通络饮联合针刺疗法治疗神经根型颈椎病49例疗效观察

目的观察通络饮联合针刺疗法治疗神经根型颈椎病的临床疗效。方法将97例神经根型颈椎病患者随机分为治疗组(49例)和对照组(48例),对照组予常规针刺治疗,治疗组在对照组治疗基础上加用通络饮。两组疗程均为21天,随访3个月,观察临床疗效,比较治疗前后疼痛程度、NDI指数及血液流变学相关指标的情况。结果 1治疗组总有效率为95.92%,而对照组总有效率为81.25%;组间临床疗效比较,差异有统计学意义(P0.05)。2治疗前后组内比较,两组疼痛VAS积分、NDI积分差异均有统计学意义(P0.05);组间治疗后比较,疼痛VAS积分、NDI积分差异,治疗组优于对照组(P0.05)。3治疗前后组内比较,治疗组全血黏度(高切、低切)、血浆比黏度差异有统计学意义(P0.05);组间治疗后比较,全血比黏度(高切、低切)、血浆黏度差异有统计学意义,治疗组优于对照组(P0.05)。结论通络饮联合针刺疗法治疗神经根型颈椎病的疗效满意,可显著改善患者的颈部疼痛及功能障碍。     

理筋整复推拿法治疗神经根型颈椎病30例临床观察

目的 观测理筋整复推拿法治疗神经根型颈椎病的临床疗效.方法 搜集门诊神经根型颈椎病确诊患者共60例随机分为治疗组与对照组各30例,治疗组采用理筋整复推拿法进行治疗,对照组采用常规针刺进行治疗.每日治疗1次,5次为1个疗程,治疗2个疗程后观察疗效.结果 总有效率93.34％,对患者症状、体征改善明显.结论 理筋整复推拿法治疗神经根型颈椎病疗效确切,安全可靠,值得推广.     

颈牵态下磁场电脉冲疗法对神经根型颈椎病效果观察

目的：探讨颈牵态下磁场电脉冲疗法对神经根型颈椎病的疗效。方法：70例神经根型颈椎病患者分为治疗组与对照组各35例,治疗组采用颈牵态下磁场电脉冲疗法,对照组仅用颈牵引治疗及TDP照射,评价两组患者疗效、视觉模拟评分（VAS）及肌力。结果：治疗组总有效率97.14%,显著高于对照组的80.00%（P〈0.05）;治疗后两组患者VAS评分及最大握力均显著优于治疗前（P〈0.01）,且治疗组优于对照组（P〈0.01）。结论：颈牵态下磁场电脉冲疗法治疗神经根型颈椎病效果显著。     

神经根型颈椎病肝肾亏虚证、气血两虚证中医证候指标专家问卷分析

目的:建立神经根型颈椎病肝肾亏虚证、气血两虚证中医证候指标。方法:通过文献循证、回顾病历资料提取相关条目,编制神经根型颈椎病中医证候专家问卷,向全国范围内遴选出的220位专家以信函的方式进行调查,根据专家咨询表的统计分析方法,采用积极系数、均数、满分比、等级和、变异系数5个指标进行分析。结果:回收有效问卷183分,积极系数为83.2%;肝肾亏虚证中,满分比>0.5、均数>1.5、变异系数<0.4的条目有"颈、肩、肢酸软绵痛"、"麻木"、"颈项肩臂活动不利"、"神疲乏力"、"腰膝酸软",舌脉部分均数、满分比>0.5的有"舌体瘦"、"舌质红"、"舌质红绛"、"少苔"、"脉弦细"、"脉沉细"、"脉弦细数",但变异系数均>0.4;气血两虚证中满分比>0.5、均数>1.5、变异系数<0.4的条目有"麻木"、"活动后痛甚、休息后痛减",舌脉部分均数、满分比>0.5的有"舌质淡"、"苔薄白"、"脉细弱",但变异系数均>0.4,条目"颈、肩、肢软痛"改为"颈、肩、肢疼痛乏力"。结论:以上条目初选为神经根型颈椎病肝肾亏虚证、气血两虚证中医证候指标。     

Periradicular therapy in lumbar radicular syndromes: Methodology and results

Summary Periradicular therapy (PRT) has become popular in the treatment of lumbar radicular complaints, both primary, due to disc herniations (Group 1), and postoperative, following disc surgery (Group 2). However, hitherto repored data on periradicular injections are more of a technical nature. The present study was designed to evaluate the therapeutic success of CT-versus fluoroscope-guided periradicular injections of local anaesthetics and corticoids, and to investigate the impact of imaging procedures on the results. We report on 80 patients who underwent CT-guided (n=40) or fluoroscope-guided (n=40) PRT for lumbar radicular irritation since April 1993. Forty patients had primary nerve root irritation due to disc protrusion, and 40 suffered from postoperative epidural fibrosis. Follow-up consisted in a clinical examination and an interview one day after each injection as well as 1 and 6 months later. Assessment was based on a score taking into account the clinical findings, the patient's complaints, and the patient's evaluation.Six months following treatment there was a significant reduction of ischialgia in both Groups 1 and 2 (p < 0.001). However, the results were significantly poorer in Group 2 (postoperative). Among the patients not operated on, those who underwent CT-guided injections had a significantly better outcome (p < 0.001). PRT had no significant influence on low back pain or pseudoradicular syndromes. The improvement of sensory disturbances achieved by both CT- and fluoroscope-guided injections in patients not previously submitted to surgery is statistically significant (p < 0.05). As compared to Group 1 (no surgery), the positive effects in patients of Group 2 were of significantly shorter duration (p<0.05). Motor deficits were not influenced by the treatment. Long-term follow-up shows that there is no positive effect in those patients in whom the first two PRT attempts had failed. Thus, PRT represents a useful long-term therapeutic alternative for lumbar radicular syndromes, particularly when due to primary discogenic compression. CT-guided injection is superior to fluoroscope-assisted treatment for both its visualization and its longer-lasting effect.     

