针刺对神经根炎模型大鼠神经功能、血液流变学和炎症因子的影响

【目的】观察针刺郄穴为主对化学性神经根炎模型大鼠的影响,以探讨针刺治疗腰椎间盘突出症的作用机理。【方法】复制化学性神经根炎模型大鼠24只,随机分为针刺组、模型组各12只,并设空白组对照12只;针刺组予以局部针刺夹脊穴,足少阳经、足太阳经郄穴及委中穴治疗,持续28 d,模型组、空白组不予治疗;观察模型大鼠行为学变化及神经细胞形态学改变,测定炎症滤纸质量,并进行血液流变学分析和炎症因子一氧化氮(NO)、白细胞介素-6(IL-6)含量的检测。【结果】针刺能改善模型大鼠患肢活动,促进痛觉、触觉恢复,改善血液流变学各项指标,减轻炎症反应,改善神经根变性,降低炎症因子水平(均P<0.05)。【结论】针刺可改善血液流变学指标、降低NO和IL-6水平、消除神经根炎症及水肿,这可能是临床上针刺郄穴为主治疗腰椎间盘突出的机理。     

Trigger Point Dry Needling

Abstract

Trigger point dry needling is a treatment technique used by physical therapists around the world. In the United States, trigger point dry needling has been approved as within the scope of physical therapy practice in a growing number of states. There are several dry needling techniques, based on different models, including the radiculopathy model and the trigger point model, which are discussed here in detail. Special attention is paid to the clinical evidence for trigger point dry needling and the underlying mechanisms. Comparisons with injection therapy and acupuncture are reviewed. Trigger point dry needling is a relatively new technique used in combination with other physical therapy interventions.     

不同针刺手法对健康人经穴氧分压的影响

本文采用氧分压（ＰＯ２）传感针，对２０例健康男性的手阳明大肠经上臂穴、曲池穴的ＰＯ２与相应非穴位的ＰＯ２值进行了测定。结果显示针刺合谷穴时，臂与曲池穴ＰＯ２升高，分别与针刺前比较，其１０＇、１５＇、２０＇的ＰＯ２值均有显著性差异（ＰＭ＜Ｏ．０５），而相应非穴位ＰＯ２变化不显著。在应用补法与泻法（提插捻转）运针后发现，施行补法时曲池穴Ｐ０２上升，泻法时ＰＯ２下降。     

The Chiropractic Subluxation: Implications for Manual Medicine

Abstract

Objectives: Studies investigating the efficacy of intra-oral myofascial therapies (IMT) for chronic temporomandibular disorder (TMD) are rare. The objective of this randomized, controlled pilot study was to compare the effects of IMT and the addition of self-care and education over 6 months on four common TMD outcome measures: inter-incisal opening range, jaw pain at rest, jaw pain upon opening, and jaw pain upon clenching.

Participants: Thirty myogenous TMD participants between the ages of 18 and 50 years, experiencing chronic jaw pain of longer than 3-month duration, were recruited for the present study.

Intervention: Included patients were randomized into one of three groups: (1) IMT consisting of two treatment interventions per week for 5 weeks; (2) IMT plus 'self-care' involving education and exercises; and (3) wait list control.

Main outcome measures: Range of motion findings were measured in millimetres by vernier callipers and pain scores were quantified using an 11-point self-reported graded chronic pain scale. Measurements were taken at baseline, 6 weeks post-treatment, and 6 months post-treatment.

Results: The results showed statistically significant differences in resting, opening, and clenching pain and opening range scores (P<0.05) in both treatment groups compared to control at 6 months. No significant differences were observed between the two treatment groups during the course of the trial.

Conclusions: This study suggests that IMT alone or with the addition of self-care may be of some benefit in the management of chronic TMD over the short-medium term. A larger scale study over a longer term (1–2 years) may be of further value.     

Myofascial Trigger Points: Translating Molecular Theory into Manual Therapy

Abstract

Theories regarding the molecular pathophysiology of myofascial trigger points (MFTrPs) have undergone fundamental revisions in recent years. New research suggests that MFTrPs are evoked by the abnormal depolarization of motor end plates. The motor endplate transduces electrical potential into muscle contraction. This review article expands the proposed etiology to include presynaptic, synaptic, and postsynaptic mechanisms, such as excessive release of acetycholine (ACh), defects of acetylcholinesterase, and upregulation of nicotinic ACh receptors, respectively. Dysfunctional motor endplates and sustained muscular contraction give rise to a localized "ATP energy crisis" associated with sensory and autonomic reflex arcs that is sustained by central sensitization. This working hypothesis has given rise to several new approaches in the treatment of MFTrPs.     

