电针治疗伴腰椎Modic改变的非特异性腰痛

目的探讨电针治疗伴腰椎Modic改变的非特异性腰痛的临床疗效。方法以82例非特异性腰痛患者为研究对象,均采用电针治疗,每周2次,4周为l疗程。根据有无腰椎终板及终板下骨质的MRI信号改变,回顾性分析了伴Modic改变与无Modic改变的临床疗效差异性。结果82例患者伴Modic改变的发生率为52．44％,且伴Modic改变组VAS和ODI评分均明显高于无Modic改变组（P〈0．01）;电针治疗后两组患者的VAS和ODI评分均较治疗前明显降低（P〈0．01）,且对无Modic改变者的临床疗效更为屁著;伴Modic改变组Ⅰ型与Ⅱ型的ODI和VAS差值均明显大于Ⅲ型（P〈0．05）,但I型与Ⅱ型问无明显差异。结论腰椎Modic改变当为非特异性腰痛的主要原因之一;电针治疗能改善疼痛和功能,但腰椎Modic改变的程度会影响电针疗效。     

腰椎终板Modic改变的研究进展

椎间盘退变是导致下腰痛的常见原因,与之密切相关的椎体终板改变也逐渐受到重视.在MRI T1和T2的和加权像上,退变的椎体终板主要表现为终板与终板下骨相对于正常终板的信号改变,同时当终板异常改变时与对应的推间盘退变也有较高的相关性.现就其国内外关于腰椎终板Modic改变的相关研究从以下:Modic改变的发病机制、影像学检查、治疗等几方面进行一综述.     

Modic改变分型的慢性非特异性腰痛的推拿近期疗效

目的：探讨不同类型Modic 改变的慢性非特异性腰痛（CNLBP）的传统推拿手法治疗的近期疗效。方法：前瞻性分析推拿治疗CNLBP患者82例,根据MRI中Modic改变分4组：A组Modic 0型43例;B组Modic I型13例,C组ModicⅡ型20例,D组Modic Ⅲ型6例。所有患者均采用统一的推拿治疗。同时采集患者一般资料、治疗前后汉化Oswestry功能障碍指数（ODI）,并采用IBM SPSS20.0进行统计分析。结果：4组间患者性别、年龄、腰痛时间、治疗前ODI等差异无统计学意义。与同组治疗前比较,治疗后4组ODI明显减小（P<0.01）。A和B之间、C和D之间ODI评分差异无统计学意义,其余组间差异均有统计学意义（P<0.05）。结论：CNLBP Modic改变是影响临床疗效的原因之一。无Modic改变和Modic I型CNLBP比ModicⅡ、Ⅲ型患者的推拿近期疗效好,提出ModicⅡ、Ⅲ型患者需要考虑叠加其他疗法。     

慢性非特异性腰痛Modic改变分型的针刺疗效分析——附78例临床资料

目的:分析慢性非特异性腰痛(CNLBP)Modic改变的针刺疗效。方法:纳入符合条件的CNLBP患者78例,根据MRI片Modic改变分为A组(无Modic改变)41例、B组37例(有Modic改变,其中B1组为Modic I型12例,B2组为Modic Ⅱ型19例,B3组为Modic Ⅲ型6例),采用相同针刺治疗。IBM SPSS20.0分析组间的性别、年龄、腰痛时间、汉化Oswestry功能障碍指数(ODI)等差异。结果:治疗后各组ODI均较治疗前减小(P0.01)。A和B1之间、B2和B3之间ODI评分差异无统计学意义(P0.05),其余组间有统计学意义(P0.05)。结论 :Modic改变可能是影响CNLBP患者临床疗效的原因之一。Modic Ⅱ、Ⅲ型患者针刺疗效较差,需要考虑叠加或选择其他治疗。     

退变椎间盘相邻终板的Modic改变及其临床意义

人类椎间盘退变后相邻终板、终板下骨质的MRI信号改变称为Modic改变。     

腰痛康治疗腰椎术后腰痛

腰痛是腰椎术后的常见并发症。自2002年1月到2005年12月,笔者自制腰痛康治疗腰椎术后腰痛,取得了满意效果,并与芬必得组对照研究,报道如下。     

腰椎术后下腰痛原因分析

目的:探讨腰椎术后下腰痛的原因.方法:回顾性分析我院近年来收治的24例腰椎术后出现下腰痛患者的临床资料.结果:导致腰椎术后下腰痛的原因有:腰椎间盘突出症复发,术后并发椎间隙感染,术后神经压迫,术后腰椎的稳定性下降,术后神经根损伤等.结论:术前准确的诊断,术中严格执行各种操作规程,谨慎小心,尽量避免导致术后下腰痛的各种人为因素,就可以最大限度的较少腰椎术后下腰痛的发生几率.     

