盐酸氨基葡萄糖联合非类固醇类抗炎药治疗小关节退变伴下腰痛

背景：盐酸葡萄糖胺对骨关节炎的治疗作用在膝关节已经得到证实,然而盐酸氨基葡萄糖与非类固醇类抗炎药物联用的治疗腰背痛鲜有报道。目的：探讨盐酸氨基葡萄糖与小剂量非类固醇类抗炎药物联用治疗腰椎小关节退变伴下腰痛的临床效果。方法：纳入35例小关节退变伴下腰痛患者,给予口服盐酸氨基葡萄糖750mg,2次/d,外加双氯酚酸钠缓释片75mg,1次/d,周期8周。使用Oswestry残疾指数、目测类比疼痛评分和SF-36量表在治疗前,治疗完成时和完成治疗后8周进行评估。结果与结论：33例完成最终的随访,男女比例为1：2,平均（41.2±10.3）岁。经过治疗,患者的腰痛和腿痛症状,腰椎功能和生活质量均有显著改善和提高（P〈0.05）。提示,盐酸氨基葡萄糖与小剂量非类固醇类抗炎药物联用对小关节退变伴腰痛患者有一定治疗作用。     

盐酸氨基葡萄糖联合尼美舒利治疗腰椎小关节骨关节炎的近期疗效

目的观察盐酸氨基葡萄糖治疗腰椎小关节骨关节炎的临床疗效。方法 2010年9月-2012年5月门诊就诊的160例腰椎小关节骨关节炎患者随机分为两组进行治疗,对照组80例,口服非甾体抗炎药物尼美舒利;试验组80例,在服用尼美舒利的基础上加服盐酸氨基葡萄糖,治疗周期为2周。对两组患者治疗前及治疗后1、2周后日常生活能力、视觉疼痛模拟、心理测评(采用症状自评量表检测)3项指标进行检测,比较两组的临床疗效,并对患者进行3个月随访。结果两组患者各指标检测结果显示,治疗后较治疗前均明显改善,试验组明显优于对照组;总有效率试验组为97.3%,对照组为86.1%,试验组明显优于对照组,组间比较差异有统计学意义(P<0.05)。结论盐酸氨基葡萄糖联合尼美舒利治疗腰椎小关节骨关节炎具有较好的临床疗效。     

盐酸氨基葡萄糖联合塞来昔布治疗膝骨性关节炎的随机对照

背景：盐酸氨基葡萄糖被认为具有治疗膝关节骨性关节炎的作用,但其是否对不同程度的骨性关节炎都有效,联合应用非类固醇类抗炎药与单用盐酸氨基葡萄糖是否存在疗效差别,尚需进一步临床研究。目的：采用前瞻性研究的方法对比单用盐酸氨基葡萄糖以及联合应用塞来昔布治疗不同程度膝关节骨性关节炎的临床疗效。方法：采用Lequesne评分将152例膝关节骨关节炎患者分为轻、中、重度,然后随机配比法均分为单用盐酸氨基葡萄糖组和盐酸氨基葡萄糖联合塞来昔布用药组,于用药后2,4,6周以及停药8,12周统计患者Lequesne评分,用药前后及组间进行对比并统计盐酸氨基葡萄糖的不良反应。结果与结论：在轻度骨性关节炎治疗组中,盐酸氨基葡萄糖组治疗4周、停药12周后Lequesne评分与治疗前比较,差异有显著性意义;而联合用药组治疗2周后评分即有改善,两组比较,评分在治疗2,4周差异有显著性意义,说明联合用药组效果改善更显著;中度骨性关节炎患者在治疗2,4,6周和停药8周时,联合用药患者Lequesne评分均低于单纯使用盐酸氨基葡萄糖患者,差异均有显著性意义(P<0.05),说明在中度骨性关节炎,盐酸氨基葡萄糖联合塞来昔布治疗效果好于单独用药;重度骨性关节炎中,两组治疗后Lequesne评分与治疗前比较,均无明显改善。结果说明对于轻度膝骨性关节炎,单用盐酸氨基葡萄糖口服即可明显改善患者临床症状,对于中度膝骨关节炎,建议联合非类固醇类抗炎药类用药,可以较好改善临床症状,而对于重度膝骨关节炎,两种方法均无效。     

