旋转手法治疗腰椎间盘突出症研究进展

腰椎间盘突出症是临床常见病症。旋转手法是腰椎间盘突出症非手术治疗的常用手法之一,近年来得到广泛的运用和深入的研究。本文就近年来该手法在腰椎间盘突出症中的运用与研究进展做一总结,以便更好的指导临床应用,提高该法治疗腰突症的安全性和有效性。     

周期性牵张椎间盘纤维环细胞肌动蛋白骨架的重排

BACKGROUND: When the intervertebral disc is under stress, the hydraulic pressure generated inside the nucleus pulposus makes the annulus fibrosus extend outward and expand, and the annulus collagen fibers are stretched so that the extracellular matrix of annulus fibrosus cells is also under the pressure. In the intervertebral disc, aggrecan is the main component of proteoglycans, matrix metalloproteinase-2 is a major enzyme for extracellular matrix degradation, and tissue inhibitor of metalloproteinase is a multifunctional specific inhibition factor for matrix metalloproteinase activity. There is a mutual regulation between the latter two to keep the homeostasis between them. OBJECTIVE: To investigate the mechanism of cyclic tensile strain in the metabolism of intervertebral disc annulus matrix. METHODS: Rat anulus fibrosus cells were subjected to 2% or 10% cyclic tensile strain at 1.0 Hz for 2 and 12 hours using Flexcell4000 tension system. Then cells were collected and cultured in conditioned medium for gene and protein detection. Real-time quantitative PCR was used to detect mRNA expression of aggrecan, matrix metalloproteinases-2 and tissue inhibitor of metalloproteinase-2. Gelatin zymography was used to detect matrix metalloproteinases-2 activity. RESULTS AND CONCLUSION: The use of 2% cyclic tensile strain had no obvious effect on the stress fiber of actin cytoskeleton, whereas actin cytoskeleton was depolymerized in response to 10% cyclic tensile strain. The 2% cyclic tensile strain raised the expression of Aggrecan at 12 hours; whereas raised the matrix metalloproteinases-2 and tissue inhibitor of metalloproteinase-2 at 2 hours, both of which were in homeostasis; matrix metalloproteinases-2 activity had no significant changes. 10% cyclic tensile strain had no effect on the mRNA expression of Aggrecan. No matter stretching 2 or 12 hours, the matrix metalloproteinases-2 was up-regulated, and the tissue inhibitor of metalloproteinase-2 was down-regulated, both of which were not in balance. Moreover, the matrix metalloproteinases-2 activity was not significantly changed. These findings indicate that the mRNA expressions of Aggrecan, matrix metalloproteinases-2 and tissue inhibitor of metalloproteinase-2 alter in response to cyclic tensile strain in rat anulus fibrosus cells, and the tensile strain induces different mechano-responses in the actin cytoskeleton.      

经皮激光汽化减压术治疗腰椎间盘突出症的临床应用进展

微创介入手术做为治疗腰椎间盘突出症(lumbar disc herniation,LDH)的有效方式在临床治疗中已得到肯定,其中经皮激光汽化减压术(percutaneous laser disc decompression,PLDD)是微创介入手术中较为理想的一种治疗方式。自1987年首次在临床应用并取得较好的疗效以来,PLDD治疗LDH已有20多年历史,本文就PLDD的研究背景及治疗原理、适应证及禁忌证、PLDD手术的应用现况、最新进展、存在的问题及展望等进行简要综述。     

激光与臭氧治疗腰椎间盘突出症的临床疗效分析及安全性探讨

目的回顾性研究对比经皮激光汽化减压术（percutaneous laser disc decompression,PLDD）与臭氧消融术（ozone ablation,O3）治疗腰椎间盘突出症（lumbar disc herniation,LDH）的临床疗效及安全性。方法选取近5年分别采用PLDD或O3治疗LDH的患者64例,PLDD组31例,O3组33例,对两种方法治疗后3和12个月的临床疗效、治疗前后的疼痛改变、复发率及并发症发生率进行比较分析。结果疗效评价,PLDD组3个月优良率80.6%、12个月优良率83.9%;O3组3个月优良率72.7%、12个月优良率60.6%。3个月疗效PLDD组与O3组比较差异无显著意义（P〉0.05）;12个月疗效PLDD组好于O3治疗组,两组比较差异有显著意义（P〈0.05）。疼痛学评价,采用疼痛视觉模拟评分法（visual analogue scale,VAS）进行评价。两组患者治疗后3和12个月的VAS值较治疗前明显降低,疼痛明显好转,与治疗前比较差异有显著意义（P〈0.05）。两组患者的并发症发生率和复发率均较小,差异无显著意义（P〉0.05）。结论 PLDD及O3两种方法安全性高,均是治疗LDH的有效方法。     