Myofascial Trigger Points: An Evidence-Informed Review

Abstract

This article provides a best evidence-informed review of the current scientific understanding of myofascial trigger points with regard to their etiology, pathophysiology, and clinical implications. Evidence-informed manual therapy integrates the best available scientific evidence with individual clinicians' judgments, expertise, and clinical decision-making. After abrief historical review, the clinical aspects of myofascial trigger points, the interrater reliability for identifying myofascial trigger points, and several characteristic features are discussed, including the taut band, local twitch response, and referred pain patterns. The etiology of myofascial trigger points is discussed with a detailed and comprehensive review of the most common mechanisms, including low-level muscle contractions, uneven intramuscular pressure distribution, direct trauma, unaccustomed eccentric contractions, eccentric contractions in unconditioned muscle, and maximal or sub-maximal concentric contractions. Many current scientific studies are included and provide support for considering myofascial trigger points in the clinical decision-making process. The article concludes with a summary of frequently encountered precipitating and perpetuating mechanical, nutritional, metabolic, and psychological factors relevant for physical therapy practice. Current scientific evidence strongly supports that awareness and working knowledge of muscle dysfunction and in particular myofascial trigger points should be incorporated into manual physical therapy practice consistent with the guidelines for clinical practice developed by the International Federation of Orthopaedic Manipulative Therapists. While there are still many unanswered questions in explaining the etiology of myofascial trigger points, this article provides manual therapists with an up-to-date evidence-informed review of the current scientific knowledge.     

温针灸治疗肩周炎疗效观察

[目的]观察比较温针疗法与电针疗法治疗肩周炎的临床疗效。[方法]将84例肩周炎惠者分为治疗组(42例)和对照组(42例),治疗组采用温针疗法,对照组采用电针疗法治疗。10次为1疗程,3个疗程后统计疗效。[结果]治疗组的临床治愈率为71.4％,总有效率为95.2％,优于对照组的42.8％和78.6％(x2=7.0,P<0.01;x2=5.2,P<0.05)。[结论]对于肩周炎患青的治疗,温针疗法的疗效优于电针疗法。     

痛点多向滞针提拉法治疗肱骨外上髁炎的疗效观察

目的:观察痛点多向滞针提拉法治疗肱骨外上髁炎的疗效。方法:将76例肱骨外上髁炎患者随机分为2组,每组38例。Ⅰ组采用痛点多向滞针提拉法治疗,Ⅱ组采用温针灸治疗。治疗后比较两组视觉模拟评分的降低程度及治愈率。结果:治疗后两组患者的VAS评分均降低,与Ⅱ组比较,Ⅰ组降低更明显,差异有统计学意义(t=4.201,P=0.000);两组治愈率比较,Ⅰ组治愈率高于Ⅱ组(χ2=5.07,P=0.024)。结论:痛点多向滞针提拉法治疗肱骨外上髁炎的疗效优于温针灸,值得临床推广应用。     

穴位注射配合针刺运动疗法治疗肩周炎60例疗效观察

[目的]观察穴位注射配合针刺运动疗法治疗肩周炎的疗效.[方法]将120例肩周炎病人随机分为治疗组60例和对照组60例.治疗组采用当归注射液穴位注射配合针刺运动疗法,对照组采用当归注射液肌肉注射配合针刺运动疗法.2个疗程后(共治疗20次)评定疗效,并进行治疗前后肩关节运动功能综合评分的比较.[结果]治疗组治愈38例,显效15例.有效5例,无效2例,总有效率为96.7%;对照组治愈27例,显效16例,有效12例,无效5例,总有效率为91.7%;两组临床疗效比较,差异无显著性意义(P＞0.05),但治疗组的治愈率显著高于对照组(P＜0.01).治疗后两组的肩关节运动功能综合评分均有显著性改善(与治疗前比较,P＜0.01),且治疗组的改善作用显著优于对照组(P＜0.01).[结论]穴位注射配合针刺运动疗法治疗肩周炎临床疗效显著.     

Recommendations for Self-Statement Inventories: Use of Valence, End Points, Frequency, and Relative Frequency

Methodological confounds and inconsistencies inevaluations of self-statements hamper exploration ofconceptual issues in cognitive assessment. Although manymeasures incorporate both positives and negatives, there is confusion in reporting; rawfrequencies, difference scores, problematic ratios(positive/negative, negative/positive), andStatesof-Mind (SOM) ratios are all used. Here, weexamine methodological issues in evaluations of valencedself-statements in two studies and formulate empiricallybased guidelines for common usage. Our findings clearlyindicate that (a) valenced thought frequencies and SOM ratios yield different information, (b) in SOMratio calculations, inventory scale end points shouldalways start at 0, (c) if scales do not start at 0,scores can be converted mathematically, and (d) the higher the SOM score, the better theindividual's adaptation on various criterion measures;this includes even extremely positive SOMs (0.91 1).Thus, SOMs are monotonic and can be used in statisticalanalyses without transformation.