平衡推拿疗法配合低强度激光治疗肌力失衡性颈椎病的临床研究

目的:以中医内病外治的理论,探讨平衡推拿疗法配合低强度激光治疗肌力失衡性颈椎病的疗效作用。方法:158例肌力失衡性颈椎病患者随机分为3组,用平衡推拿疗法45例(推拿组),采用低强度激光治疗48例(理疗组),用平衡推拿疗法配合低强度激光治疗65例(治疗组),观察症状、体征。结果:治疗组与理疗组比较,有显著差异(P<0.05);治疗组与推拿组比较,有显著差异(P<0.05)。结论:平衡推拿疗法配合低强度激光治疗肌力失衡性颈椎病优于单用一种疗法。     

A comparative study of a nerve block therapy with and without a deeply inserted acupotomy applied to hyeopcheok points for lumbosacral radiculopathy: Safety,effectiveness, cost-effectiveness (a randomized controlled,two-arm,parallel study,pilot study,assessor-blind)

Introduction:The prevalence of lumbosacral radiculopathy is estimated to be approximately 3% to 5% in patient populations. Lumbosacral radiculopathy is largely caused by a complex interaction between biomechanical and biochemical factors. Nerve block therapy (NBT) mainly treats lumbosacral radiculopathy by improving the biochemical factors, whereas acupotomy mainly focuses on improving the biomechanical factors. Therefore, it is thought that synergistic effects may be obtained for the treatment of lumbosacral radiculopathy when both NBT and acupotomy are combined. However, no study in China and Korea, where acupotomy is majorly provided, has reported the effects of such a combination treatment. Therefore, this study aimed to evaluate the safety, effectiveness, and cost-effectiveness of the concurrent use of a deeply inserted acupotomy and NBT for the treatment of lumbosacral radiculopathy.Methods/design:This is an open-label, parallel, assessor-blinded, randomized controlled trial, which will include 50 patients with lumbosacral radiculopathy. After patients voluntarily agree to participate in the study, they will be screened, and will undergo necessary examinations and tests according to the protocol. Those who satisfy the selection criteria will be randomly assigned to either the NBT + acupotomy or NBT groups in a 1:1 ratio. Both groups will undergo 2 NBTs once every 2 weeks from 1 week after the screening test. The treatment group will receive additional acupotomy twice a week for 4 weeks. The primary endpoint is the Oswestry Disability Index, whereas the secondary endpoints are the Numeral Rating Scale, European Quality of Life 5-dimension, McGill pain Questionnaire, Roland-Morris Disability Questionnaire, safety assessment, and economic feasibility evaluation. The measurements will be made at 0, 2, 4, and 8 weeks.Ethics and dissemination:This trial has received complete ethical approval from the Ethics Committee of Catholic Kwandong University International St. Mary''s Hospital (IS20OISE0085). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.     

桂枝加葛根汤联合项三针治疗神经根型颈椎病的疗效及安全性观察

目的:分析探讨桂枝加葛根汤联合项三针治疗神经根型颈椎病(Cervical Spondylotic Radiculopathy,CSR)的疗效及安全性.方法:选取2017年12月-2019年12月期间我院收治的90例CSR患者,采用随机数字表法分为观察组(45例)和对照组(45例).对照组给予口服甲钴胺片治疗,观察组在此...     

Evaluation of lung function and clinical features of interlaminar cervical epidural steroid injections: a randomized controlled trial

ObjectiveInterlaminar cervical epidural steroid injections (ICESIs) are commonly used to treat axial neck pain and cervical radicular pain. However, local anesthetics can spread to and block the phrenic nerve and upper segments of the thoracic spinal cord where the sympathetic innervation of the lungs emerges. Therefore, changes in lung function may occur following ICESIs.MethodsThe primary outcome measure was the pulmonary function test (PFT) result 30 minutes before and after ICESI with ropivacaine (0.1875% or 0.25%). The secondary outcome measure was the comparison of the pain scores and functional disability between the two concentrations of ropivacaine 4 weeks after the ICESIs.ResultsFifty patients were randomly assigned to either the R1 (0.1875% ropivacaine) or R2 (0.25% ropivacaine) group. No significant difference was observed between the pre-ICESI and 30-minute post-ICESI PFT results within each group, and no difference was observed between the two groups. After 4 weeks of treatment, both groups showed a significant decrease in pain scores and functional disability; however, no significant differences were observed between the two groups.ConclusionsThis study showed no significant change in lung function after ICESIs in either group and no local anesthetic concentration-based difference in the clinical efficacy of the ICESIs.     