盐酸氨基葡萄糖治疗椎间盘源性腰痛的随机对照研究

目的探讨单用和联用盐酸氨基葡萄糖与非甾体抗炎药(NSAID)在椎间盘源性腰痛(DLBP)治疗中的有效性。方法 2011年1月-12月72例DLBP患者,男42例,女30例;年龄22～71岁;体重43～84 kg;病程0.5～10年。通过随机数字表的方法,将患者分为3组。A组给予盐酸氨基葡萄糖胶囊750 mg,2次/d,同时给予尼美舒利分散片100 mg,2次/d;B组给予盐酸氨基葡萄糖胶囊750 mg,2次/d;C组给予尼美舒利分散片100 mg,2次/d。3组均用药8周后停药,用药期间停用其他活血化瘀类药物及物理治疗。选取治疗前及治疗后第4、8、16周4个时间点,运用疼痛数字评价量表(NRS)、Oswestry功能障碍指数(ODI)、生活质量评价量表SF-36分别对3组患者的腰痛、腰部功能及生活质量进行评价。结果 63例获得随访,失访率12.5%。各组患者NRS评分、ODI评分、SF-36评分在治疗前后比较差异均有统计学意义(P<0.05),A组疗效明显优于B、C两组,B组治疗后各项数据较治疗前明显改善(P<0.05)。结论单用盐酸氨基葡萄糖治疗DLBP有效,且在停药后,仍有一定疗效,联用NSAID效果更佳;远期疗效有待进一步随访。     

急性和亚急性下腰痛患者腰椎MRI影像学特征分析

目的:探讨急性和亚急性下腰痛患者腰椎MRI影像学特征及临床意义。方法:回顾性连续收集因下腰痛至本院就诊并行腰椎MRI检查患者177例。根据病程时间将患者分为亚急性下腰痛组(n=103)和急性下腰痛组(n=74例),另招募42例无下腰痛志愿者作为正常对照组。采用视觉模拟评分(visual anologue scale,VAS)评定患者腰痛程度。观察各组研究对象腰椎MRI影像学特征,包括:椎间盘退变、椎间盘突出、椎间盘膨出、纤维环后方高信号、Schmorl结节、椎体终板炎、小关节退变、小关节积液、棘间韧带高信号、皮下或椎后旁肌肉水肿、小关节退变等,对不同组间腰椎MRI影像学特征分布进行统计学比较分析。结果:与正常对照组相比,急性、亚急性下腰痛组研究对象椎间盘退变、椎间盘突出发生率较高(P0.05)。3组间椎间盘膨出、Schmorl结节、腰椎终板Modic改变发生情况差异无统计学意义。急性下腰痛组患者腰椎MRI纤维环后方高信号、棘间韧带高信号、皮下或椎后旁软组织肿胀发生率均高于亚急性下腰痛组和正常对照组(P0.05);亚急性下腰痛组患者中小关节退变和小关节积液发生率均高于急性下腰痛组和正常对照组(P0.05)。结论:椎间盘退变、突出是腰痛症状持续存在的原因;腰椎间盘局限性高信号、棘间韧带高信号和皮下或椎后旁软组织肿胀与急性下腰痛相关;小关节退变、小关节积液与亚急性下腰痛有关。     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景:腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少。目的:调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用。方法:测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值<7°定义为小关节对称,差值≥7°定义为小关节不对称。对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级。结果与结论:①小关节是否对称在年龄及性别上差异无显著性(P>0.05)。②小关节不对称与椎间盘退变程度之间无显著关联(P>0.05)。③在L4～L5节段小关节不对称组比小关节对称组的小关节退变程度更重(P<0.01)。提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4～L5节段,小关节不对称可能会引起小关节的退变。     

