BackgroundLumbar disc herniation with radiculopathy (LDHR) is a leading cause of disability worldwide. For patients with moderate pain, Traditional Chinese Medicine approaches, including Yaobitong (YBT) capsules and lumbar oblique pull manipulation (LOPM), are widely used in clinical practice, often in combination. However, high-quality evidence supporting the superiority of this combination over monotherapy is lacking. This multicenter, randomized, three-arm, parallel-group controlled trial conducted at 13 tertiary hospitals in China aimed to evaluate the efficacy and safety of combining YBT with LOPM in LDHR patients with moderate pain.MethodsA total of 426 LDHR patients with moderate pain (Visual Analogue Scale [VAS] score ≥ 4 to < 7) were randomly assigned to receive either YBT alone (n = 146), LOPM alone (n = 137), or a combination of both (n = 143). The primary outcome was change in the Oswestry Disability Index (ODI) from baseline to week 2. Secondary outcomes included leg pain VAS scores, low back pain VAS scores, 12-Item Short Form Health Survey (SF-12), adverse events, and disc resorption rates. Outcome measurements were assessed at baseline, 3 days, 1 week, 2 weeks, 6 weeks, 14 weeks, and 26 weeks.ResultsAt 2 weeks, the mean reduction in ODI was −19.4 (95% CI, −21.4 to −17.5) in the YBT group, −19.4 (95% CI, −21.4 to −17.5) in the LOPM group, and −21.1 (95% CI, −23.0 to −19.1) in the combination group. The adjusted mean difference was 0.5 (95% CI, −2.3 to 4.9; p = 0.99) for YBT versus combination and 1.3 (95% CI, −2.1 to 5.1; p = 0.68) for LOPM versus combination. No statistically significant differences in ODI reduction were detected between groups at any follow-up time point (all p > 0.05). No statistically significant differences in any of the secondary outcomes were detected between groups at any follow-up time point (all p > 0.05). No apparent safety signal was observed in any of the three groups during the short 2-week intervention period.ConclusionThe combination therapy with YBT and LOPM was not superior to either monotherapy in improving functional disability, pain, or quality of life among LDHR patients with moderate pain.Clinical trial registrationhttps://www.chictr.org.cn, ChiCTR2200066051.

Background: Baimai ointment is a traditional Tibetan topical ointment, which is widely used for various diseases related to the skeletal muscular system and neurological rehabilitation. It has demonstrated good clinical effectiveness. However, there is currently a lack of high-quality evidence regarding the clinical effectiveness of Baimai ointment in treating lumbar disc herniation (LDH). Purpose: In this study, we conducted a prospective, multicenter, double-blind, randomized controlled trial at eight hospitals in China to investigate the clinical effectiveness of Baimai ointment in the treatment of LDH. Methods: Participants aged 18-65 years were diagnosed as LDH and were randomly assigned to receive either Baimai ointment or placebo. The treatment duration was 2 weeks, with 1-week follow-up after treatment. The primary outcome measures included VAS and JOA score. The secondary outcome measures included Likert scale, compliance with health education and the incidence of rescue therapy. The intervention effects on these outcomes were examined by generalized estimating equations (GEE) with baseline measurement as the covariates. All statistical analysis were performed using SPSS 25.0 and Python 3.11. Results: In total, 228 participants were screened from August 25, 2021 to January 31, 2022 at 8 Grade-A tertiary hospitals in China. Finally, 194 eligible participants were randomly assigned to the Baimai ointment group and placebo group in a 1:1 ratio. At the end of 2-week treatment (14th day) and 1-week follow-up after treatment (21st day), the decrease of VAS reached 39.57% (95% CI: 34.29, 44.86) and 36.85% (95% CI: 32.04, 41.66), the decrease in JOA score reached 27.74% (95% CI: 23.05, 32.43) and 26.25 % (95% CI: 20.82, 31.69) in Baimai ointment group. A significant group-by-time interaction indicated a difference for VAS between intervention over time (chi(2) = 26.81, p = 0.020), but JOA score and Likert scale did not reach statistical significance. The adjusted net difference of VAS was statistically significant from 10th day of treatment (p < 0.05). After 2-week treatment, the relief rate of VAS was 30.85% (21.95, 41.34) in Baimai ointment group and 22.73% (14.75, 33.13) in placebo group (chi(2) = 1.53, p = 0.217). It demonstrated Baimai ointment in improving VAS and JOA score was valuable from a clinical view by measuring MCID. Moreover, the Likert scale, the incidence of rescue therapy and compliance with health education did not reach statistical significance. There was no evidence showing that Baimai ointment could cause serious adverse reactions in treating patients with LDH. Conclusion: Baimai ointment demonstrated significantly higher rates of symptom relief compared to the placebo for LDH patients, particularly in terms of relieving pain. Moreover, further high-quality randomized controlled trials were necessary to confirm these positive results. The study protocol is registered with the Clinical Trials Registry (registration number: ISRCTN11912818).

