Objective:Acupotomy based on the meridian-sinew theory of traditional Chinese medicine has benefits in treating knee osteoarthritis (KOA). The current study aims to prove that acupotomy at the sinew points of Sanheyang protect the knee joint and alleviate the progression of moderate KOA by evaluating KOA symptoms, cartilage structure, and analyzing the changes of cytokines in rabbit cartilage.Methods:The model used was mono-iodoacetate-induced moderate KOA in the rabbit's right leg. Rabbits were divided into the model group, the acupotomy group, and the control group, with each group receiving two parts of treatment for 2 weeks and 4 weeks. We evaluated pain in the knee joint and range of motion. The articular cartilage sections were stained with Safranin O/Fast Green and Masson. We used immunohistochemistry and real-time PCR to detect the protein and mRNA expressions of collagen prototype II (COL-II), matrix metalloproteinase 13 (MMP13), and integrin-β1 (ITG-β1).Results:Compared with the model group, the acupotomy group had higher body weight, lower pain score, higher range of motion, lower Mankin score, and significantly lower protein and mRNA expression of MMP13. After 4 weeks of treatment, Col-II expression in the acupotomy group was significantly higher than that in the model group and the expression of ITG-β1 in the model group was abnormally increased.Conclusion:Acupotomy at Sanheyang improved the pain symptoms and range of joint motion in rabbits with moderate KOA, and could protect Col-II by regulating MMP13, which may be related to ITG-β1-mediated mechanical force transmission, thus reducing the damage to cartilage structure and delaying the progression of moderate KOA.

足太阳经是唯一"主筋所生病"的经脉,病候中所述"胭如结""胭痛""胭挛"均属于膝痹的常见症状,且其经筋、经别的循行亦与膝胭密切相关,但鲜有从足太阳经论治膝痹的相关报道.膝痹发病与足太阳经易感外邪侵袭耗损阳气导致阳不柔筋密切相关.治疗膝痹的常用经脉、穴位和方法均直接或间接作用于足太阳经,可恢复膝周阳气,达柔筋缓节之效.本研究基于足太阳经与膝关节的关联特点,以"通阳柔筋"为切入点,从膝痹的病因、病机和治疗等方面进行深入探讨,进一步丰富足太阳经"主筋所生病"的理论内涵,为膝痹论治提供参考.

目的 探讨中医骨伤科学教学活动中翻转课堂联合PBL教学新模式的应用效果.方法 以我校2016级和2018级卓越针推班参加学习中医骨伤科学的205名学生为研究对象,2016级为对照组(97人),2018级为试验组(108人),对照组采用PBL教学法授课,试验组采用翻转课堂+PBL的模式联合教学.采用课程成绩=平时成绩+临床思维能力+期末考试成绩的方案评价客观成绩,围绕个人能力提升与课堂教学效果两方面进行主观问卷调查分析,小组访谈收集、整理学生的反馈意见.结果 试验组在课程总成绩、期末总成绩和临床思维能力均显著高于对照组(P<0.05),80分以上人数比例也明显增加;主观问卷调查显示多项能力获得提升的人数百分比显著高于对照组(P<0.05),课堂效果方面的评分显著高于对照组(P<0.05),访谈结果肯定了联合教学新模式的积极效应.结论 翻转课堂联合PBL的教学新模式有利于提高中医骨伤科学的教学质量、提升学生综合素质,两种方法的教学效果相辅相成,更好地落实了"以学生为中心"的教育理念.

目的 从抗炎方面探讨针刀松解膝骨关节炎模型兔"三合阳"保护关节软骨,改善膝关节功能的相关机制.方法 36只健康新西兰兔取12只作为空白组,其余24只采用单碘乙酸(monoiodoacetic acid,MIA)建立兔膝骨关节炎(knee osteoarthritis,KOA)模型,2周后,造模成功的新西兰兔随机分为模型组、针刀组,每组12只.针刀组松解"三合阳"进行治疗,每3天1次.分别于治疗2周、4周后对各组行骨关节炎严重程度指数(Lequesne MG)评分,依据X线结果行K-L(Kellgren-Lawrence)评分,取材后观察膝关节大体情况,苏木精-伊红(Hematoxylin-eosin staining,HE)染色后对关节软骨进行Mankin's评分,酶联免疫吸附法(ELISA)检测关节液中白介素-10(interleukin-10,IL-10)的水平,免疫印迹法(Western Blot,WB)和实时荧光定量PCR法(real-time quantitative PCR,RT-PCR)法检测软骨组织中白介素-1β(interleukin-1β,IL-1β)和肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)的蛋白和mRNA表达.结果 造模第4周、第6周后,模型组较空白组Lequesne MG评分、K-L评分、Mankin's评分、关节软骨中IL-1β和TNF-α的mRNA和蛋白表达水平均显著升高(P<0.01),关节液中IL-10蛋白表达水平显著降低(P<0.01);针刀组较模型组Lequesne MG评分、K-L评分、Mankin's评分、关节软骨中IL-1β和TNF-α的mRNA和蛋白表达水平均显著降低(P<0.01),关节液中IL-10蛋白表达水平显著升高(P<0.05,P<0.01).结论 针刀松解"三合阳"可纠正KOA模型兔膝关节力学失衡,下调关节软骨中IL-1β、TNF-α的表达以减轻炎症反应,上调关节液中IL-10的表达以抑制炎症相关因子释放,保护关节软骨,改善膝关节功能.