退变性腰椎疾病患者小关节囊中P物质的表达

背景:以往基于动物实验或尸体的研究发现,腰椎小关节源性腰痛中退变的腰椎小关节软骨下骨和钙化软骨神经纤维中P物质增多.目的:观察退变性腰椎患者中小关节囊中P物质的表达变化.方法:采用术前诊断性封闭方法筛选出18例退变性慢性腰痛患者,行小关节囊切除,切除的小关节囊标本作为实验组,选取18例骨折前无腰痛的腰椎骨折患者的小关节囊标本为对照组,进行P物质免疫组化染色,观察P物质免疫组化染色阳性神经纤维的分布情况.结果与结论:实验组中15例可见P物质阳性神经纤维,3例未见阳性反应.P物质神经纤维在小关节囊内的定位与分布基本一致,关节囊上的P物质神经纤维大部分沿血管走行,血管周围阳性神经纤维密度较大,也有一些P物质神经不与血管伴行,独立走行于关节囊基质中,另外在小关节软骨下骨区亦有少量独立走行的P物质纤维.对照组腰椎小关节囊中5例可见少量P物质阳性神经纤维,13例为阴性.由此得出,腰椎小关节囊病理改变与退变性腰痛有明显关系,小关节囊中P物质阳性神经纤维可能参与了退变性腰痛疼痛的发生.小关节囊病理改变在小关节源性腰痛发生中起重要作用.     

CT诊断腰椎小关节退变的临床意义

腰椎小关节退变是腰椎退变的重要组成部分，是引起患者腰腿痛的常见原因。但在临床工作中常被忽视，相关文献把椎小关节退变伴腰腿痛命名为椎小关节综合征。本组收集了130例有腰椎小关节退变CT表现的病例，综合分析如下。     

脊神经后支阻滞联合冲击波疗法治疗腰椎小关节源性腰痛的疗效观察

腰椎小关节(关节突关节)源性慢性腰痛是指由于腰椎小关节退变、损伤、炎症等因素导致病程＞3个月的腰痛,占慢性腰痛的15％-40％[1-2].大多数患者通过保守治疗无法取得满意的疗效,随着病情的反复发作症状越来越重.近年来,关于中医中药、体外冲击波疗法、脊神经后支阻滞/毁损、射频脉冲等技术治疗腰椎小关节源性慢性腰痛的报道逐...     

小关节源性下腰痛伴发膝骨关节炎:小关节倾斜角度的生物力学意义

背景:下腰痛是骨科患者常见的临床表现,并且很大一部分患者同时伴有膝关节退变的表现。虽然现在已明确提出"腰-膝综合征"这一概念,但目前针对下腰痛病变所涉及到的腰椎小关节及膝关节退变的文献报道并不多见。目的:对于因小关节源性退变导致下腰痛同时伴发膝骨关节炎的相关文献进行总结及分析。方法:计算机检索1998年1月至2014年8月Pub Med数据库、中国期刊全文数据库的相关文章,英文检索词"low back pain,knee osteoarthritis,lumbar facet joint,total knee replacement,block treatment,non-fusion techniques,inflammatory factor,drug treatment";中文检索词"下腰痛,膝骨关节炎,腰椎小关节,膝关节置换,封闭治疗,非融合技术,炎症因子,药物治疗"。排除重复性研究及部分相关性较低的基础类文章。结果与结论:共计检索出157篇中英文文献,最终选择60篇文献进行综述。对于小关节源性下腰痛,目前认为继发性促进骨关节炎进展可能性大。在病理生理中,肿瘤坏死因子α、白细胞介素1β和基质金属蛋白酶等或许起着十分重要的作用。至于生物力学中,小关节倾斜角度的生物力学意义、倾斜角度与关节退行性变的关系是研究的重心。在临床治疗中,早期予以常规封闭治疗明确疼痛来源,轻症者行固定、功能锻炼延缓疾病进展,晚期则行手术治疗以恢复功能,缓解疼痛。     

康复治疗结合盐酸氨基葡萄糖治疗肩关节周围炎的疗效观察

目的探讨康复治疗结合盐酸氨基葡萄糖治疗肩关节周围炎的临床疗效。方法将2009年3月-2011年11月在成都军区总医院康复医学科门诊和住院的90例肩关节周围炎患者随机分为两组,治疗组45例,采用运动疗法结合口服盐酸氨基葡萄糖治疗90d;对照组45例,仅采用运动疗法治疗90d。结果治疗90d后,在临床疗效方面,治疗组总有效率86．7％;对照组总有效率66．7％,差异有统计学意义（P〈O．05）。在康复疗效方面,两组患者肩关节疾患治疗成绩判定标准中疼痛、肌力、关节活动度（ROM）、日常生活能力（ADL）和关节稳定性5个方面均有明显改善（P〈0．01）;和对照组相比,治疗组在疼痛、ROM、ADL3个方面改善更明显（P〈0．05）。结论康复治疗结合盐酸氨基葡萄糖治疗肩关节周围炎疗效比单独采用康复治疗要好。     