目的 观察针刀镜下松解术联医用几丁糖注射治疗冻结肩的临床疗效.方法 回顾性分析45例采用针刀镜下松解术联合医用几丁糖注射治疗的冻结肩患者临床资料.比较术前、术后1周、术后1个月、术后3个月的肩关节疼痛视觉模拟量表(VAS)评分、Constant-Murley肩关节功能评分.评价临床疗效,记录切口愈合情况及不良反应发生情况.结果 与术前相比,术后1周、术后1个月、术后3个月患者VAS评分均明显降低,Constant-Murley肩关节功能评分明显升高,差异均具有统计学意义(P＜0.01).随着时间的变化,VAS评分逐渐降低,Constant-Murley肩关节功能评分逐渐升高,差异均有统计学意义(P＜0.01).治疗有效率为91.11%,手术过程中无不良反应发生,术后切口Ⅰ期愈合.结论 针刀镜下松解术联合医用几丁糖注射治疗冻结肩,可明显缓解肩关节疼痛症状,改善肩关节功能,且损伤小,操作简便,安全性高.

目的:探讨零切迹颈椎前路椎间融合术(Anterior Cervical Discectomy and Fusion,ACDF)治疗双节段颈椎病术后矢状位参数的变化.方法:回顾性分析2017年5月至2021年5月行双节段椎间融合且使用ROI-C融合器的患者,建立Excel数据库,观察胸1倾斜角(T1S)、C2～7 Cobb角、C2～7矢状面轴向距离(C2～7 SVA)及手术节段角(SA)术前及末次随访时的变化.采用t 检验或非参数检验分析术前及末次随访时各数据是否存在差异;Pearson相关或秩相关(Spearman法)分析各数值之间的相关性.结果:共纳入35例患者,男12例,女23例;年龄为46～69岁,平均为(57.94±6.05)岁;随访时间为6～38个月,平均为(9.23±7.97)个月.手术节段C3～4、C4～5 1例,C4～5、C5～6 20例,C5～6、C6～7 14例.末次随访时T1S、C2～7 Cobb角及手术节段角较术前增加,差异有统计学意义(P＜0.05).相关性:T1S与C2～7 Cobb角、T1S与C2～7矢状面轴向距离、T1S与手术节段角及C2～7 Cobb角与手术节段角之间存在正相关性(P＜0.05).结论:对于双节段颈椎病患者,使用ROI-C融合器行颈椎前路椎间融合术能够改善颈椎矢状位参数,恢复颈椎矢状位平衡,对于颈椎病的治疗有积极作用.

脊髓型颈椎病由于脊髓受压的程度、范围等不同,导致临床症状复杂多样. 部分患者临床表现与脑梗死相一致,极易误诊为脑梗死[1] . 本院收治 1例误诊为脑梗死的脊髓型颈椎病患者,行颈椎前路手术取得了满意的临床疗效,现报告如下.