经皮激光气化减压术治疗腰椎问盘突出症后椎问隙高度改变和中长期临床疗效

目的观察经皮激光气化减压术（pereutaneous laser disc decompression,PLDD）治疗腰椎间盘突出症后椎间隙高度的变化和中长期临床疗效。方法腰椎间盘突出症患者（L4-5）256例,行PLDD治疗,激光输出功率10w,脉冲时间1s,脉冲间隔时间1s。术后随访6、18和60个月,比较术前、术后手术节段椎间隙高度（intervertebral height,IH）变化、手术前后疼痛的VAS评分、Oswestry功能障碍指数（Oswestry Disability Index,ODI）和改良Menab疗效评分法,以评估临床疗效。结果术前、术后VAS疼痛评分及ODI评分较术前明显缓解（P〈0．05）;术前、术后手术节段椎间隙高度比较差异无显著性（P〉0．05）;术后18和60个月满意率（Menab评分优良者）分别为90．3％和86．2％。结论PLDD治疗腰椎间盘突出症远期效果好,同时可有效维持椎间隙高度。     

经皮激光椎间盘减压术联合熥敷颈腰痛砂治疗腰椎间盘突出症临床观察

目的 观察PLDD联合熥敷颈腰痛砂治疗LDH的临床疗效。方法 采用随机数字表法将68例患者分为治疗组(PLDD+熥敷颈腰痛砂)、对照组(单纯PLDD治疗)各34例。组内及组间比较两组受试者治疗前及治疗后1周、1个月、2个月、6个月后的视觉模拟疼痛评分(VAS)、日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)及改良MacNab疗效的优良率,并进行安全性评价。结果 两组治疗前VAS、ODI、JOA比较,差异无统计学意义(P>0.05)。与本组治疗前比较,两组经治疗后VAS、ODI、JOA均明显改善(P<0.05);术后1周、术后1个月、术后2个月治疗组在疼痛缓解程度上优于对照组,差异有统计学意义(P<0.05);治疗组患者术后1周、术后1个月、术后2个月、术后6个月JOA疼痛评分、ODI评分均优于对照组,差异有统计学意义(P<0.05);两组患者术后2个月、术后6个月的有效率比较,差异无统计学意义(P>0.05);治疗组患者术后2个月、术后6个月优良率分别为94.1%、97.1%,优于对照组术后2个月、术后6个月的优良率,差异有统计...     

腰椎间盘突出症注射治疗国内近况

注射治疗腰椎间盘突出症仍有许多悬而未解的问题.虽然现有的研究已证实硬膜外皮质类固醇注射有效,但仍需高质量的研究对其疗效进行观察.本文就腰突症的注射治疗近况总结如下.……     

从“肾”论治激素性骨质疏松症的研究进展

近年来,激素(Glucocorticoid,GC)在临床上的不规范及大剂量使用导致糖皮质激素性骨质疏松(Glucocorticoid-induced osteoporosis,GIOP)的发病逐渐增多.中医药防治GIOP疗效确切,备受关注,但由于缺乏客观的药效学机制及分子学依据,难以达到标准化防治水平.Wnt/β-ca...     

PLDD联合针灸及杜仲腰痛丸治疗腰椎间盘突出症临床观察

目的:观察分析经皮激光汽化减压术(Percutaneous laser discdecompression,PLDD)联合针灸及杜仲腰痛丸治疗腰椎间盘突出症(Lumbar dise herniation,LDH)的临床疗效。方法:回顾性分析2013年5月—2016年6月在甘肃省中医院脊柱骨科采用PLDD联合针灸及杜仲腰痛丸治疗的117例LDH患者的临床资料,按不同疗法分为3组:A组(PLDD+针灸组)患者37例;B组(PLDD+中药组)患者41例;C组(PLDD+针灸+中药组)患者39例。记录各组不同时间点VAS疼痛评分,评价术后随访2个月的临床疗效,分析各治疗手段的有效性,总结治疗经验。结果:治疗后1周、2周、1个月、6周和2个月,C组VAS评分明显低于A、B组,且C组疼痛评分的减轻程度显著高于A、B组,差异具有统计学意义(P0.05);术后随访2个月,A、B、C 3组有效率无明显统计学意义(P0.05),优良率分别为67.6%、65.9%、76.9%,C组明显高于A、B两组,差异具有统计学意义(P0.05)。结论:运用PLDD联合针灸及杜仲腰痛丸治疗LDH疗效显著,值得临床推广运用。     

探讨绝经后骨质疏松症“从肝论治”思想的相关机理

绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)在骨质疏松症(osteoporosis,OP)中占有比例最大,严重影响中老年女性的健康及生活质量。中医药治疗PMOP有独特的优势,但PMOP的中医诊疗指导思想多以藏象"肾-骨"为主要理论依据,往往忽略了"肝"的重要作用。女子以肝为先天,对于中老年女性来说,"从肝论治"尤为重要。笔者基于对肝主疏泄-畅情志、肝藏血、肝-筋等肝生理功能与PMOP的发病相关机理作一探讨,以期对PMOP的防治诊疗提供新思路。