目的 观察针刺四关穴联合黄芪桂枝五物汤治疗脊髓损伤并四肢疼痛的效果.方法 对脊髓损伤并四肢疼痛患者分别行常规药物治疗(A组)、行针刺四关穴治疗(B组)、口服黄芪桂枝五物汤治疗(C组)及行针刺四关穴联合口服黄芪桂枝五物汤治疗(D组),通过美国脊柱损伤协会(ASIA)神经功能分级及视觉模拟评分法(VAS)来考察4种治疗对患者脊髓感觉和运动神经功能的改善及疼痛缓解的效果.结果 4组经不同治疗方式治疗后神经功能(脊髓感觉和运动神经功能)分级水平均明显提高,疼痛程度均明显降低.C组、D组治疗后的神经功能分级水平明显高于A组,B组、D组治疗后四肢疼痛程度明显低于A组,D组治疗后的神经功能分级水平明显高于B组、C组,疼痛程度明显低于B组、C组,C组治疗后的神经功能分级水平明显高于B组,B组治疗后四肢疼痛程度明显低于C组,差异均有统计学意义(均P＜0.05).结论 采用中医治疗能明显改善患者的脊髓损伤及缓解疼痛,针刺四关穴联合黄芪桂枝五物汤治疗,较单一治疗方式更有利于促进患者脊髓损伤的改善及四肢疼痛的缓解,值得临床推广运用.

目的 评价电针结合五苓散治疗脊髓损伤神经源性低顺应性膀胱患者的临床效果.方法 对脊髓损伤神经源性低顺应性膀胱患者行电针结合五苓散治疗,观察治疗前后及联合治疗与单一治疗在临床症状消失时间、膀胱功能及排尿功能中的差异.结果 联合治疗组与常规治疗和单一治疗组比较,尿频、尿急、尿痛时间均较低(P＜0.05),膀胱容量、最大排尿量、每次排尿量均较高(P＜0.05),残余尿量明显减少(P＜0.05).结论 电针结合五苓散治疗能有效提高脊髓损伤神经源性低顺应性膀胱患者疗效,具有临床推广价值.

目的 考察中低强度运动训练对早期高血压大鼠(SHR)中枢系统血管紧张素转化酶2-人血管紧张素(1-7)-G蛋白偶联受体[ACE2-Ang (1-7)-Mas]与血管紧张素转化酶-人血管紧张素Ⅱ-血管紧张紊1型受体(ACE-AngⅡ-AT1)轴的影响,探讨中低强度运动训练对SHR血压调节能力的作用机制.方法 采用大鼠跑台的训练方式对大鼠进行中低强度运动训练,采用静脉快速注射苯肾上腺素引起反射性心动过缓或过速,采用"尾套法"记录心率变化(△HR)、血压变化(△MAP),利用大鼠脑立体定位仪结合大鼠脑图谱进行大鼠中枢系统延髓腹外侧部(RVLM)、孤束核(NTS)和室旁核(PVN)组织的定位剥离,采用Real-time PCR检测ACE2-Ang(1-7)-Mas与ACE-AngⅡ-AT1轴血管紧张素转化酶2(ACE2)、G蛋白偶联受体(Mas)、血管紧张素转化酶(ACE)、血管紧张素1型受体(AT1)的mRNA表达.结果 与同源正常血压大鼠安静(WKY+Sed)组相比,自发性高血压大鼠安静(SHR+Sed)组LVEDP、LVM升高,-dp/dt max降低,差异均有统计学意义(P＜0.05),自发性高血压大鼠运动(SHR+ExT)组与自发性高血压大鼠安静(SHR+Sed)组相比,LVEDP、LVM降低,差异有统计学意义(P＜0.05)、+dp/dt max、-dp/dt max升高;与WKY+ Sed组相比,SHR+ Sed组压力反射敏感性(BRS)下降,差异均有统计学意义(P＜0.05),SHR+ ExT组的BRS较SHR+ Sed组增强,差异有统计学意义(P＜0.05);在RVLM、NTS及PVN中,与WKY+ Sed组相比,SHR+ Sed组ACE2均下降,差异均有统计学意义(P＜0.05),RVLM及PVN中的ACE、AT1上升,NTS中的AT1上升(P＜0.05);在RVL、MNTS及PVN中,WKY+ ExT组的ACE2、ACE、AT1与WKY+ Sed组差异无统计学意义,SHR+ ExT组的ACE2较SHR+Sed组增强,差异有统计学意义(P＜0.05),AT1下降,差异有统计学意义(P＜0.05),与WKY+ Sed组、WKY+ ExT组差异无统计学意义;在PVN中,与WKY+ Sed组、WKY+ ExT组相比,SHR+ ExT组的ACE增强,差异有统计学意义(P＜0.05).结论 中低强度运动训练通可能通过改善BRS、调节ACE2-Ang(1-7)-Mas与ACE-AngⅡ-AT1轴ACE2、ACE、AT1的表达改善自发性大鼠血压.