Objective:To investigate the clinical effect of buccal acupuncture on the patients with pain and functional limitation after posterior lumbar interbody fusion based on the concept of enhanced recovery after surgery.Methods:The medical records of 47 patients who underwent posterior lumbar interbody fusion in the Dongzhimen Hospital of Beijing University of Chinese Medicine from October 2020 to March 2021 were collected for a retrospective study.The patients were assigned into an observation group（n=26） and a control group（n=21） according to the treatment methods.The control group received celecoxib at a dose of 200 mg/qd, and the observation group additionally received buccal acupuncture at 30 min/qd.The visual analogue scale（VAS） score, Japanese Orthopaedic Association（JOA） score, interleukin-6（IL-6）,white blood cell count（WBC）,neutrophil count（NE）,and C-reactive protein（CRP） were compared between the two groups on days 1,3,and 7 after operation.Results:On day 7 after operation, the mean VAS score of the observation group was lower than that of the control group（P＜0.05）,and the JOA score was different between the two groups（P＜0.05）.On day 3 after operation, the WBC,NE,CRP,and IL-6 showed differences between the two groups（P＜0.05）.On day 7 after operation, the observation group had lower CRP and IL-6 than the control group（P＜0.05）.Conclusion:The observation group outperformed the control group in restoring the scores and indicators.Buccal acupuncture can effectively alleviate postoperative pain and inflammatory response and helps to reduce or eliminate the physical and mental impairment of patients with early functional exercise.This therapy is in accordance with the concept of enhanced recovery after surgery.Moreover, it is characterized by low cost and simple acupoint selection, and thus is worthy of promotion in clinical practice.

Objective: To evaluate the efficacy and safety of Baimai ointment in patients with lumbar disc herniation (LDH). Methods: This study presents a prospective randomized, double-blind, placebo-controlled, multicenter clinical trial protocol. A total of 194 cases will be employed, with a 1:1 allocation ratio for each group. Patients will receive either Baimai ointment or placebo over a 14-day treatment period, which will be followed by a 1-week follow-up period. Visual analogue scale scores will be used for the level of pain, the Japanese Orthopedic Association score will be measured primarily to determine the functional status, the Likert scale will be graded for the level of numbness, and rescue therapy use and compliance with health education will be recorded. Laboratory tests and adverse event records will also be applied for safety assessments. Discussion: In summary, this trial will assess the clinical efficacy and safety of Baimai ointment for LDH for the first time. The use of a placebo has the advantage of precluding anticipatory biases resulting from inadequate blinding. Outcome assessors, data managers, statisticians, and all related study staff will be blinded to avoid any bias caused by subjective factors in the study subjects and investigators. Valuable information for clinical LDH treatment and future research on Baimai ointment will be generated from the findings.

目的:探讨皮质骨轨迹(CBT)椎弓根螺钉治疗腰椎后路融合术后邻椎病(ASD)的疗效和优势.方法:回顾性分析2017年9月至2021年7月应用皮质骨轨迹椎弓根螺钉治疗邻椎病23例患者临床资料.其中男7例,女16例;年龄为58～81岁;与初次手术间隔时间为1.7～10.0年.统计患者体重指数(BMI)、手术节段、手术时间、术中出血量、手术并发症等.通过影像学检查判断是否发生内固定松动、假关节形成和再次邻近节段退变.比较术前及末次随访时腰痛和腿痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,评估患者手术前后疼痛缓解和功能改善情况.结果:所有患者均顺利完成手术,手术时间为(210±38)min;术中出血量平均为309 mL(300～400 mL).2例术后并发急性膀胱炎,给予抗感染后治愈.未出现螺钉松动及假关节形成等内固定相关并发症,未再次出现症状性邻近节段退变.术前患者腰痛VAS评分为(4.8±1.1)分,腿痛评分为(6.1±1.6)分,ODI评分为50.6％±8.3％.末次随访患者腰痛VAS评分为(1.7±0.5)分,腿痛评分为(1.3±0.4)分,ODI评分为13.5％±5.1％.所有患者随访时间平均为37个月(17～52个月),末次随访患者各指标评分均较术前明显改善,差异有统计学意义(P＜0.01),总体临床效果满意.结论:皮质骨轨迹椎弓根螺钉应用于腰椎术后邻椎病,有损伤小、抗拔出力强的优势,可作为腰椎邻椎病手术方案.

