针刺疗法在骨科的应用进展

<正>骨科相关疾病的治疗方式多样,其中针刺以中医理论作为指导,具有适应范围广、疗效显著、使用方便等优势。自古至今,被广泛应用于临床治疗骨科疾病,形成了独特的治疗体系。1在脊柱疾病的应用1. 1颈椎病颈椎病的常见典型症状为颈部疼痛、上肢麻木或伴有放射样疼痛,严重者可出现踩棉花感、行走不稳等症状。王明明~([1])开展的一项"项七针"治疗椎动脉型颈椎病的临床疗效观察     

Acupuncture therapy for chronic lower back pain: a systematic review

INTRODUCTION

Chronic low back pain is a common condition affecting a significant proportion of the population and has large economic implications on the society. Acupuncture has grown in popularity as an alternative therapy for chronic low back pain. Recent National Institute for Health and Clinical Excellence (NICE) guidelines on low back pain offer a course of acupuncture as a baseline treatment option according to patient preference. The aim of this systematic review was to evaluate if this treatment option is justified in view of recent evidence available on the efficacy of acupuncture.

MATERIALS AND METHODS

Studies included were identified by a PubMed search for relevant, randomised, controlled trials on the 23 July 2009. A systematic review was performed.

RESULTS

Fifteen randomised controlled trials were identified. Of these, four met the eligibility criteria and were critically appraised. These trials suggest acupuncture can be superior to usual care in treating chronic low back pain, especially, when patients have positive expectations about acupuncture.

CONCLUSIONS

NICE guidelines of a course of acupuncture, offered according to patient preference as a treatment option for chronic low back pain, are justified.     

铍针治疗颈椎病性颈痛61例临床观察

颈椎痫为临床上多发病、常见病，而颈部疼痛是颈椎病最常见的症状之一，在各型颈椎病中均可出现。自2006年7月至2007年6月运用铍针治疗颈椎病性颈痛61例，疗效满意，报告如下。     

基于APP的放松疗法对慢性下腰痛患者情绪、疼痛和腰部功能的影响

目的 探讨基于APP的放松治疗(relaxation therapy based on APP,RTBOA)对慢性下腰痛患者(CHRONIC LOW BACK PAIN,CLBP)情绪、疼痛和腰部功能的影响.方法 选择2018年3月至2020年3月在本院就诊的84例CLBP患者作为研究对象,采用随机数字表法分为对照组和...     

发散式冲击波治疗间盘源性下腰痛近期疗效观察

目的：评价发散式冲击波（RSWT）治疗间盘源性下腰痛的近期疗效。方法：对43例间盘源性下腰痛患者进行发散式冲击波治疗,配合适当的卧床休息和躯干核心稳定肌功能锻炼,比较治疗1w、2w及治疗结束后1月、3月随访时的患者的VAS疼痛评分及Oswestry功能指数的变化。结果：治疗后1w、2w、1月、3月不同时段所观察记录VAS疼痛分值及Oswestry功能指数均较治疗前明显下降,差异有显著性（P〈0．05）。结论：发散式冲击波可有效缓解下腰背部疼痛并能改善腰部功能,其近期疗效满意,值得推广并行进一步前瞻对照研究。     

椎间盘内电热疗法治疗盘源性腰痛的疗效

目的探讨经皮椎间盘内电热治疗(IDET)对盘源性腰痛(DLBP)的临床疗效。方法对49例(49个病变椎间盘)DLBP患者行CT联合"C臂"X线机引导下IDET的治疗,其中Pfirrmann分级Ⅱ级26例,Ⅲ级23例。采用WHO疼痛缓解标准,将疼痛缓解程度分为无缓解、轻微缓解、部分缓解和完全缓解。结果对49个椎间盘均穿刺成功并行IDET治疗。术后1周及1、3和6个月随访,Ⅱ级、Ⅲ级两组患者疼痛缓解均随着术后时间的延长而逐渐明显,术后6个月时Ⅱ级患者有效率[88.46%(23/26)]高于Ⅲ级患者[60.87%(14/23),P0.05]。术中、术后均未出现严重并发症。结论IDET治疗DLBP近期疗效较好,术后6个月时Pfirrmann分级为Ⅱ级的患者疗效优于Ⅲ级。     