脊髓损伤所致的神经源性肠在临床上较为棘手,长期治疗效果不佳.现越来越多学者从不同方面对其进行研究,研究结果令人满意.有文献报道,美国每年脊髓损伤的发病人数约为12000例,其并发症包括神经源性肠、神经源性膀胱、性功能障碍等.

目的 研究补骨颗粒含药血清对软骨细胞硫氧还蛋白2 (Trx2)表达水平及信号转导通路的调控作用,揭示Trx2对软骨细胞凋亡的调控机理.方法 选取2016年9-12月之间接受膝关节表面置换的骨性关节炎(OA)患者和因车祸需行截肢手术患者的膝关节软骨组织,分为4组,A组用空白血清DMEM完全培养液培养第3代正常软骨细胞,B组用补骨颗粒含药血清DMEM完全培养液培养第3代正常软骨细胞,C组用空白血清DMEM完全培养液培养第3代OA软骨细胞,D组用补骨颗粒含药血清DMEM完全培养液培养第3代OA软骨细胞,比较不同血清对OA软骨细胞及软骨细胞的氧化歧化酶(SOD)值以及Trx2、凋亡信号调节激酶-1(ASK1)、硫氧还蛋白结合蛋白(TXNIP)及Caspase 3的mRNA和蛋白含量的影响.结果 不同血清处理细胞后,C组SOD含量、TXNIP蛋白含量均低于A、B、D组,Trx2、TRXR2、ASK1、Caspase 3 mRNA含量及蛋白含量均高于A、B、D组,差异有统计学意义(P＜0.05).结论 补骨颗粒含药血清通过调控TXNIP-Trx2-ASK1信号途径来发挥抵抗氧化应激和细胞凋亡作用,能够逆转OA软骨细胞的SOD值及Trx2、TRXR2等的mRNA及蛋白含量.

目的 观察悬吊运动疗法(SET)结合聚焦超声波治疗非特异性慢性下背痛(LBP)的疗效.方法 采用随机数字表法将50例LBP患者分为治疗组和对照组,其中对照组给予低周波、温磁振治疗,治疗组在上述基础上同时辅以SET训练、聚焦超声波.于治疗前、治疗3周后分别采用JOA腰背痛疗效判断标准对两组患者腰痛情况进行评定.结果 经3周治疗后,治疗组JOA下腰痛评分较对照组患者改善显著;治疗组患者JOA下腰痛评分改善率及治愈显效率亦优于对照组(P＜0.05).结论SET训练结合聚焦超声波可显著减轻LBP患者腰背痛症状,促其腰椎功能改善.

