中医对脊柱相关疾病中眩晕与腰痛的认识

脊柱相关疾病是指颈、胸、腰椎的骨关节、椎间盘及椎周围软组织遭受损伤或退行性改变，在一定诱因条件下发生脊柱小关节错位、椎间盘突出、韧带钙化或骨质增生，直接或间接对神经根、椎管内外血管、脊髓或交感神经等产生刺激或压迫，导致脊椎损伤疾患以外的多系统症状和体征的疾病。本文将对眩晕和腰痛从中医的病因病理、与经络的关系、治疗方法等方面做一综述。     

Ergebnisse einer Doppelblindprüfung Diclofenac+Vitamin B1, B6, B12 versus Diclofenac bei Patienten mit akuten Beschwerden im Lendenwirbelsäulenbereich

Summary Several clinical trials have shown that the duration of treatment of painful vertebral syndromes can be shortened by using a combination of vitamins B₁, B₆, B₁₂ and diclofenac instead of diclofenac. In addition, a more efficient pain relief could be achieved by the combination therapy.In order to confirm these results, we compared the clinical efficacy of diclofenac (25 mg) and a combination preparation with diclofenac (25 mg) plus vitamins B₁ (thiamine nitrate 50 mg), B₆ (pyridoxine hydrochloride 50 mg) and B₁₂ (cyanocobalamin 0.25 mg) in a multicentric randomized double-blind study including 418 patients. All patients received 3×2 capsules daily for a maximum of 2 weeks. In case of total pain relief, therapy should be discontinued after one week.Data of 376 patients could be evaluated. 53 out of 184 patients receiving the combination and 48 out of 192 patients treated with diclofenac alone could stop therapy due to sufficient pain relief after one week.The evaluation of the Hoppe Pain Questionnaire and the data concerning pain intensity also revealed better results for the combination preparation. The differences in favour of the B-vitamin-diclofenac-combination were statistically significant in patients with severe pain at the beginning of therapy.Considering undesirable side-effects (symptoms in 70 out of 418 patients) there were no significant differences between the two medications.This clinical trial provides further evidence that the combination therapy with diclofenac plus B-vitamins is more effective than diclofenac alone for the treatment of painful vertebral syndroms.

     

Einsparung von Diclofenac durch B-Vitamine: Ergebnisse einer randomisierten Doppelblindprüfung mit reduzierten Tagesdosierungen von Diclofenac (75 mg Diclofenac versus 75 mg Diclofenac plus B-Vitamine) bei akuten Lendenwirbelsäulensyndromen

Summary Pain syndromes of the lumbar spine are one of the main problems in orthopedic practice. The therapeutic effect of NSAIDs is not subject to doubt in this connection.But considering that the application of NSAIDs is frequently associated with side effects, a reduction of dosage would be to the patient's benefit. Clinical studies have shown that concomitant treatment with vitamins B₁, B₆, B₁₂ and diclofenac leads to a more efficient pain relief than treatment using diclofenac alone and thus provides the possibility of saving NSAIDs.This clinical trial was carried out in order to determine whether these results can also be achieved when a reduced dosage of diclofenac (75 mg daily) is used.123 patients with acute pain syndromes of the lumbar spine were treated with either B-vitamins and diclofenac or diclofenac alone for a maximum of 7 days. There was the option to terminate therapy in the trial after 3–4 days in the case of total pain relief.45 patients could stop the treatment due to remission of symptoms. 30 patients belonged to the combination therapy group, the other 15 took diclofenac alone; this difference is statistically significant (p< 0.05).All parameters concerning pain relief and movement of the vertebral column showed statistically significant differences in favour of the B-vitamin-diclofenac-combination, too.The results document the positive influence of B-vitamins on painful vertebral syndromes and indicate that B-vitamins contribute to saving of NSAIDs by shortening the treatment time and reducing daily NSAID-dosage.

     

主诉腰痛女性患者骨密度和骨质疏松患病率分析

目的研究主诉腰痛女性患者腰椎和髋部骨密度(BMD)测量的临床意义及骨质疏松(OP)患病率。方法采用扇形束双能X线骨密度仪(DEXA)测量主诉为腰痛的女性患者的腰椎和髋部BMD,并与对照组的BMD比较,同时比较其相应骨质疏松(OP)患病率。结果临床主诉以腰痛为主的女性病人腰椎及髋部BMD比以关节痛或全身痛为主诉者的低,(P＜0.05);主诉腰痛者各骨骼部位的OP检出率明显高于关节痛或全身痛者,且均与正常对照组有显著性差异(P＜0.05)。结论骨质疏松是女性腰痛病人就诊的主要原因之一,腰痛患者OP患病率较高;腰椎BMD测定是诊断骨质疏松症的重要手段。     

