神经弹拨术治疗腰椎间盘突出症前后血液流变学改变

背景椎间盘在生理状态下是与循环隔绝的无血管组织,营养来源于周围血管的渗透作用.任何影响椎间盘周围毛细血管网的因素,都是影响椎间盘营养的危险因素,椎间盘的功能变化可能影响血液流变学系统及椎间盘本身的细胞代谢和转运.目的探讨神经弹拨术治疗腰椎间盘突出症(Protrusion of lumbar intervertebral disk,LIDP)前后与血液流变学的相关性.设计非随机对照的研究.地点和对象1999-01/2001-12菏泽市立医院收治LIDP患者100例,男63例,女37例;年龄17～60岁,平均35.84岁;病程2 d～14年.健康组50例为健康体检抽取,男28例,女22例;平均37.63岁.干预对100例LIDP患者应用神经弹拨术治疗前后及50例健康成年人的血液流变学9项指标进行检测比较.全血自动黏度快测仪测定全血比高切、中切及低切黏度值.血细胞比容(HCT)采用温氏(Wintrobe)法.红细胞沉降率(FSR)采用魏氏国际标准法.红细胞降率K值,经公式换算而成.血浆纤维蛋白原采用亚硫酸钠比浊法.体外血栓长度采用SDZ-Ⅱ型体外血栓测定仪测定.体外血栓湿重采用TG328A电光分析天平测定.要观察指标检测血液流变学指标.结果100例患者治疗前血细胞比容、全血比黏度(高切、中切及低切)、体外血栓长度及湿重分别为0.44±0.03,(5.78±0.46),(7.74±0.69),(15.49±1.04)mPa·s,(17.69±5.14)mm,(69.49±15.14)mg,高于健康组0.43±0.03,(5.59±0.36),(7.30±0.46),(14.86±1.02)mpa·s,(14.10±2.46)mm,(58.98±12.31)mg],而治疗后又趋于正常,t=2.74～6.10,P＜0.05或P＜0.01.结论LIDP患者血流呈黏稠倾向,其病因及疗效可能与血液流变学相关,疼痛解除血液流变学恢复正常.

Changes of hemorheology before and after nerve tan bo shu therapy in patients with prolapse of lumbar intervertebral disc

BACKGROUND: Under physiological condition, intervertebral discs are avascular tissues that are isolated from circulation and their nutrition originates from osmosis of the blood vessels around. Any factor that can influence the capillary networks around the intervertebral discs is the risk factor that can influence the nutrition of them. The changes of intervertebral disc function can probably influence the hemorheological system and the cell metabolism and transport of the intervertebral discs themselves.OBJECTIVE: To investigate the correlation between nerve tan bo shu therapy in patients with protrusion of lumbar intervertebral disc(LIDP) and the hemorheology.DESIGN: A nonrandomized controlled study was conducted.SETTING and PARTICIPANTS: One hundredpatients with LIDP treated in the Heze Municipal People's Hospital from January, 1999 to December,2001, with 63 males and 37 females, aged 17 -60 years old(a mean age of 35.84 years old).The course of disease was from 2 days to 14 years. Fifty patients in health group were selected from health examination, 28 males and 32 females, averaged 37.63 years old.INTERVENTIONS: Nine hemorheological indexes of 100 patients with LIDP before and after nerve tan bo shu therapy and 50 healthy adults were detected and compared. The whole blood specific viscosity(WBSV) of high,middle and low degree was measured by an automatic fast determination instrument of the whole blood viscosity; hematocrit(HCT) by Wintrobe's method; erythrocyte sedimentation rate(ESR) by Westergren's international standard method; K(ESR rate) was worked out by formula conversion; plasma fibrinogen(Fib) was measured by sodium sulfite turbidimetry; length of external thrombus by external thrombus determination instrument of SDZ-2; wet mass of external thrombus by TG328A photoelectric analytical balance.MAIN OUTCOME MEASURES: The hemorheological indexes were detected.RESULTS: The HCT, whole blood specific viscosity(high, middle and low degree), length and wet mass of external thrombus were (0. 44 ±0. 03),(5. 78 ± 0. 46), (7.74±0.69), (15.49±1.04) mPa·s, (17.69±5.14) mm, (69.49 ± 15.14) mg respectively and which were higher than those of health group (0.43 ± 0. 03), (5.59 ± 0.36), (7.30 ± 0. 46),(14.86±1.02) mpa· s, (14.10±2.46) mm, (58.98±12.31)mg] .After treatment, these indexes became normal( t = 2. 74 - 6. 10, P ＜ 0.05 or P ＜ 0. 01).CONCLUSION: The blood of patients with LIDP has a tendency to be ropy and the cause and the curative effect are probably related to the hemorheology that can return to normal after the pains are eliminated.