Objective To explore the clinical effects of treatment with neuromuscular electrical stim-ulation in neurogenic bladder (NB)caused by spinal cord injury. Methods Seventy-two cases of NB caused by spinal cord injury were divided into the electrical stimulation group (n=36)and the conventional therapy group (n=36)randomly. The conventional therapy group received conventional therapy,the electrical stimu-lation group received conventional therapy and neuromuscular electrical stimulation. The total efficiency,24 h frequency of urination,urinary output,residual urine volume each time and ASIA score were compared in two groups after treatment. Results The total efficiency,24 h frequency of urination,urinary output,residual u-rine volume each time and ASIA score of the electrical stimulation group were better than those of conventional therapy group [97.2% vs. 55.6%,(5.1 ±1.2)times vs. (8.3 ±2.2)times,(189.9 ±11.4)ml vs.(145.3 ±10.8)ml,(90.2 ±2.4)ml vs. (110.1 ±3.3)ml,P<0.05]. There was no statistical differ-ence of ASIA scores in two groups. There was no obvious adverse events in both groups. Conclusion Neuro-muscular electrical stimulation has specific advantage in treatment of NB caused by spinal cord injury,which can significantly improve the clinical symptoms and is conducive to the rehabilitation of patients.

Objective To investigate the timing options of conservative treatment and operation treatment for lum-bar intervertebral disc. Methods From May 2012 to August 2013,the clinical data of 120 patients with lumbar disc herni-ation were retrospectively analyzed. Ninety-four patients(78. 33% )underwent conservative treatment,mainly including ac-upuncture,traction,massage therapy,physical therapy and drug therapy. Twenty-six patients(21. 67% )underwent opera-tion treatment,the proportion was 21. 67% ,mainly including semi laminectomy and windowing method. Before and after treatment,the changes of symptoms and signs and recovery daily living were evaluated,and the treatment effects were com-pared. Results The total effective rate was 91. 48% in the treatment group and 92. 30% in the control group,there was significant difference(P ﹥ 0. 05). Conclusions The curative effects of conservative treatment and operation treatment for lumbar disc are the same. The key lies in strict master of contraindications in the treatment process,grasp the timing of treatment options,in order to improve the lumbar function of patients.

Objective To observe the effect of spinal decompression system DRX9000 and reduction traction manipulation in the treatment of lumbar disc herniation.Methods Eighty patients with lumbar disc herniation in the second hospital of Fuzhou were randomly divided into two groups,the observation group (40 cases) were taken electric traction treatment,the control group (40 cases)were taken the traditional manual traction.To observe the efficacy of the two groups before treatment and one month after treatment.Results One month after the treatment,33 cases were excellent in the observation group,5 cases were good,the excellent and good rate was 95％.In the control group,21 cases were excellent,good in 8 cases,the excellent and good rate was 72.5％,the difference between the two groups was significant(P ＜ 0.05).Compared with Oswestry score before and after treatment,the Oswestry scores decreased significantly in the treatment group (P ＜ 0.05).Conclusions Electric traction is a new method which is to restore its shape in the treatment of lumbar intervertebral disc lesion,it has a good clinical therapeutic effect.

目的探讨减重步行训练治疗胫腓骨骨折的效果。方法选择82例胫腓骨骨折手术患者,随机分为减重步行训练康复训练组和常规康复对照组,比较二组膝关节功能恢复状况及术后生活质量。结果观察组膝关节恢复优良人数及满意率明显高于对照组(P<0.05);生理领域明显优于对照组(P<0.05)。结论减重步行训练能够有效恢复胫腓骨骨折患者膝关节功能状况,提高患者生存质量。