Acupuncture treatment of 32 cases of lumbar intervertebral disc protrusion

Yaoyangguan (GV 3), Shiqizhui (Ex-B 8) and Yanglingquan (GB 34) were selected as main points and a three-part needle insertion technique was used to treat 32 cases of lumbar intervertebral disc protrusion. The curative rate was 96.9%. Deep puncture is the key to the treatment. Author: Chen Feng(1962-), male, junior consultant doctor Translator: Wang Si-you     

Prevalence of facet joint arthrosis in lumbago patients–CT scan evaluation

IntroductionThere are multiple causes of low back pain (LBP), the leading ones being degeneration of intervertebral disc, lumbar spinal stenosis(LSS) and facet joint arthrosis(FJA). There are number of studies done earlier on disc degeneration and LSS, however the studies on facet joint arthrosis are limited and incomplete. Hence the present study was undertaken to assess the prevalence of FJA of lumbar spine in lumbago patients of Delhi NCR region of India.MethodThe present study was conducted in the Departments of Radiodiagnosis of Santosh Medical College, Ghaziabad and Safdarjung Hospitals, New Delhi. Thirty eight patients were selected for CT scan imaging after pre-defined questionnaire and informed consent. The images were assessed on Philips Dicom viewer for facet joint arthritic changes.ResultsA high prevalence of 52.6% was seen in cases of LBP. FJA was seen in 80% of female cases and the highest prevalence of arthrosis was seen at lumbar spinal level of L4-L5.DiscussionFacet joint arthrosis plays an important role in low back pain. The prevalence of FJA increases caudally from L1 to L5, with the highest incidence being at the L4–L5 spinal level. The prevalence of FJA is seen more in females than males.     

腰腿痛患者报告结局量表的应用分析

目的:检验腰腿痛患者报告结局量表的信度、效度及反应度.方法:2010年8月至2012年1月,纳入住院腰椎间盘突出症及腰椎管狭窄症患者患者200例,男93例,女107例;年龄22～65岁,平均50.3岁;腰椎间盘突出症144例,腰椎管狭窄症56例 应用腰腿痛患者报告结局量表对患者进行测评,并对量表进行信度、效度、反应度分析.结果:39例病情无变化患者两次评分无显著性差异(P＞0.05),且有显著相关性(r＞0.9);该量表同Oswestry功能障碍指数问卷(ODI)对患者评分结果具有显著相关性(r＞0.8);该量表总体克朗巴赫α系数为0.931,总体Guttman折半系数为0.912;该量表KMO统计量为0.919,Bartlett球形检验卡方值l 882.975(P＜0.01),因子分析方法提取特征根值＞1的3个公因子,累计贡献率为64.364％;43例病情有好转患者两次评分结果分别为34.80±9.00和28.77±8.73,两者差异有统计学意义(P＜0.01).结论:腰腿痛患者报告结局量表有较好的信度、效度及反应度,可作为腰腿痛患者临床疗效的评价工具.     

腰痛灵栓治疗椎间盘突出与活血化瘀的关系

目的:观察腰痛灵栓(川乌、桂枝、麝香等)对椎间盘突出的抗炎、镇痛与活血化瘀的关系。方法:建立大鼠化学神经根炎模型,观察腰痛灵栓对炎症、痛阈、步态和血清中磷脂酶A2(PLA2)、肾上腺素、去甲肾上腺素含量的影响;采用大鼠寒凝型血瘀证模型观察其对血液流变性的影响;用小鼠耳廓微循环法观察其对微循环的作用。结果:腰痛灵栓剂对大鼠神经根炎模型的炎症有显著的抑制作用、对其步态和痛阈有明显恢复作用,能显著降低血清中磷脂酶A2(PLA2)的含量,对肾上腺素、去甲肾上腺素的水平有升高趋势;能显著改善“血瘀”大鼠的血液流变性,显著改善小鼠耳廓微循环。结论:腰痛灵栓的抗炎、镇痛作用与活血化瘀作用密切相关。     

有限手术原则治疗腰痛伴坐骨神经痛

有限手术治疗原则是指对腰腿痛患者以临床症状和体征为依据，由简到繁，循序渐进选择性地应用各种特殊检查，尽可能用最简单的检查手段获得确实的节段定位诊断，并有针对性地对神经根和硬膜囊确切受压部位减压，最大限度保持腰椎的稳定性，对丧失者及时重建。本文介绍了诊断程序和治疗方法的选择。７７例腰痛伴坐骨神经痛患者按上述原则检查和治疗，经平均４．７年的随诊，优良率为８４．４％，．４例发生ＦＢＳＳ（５．６％）。     

腰痛Ⅰ号方治疗实验性神经根炎的病理学观察

腰痛I号治疗实验性大白鼠神经性根炎的病理组织学改变的结果表明：腰痛I号可使炎症减轻,促进变性神经纤维的恢复,减少胶质细胞和胶质纤维的增多,减轻瘢痕化及瘢痕对周围神经组织的挤压。