双醋瑞因联合盐酸氨基葡萄糖、双氯芬酸钠治疗骨性关节炎疗效比较

目的：研究双醋瑞因联合盐酸氨基葡萄糖和双氯芬酸钠治疗骨性关节炎的可行性及安全性。方法：选取100例骨性关节炎患者,随机分入双醋瑞因组联合双氯芬酸钠组（A组）、盐酸氨基葡萄糖联合双氯芬酸钠组（B组）、单用双氯芬酸钠组（C组）和双醋瑞因组联合双氯芬酸钠和盐酸氨基葡萄糖组（D组）四组中,用药12周后观察治疗前后临床疗效和综合疗效评分。结果：1.四组治疗方案在VAS评分、关节疼痛度评分方面均有良好改善率;2.D组治疗方案优于A、B、C三组。结论：双醋瑞因联合盐酸氨基葡萄糖和双氯芬酸钠治疗骨性关节炎是可行、安全、优效的方案。     

盐酸/硫酸氨基葡萄糖治疗膝骨关节炎的成本效果分析

背景：膝骨关节炎的治疗通常是一个长期用药的过程,所需费用较高,因此选用合理的治疗方案至关重要。目的：比较盐酸氨基葡萄糖、硫酸氨基葡萄糖治疗膝骨关节炎的成本-效果,进行经济学评价,为临床提供有效、实用治疗方案。方法：将78例膝骨关节炎患者随机均分为口服盐酸氨基葡萄糖组和硫酸氨基葡萄糖组。观察治疗第3,6周两组骨关节炎指数和Lequesne疼痛与功能指数并运用药物经济学方法进行成本-效果分析。结果与结论：膝骨关节炎治疗后两组患者各指标进行比较：①总有效率：第3周分别为83.8%和82.1%,第6周的总有效率分别为91.9%和90.7%。②成本-效果比：第3周分别为6.24和5.37,第6周分别为11.38和9.70。③敏感度分析：第3周分别为5.30和4.55,第6周分别为9.67和8.24。说明盐酸氨基葡萄糖与硫酸氨基葡萄糖均能明显地改善膝骨关节炎患者的关节炎指数及膝关节功能,但硫酸氨基葡萄糖有更好的成本-效果比。因此,硫酸氨基葡萄糖能比盐酸氨基葡萄糖以更少治疗成本获得更大的效益。     

“养筋汤”加味合盐酸氨基葡萄糖片口服治疗膝骨性关节炎28例

目的：观察“养筋汤”加味合盐酸氨基葡萄糖片口服治疗膝骨性关节炎的临床治疗疗效。方法：将56例膝骨性关节炎患者随机分为治疗组与对照组,治疗组28例采用“养筋汤加味”合盐酸氨基葡萄糖片口服治疗,对照组28例单纯采用盐酸氨基葡萄糖片口服治疗。结果：治疗组28例中,优秀18例,良好7例,无效3例,总优良率为89.2％;对照组28例中,优秀10例,良好8例,无效10例,总优良率为64.3％(P<0.05)。结论 “养筋汤”加味合盐酸氨基葡萄糖片口服治疗早期膝骨性关节炎临床效果较明显,临床上可供借鉴。     