BACKGROUND: The treatment of cervical spondylosis with total disc replacement can retain the range of motion of the cervical lesion segment and can effectively improve the symptoms of cervical spondylosis with sympathetic symptoms. OBJECTIVE: To investigate the clinical efficacy of total disc replacement for cervical spondylosis with sympathetic symptoms.METHODS: Retrospective analysis was made on 56 patients with cervical spondylosis with obvious sympathetic symptoms such as dizziness and headache who were operated on from December 2018 to December 2021. The sagittal parameters of the cervical spine before, 3 months after surgery and at the last followup were observed and compared, including cervical sympathetic symptom score and Japanese Orthopaedic Association Scores, operation segment angle, C2-C7 Cobb angle, C2-C7 sagittal vertical axis and T1 slope. The correlation between the changes in sympathetic symptoms and Japanese Orthopaedic Association Scores before and after surgery and the changes in cervical sagittal parameters before and after surgery was analyzed. RESULTS AND CONCLUSION:（1） All patients showed improvement in sympathetic symptoms after surgery, and the sympathetic symptom scores and Japanese Orthopaedic Association Scores were significantly improved at 3 months and at the last follow-up compared with those before surgery（P ＜ 0.05）, but Japanese Orthopaedic Association Scores did not show significant differences at the last follow-up compared with those at 3 months after surgery（P ＞ 0.05）.（2） The cervical sagittal parameters increased at 3 months and at the last follow-up compared with those before surgery, but not at the last follow-up compared with those at 3 months after surgery（P ＞ 0.05）.（3） The pre-and post-operative change values of sympathetic symptom scores significantly correlated with the preand post-operative change values of operation segment angle and C2-7 Cobb angle（P ＜ 0.05）.（4） The results indicate that total disc replacement has a good effect in the treatment of cervical spondylosis with sympathetic symptoms, which is conducive to restoring the sagittal parameters of the cervical spine and alleviating the sympathetic symptoms of patients.

目的 探究益气化瘀方结合神经妥乐平对脊髓型颈椎病术后患者神经功能恢复、生活质量及机体氧化应激反应的影响.方法 选取2017年6月—2019年12月因脊髓型颈椎病在北京中医药大学东直门医院行颈椎前路人工间盘置换术的患者68例,随机分为对照组和观察组各34例.对照组术后采用神经妥乐平口服治疗,观察组术后采用神经妥乐平和益气化瘀方口服治疗,2组均连续治疗1个月.记录2组患者术前及术后2周、1个月、3个月、6个月、1年的颈椎JOA评分、生活质量NDI评分,于治疗前和治疗1个月后采用酶联免疫吸附法测定患者血清丙二醛(MDA)、总抗氧化能力(T-AOC)、去甲肾上腺素(NE)及皮质醇(Cor)水平.结果 2组患者术后各时间段颈椎JOA评分均明显高于术前(P均<0.05);2组患者术前、术后2周、术后1个月、术后3个月颈椎JOA评分比较差异均无统计学意义(P均>0.05),观察组患者术后3个月、6个月、1年的颈椎JOA评分均明显高于对照组(P均<0.05).2组患者术后各时间段NDI评分均明显低于术前(P均<0.05);观察组患者术后2周、1个月、3个月的NDI评分均明显低于对照组(P均<0.05);术后6个月和术后1年,2组NDI评分比较差异均无统计学意义(P均>0.05).治疗1个月后,观察组血清MDA、NE及Cor水平均明显低于对照组,T-AOC水平明显高于对照组,差异均有统计学意义(P均<0.05).结论 益气化瘀方联合神经妥乐平治疗,在早期可通过消炎止痛、减轻氧化应激反应作用,减轻脊髓型颈椎病术后患者疼痛,保护神经,改善患者生活质量,在长期疗效中能够显著促进患者术后神经功能恢复.