Objective To investigate the effects of different catheterize ways on the bladder rehabilitation of spinal cord injury patients and its clinical application.Methods One hundred and eight patients with spinal cord injury were divided into 3 groups according to the different catheterization ways:intermittent catheterization group,the indwelling catheterization group and bladder made fistula group.The micturition function recovery,complications and urine dynamics index of the three groups were recorded.Results The total effective rate were 94.44％ (34/36),72.22％ (26/36),58.33％ (21/36) respectively in intermittent catheterization group,indwelling catheterization group and bladder made fistula group,and the difference was statistically significant (x2 =36.556,P =0.000).Complication rates were 2.78％ (1/36),22.22％ (8/36) and 27.78％ (10/36) respectively in intermittent catheterization group indwelling catheterization group,bladder made fistula group,and the difference was statistically significant (x2 =50.333,P＜0.05).In intermittent catheterization group,the biggest bladder capacity was (258.97 ± 32.15) ml,maximum urethral pressure was (54.18 ± 8.74) cm H2O,he biggest closure pressure was (32.58 ± 8.97) cm H2O and urinary function length was(6.28 ± 1.35) cm.As for Indwelling catheterization group,biggest bladder capacity was(178.18 ± 49.35) ml,maximum urethral pressure was (36.11 ± 10.12) cm H2O,the biggest closure pressure was(21.69 ± 10.45) cm H2O and urinary function length was(4.21 ± 1.57) cm; In Bladder made fistula group,the biggest bladder capacity,maximum urethral pressure,the biggest closure pressure and urinary function length were (154.88 ± 42.84) ml,(33.45 ± 11.07) cm H20,(20.12 ± 10.88) cm H2O,(4.02 ± 1.61) cm,and the differences of regarding the all above indices were significant among three groups (F =60.759,45.595,16.146,24.670 respectively,P ＜ 0.05).Conclusion Intermittent catheterzation way was promoted the bladder function recovery,reduced complications effectively for patients with spinal cord injury.Therefore it was an effective method for patients in terms of the bladder rehabilitation.

目的探讨截肢后幻肢痛的中西医结合康复治疗方法。方法采用针刺治疗、经皮电神经刺激疗法、超声波药物透入疗法、运动疗法、中药熏洗治疗、药物静滴治疗、心理治疗等中西医结合康复措施对截肢后幻肢痛患者进行综合治疗,采用简化的McGill疼痛问卷(SF-MPQ)进行评定。结果21例患者治疗前后疼痛评定指数(PRI)、现时疼痛强度(PPI)均有明显改善(P<0.01)。结论对截肢后幻肢痛应及早采取多手段的中西医结合综合康复治疗。

<正>幻肢痛(phantom limb pain)是神经痛的一种类型,是主观感觉已切除的肢体仍然存在,并有不同程度、不同性质疼痛的幻觉现象,该幻肢发生的疼痛称为幻肢痛[1]。是截肢后常见并发症之一,常伴有幻肢觉和残肢痛。1551年首见于文献报道,1871年被Silas Weir Mitchell正式命名为幻肢痛。

目的:评价神经妥乐平对截肢后幻肢痛的疗效及安全性.方法:对17例截肢后幻肢痛患者使用神经妥乐平,采用疼痛视觉模拟评分法(VAS法)来评定疗效并进行统计学分析.结果:治疗后患者疼痛强度有显著性降低(P＜0.01),无严重的不良反应.结论:神经妥乐平可安全有效治疗截肢后幻肢痛.

目的:观察减重步行训练对下肢骨不连的治疗效果。方法:15例下肢骨不连患者给予减重步行训练。结果:治疗后,1-3个月时骨折愈合5例(33.3%);3-4个月时8例(53.3%);4-6个月时1例(6.7%)。结论:减重步行训练可促进下肢骨不连的愈合。

观察减重步行训练对脊髓损伤后行走能力障碍的康复治疗作用.方法:对31例T12～L2脊髓损伤患者在传统康复基础上,运用减重支持步行训练治疗.采用功能性步行量表,Fugl-Meyer评定法,Barthel指数法对治疗效果进行评价.结果:31例患者经过减重步行训练后,步行能力、平衡能力和生活自理能力有显著提高(P〈0.05).结论:减重步行训练能有效提高脊髓损伤患者的步行能力.

三维牵引又称多方位牵引,是近几年治疗腰椎间盘突出症的较好疗法.我科对431例患者作了疗效观察,现报告如下.