Cervical spine disease and anaesthesia

Surgery on the cervical spine is commonly performed to relieve compression of the spinal cord (myelopathy), a nerve root (radiculopathy) or to provide bony stabilization to prevent secondary neurological injury. The pathological causes of myelopathy and radiculopathy are a common consequence of osteoarthritis or less commonly due to disc herniation, tumours, trauma, infection and multisystem disease, and in some conditions as a result of their associated pathologically or surgically induced instability. Successful anaesthetic management should involve a meticulous preoperative assessment of the patient's airway, a systemic review especially in patients with comorbidities and multisystem disease, and attention to their medication and analgesic requirements. Preoperative discussion with the surgical team allows planning of airway management, patient positioning, cardiovascular support (in cases with the potential for significant blood loss), the availability of appropriate blood products and monitoring, postoperative pain management and ward destination.     

Normal multiplanar movement of the spinal cord during unilateral and bilateral straight leg raise: Quantification,mechanisms, and overview

The purpose of this investigation was to provide a full set of normal data describing neural biomechanics within the vertebral canal in all three planes with unilateral and bilateral SLR tests to allow for clinical comparison with clinical cases. This is done following the notion that, due to neural continuum, tensile forces are transmitted through the lumbosacral nerve roots and dura to the conus medullaris (linear dependency principle). In this controlled radiologic study 10 asymptomatic volunteers were scanned with 1.5T magnetic resonance scanner (Siemens Magnetom Aera, Erlangen, Germany) using different scanning sequences for planning and for measurement purposes. Conus displacement in both antero‐posterior direction (sagittal slices) and lateral direction (axial slices) was quantified during unilateral passive left, right SLR, and bilateral SLR and compared with the position of the conus in the neutral (anatomic) position. It is shown that the conus medullaris displaced laterally and anteroposteriorly in response to unilateral and bilateral SLRs. Pearson's correlations were higher than 0.95 for both intra‐ and inter‐observer reliability. The observed power was higher than 0.99 for all the variables tested. Following this, the authors conclude that lateral and antero‐posterior displacement of conus medullaris into the vertebral canal occurs consistently with unilateral and bilateral SLRs following directions predicted by tension vectors. Summative information collected in this line of research in neuroradiology is here presented. We believe we have presented the first conclusive and complete full set of normal data on non‐invasive, in vivo, normative measurement of spinal cord displacement with the SLR ever presented. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1335–1342, 2017.

     

Electromyographic and lower extremity short time to inversion recovery magnetic resonance imaging findings in lumbar radiculopathy

To determine if short TI (time to inversion) recovery (STIR) magnetic resonance imaging (MRI) is useful in assessing lower extremity (LE) denervation in subacute lumbar radiculopathy (LR), 25 subjects underwent lumbar spine MRI, LE STIR MRI and needle electromyography (EMG). In 23 (92%) subjects there was a positive correlation between LE STIR MRI and EMG (P < 0.009). Increased signal intensity on LE STIR MRI corresponds closely with spontaneous activity on EMG in subacute LR and may be a useful adjunct diagnostic tool. © 1997 John Wiley & Sons, Inc. Muscle Nerve 20:1191–1193, 1997     

A syndrome of concurrent central and peripheral nervous system involvement due to Epstein-Barr virus infection

Epstein-Barr virus infection can affect both the central and peripheral nervous systems. In some patients this occurs concurrently. Two patients are presented with encephalopathy and acute quadriparesis with diminished reflexes. Positive serology for Epstein-Barr virus was found in both patients. Both patients had a cerebrospinal fluid pleocytosis in the setting of progressive weakness. Electrophysiologic studies early in the course of their illness demonstrated abnormal F-wave latencies with normal distal conduction. Electromyographic studies demonstrated prominent spontaneous activity in affected limbs. As both the encephalopathy and weakness improved, the electrophysiologic abnormalities improved. This presentation is characteristic of acute Epstein-Barr virus infection. Pathologic studies in other patients have documented both anterior horn cell degeneration and edema as well as cellular infiltration of nerve roots which are responsible for the paralysis with diminished reflexes and electrophysiologic findings. The prognosis for these patients is generally good. © 1996 John Wiley & Sons, Inc.