目的 探讨矢状位参数在颈椎前路椎间盘切除减压植骨融合术治疗3节段脊髓型颈椎病中的价值.方法 采用颈椎前路椎间盘切除减压植骨融合术(ACDF)治疗36例3节段脊髓型颈椎病患者.比较手术前后手术节段角度(SA)、C2～7 Cobb角、C2～7矢状位轴向距离(C2～7 SVA)和T1倾斜角(T1 S),分析手术前后颈椎矢状位参数间及其与颈椎JOA评分的相关性.结果 患者均获得随访,时间6～24(12.59±10.21)个月.T1S、C2～7 Cobb角、SA、JOA评分术后均较术前明显增加(P<0.05).C2～7SVA术前与术后比较差异无统计学意义(P>0.05).手术前后T1S、C2～7 Cobb角、SA、JOA评分相互呈正相关关系(P<0.05).术前C2～7SVA与术前T1S、C2～7 Cobb角、SA、JOA评分无相关关系(P>0.05).术后C2～7SVA与术后C2～7 Cobb角、SA、JOA评分呈负相关关系(P<0.05).术前与术后颈椎矢状位参数间变化量的相关性分析显示,ΔT1S、ΔC2～7 Cobb角、ΔSA与ΔJOA评分相互呈正相关关系(P<0.05),ΔC2～7SVA值与ΔC2～7 Cobb角、ΔSA、ΔJOA评分呈负相关关系(P<0.05).结论 ACDF治疗3节段脊髓型颈椎病疗效显著,并且可以加强颈椎各矢状位参数之间的相关性,最终达到恢复颈椎矢状位参数平衡的目的.

目的:对比单纯经皮椎体成形术（PVP）与应用刮匙器结合PVP治疗椎体内缺血性骨坏死（Kummell病）的临床疗效。方法:对本科2019年1月至2021年3月期间诊断为Ⅰ期或Ⅱ期Kummell病且行单纯PVP或刮匙器结合PVP治疗的35例患者进行回顾性研究，其中观察组15例采用刮匙器结合PVP治疗，对照组20例采用单纯PVP治疗。对比两组手术前、术后第3天、术后3个月随访时的视觉模拟评分法（VAS）评分、Oswestry功能障碍指数（ODI）、椎体前缘高度、Cobb角。同时观察术中骨水泥填充情况、渗漏情况、分布情况及相关并发症。结果:术中骨水泥注入量观察组与对照组差异有统计学意义（P＜0.05）;观察组发生骨水泥渗漏2例，其中椎体前骨水泥渗漏1例，上终板渗漏1例，对照组见椎体前渗漏1例，观察组骨水泥渗漏率比较对照组，差异无统计学意义（P＞0.05）。两组患者术后第3天的VAS评分、ODI、椎体前缘高度、Cobb角较术前均有好转，差异有统计学意义（P＜0.05）。观察组术后3 d VAS评分、ODI、椎体前缘高度及Cobb角较对照组差异无统计学意义（P＞0.05）。术后3个月随访时各指标与术后3 d比较差异无统计学意义（P＞0.05）。术后X线显示观察组11例患者骨水泥分布呈弥散型，4例呈团块型，对照组中13例呈致密团块型，7例呈弥散型，差异有统计学意义（P＜0.05）。结论:刮匙器结合PVP相较于单纯PVP,二者在缓解患者腰背部疼痛，改善功能，恢复后凸畸形及椎体高度方面没有明显差异。但刮匙器的使用可以使得骨水泥在椎体内更加充分地弥散，其是否有助于减少远期椎体再塌陷有待进一步研究。

目的:观察Z型拨针治疗腰背肌筋膜炎的临床效果.方法:回顾性分析2018年6月至2020年1月采用Z形拨针治疗腰背肌筋膜炎36例患者的病例资料,采用局部VAS评分评价患者疼痛改善情况,JOA评分、ODI评价腰部功能改善情况.结果:所有患者经过Z型拔针治疗1～3个疗程,2周及末次随访与术前相比,患者疼痛(VAS疼痛评分)、腰椎功能(JOA评分,ODI评分)均明显改善,差异有统计学意义(P＜0.05),总有效率为94.4％.结论:Z型拨针治疗腰背肌筋膜炎临床疗效确切,可明显缓解患者腰背部疼痛,改善腰部功能,适合临床推广应用.