特殊的腰痛“腰椎过度前曲型”的治疗

在推拿临床工作中，慢性腰肌劳损是我们经常见到的多发病症，发病原因多种多样，大多发病原因是由于长期反复的过度腰部运动及过度负荷，急性腰扭伤后治疗不及时、处理方法不当等原因所致。慢性腰肌劳损与气候、环境条件也有一定关系，气温过低或湿度太大都可促发或加重腰肌劳损。     

腰椎ModicⅠ型终板退行性变的高场强核磁共振诊断特点

目的:探讨腰椎ModicⅠ型终板退行性变高场强MRI影像特点,为该病的诊断提供依据。方法:回顾性分析39例腰椎ModicⅠ型终板退行性变患者的高场强MRI图片。男16例,女23例,年龄40～81岁,中位数56岁;均有腰背部疼痛不适、活动受限症状;均无外伤、发热及血象异常等病史。结果:本组39例,共96椎终板发生病变。病变分布:L2下缘1椎,L3上缘2椎,L3下缘8椎,L4上缘9椎,L4下缘17椎,L5上缘19椎,L5下缘20椎,S1上缘20椎。4例8椎MRI表现为T1WI混杂高信号,抑脂序列信号减低;其余受累椎体MRI表现为T1WI信号降低,T2WI信号增高,椎体上下缘毛糙,部分呈毛刷样改变;相邻椎体终板退变大致呈吻状对称分布;与病变终板平行的椎间盘T2WI信号降低,上下径变窄,有膨出或突出征象。结论:腰椎ModicⅠ型终板退变多发生在L4～5、L5S1节段,受累椎体终板T1WI信号降低、T2WI信号增高,与病变终板平行的椎间盘有突出或膨出表现,无椎间盘破坏征象,可与早期椎间盘感染性病变相鉴别。     

中药薰蒸治疗椎间盘源性下腰痛的临床观察

目的：观察中药薰蒸治疗椎间盘源性下腰痛的疗效及其安全性。方法：采用中药薰蒸治疗椎间盘源性下腰痛30例,并与口服萘酊美酮胶囊治疗进行对比观察。结果：经治一个疗程及一月后,治疗组（采用中药薰蒸治疗）疼痛评分减少优于对照组（口服萘酊美酮胶囊治疗）。结论：中药薰蒸治疗椎间盘源性下腰痛疗效确切,复发率低,且无明显不良反应,值得进一步椎广豇鼠。     

督灸治疗脾肾阳虚型绝经后骨质疏松症患者腰背痛的临床研究

目的：观察督灸治疗脾肾阳虚型绝经后骨质疏松症患者腰背痛的效果。方法：选择70例骨质疏松症腰背痛患者,随机分为对照组和治疗组（每组35例）。对照组采用常规钙剂治疗;治疗组在常规治疗基础上,配合督灸疗法。在治疗前及每个疗程结束后进行VAS和ODI评估。结果：督灸能够有效减轻患者腰背痛的程度（降低VAS）,并能由此改善患者功能障碍（降低ODI）。结论：督灸为绝经后骨质疏松症腰背痛的治疗提供一个安全、有效、易于接受的方法,可望提高患者的生存质量。     

腰椎术后下腰痛的机制探讨及中药治疗方法

腰痛病因有椎间盘源性、小关节源性、骶髂关节源性、肌肉源性、硬膜外瘢痕源性、骨质疏松源性、社会精神源性;中药治疗有风寒湿痹证、寒湿瘀血证、寒瘀气滞证、肾阳亏虚证、阳虚寒痰证、肾阴亏虚证、阴虚瘀阻证、湿热痰瘀证等。     

电针结合艾灸治疗腰椎源性下腰痛疗效观察

目的观察电针结合艾灸治疗腰椎源性下腰痛的临床疗效。方法76例腰椎源性下腰痛患者采用电针和艾灸治疗,疗程20天;观察临床疗效及治疗前后VAS评分变化。结果痊愈率为71．05％,总有效率为98．68％;VAS评分由治疗前（6．3±1．0）分降至（3．3±0．6）分,治疗前后VAS评分有非常著性差异（P〈0．01）。结论电针结合艾灸能明显减轻腰椎源性下腰痛。     

《针灸临床实践指南:非特异性腰痛》临床问题调查问卷

The questionnaire aims to collect clinical questions for the Clinical Practice Guideline of Acupuncture-Moxibustion: Non-Specific Low Back Pain. This questionnaire is consisted of single-choice questions, multiple-choice questions, ranking questions, and open questions. Readers are recommended to complete the open questions by using patients, intervention, comparator and outcome (PICO) framework, referring to the examples. The survey would take about 30 min to finish, and the answers from participants would greatly contribute to the formation of Clinical Practice Guideline of Acupuncture-Moxibustion: Non-Specific Low Back Pain.     