中医药治疗神经根型颈椎病的现状

中医药治疗神经根型颈椎病的主要目的在于纠正颈椎的病理解剖状态,消除或缓解症状、阻止或减缓疾病进展、利于创伤恢复及疾病康复、预防疾病复发。大多数神经根型颈椎病（CSR）经中药、手法、针灸、牵引、针刀、物理治疗、综合疗法治疗可痊愈或缓解,但是在适应症、操作规范、疗效评价、安全性评价等方面还存在一些问题。     

Acute neuropathies after peripheral blood stem cell and bone marrow transplantation

Neuromuscular complications are not uncommon after bone marrow and stem cell transplantation, especially in patients with allogeneic transplantations and graft-versus-host disease. The pathogenesis of these complications remains unclear, but the changes in immune modulation that occur after transplantation are likely to play a key role. We describe 4 patients who developed brachial plexopathy (3 cases) or multiple lumbosacral radiculopathies (1 case) between 5 days and 4 months after autologous peripheral blood stem cell (3 cases) or allogeneic bone marrow transplantation without evidence of graft-versus-host disease (1 case). Infectious, tumor-related, toxic, and metabolic causes were excluded in all cases. Recovery was limited in two cases and nearly complete in the other two patients. Brachial plexopathies and polyradiculopathies are potential complications of peripheral blood stem cell and bone marrow transplantation. It is possible that these disorders may be the result of autoimmune phenomena directed against specific nerve antigens.     

Fibrillation potentials in paraspinal muscles in chronic lumbosacral radiculopathy

To assess the rate of fibrillation and/or positive sharp waves (FPSW) in the paraspinal muscles (PM) of patients with chronic lumbosacral radiculopathy, PM and leg muscles of 179 patients, 111 men and 68 women, aged 24-68 years (mean 49.0 +/- 9.3), were tested. Illness duration ranged from 8 months to 40 years (9.4 +/- 7.5 years). FPSW were detected in 38 patients (21.2%). In 28 of them (15.6%), FPSW were present in the limb muscles only, in eight (4.5%) in both PM and limb muscles, and in two (1.1%) solely in the PM. FPSW were accompanied in all the above patients by chronic neurogenic changes of motor unit potentials. Logistic regression analysis did not show any significant difference between: (i) the patients with and without fibrillations in leg and/or PM muscles, and (ii) between those with FPSW in both the PM and leg muscles and those with FPSW in the leg muscles only, when the effect of age and duration of illness were considered. These suggest that the paucity of FPSW in the PM is rather genuine and does not depend on the timing of the examination. In consequence, PM electromyography seems to be not as valuable in chronic radiculopathy as it is in the acute stage.     

颈椎间盘突出症的手术治疗

目的探讨不同类型颈椎间盘突出的手术治疗和效果。方法回顾性分析65例颈椎间盘突出，其中脊髓型53例，神经根型12例，均行前路开槽减压植骨融合术。结果脊髓型椎间盘突出术后症状和体征消失明显较神经根型颈椎间盘突出症术后效果好，脊髓型优艮率92．45%，可、差类10例患者中，神经根型占50％。结论脊髓型椎间盘突出症患者出现症状和体征者。应积极行手术治疗，对于神经根型的行前路手术应慎重考虑。     

Nerve injury proximal or distal to the DRG induces similar spinal glial activation and selective cytokine expression but differential behavioral responses to pharmacologic treatment

The specific mechanisms by which nervous system injury becomes a chronic pain state remain undetermined. Historically, it has been believed that injuries proximal or distal to the dorsal root ganglion (DRG) produce distinct pathologies that manifest in different severity of symptoms. This study investigated the role of injury site relative to the DRG in (1) eliciting behavioral responses, (2) inducing spinal neuroimmune activation, and (3) responding to pharmacologic interventions. Rats received either an L5 spinal nerve transection distal to the DRG or an L5 nerve root injury proximal to the DRG. Comparative studies assessed behavioral nociceptive responses, spinal cytokine mRNA and protein expression, and glial activation after injury. In separate studies, intrathecal pharmacologic interventions by using selective cytokine antagonists (interleukin-1 [IL-1] receptor antagonist and soluble tumor necrosis factor [TNF] receptor) and a global immunosuppressant (leflunomide) were performed to determine their relative effectiveness in these injury paradigms. Behavioral responses assessed by mechanical allodynia and thermal hyperalgesia were almost identical in the two models of persistent pain, suggesting that behavioral testing may not be a sensitive measure of injury. Spinal IL-1beta, IL-6, IL-10, and TNF mRNA and IL-6 protein were significantly elevated in both injuries. The overall magnitude of expression and temporal patterns were similar in both models of injury. The degree of microglial and astrocytic activation in the L5 spinal cord was also similar for both injuries. In contrast, the pharmacologic treatments were more effective in alleviating mechanical allodynia for peripheral nerve injury than nerve root injury, suggesting that nerve root injury elicits a more robust, centrally mediated response than peripheral nerve injury. Overall, these data implicate alternate nociceptive mechanisms in these anatomically different injuries that are not distinguished by behavioral testing or the neuroimmune markers used in this study.