Spinal manipulative therapy and exercise for seniors with chronic neck pain

Background contextNeck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors.PurposeTo assess the relative effectiveness of SMT and supervised rehabilitative exercise, both in combination with and compared to home exercise (HE) alone for neck pain in individuals ages 65 years or older.Study design/settingRandomized clinical trial.Patient sampleIndividuals 65 years of age or older with a primary complaint of mechanical neck pain, rated ≥3 (0–10) for 12 weeks or longer in duration.Outcome measuresPatient self-report outcomes were collected at baseline and 4, 12, 26, and 52 weeks after randomization. The primary outcome was pain, measured by an 11-box numerical rating scale. Secondary outcomes included disability (Neck Disability Index), general health status (Medical Outcomes Study Short Form-36), satisfaction (7-point scale), improvement (9-point scale), and medication use (days per week).MethodsThis study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Linear mixed model analyses were used for comparisons at individual time points and for short- and long-term analyses. Blinded evaluations of objective outcomes were performed at baseline and 12 weeks. Adverse event data were collected at each treatment visit.ResultsA total of 241 participants were randomized, with 95% reporting primary outcome data at all time points. After 12 weeks of treatment, the SMT with home exercise group demonstrated a 10% greater decrease in pain compared with the HE-alone group, and 5% change over supervised plus home exercise. A decrease in pain favoring supervised plus HE over HE alone did not reach statistical significance. Compared with the HE group, both combination groups reported greater improvement at week 12 and more satisfaction at all time points. Multivariate longitudinal analysis incorporating primary and secondary patient-rated outcomes showed that the SMT with HE group was superior to the HE-alone group in both the short- and long-term. No serious adverse events were observed as a result of the study treatments.ConclusionsSMT with HE resulted in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone. Supervised exercise sessions added little benefit to the HE-alone program.     

冲击波复合激痛点注射对颈肩肌筋膜疼痛综合征的治疗效果

目的比较压痛点注射、体外冲击波疗法(extracorporeal shock wave therapy,ESWT)以及ESWT复合激痛点注射治疗颈肩肌筋膜疼痛综合征的安全性和有效性。方法 2013年5月至2015年2月在门诊诊治的颈肩肌筋膜疼痛综合征患者90例,男48例,女42例,年龄18~65岁,随机分为三组,每组30例。A组:每个压痛点注射复合镇痛液5ml;B组:以压痛点定位冲击点,每次治疗一个或多个冲击点(疼痛区域),每个冲击点次数2 000次;C组:冲击波治疗后,在冲击波诱发的激痛点注射复合镇痛液5 ml。三组的治疗周期均为每周1次,连续治疗3次,治疗时间为5~10min,并随访记录首次治疗前(T0)、首次治疗后即刻(T1)、首次治疗后1周(T2)、2周(T3)、3周(T4)的VAS评分、颈椎的活动度(ROM)评分、症状改善优良率、总有效率。结果 90例患者中81例获得完全随访,B组有3例、C组有2例出现了皮下淤血,3d后消散,无其他不良事件发生。与T0时比较,T1~T4时三组VAS评分均明显降低(P0.05);T2~T4时,三组的VAS评分随着时间的延长、治疗次数的增加逐渐降低;T1时B组和C组的VAS评分明显低于A组(P0.05),T2、T3时C组VAS评分明显低于A组和B组(P0.05),T4时C组VAS评分明显低于A组(P0.05)。与T0时比较,T3时三组ROM评分均明显降低(P0.05),T3时B组和C组ROM评分明显低于A组(P0.05)。末次随访总有效率C组明显高于A组和B组(P0.05),A、B两组差异无统计学意义。结论 ESWT复合激痛点注射治疗颈肩肌筋膜疼痛综合征无明显损伤、安全、简便、疗效显著、患者满意度高,可作为颈肩肌筋膜疼痛综合征综合治疗的选择。     

Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults

Background

The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.