目的 系统评价补肾活血法对骨质疏松性椎体压缩骨折(Osteoporotic vertebral compression fracture,OVCF)术后患者的疗效.方法 检索CNKI、WanFang、VIP、SinoMed、Pubmed、Embase、Co?chrane Library及Web of Science文献数据库,收集自建库至2021年8月补肾活血法治疗骨质疏松性椎体压缩骨折的随机对照试验,应用RevMan 5.4软件进行Meta分析.结果 纳入15项随机对照试验研究,共1208例患者,试验组608例,对照组600例,Meta分析结果显示:试验组临床疗效总有效率均优于单纯对照组[RR=1.19,95％CI=(1.11,1.28),P<0.00001];应用补肾活血法时长在3个月以上时间段,试验组VAS评分均优于对照组[MD=?0.86,95％CI(?0.98,?0.75),P<0.00001];试验组在提高骨质疏松骨折患者术后Oswestry功能障碍指数问卷(Oswestry disability index,ODI)评分方面优于对照组[MD=?6.51,95％CI(?7.14,?5.88),P<0.00001];干预时长为6个月时,试验组在增强骨硬度方面明显优于对照组[MD=?0.16,95％CI(?0.18,?0.14),P<0.00001],在提升血清骨钙素(BGP)水平明显高于对照组[MD=?3.72,95％CI(?4.67,?2.77),P<0.00001],在降低I型胶原交联羧基末端肽(CTX?I)方面明显优于对照组[MD=?106.87,95％CI(?116.18,?97.56),P<0.00001],在降低血清NTX?I方面略优于对照组[MD=?0.65,95％CI(?7.22,5.93),P=0.85].结论 补肾活血法在OVCF术后患者的疗效确切,能够更迅速的缓解疼痛,加快骨质疏松性椎体压缩骨折术后康复,改善骨代谢、增加骨矿吸收、增强成骨细胞活性、抑制破骨细胞活性、增强腰椎部骨密度.但仍需设计更大样本量、多中心的随机对照试验进行论证.

目的:对比单纯经皮椎体成形术(PVP)与应用刮匙器结合PVP治疗椎体内缺血性骨坏死(Kummell病)的临床疗效.方法:对本科2019年1月至2021年3月期间诊断为Ⅰ期或Ⅱ期Kummell病且行单纯PVP或刮匙器结合PVP治疗的35例患者进行回顾性研究,其中观察组15例采用刮匙器结合PVP治疗,对照组20例采用单纯PVP治疗.对比两组手术前、术后第3天、术后3个月随访时的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、椎体前缘高度、Cobb角.同时观察术中骨水泥填充情况、渗漏情况、分布情况及相关并发症.结果:术中骨水泥注入量观察组与对照组差异有统计学意义(P＜0.05);观察组发生骨水泥渗漏2例,其中椎体前骨水泥渗漏1例,上终板渗漏1例,对照组见椎体前渗漏1例,观察组骨水泥渗漏率比较对照组,差异无统计学意义(P＞0.05).两组患者术后第3天的VAS评分、ODI、椎体前缘高度、Cobb角较术前均有好转,差异有统计学意义(P＜0.05).观察组术后3 d VAS评分、ODI、椎体前缘高度及Cobb角较对照组差异无统计学意义(P＞0.05).术后3个月随访时各指标与术后3 d比较差异无统计学意义(P＞0.05).术后X线显示观察组11例患者骨水泥分布呈弥散型,4例呈团块型,对照组中13例呈致密团块型,7例呈弥散型,差异有统计学意义(P＜0.05).结论:刮匙器结合PVP相较于单纯PVP,二者在缓解患者腰背部疼痛,改善功能,恢复后凸畸形及椎体高度方面没有明显差异.但刮匙器的使用可以使得骨水泥在椎体内更加充分地弥散,其是否有助于减少远期椎体再塌陷有待进一步研究.