目的:探讨针刀通过降低软组织张力治疗颈型颈椎病的临床疗效及相关机制.方法:选取符合颈型颈椎病诊断标准的60例受试者,采用随机数字表法将受试者按照单盲随机原则分为治疗组和对照组,治疗组30例采用常规针刀治疗,对照组30例采用安慰针刀治疗.分别在治疗前、治疗后及随访时对受试者进行VAS评分、NPQ评分、项部软组织张力及颈项部温度测量.结果:治疗结束后,治疗组临床疗效优于对照组(P＜0.05),且治疗组远期疗效持久;两组治疗后VAS评分、NPQ评分较治疗前均显著降低(P＜0.05),且治疗后和随访时治疗组VAS评分、NPQ评分较对照组显著降低(P＜0.05);两组治疗后测试各部位软组织肌张力均显著降低(P＜0.05),且治疗后和随访时治疗组在左测C4～5、双侧肩胛提肌软组织张力显著低于对照组(P＜0.05);治疗组治疗后在双侧C4 ～5、 C6～7、肩胛提肌部位温度均显著升高(P＜0.05),对照组治疗后在左侧C4～5温度显著升高(P＜0.05),且治疗后及随访时治疗组在双侧C4～5 、C6～7、肩胛提肌部位的温度均显著高于对照组(P＜0.05),两组胸锁乳突肌温度差异无统计学意义(P＞0.05).结论:针刀疗法能有效改善颈型颈椎病临床症状,其作用机制可能与针刀降低软组织张力后提升局部肤温、发挥温通效应有关.

目的:从肌筋膜链角度,探讨足三阴经筋的解剖基础,为临床经筋疗法提供理论支撑.方法:分析足三阴经筋的分布、病候,并与肌筋膜链前深线解剖、功能对比,阐释足三阴经筋的解剖结构.结果:足三阴经筋的线性分布呈现混合分布趋势.在足踝小腿部,长屈肌及肌腱可视为足太阴经筋,趾长屈肌及肌腱可视为足少阴经筋.在阴股部,股内侧肌及股内收肌群的股骨止点可被视为足太阴经筋,股内收肌群结合体可被视为足厥阴经筋,大收肌后部及半腱肌半膜肌可被视为足少阴经筋.在躯干部,足太阴经筋与腰大肌筋膜密切相关,足少阴经筋与脊柱椎体前筋膜更为切合.从功能上,足厥阴经筋突出了股内收肌群与耻骨的解剖关系,足少阴、足太阴经筋突出了下肢内侧与腰腹的关系.结论:足三阴经筋分布与下肢内侧及腹腔后壁肌筋膜密切相关,由于经筋的功能性,需要进一步从解剖、功能、生物力学和病候等方面对足三阴经筋深入探讨.

目的:观察第二课堂教学对针灸推拿专业临床前课程教学效果的影响.方法:校内专业教师与校外特聘临床专家共同形成第二课堂教学团队,设计筋骨脉理论及实操第二课堂教学方案,将2017级针灸推拿专业五年制整班学生分为自愿参加筋骨脉理论及实操第二课堂的试验组和不参加筋骨脉理论及实操第二课堂的对照组,第二课堂开设时段为本科第四学期至第七学期,同步观察比较两组临床前课程成绩并进行统计学分析.结果:试验组和对照组大一《人体解剖学》课程成绩没有统计学差异(P>0.05),两组具有可比性.第二课堂开设期间,试验组和对照组的《针灸推拿临床解剖》《刺法灸法学》《推拿学》《针灸推拿综合实训》课程成绩差异没有统计学意义(P>0.05).结论:针灸推拿专业相关理论及技能第二课堂对针灸推拿本科临床前教学专业课程成绩无影响.作为本科专业课教学的有益补充,第二课堂教学对专业课教学及人才培养的促进作用评估是一长期系统工程.教育教学研究需要严格的试验设计,教学效果评价方法仍然是教学研究的重点.