Sacroiliac dysfunction in construction workers

BACKGROUND: In the literature of manual medicine the sacroiliac joint is widely accepted as a potential source of low back pain. On the other hand, some investigations have detected sacroiliac joint dysfunction without concomitant low back pain. The prevalence of sacroiliac dysfunction in the population has been noted in the medical literature to be between 19.3% and 47.9%. However, the prevalence of sacroiliac dysfunction in the general population and for construction workers is unknown. OBJECTIVE: This article presents results from the Hamburg Construction Workers Study in respect to sacroiliac diagnostics. The prevalence of and connection between sacroiliac dysfunction and low back pain are particularly interesting. DESIGN AND PARTICIPANTS: The sacroiliac joint diagnostics were studied in a cross-section investigation of a cohort of 480 male construction workers. Manual examination is the standard in the diagnostics of sacroiliac joint conditions at present. The assessment of sacroiliac joint function by standing flexion test, the spine test, the iliac compression test, and the iliac springing test was operationalized as two categories: sacroiliac dysfunction I and II. RESULTS: A prevalence of 29.0% was found for dysfunction I and 6.3% for dysfunction II, whereas a prevalence of 7.9% was found for the coprevalence of low back pain and sacroiliac dysfunction on the day of examination. This study demonstrated no statistical associations between low back pain and sacroiliac joint dysfunction. CONCLUSIONS: The reason why symptomatic and asymptomatic sacroiliac dysfunctions exist has not yet been sufficiently explained. The identification of pain-provoking factors should be the aim of subsequent investigations. A further study with a prospective design will be necessary to answer the questions that remain.     

Association between muscle function and low back pain in relation to pregnancy.

OBJECTIVE: To investigate the association of muscle function and subgroups of low back pain (no low back pain, pelvic girdle pain, lumbar pain and combined pelvic girdle pain and lumbar pain) in relation to pregnancy. DESIGN: Prospective cohort study. SUBJECTS: Consecutively enrolled pregnant women seen in gestational weeks 12-18 (n = 301) and 3 months postpartum (n = 262). METHODS: Classification into subgroups by means of mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history and a pain drawing. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were investigated. RESULTS: In pregnancy 116 women had no low back pain, 33% (n = 99) had pelvic girdle pain, 11% (n = 32) had lumbar pain and 18% (n = 54) had combined pelvic girdle pain and lumbar pain. The prevalence of pelvic girdle pain/combined pelvic girdle pain and lumbar pain decreased postpartum, whereas the prevalence of lumbar pain remained stable. Women with pelvic girdle pain and/or combined pelvic girdle pain and lumbar pain had lower values for trunk muscle endurance, hip extension and gait speed as compared to women without low back pain in pregnancy and postpartum (p < 0.001-0.04). Women with pelvic girdle pain throughout the study had lower values of back flexor endurance compared with women without low back pain. CONCLUSION: Muscle dysfunction was associated with pelvic girdle pain, which should be taken into consideration when developing treatment strategies and preventive measures.     

Glucosamine therapy compared to ibuprofen for joint pain

To determine the effectiveness of oral glucosamine with ibuprofen for the relief of joint pain in osteoarthritis a mini-review (Griffiths, 2002) of double-blind randomized controlled trials comparing the two was undertaken. The population was adult patients diagnosed with osteoarthritis at any site. The outcome was arthritic pain reduction. Searches on Medline, Embase, AMED, the Cochrane Library and the Merck index identified four trials. Of these, two studies were obtainable and were included in the review. Both compared 1.2 g ibuprofen daily with 1.5 g glucosamine sulphate daily, in three divided doses. The combined number of participants in the studies was 218. The results of these studies showed glucosamine to be of similar efficacy to ibuprofen. The conclusion is that glucosamine is effective in relieving joint pain associated with osteoarthritis. Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties; these disease-modifying effects are not seen with simple analgesics and are of particular benefit. In practice glucosamine can be used as an alternative to anti-inflammatory drugs and analgesics or as a useful adjunct to standard analgesic therapy.     

The effect of muscle energy techniques on disability and pain scores in individuals with low back pain

CLINICAL SCENARIO: Low back pain is the most common type of pain reported by adults in the United States. A variety of manual therapy techniques are used in the management of low back pain to reduce pain, improve function, and reduce disability. In recent years, muscle energy techniques have been increasingly used in clinics to treat low back pain. By definition, a muscle energy technique involves the patient performing a voluntary muscle contraction "in a precisely controlled direction, against a distinctly executed counter force applied by the operator." Muscle energy techniques provide a conservative alternative for clinicians treating patients with precautions or contraindications to joint manipulation.