A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain

Many clinical trials on chiropractic management of low back pain have neglected to include specific forms of care. This study compared two well-defined treatment protocols. The objective was to compare the outcome of flexion–distraction (FD) procedures performed by chiropractors with an active trunk exercise protocol (ATEP) performed by physical therapists. A randomized clinical trial study design was used. Subjects, 18 years of age and older, with a primary complaint of low back pain (>3 months) were recruited. A 100 mm visual analogue scale (VAS) for perceived pain, the Roland Morris (RM) Questionnaire for low back function, and the SF-36 for overall health status served as primary outcome measures. Subjects were randomly allocated to receive either FD or ATEP. The FD intervention consisted of the application of flexion and traction applied to specific regions in the low back, with the aid of a specially designed manipulation table. The ATEP intervention included stabilizing and flexibility exercises, the use of modalities, and cardiovascular training. A total of 235 subjects met the inclusion/exclusion criteria and signed the informed consent. Of these, 123 were randomly allocated to FD and 112 to the ATEP. Study patients perceived significantly less pain and better function after intervention, regardless of which group they were allocated to (P<0.01). Subjects randomly allocated to the flexion–distraction group had significantly greater relief from pain than those allocated to the exercise program (P=0.01). Subgroup analysis indicated that subjects categorized as chronic, with moderate to severe symptoms, improved most with the flexion–distraction protocol. Subjects categorized with recurrent pain and moderate to severe symptoms improved most with the exercise program. Patients with radiculopathy did significantly better with FD. There were no significant differences between groups on the Roland Morris and SF-36 outcome measures. Overall, flexion–distraction provided more pain relief than active exercise; however, these results varied based on stratification of patients with and without radiculopathy and with and without recurrent symptoms. The subgroup analysis provides a possible explanation for contrasting results among randomized clinical trials of chronic low back pain treatments and these results also provide guidance for future work in the treatment of chronic low back pain.     

罗库溴铵静脉注药痛

罗库溴铵静脉注射时有些病人会诉说注药局部疼痛或引起肢体不自主抽动.发生机制可能与肌松药pH值偏低、激肽原级联反应以及罗库溴铵刺激C神经纤维和肥大细胞反应有关.预先静脉注射利多卡因、芬太尼类药物、枢复宁、右旋美托咪啶、阈下剂量氯胺酮或8.4%碳酸氢钠能明显降低罗库溴铵诱发注药局部疼痛的程度和发生率.     

Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain

BACKGROUND AND OBJECTIVES: The aim of this study was to determine whether low power laser therapy (Gallium-Arsenide) is useful or not for the therapy of chronic low back pain (LBP). STUDY DESIGN/MATERIALS AND METHODS: This study included 75 patients (laser + exercise-25, laser alone-25, and exercise alone-25) with LBP. Visual analogue scale (VAS), Schober test, flexion and lateral flexion measures, Roland Disability Questionnaire (RDQ) and Modified Oswestry Disability Questionnaire (MODQ) were used in the clinical and functional evaluations pre and post therapeutically. A physician, who was not aware of the therapy undertaken, evaluated the patients. RESULTS: Significant improvements were noted in all groups with respect to all outcome parameters, except lateral flexion (P < 0.05). CONCLUSIONS: Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP.     

Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury

Background Context

Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings.

Ten-year survey reveals differences in GP management of neck and back pain

Purpose

Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner’s (GP) care is similar. While GP’s management of LBP is well documented, little is known about GP’s management of neck pain. We aimed to describe GP’s management of new neck pain and compare this to GP’s management of new LBP in Australia between April 2000 and March 2010.

Methods

All GP–patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations.

Results

General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP–patient encounters, respectively. GP’s primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests.

Conclusions

This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.     

The use of STarT back screening tool to predict functional disability outcomes in patients receiving physical therapy for low back pain

BACKGROUND CONTEXT

The STarT Back Screening Tool (SBST) categorizes risk of future disability in patients with low back pain (LBP). Previous studies evaluating the use of SBST in physical therapy (PT) populations do not reflect the ethnic and socioeconomic diversity occurring in clinical practice and lack statistical power to evaluate factors associated with outcomes within each SBST risk category.

Using the concept of ideomotor therapy in the treatment of a patient with chronic neck pain: A single system research design

BackgroundA contemporary understanding of pain neurophysiology describes the experience of pain as a multi-system output mechanism in which the perception and localisation of pain sensations cannot be separated from concurrent motor output responses generated to resolve a perceived threat to tissues. It has been suggested that the resolution of pain is dependant on an appropriate motor response, and that such a response should proceed as the result of instinctive, in-built mechanisms. Ideomotor movements constitute the prevailing expression of instinctive movement response in humans. The enhancement of corrective ideomotor movement expression may lead to improvements in pain intensity and disability in symptomatic patients whose instinctive responses have been suppressed. A manual technique can be employed therapeutically to elicit fuller expression of ideomotor movement in patients suffering pain.ObjectivesTo document the outcome of short-term pain and disability in a patient with chronic neck and shoulder girdle pain treated with ideomotor-based manual therapy and self-management exercise using a single system experimental design.MethodsA prospective A–B–C single system experimental design consisting of a 3-week baseline data collection phase (A), a 3-week treatment and self-management phase (B), and a 3-week self-management phase (C). Treatment and self-management were provided using a light touch technique based on ideomotor principles. Five validated outcome measures were recorded weekly and displayed graphically for visual inspection and analysis.ResultsVisual analysis of the plotted outcome measures as a function of time indicated a reduction in pain intensity and perceived disability concurrent with the introduction of treatment (Phase B). These changes appear to be clinically relevant.ConclusionsThe results imply a relationship between the introduction of ideomotor-based manual therapy and self-management, and clinically relevant reductions in pain intensity and perceived disability in a patient suffering severe chronic neck and shoulder girdle pain. It is hoped that this study will provoke further interest in this concept and draw attention to a possible mechanism and explanation for some of the effects of commonly used indirect manual therapy techniques.     