Therapeutic evaluation of lumbar tender point deep massage for chronic non-specific low back pain

Objective

To observe the therapeutic effect of lumbar tender point deep tissue massage plus lumbar traction on chronic non-specific low back pain using change in pressure pain threshold, muscle hardness and pain intensity as indices.

Methods

We randomly divided 64 patients into a treatment group (32 cases) and a control group (32 cases). Two drop-outs occurred in each group. Patients in the treatment group received tender point deep tissue massage plus lumbar traction and patients in the control group received lumbar traction, alone. We used a tissue hardness meter/algometer and visual analog scale (VAS) to assess the pressure pain threshold, muscle hardness and pain intensity.

Results

Following treatment, we obtained the following results in the treatment and control groups, respectively: the pressure pain threshold difference was 1.5±0.8 and 1.1±0.7; the muscle hardness difference was 4.2±1.6 and 3.5±1.3; and the VAS score difference was 1.9±0.9 and 1.4±0.8. Compared to the control group, the treatment group had higher pressure pain threshold (t=2.09, P<0.05), and lower muscle hardness (t=2.05, P<0.05) and pain intensity (t=2.46, P<0.05).

Conclusion

Lumbar tender point deep tissue massage combined with lumbar traction produced better improvement in pressure pain threshold, muscle hardness and pain intensity in patients with chronic non-specific low back pain than with lumbar traction alone.     

针刺阳维脉治疗顽固性腰痛验案举隅

腰痛为临床常见症状,顽固性者治疗较为不易。文章介绍针刺阳维脉治疗顽固性腰痛验案一则,以期为临床诊治本病拓展思路,提供参考。     

Comparative literature study between investigations in foreign Science Citation Index journals and Chinese core domestic journals in the treatment of low back pain with acupuncture

Objective

To investigate the quality and methods of clinical research literature published in foreign Science Citation Index (SCI) journals studying the treatment of low back pain with acupuncture. To conduct a comparative study with clinical research literature published in Chinese core domestic journals, and to understand the prospects of current research trends of acupuncture clinical studies in Western countries and China.

Methods

Studies on clinical acupuncture treatment of low back pain in English SCI journals and four Chinese core domestic journals dated from 2002 to 2012 were sourced and summarized for this study. Objective analysis and evaluation on the differences in subject and scope of study on low back pain by foreign and Chinese researchers were conducted.

Results

Forty-seven English studies and 115 Chinese studies met our inclusion criteria. A keyword search revealed different kinds of low back pain related conditions in English and Chinese studies. The English studies were broad in scope, while the Chinese studies were more focused. There were also differences in the understanding and definition of concepts and study orientation.

Conclusion

More study should be undertaken to understand the contradictions that acupuncture faces in view of modern research to further advance the field.     

Comparative literature study between investigations in foreign Sci- ence Citation Index journals and Chinese core domestic journals in the treatment of low back pain with acupuncture

OBJECTIVE： To investigate the quality and meth- ods of clinical research literature published in for- eign Science Citation Index （SCI） journals studying the treatment of low back pain with acupuncture. To conduct a comparative study with clinical re- search literature published in Chinese core domes- tic journals, and to understand the prospects of cur- rent research trends of acupuncture clinical studies in Western countries and China. METHODS： Studies on clinical acupuncture treat- ment of low back pain in English SCI journals and four Chinese core domestic journals dated from 2002 to 2012 were sourced and summarized for this study. Objective analysis and evaluation on the differences in subject and scope of study on low back pain by foreign and Chinese researchers were conducted. RESULTS： Forty-seven English studies and 115 Chi- nese studies met our inclusion criteria. A keyword search revealed different kinds of low back pain re- lated conditions in English and Chinese studies. The English studies were broad in scope, while the Chinese studies were more focused. There were al-so differences in the understanding and definition of concepts and study orientation. CONCI.IJSION： More study should be undertaken to understand the contradictions that acupuncture faces in view of modern research to further ad- vance the field.     

针刀经筋层松解术治疗非特异性下腰痛临床研究

目的观察针刀经筋层松解术治疗非特异性下腰痛的临床疗效。方法将180例患者随机分为治疗组(90例)和对照组(90例),对照组采用传统针灸疗法,每天1次,连续治疗5次;治疗组予针刀经筋层松解术治疗1次。观察临床疗效及感觉疼痛、活动疼痛的视觉模拟评分以及Oswestry功能障碍指数的变化情况。结果治疗组、对照组总有效率分别为94.4%、91.1%;组间临床疗效比较,差异无统计学意义(P>0.05)。治疗组、对照组治疗前后组内比较,感觉疼痛评分、活动疼痛评分及Oswestry指数差异均有统计学意义(P<0.01);组间治疗后比较,感觉疼痛评分、活动疼痛评分差异有统计学意义(P<0.05)。结论针刀经筋层松解术治疗非特异性下腰痛疗效显著,可以明显改善疼痛症状。