目的:通过观察电针对急性骨骼肌钝挫伤大鼠恢复过程中肌特异性受体酪氨酸激酶(MuSK)和淀粉样前体蛋白(APP)表达的影响,初步探讨电针促进骨骼肌神经肌肉接头重建的相关机制.方法:将54只雄性SD大鼠随机分为正常对照组(A组)、模型组(B组)、电针组(C组),每组18只.采用自制重物打击装置建立大鼠右侧骨骼肌急性钝挫伤模型,A组不造模.B组造模后自然恢复,C组选取左侧“足三里”和右侧“阿是穴”在造模后24 h行电针治疗,15 min/次,2d1次.于造模后7、28、56 d分别取材6只动物,采用HE染色观察大鼠腓肠肌组织形态结构的变化,Western Blot检测MuSK及APP的蛋白表达情况.结果:HE结果显示正常大鼠腓肠肌肌纤维排列整齐,呈粉色,肌细胞大小均匀整齐.造模后7d,B组大鼠腓肠肌肌纤维溶解断裂、排列紊乱且有大量炎性细胞浸润;C组出现少量新生肌细胞和肌纤维形成且排列略为整齐;造模后28 d,B组大鼠新生肌细胞增多,炎性细胞减少,有部分肌纤维形成但排列仍不整齐;C组大鼠肌纤维进一步增多且排列较为整齐;造模后56 d,B组大鼠肌纤维排列逐渐整齐,炎性细胞明显减少;C组大鼠腓肠肌损伤基本愈合,形态结构基本完整.Western blot结果显示,在正常大鼠骨骼肌中MuSK、APP蛋白的表达水平均较少;造模成功后,与A组相比各取材时间点B组大鼠骨骼肌内MuSK、APP蛋白的表达增多且差异具有统计学意义(P＜0.05);与B组相比,C组MuSK和APP蛋白在损伤后第7天时表达升高,第28天时达到峰值,56 d时表达有所回落,且各取材时间点C组表达高于B组(P＜0.05).结论:电针可以促进急性骨骼肌钝挫伤大鼠骨骼肌的恢复,正向调控骨骼肌修复过程中MuSK、APP的表达,从而有利于NMJ的再生.

目的 观察应用小针刀疗法治疗枕大神经痛的临床疗效.方法 根据43位枕大神经痛患者经过针刀治疗前后其疼痛程度的改变判定针刀疗法的效果.结果 43例中,痊愈31例,好转9例,无效3例.总有效率93％.治疗前V A S评分为(6.55±1.42)分,治疗后为(1.62±1.11)分,6个月随访为(1.04±0.98)分.结论 小针刀疗法治疗枕大神经痛疗效明显,指切法进针操作安全,不良反应率低,值得临床推广.

目的 通过社区中医师针刀技能培训项目,分析影响针刀技能培训效果的相关因素,探讨适宜的针刀技能培训方案.方法 收集2015～2017年期间参加针刀技能培训项目的40名社区中医师培训前、后相关资料,用V1.0.0试卷分析系统分析笔试考试和操作考核项目难度、区分度、考试结果,对学员培训前、后6个月患者量进行统计分析.结果 笔试考试和操作考核项目难度、区分度均良好,笔试成绩和操作成绩正相关(P<0.05),学员培训后6个月内的患者量较培训前显著增加(P<0.05),培训前患者量≥1的学员较患者量为0的学员培训后患者量增加更明显(P<0.05).结论 对社区中医师进行针刀技能培训切实可行,但培训考核系统必须可靠,患者量是学以致用的重要体现但受多因素影响.培养针刀诊疗思维是核心目的,培训前有相关诊疗经历的社区中医师在培训后针刀临床能力提高更快.

