铁棒锤止痛膏治疗肩周炎临床疗效观察

目的 观察奇正铁棒锤止痛膏治疗肩周炎的临床疗效.方法 将177例肩周炎患者采用简单随机数字表法随机分为观察组(90例)与对照组(87例).观察组外敷奇正铁棒锤止痛膏,1次/d,1贴/次;对照组外敷天和骨通贴.比较2组患者用药前,用药7、14、21 d的关节评分及用药21 d的临床疗效.结果 治疗7、14、21 d与治疗前比较,2组患者肩关节疼痛评分[观察组分别为(19.3±3.6)、(21.3±2.6)、(23.4±5.5)分比(12.6±4.7)分;对照组分别为(18.8±4.1)、(20.7±3.6)、(22.3±3.4)分比(14.0±5.5)分]、肩关节功能评分[观察组分别为(12.0±1.9)、(12.8±1.9)、(13.4±2.0)分比(11.0±2.2)分;对照组分别为(12.0±2.1)、(12.7±1.9)、(13.4±2.1)分比(10.8±2.5)分]、肩关节活动度评分[观察组分别为(18.9±3.8)、(21.2±3.8)、(22.6±3.4)分比(17.8±3.8)分,对照组分别为(18.9±3.2)、(20.2±3.2)、(20.7±2.9)分别(17.4±3.2)分]均有明显改善(均P＜0.01),治疗21 d后,观察组的肩关节活动度评分优于对照组(P＜0.05).观察组中治愈2例,好转84例,无效4例,总有效率95.5%;对照组治愈1例,好转75例,无效11例,总有效率为87.3%,观察组疗效明显优于对照组(P＜0.05).结论 奇正铁棒锤止痛膏治疗肩周炎疗效明显,且在8 h外敷时间内不易产生过敏反应.     

电针对于腰神经根压迫兔子肌肉状态及电生理变化的作用

Objective

To observe the effects of electroacupuncture on force-displacement value (FDV) of muscle state and electrophysiology of the muscle in rabbits with lumbar nerve root compression.

Methods

Thirty New Zealand white rabbits were randomly divided into a control, a model, an electro-acupuncture acupoints (EAA), a medication, and an electro-acupuncture un-acupoints (EAU) group. All rabbits except those in the control group were subject to modeling (surgical lumbar nerve root compression). The control group was sham-operated without nerve root compression. The EAA group received electro-acupuncture at bilateral Shenshu (BL23) and Dachangshu (BL25) that were located 1.5 cun lateral to the posterior midline on the lower border of the spinous process of the 2nd and 4th lumbar vertebra, respectively. The EA was 15 mm deep and the frequency was 2 Hz. Each session lasted for 20 min per day for a total of 14 times. The medication group was treated with Loxoprofen sodium by gastrogavage at 4 mg/kg per day for 14 days. The EAU group received electro-acupuncture identical to the EAA group with regard to the treatment frequency and duration except a different acupoint at the tip of rabbit tail. Muscle states were determined by measuring FDVs of the bilateral biceps femoris using the Myotonometer® fast muscle state detector. Meanwhile, the prolonged and non-prolonged insertion potentials were measured by electromyography before and after modeling and after treatment. Latency, amplitude (Amp) of evoked potential, motor nerve conduction velocity (MNCV) were also determined after treatment.

Results

(1) After modeling, FDVs of right side activation (RSA, P=0.003) and right side relaxation (RSR) in the model group (P=0.000) were significantly decreased in comparison to the control group. The number of rabbits with non-prolonged insertion potentials in the model group was also significantly decreased (P=0.015) in comparison to the control group. (2) After treatment, FDVs of RSR were significantly increased in the EAA (P=0.000) and medication groups (P=0.018) in comparison to the model group. The increase in FDVs of RSR in the EAA group was significantly higher than that in EAU (P=0.000) and medication groups (P=0.002). MNCV in the model group was reduced compared with the control group (P=0.000). The reduction in MNCV after modeling was reversed in the EAA group (P=0.000) and medication group (P=0.008) after treatment and the increases were significant in both treatment groups in comparison to the model group. The EAA group had a greater MNCV recovery than the medication group (P=0.022).

Conclusion

Electro-acupuncture could improve the rehabilitation and regeneration of FDVs and the electrophysiology index of the muscle with nerve control impairment.     