A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction

Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit. Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.     

Neck and back pain specific outcome assessment questionnaires in the Spanish language: a systematic literature review

Background contextAccurate measurement of functional improvement in clinical practice is becoming increasingly recognized as essential in demonstrating whether patients are deriving meaningful benefit from care. Several simple questionnaires have been developed for this purpose. The majority of these have been developed in English. In North America, there is a growing need for clinical tools, including outcome assessment tools that are available in the Spanish language.PurposeThe purpose of this study was to systematically review the literature regarding spine-specific outcome assessment questionnaires that are available in Spanish and to examine the evidence on their clinical utility.Study designSystematic review.MethodsThe Medline, CINAHL, Embase, and MANTIS databases were searched for any studies on the topic of outcome assessment questionnaires in the Spanish language. Relevant articles were reviewed, and the data on reliability, validity, time to completion, and any other properties of the questionnaire was extracted.ResultsThe search strategy identified 287 articles, of which 10 were deemed relevant. With regard to neck pain, data were found regarding Spanish translations of the Northwick Park Neck Pain Questionnaire, Neck Disability Index (NDI), and Core Outcome Measure for neck pain. With regard to low back pain, data were found regarding Spanish translations of the Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), and the North American Spine Society—American Academy of Orthopedic Surgeons questionnaire.ConclusionsSeveral reliable and valid outcome assessment questionnaires are available in the Spanish language. All were originally developed in English. It appears from the data reviewed that the most useful instruments are the NDI for neck pain patients and the ODI and RMQ for low back pain patients. The current trend is for the development of culturally adapted versions of these questionnaires that are specific to a particular country or region.     

Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function

Introduction

Various studies have shown that spine stabilisation exercise therapy elicits improvements in symptoms/disability in patients with chronic non-specific low back pain (cLBP). However, few have corroborated the intended mechanism of action by examining whether clinical improvements (1) are greater in patients with functional deficits of the targeted muscles and (2) correlate with post-treatment improvements in abdominal muscle function.

Methods

Pre and directly after 9 weeks’ therapy, 32 cLBP patients (44.0 ± 12.3 years) rated their LBP intensity (0–10) and disability (0–24, Roland–Morris; RM) and completed psychological questionnaires. At the same timepoints, the voluntary activation of transversus abdominis (TrA), obliquus internus and obliquus externus during “abdominal-hollowing” and the anticipatory (“feedforward”) activation of these muscles during rapid arm movements were measured using M-mode ultrasound with tissue Doppler imaging.

Results

Pre-therapy to post-therapy, RM decreased from 8.9 ± 4.7 to 6.7 ± 4.3, and average pain, from 4.7 ± 1.7 to 3.5 ± 2.3 (each P < 0.01). The ability to voluntarily activate TrA increased by 4.5% (P = 0.045) whilst the anticipatory activation of the lateral abdominal muscles showed no significant change (P > 0.05). There was no significant correlation between the change in RM scores after therapy and either baseline values for voluntary (r = 0.24, P = 0.20) or anticipatory activation (r = 0.04, P = 0.84), or their changes after therapy (voluntary, r = 0.08, P = 0.66; anticipatory, r = 0.16, P = 0.40). In multiple regression, only a reduction in catastrophising (P = 0.0003) and in fingertip–floor distance (P = 0.0006) made unique contributions to explaining the variance in the reduction in RM scores.

Conclusion

Neither baseline lateral abdominal muscle function nor its improvement after a programme of stabilisation exercises was a statistical predictor of a good clinical outcome. It is hence difficult to attribute the therapeutic result to any specific effects of the exercises on these trunk muscles. The association between changes in catastrophising and outcome serves to encourage further investigation on larger groups of patients to clarify whether stabilisation exercises have some sort of “central” effect, unrelated to abdominal muscle function per se.