目的:运用网络药理学方法探讨身痛逐瘀汤治疗腰椎间盘突出症(LDH)的作用机制.方法:利用中药系统药理学数据库与分析平台(TCMSP)、化学专业数据库获取身痛逐瘀汤中各味中药的相关化学成分,于SwissTargetPrediction平台实现活性成分靶点预测;分别于人类基因数据库(GeneCards)、在线人类孟德尔遗传数据库(OMIM)、DisGeNET数据库检索LDH疾病靶点;将中药成分靶点与LDH靶点取交集,即身痛逐瘀汤治疗LDH的潜在作用靶点;应用Cytoscape软件构建身痛逐瘀汤治疗LDH的中药-化学成分-交集靶点网络图;利用String数据库完成蛋白质-蛋白质相互作用分析及关键靶点的筛选,运用Cytoscape构建网络图;通过DAVID平台对关键靶点进行基因本体(GO)富集分析和京都基因和基因组百科全书(KEGG)富集分析,初步揭示其作用机制.以髓核细胞作为实验研究对象,分为单纯压力组与中药组(加入身痛逐瘀汤中药血清干预),置于静水压加载装置,1 MPa加压干预下作用2、4、6 h,应用凋亡试剂盒检测髓核细胞的凋亡情况,通过蛋白质印迹法检测髓核细胞核因子κB p65、基质金属蛋白酶-13(MMP-13)、胱天蛋白酶3蛋白的表达情况.结果:筛选得到身痛逐瘀汤121个活性成分和871个作用靶点,LDH疾病相关靶点438个,身痛逐瘀汤治疗LDH的潜在作用靶点75个,关键作用靶点69个;GO及KEGG富集分析显示关键靶点主要通过参与癌症通路、促分裂原活化的蛋白激酶信号通路、磷脂酰肌醇-3-激酶-蛋白激酶B信号通路、肿瘤坏死因子信号通路、核因子κB信号通路等信号通路对LDH进行调控.身痛逐瘀汤可降低髓核细胞凋亡,降低核因子κB p65、MMP-13、胱天蛋白酶3的蛋白表达水平(P<0.05).结论:身痛逐瘀汤通过多成分、多靶点、多通路治疗LDH,其作用机制可能与核因子κB信号通路的抑制以及细胞外基质的分解代谢相关.

脊髓型颈椎病是临床常见的颈椎退行性病变疾患,其症状较重且常随病情进展而加重,因此需及时手术治疗,目前多采用减压融合术,但术后部分患者仍残留脊髓神经受损症状,西医目前尚无有效方法,而中医近年相关研究取得满意效果,能有效改善患者术后残留症状,并加速其脊髓神经功能康复.本文就脊髓型颈椎病术后脊髓神经功能康复的中医药治疗研究进行综述.

目的:观察钹针治疗是否为腰椎术后综合征的有效治疗方法.方法:回顾性分析2017年10月至2020年10月期间门诊收治的40例腰椎术后综合征患者,这些患者都曾进行腰椎开放手术且术后存在不同程度的腰痛症状,年龄56～78岁,平均65.5岁.入组后的患者都接受Z型钹针治疗,根据疼痛减轻、生活质量改善程度来评价临床疗效.结果:完成治疗后及末次随访时,患者VAS评分、Oswestry腰痛失能指数均较治疗前明显下降,且差异均有统计学意义(P＜0.05);末次随访时,改良MacNab评分标准优良率85.00％.结论:钹针治疗对多数腰椎开放手术后仍存在持续下腰痛的患者有效,但临床上需要严格区分腰椎术后综合征与腰椎手术失败综合征,只有严格控制适应证才能取得满意的治疗效果.

目的 了解腰椎术后自体血回输引流和单纯引流对患者预后的影响.方法 以本院骨科2018年8月～2020年9月住院行腰椎后路开放内固定+融合术的患者为对象,按术后采用的不同引流方式分为自体血回收引流组:从术后采用自体血回输装置引流的患者中随机抽取50名;单纯引流(对照)组:从术后采用引流袋引流的患者中随机抽取50名.回顾性比较分析2组患者的术后引流量、术后实际引流、总显性失血量、总自体血回输量,以及术后d1、d3、d7的贫血指标、感染指标及白蛋白水平.结果 2组患者的性别、年龄、手术耗时与手术节段具有可比性(P＞0.05),术前Hb、Hct、ALB、WBC、NE％以及术中出血量、术中自体血回输量及术后实际引流量相近(P＞0.05);术后d1、d3、d7的Hb、Hct、ALB、WBC、NE％、CRP,以及术前与术后的Hb、Hct、ALB差值,术后与术前的WBC、NE％、CRP差值均无明显差异(P＞0.05).自体血回收引流组与对照组患者术后引流量(mL)及总显性失血量(mL)分别为554.40±176.82 vs 337.80±102.43,1 048.40±282.87 vs 791.80±277.02(P＜0.05).结论 腰椎术后采用自体血回输引流较单纯引流增加了患者引流量,而对患者贫血、白蛋白及感染等指标的改善不明显;患者腰椎术后不宜常规使用自体血回输装置引流.