电针治疗腰椎间盘突出症术后下肢麻木172例及肌电图变化

[目的]研究电针治疗腰椎间盘突出症术后下肢麻木的疗效。[方法]将172例腰椎间盘突出症术后出现下肢麻木的患者分为两组,治疗组采用电针治疗,每日1次,10次1疗程,治疗两疗程,对照组使用甲钴胺口服治疗,连续服用25天,进行疗效比较,同时对两组患者进行治疗前后肌电图F波传导速度和频率进行检查对比。[结果]电针组总有效率为87.21%,药物组总有效率为74.42%,治疗组疗效明显优于对照组(P<0.05)。两组治疗前后F波传导速度和发生频率均较治疗前有明显改善(P<0.001),电针组明显优于药物组((P<0.001))。[结论]电针治疗可有效治疗腰椎间盘突出症患者术后下肢麻木症状,改善F波传导速度和发生频率。     

靶向TNF—α的反义寡核苷酸治疗人工关节磨损微粒诱导的骨溶解的实验研究

[目的]研究单次皮下注射靶向肿瘤坏死因子α(tumor necrosis factor,TNF-α)的反义寡核苷酸(anti-sense oligonucleotides,ASO)治疗人工关节磨损微粒诱导的骨溶解的作用,探讨用于防治人工关节置换后假体松动的可能性.[方法] 采用小鼠颅骨建立微粒诱导的骨溶解的动物模型,分为5组:第1组为假手术组,第2组为阳性对照组,第3组为低剂量治疗组,第4组为高剂量治疗组,第5组在第四组处置的基础上再次给予TNF-α.通过甲苯胺蓝染色观察颅骨表面骨吸收陷窝的数量并测量其面积,通过抗酒石酸的酸性磷酸酶(tartrate-resistant acid phospha-tase,TRAP)染色来观察破骨细胞并进行计数,通过定量试剂盒对TRAP的活性进行定量研究.同时采用RT-PCR和ELISA的方法检测TNF-α的表达.[结果]靶向TNF-α的ASO可以显著下调靶基因的表达,对微粒诱导的骨溶解有明显的抑制作用.骨吸收陷窝的数目与面积以及破骨细胞的数量均较阳性对照组有明显下降,定量研究显示TRAP的活性也有明显的下降.这种改变与ASO的用量呈明显的依赖性,高剂量组的治疗结果接近于假手术组.再次给予TNF-α可以逆转这种抑制效果.[结论]靶向炎症因子TNF-α的反义核酸通过抑制TNF-α表达,抑制了由微粒诱导的骨溶解.为防治人工关节置换后假体松动提供了一种很有应用前景的治疗策略.     

温针灸对腰神经根受压大鼠模型一氧化氮合酶和降钙素相关基因肽的影响

BACKGROUND： Varying degrees of inflammatory responses occur during lumbar nerve root compression. Studies have shown that nitric oxide synthase （NOS） and calcitonin gene-related peptide （CGRP） are involved in secondary disc inflammation. OBJECTIVE： To observe the effects of warm acupuncture on the ultrastructure of inflammatory mediators in a rat model of lumbar nerve root compression, including NOS and CGRP contents. DESIGN, TIME AND SETTING： Randomized, controlled study, with molecular biological analysis, was performed at the Experimental Center, Sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University, between September 2006 and April 2007. MATERIALS： Acupuncture needles and refined Moxa grains were purchased from Shanghai Taicheng Technology Development Co., Ltd., China; Mobic tablets were purchased from Shanghai Boehringer Ingelheim Pharmaceuticals Co., Ltd., China; enzyme linked immunosorbent assay （ELISA） kits for NOS and CGRP were purchased from ADL Biotechnology, Inc., USA. METHODS： A total of 50, healthy, adult Sprague-Dawley rats, were randomly divided into five groups normal, model, warm acupuncture, acupuncture, and drug, with 10 rats in each group. Rats in the four groups, excluding the normal group, were used to establish models of lumbar nerve root compression. After 3 days, Jiaji points were set using reinforcing-reducing manipulation in the warm acupuncture group. Moxa grains were burned on each needle, with 2 grains each daily. The acupuncture group was the same as the warm acupuncture group, with the exception of non-moxibustion. Mobic suspension （3.75 mg/kg） was used in the oral drug group, once a day. Treatment of each group lasted for 14 consecutive days. Modeling and medication were not performed in the normal group. MAIN OUTCOME MEASURES： The ultrastructure of damaged nerve roots was observed with transmission electron microscopy; NOS and CGRP contents were measured using ELISA. RESULTS： The changes of the radicular ultramicrostructure were characterized by Wallerian degeneration; nerve fibers were clearly demyelinated; axons collapsed or degenerated; outer Schwann cell cytoplasm was swollen and its nucleus was compacted. Compared with the normal group, NOS and CGRP contents in the nerve root compression zone in the model group were significantly increased （P 〈 0.01）. Nerve root edema was improved in the drug, acupuncture and the warm acupuncture groups over the model group. NOS and CGRP expressions were also decreased with the warm acupuncture group having the lowest concentration （P 〈 0.01）. CONCLUSION： In comparison to the known effects of Mobic drug and acupuncture treatments, the warm acupuncture significantly decreased NOS and CGRP expression which helped improve the ultrastructure of the compressed nerve root.     

