 of 3 centers. Treatment consisted of injection of 2% ozone (10 mL): 3 mL delivered into the nucleus pulposus and 7 mL delivered into the adjacent paravertebral tissues. The first 8 patients received only ozone injections, whereas subsequent patients also received periganglionic methylprednisolone (40 mg) and 0.5% bupivacaine (1 mL) injections. Patients were evaluated at baseline and at 1 month, 6 months, and 12 months after treatment using the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for leg pain and for back pain. Analgesic medication use was also assessed at each timepoint.ResultsOverall, 91% (32/35) of the per-protocol patients (those who completed follow-up and did not have significant protocol deviations) showed detectable improvement in ODI at 1-month follow-up; this increased to 93% (26/28) of patients at 12-months follow-up. At 1 month after treatment, 60% (21/35) of patients showed significant improvement in ODI scores (P = .01); 54% (19/35) showed significant improvement in VAS scores for leg pain (P = .05); and 49% (17/35) showed significant improvement in VAS scores for back pain (P = .12). At 6 months after treatment, 67% (22/33) of patients showed significant improvement in ODI scores (P = .02); 64% (21/33) showed significant improvement in VAS scores for leg pain (P = .01); and 52% (17/33) showed significant improvement in VAS scores for back pain (P = .12). At 12 months after treatment, 68% (19/28) of patients showed significant improvement in ODI scores (P < .01); 64% (18/28) showed significant improvement in VAS scores for leg pain (P < .01); and 61% (17/28) showed significant improvement in VAS scores for back pain (P = .09). Leg pain typically subsided more quickly than back pain. Use of analgesic medications also significantly decreased at all follow-up timepoints compared to baseline (P < .01). There were no adverse events or device-related issues.ConclusionsAt 1, 6, and 12 months after treatment, patients experienced significant improvements in pain and function as well as significantly decreased use of analgesic medication. Taken together with the absence of adverse events at 1-year follow-up, these data suggest that oxygen-ozone treatment is a safe and effective therapy for contained herniated discs.     

The acute effect of acupuncture on 20-km cycling performance.

OBJECTIVE: To examine acupuncture's effect on cycling performance. DESIGN: This was a prospective, single-blind, patient as own control (repeated measures), crossover design. Subjects underwent 3 tests a week, riding a stationary bike for 20-km as fast as able. Before each test, they received acupuncture (test A), "sham" acupuncture (test B), and no intervention (control, test C) once each in a random order. SETTING: University of Alberta, Faculty of Rehabilitation Medicine. PARTICIPANTS: 20 male cyclists (age, 18 to 30 years) were recruited via convenience sampling of students and general public. Athletic ability was assessed through a questionnaire and modified Par-Q. INTERVENTIONS: Acupuncture, sham acupuncture, and no intervention in random order with each subject before each test. Acupuncture points were chosen on the basis of Traditional Chinese Medicine and administered immediately before cycling. Sham was shallow needling of known acupoints. MAIN OUTCOME MEASUREMENTS: The outcome measures of each of the tests were time to completion, VAS for lower extremity/exercise-induced pain, Borg rating of perceived exertion (RPE), and blood lactate concentrations, recorded immediately following each test. RESULTS: Mean times to Test A, B, and C completion were 36.19 +/- 5.23, 37.03 +/- 5.66, and 37.48 +/- 6.00 minutes, respectively, P = 0.76. Mean RPE scores after tests A, B, and C were 17.65 +/- 0.67, 16.95 +/- 0.99, and 16.85 +/- 0.88, respectively, P = 0.0088. Mean VAS scores after tests A, B, and C were 7.72 +/- 0.86, 7.94 +/- 0.78, and 8.08 +/- 0.69, respectively, P = 0.76. CONCLUSIONS: The only statistically significant finding was that acupuncture gave higher RPE scores compared to the other tests. The clinical significance was that the higher RPE scores gave lower time and VAS scores.     

CT引导经皮椎体成形术治疗椎体转移瘤

目的:回顾性评价CT引导下经皮椎体成形术治疗椎体转移瘤的疗效及其并发症。方法:2008-10～2010-10共治疗椎体转移瘤患者27例,共36个椎体。患者均有顽固性胸背痛,术前VAS评分平均9.1分,伴脊髓压迫者2例,术前Frankel分级C级3例,D级4例,均采用CT引导下经皮椎体穿刺行病变椎体内骨水泥注射治疗。随访观察并发症发生情况及治疗效果。结果:36个椎体在CT引导下均一次穿刺成功,术后疼痛缓解有效率为88.4%,完全缓解率27.9%,VAS评分术后(2.5±1.6)较术前(7.4±1.3)显著下降(P<0.05)。随访7～24个月,中位数10.8个月,末次随访时VAS评分2.98±0.81分,有效率78%,与术前比较差异有显著性(P<0.01);骨水泥外溢发生率为25%,无一例发生严重并发症。结论:CT引导下经皮椎体成形术具有良好的止痛及预防病理性骨折作用,改善患者生活质量,是治疗椎体转移性肿瘤安全、有效的方法。     

Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study

PURPOSE: To prospectively assess the short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures (VCF) treated with percutaneous vertebroplasty (PV) compared with optimal pain medication (OPM). METHODS: Randomization of patients in 2 groups: treatment by PV or OPM. After 2 weeks, patients from the OPM arm could change therapy to PV. Patients were evaluated 1 day and 2 weeks after treatment. Visual analog score (VAS) for pain and analgesic use were assessed before, and 1 day and 2 weeks after start of treatment. Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) and Roland-Morris Disability (RMD) questionnaire scores were assessed before and 2 weeks after start of treatment. Follow-up scores in patients requesting PV treatment after 2 weeks OPM treatment were compared with scores during their OPM period. RESULTS: Eighteen patients treated with PV compared with 16 patients treated with OPM had significantly better VAS and used less analgesics 1 day after treatment. Two weeks after treatment, the mean VAS was less but not significantly different in patients treated with OPM, whereas these patients used significantly less analgesics and had better QUALEFFO and RMD scores. Scores in the PV arm were influenced by occurrence of new VCF in 2 patients. After 2 weeks OPM, 14 patients requested PV treatment. All scores, 1 day and 2 weeks after PV, were significantly better compared with scores during conservative treatment. CONCLUSION: Pain relief and improvement of mobility, function, and stature after PV is immediate and significantly better in the short term compared with OPM treatment.