关刺结合温通针法治疗膝骨关节炎临床研究

目的观察关刺结合温通针法治疗膝骨关节炎的临床疗效。方法将320例膝骨关节炎患者随机分为治疗组(关刺结合温通针法组)161例、对照组(单纯针刺组)159例,并进行两组间的疗效评估。结果治疗组总有效率为90.7%,对照组总有效率为79.9%。两组疗效比较差异有统计学意义(P0.05)。结论关刺结合温通针法治疗膝骨关节炎的疗效优于单纯针刺治疗。     

急诊179例自杀患者特征回顾分析

目的 通过对急诊179例自杀患者回顾分析,找出自杀的原因及方式等结构特征.方法 对179例自杀患者一般情况、社会特征、自杀原因、方式等结构的分布进行统计分析.结果 社会弱势人群自杀比例较高,家庭纠纷占自杀原因首位,服毒占自杀方式首位,男女比例1:3.结论 构建和谐社会,避免家庭矛盾,加强自杀高危人群的健康教育和危机干预,加强对弱势人群的教育,加强毒药、危险药品的管理,是预防自杀的重要措施.     

多孔羟基磷灰石、纤维蛋白和金葡液复合物修复骨缺损的实验研究

目的探讨珊瑚多孔羟基磷灰石(CHAP)、纤维蛋白(FS)及金葡液(SAI)复合物修复骨缺损的作用,以及作为人工骨移植替代材料的可行性. 方法采用新西兰大白兔54只在双侧桡骨制备骨缺损模型后分成实验组、对照组及空白组.将CHAP-FS-SAI复合物植入骨缺损处作为实验组,自体骨植入作为对照组,空白组不植入任何物质;术后2、4、8和12周分别取2只兔行大体标本观察、组织学、X线片观察及生物力学测试,比较各组修复骨缺损的能力. 结果实验组术后2周见植入物与骨端形成紧密的纤维性连接,镜下可见CHAP周围大量成纤维细胞、软骨细胞及毛细血管增生;对照组有少量骨痂形成,有软骨细胞、骨母细胞及破骨细胞.4、8周两组均见大量骨痂形成,镜下见软骨细胞钙化,组织骨和板层骨.12周实验组及对照组均见大量成熟的骨细胞及板层骨;实验组见植入物完全骨化,塑形完全,CHAP未完全降解.空白组12周骨缺损区为纤维瘢痕组织填充,镜下主要为大量成纤维细胞.X线片2周实验组与对照组有骨痂影,4周骨痂影增多.8周实验组骨缺损消失,CHAP分散在骨痂中;对照组骨折线消失,髓腔开始形成.12周实验组和对照组骨皮质连续,髓腔复通,塑形完全.空白组12周骨缺损区无骨性连接.生物力学测试最大扭矩及抗扭刚度在术后4、8、12周实验组与对照组均无差异(P＞0.05),但术后2周,实验组高于对照组,差异有统计学意义(P＜0.05). 结论 CHAP-FS-SAI复合物具有较强的成骨能力和良好的生物相容性,能作为自体骨移植的一种替代物修复骨缺损.     

杵针治疗腰椎间盘突出症的多中心随机对照研究

目的比较杵针和电针治疗血瘀型腰椎间盘突出症的临床疗效差异。方法将233例血瘀型腰椎间盘突出症患者随机分成治疗组117例和对照组116例。治疗组采用杵针治疗,穴取腰阳关八阵穴、河车路命门至长强段、环跳、阳陵泉,隔天治疗1次,20 min/次,每周3次,12次为1个疗程,共观察治疗1个疗程;对照组穴取腰阳关、十七椎、环跳、阳陵泉,治疗时间和周期与治疗组相同。观察两组的临床疗效,并记录两组患者治疗前后及治疗后1个月随访时下腰痛评分(JOA评分)。结果两组腰椎间盘突出症患者治疗后,治疗组总有效率86.32%,对照组总有效率90.52%,两组比较差异无统计学意义(P>0.05),说明两组临床疗效相当。两组腰椎间盘突出症患者治疗后及1个月后随访时的JOA评分与治疗前比较均有显著性提高(P<0.01),而各时间点组间差异均无统计学意义(P>0.05)。结论杵针与电针治疗血瘀型腰椎间盘突出症临床疗效相当,但杵针无创伤、无痛苦、操作方便,患者易于接受,值得临床推广应用。