Introduction: Currently, many clinical experiments are being conducted to study the effect of acupuncture on skeletal muscle contusions, and its therapeutic effect has been confirmed to some extent. However, the mechanism of recovery by electroacupuncture (EA) in skeletal muscles after blunt trauma remains unknown. Objective: To determine whether EA at Zusanli can contribute to the regeneration of contused skeletal muscle and the molecular mechanism involved. Methods: Masson’s trichrome staining and hematoxylin and eosin staining were used to measure the area of fibrotic tissue and determine the number of centrally nucleated muscle fibers respectively. The different immune phenotypes of macrophages were determined by flow cytometry. Then, ELISA was used to analyze the levels of interleukin-4 (IL-4), IL-6, interferon-α (IFN-α) and interferon-γ (IFN-γ) in the injured tissue. Finally, the expression of MyoD in the tissue was detected by quantitative real-time polymerase chain reaction. Results: EA at Zusanli helped regenerate contused skeletal muscle by alleviating fibrosis and increasing the size of the regenerating myofibres in the injured skeletal muscle. EA at Zusanli increased the number of M2 macrophages and decreased the number of M1 macrophages in contused skeletal muscle. EA at Zusanli decreased the level of cytokine IFN-γ and increased the levels of IL-4, interleukin-13 (IL-13), and IFN-α, which promoted macrophage polarization during the fibrosis recovery process in the contused skeletal muscle. EA at Zusanli could increase the expression of MyoD in tissues. Conclusions: EA at Zusanli promoted macrophage polarization during the fibrotic process in contused skeletal muscle by decreasing cytokine IFN-γ and increasing IL-4, IL-13, and IFN-α, which contributed to the regeneration of the contused skeletal muscle.

Objective. To explore the effects of electroacupuncture (EA) at ST36 (EA-ST36) and at Ashi acupoints (EA-Ashi) on skeletal muscle repair. Methods. Seventy-five rabbits were randomly divided into five groups: normal, contusion, EA-Ashi, EA-ST36, and EA at Ashi acupoints and ST36 (EA-AS). EA (0.4 mA, 2 Hz, 15 min) was applied after an acute gastrocnemius contusion. The morphology of myofibers and neuromuscular junctions (NMJs) and expressions of growth differentiation factor-8 (GDF-8), acetylcholinesterase (AChE), Neuregulin 1 (NGR1), and muscle-specific kinase (MuSK) were assessed 7, 14, and 28 days after contusion. Results. Compared with that in contusion group, there was an increase in the following respective parameters in treatment groups: the number and diameter of myofibers, the mean staining area, and continuities of NMJs. A comparison of EA-Ashi and EA-ST36 groups indicated that average myofiber diameter, mean staining area of NMJs, and expressions of AChE and NRG1 were higher in EA-Ashi group, whereas expression of GDF-8 decreased on day 7. However, increases in myofiber numbers, expressions of MuSK and AChE, as well as decreases in GDF-8 expression, and the discontinuities were observed in EA-ST36 group on the 28th day. Conclusion. Both EA-ST36 and EA-Ashi promoted myofiber regeneration and restoration of NMJs. EA-Ashi was more effective at earlier stages, whereas EA-ST36 played a more important role at later stages.

目的:探讨电针足三里+阿是穴促进急性钝器伤后家兔腓肠肌生物力学属性恢复的作用和相关机制.方法:将60只新西兰大白兔随机分为正常组、自然愈合组、电针组,制作家兔腓肠肌急性钝器伤模型,电针组给予足三里+阿是穴穴位电刺激(0.4mA,2Hz,15min),自然愈合组不予针刺治疗,自然愈合.分别于损伤后各时间点(7d、14d、28d、42d)取材、进行腓肠肌的拉伸试验,检测腓肠肌极限载荷、屈服载荷、极限强度、屈服强度、杨氏模量等生物力学指标的变化.结果:与自然愈合组比较,在损伤后第28天电针组极限载荷、屈服载荷显著大于自然愈合组(P＜0.05),极限强度、屈服强度经治疗后也较自然愈合组更强(P＜0.05),基本接近于正常组(P＞0.05);杨氏模量是反映腓肠肌刚度性能的重要指标,电针组也明显大于自然愈合组(P＜0.05).结论:电针足三里+阿是穴能够有效促进家兔腓肠肌急性钝器伤后生物力学属性的恢复,损伤后治疗28天时效果最好.其机制可能与电针促进肌纤维再生、微观结构的恢复、促进毛细血管网的重建有关.

Objective To investigate the roles of electroacupuncture in prevention of excessive fibrosis of the skeletal muscle.Meth-ods The acute skeletal muscle contusion model was produced at the gastrocnemius by specific device;all rabbits were divided into model control group( group A);electroacupuncture stimulation ouch point group( group B);electroacupuncture stimulation tsusanli group( group C);electroacupuncture stimulation ouch point and tsusanli group(group D).At 7,14,28th day after injury,and the expressions of vimentin and collagen-Ⅰwere tested by immunohistochemistry.Results At 7th day after injury,the expression of collagen-Ⅰ were no significant differ-ences between the electroacupuncture groups and group A;at 14th day after injury,the expression of collagen-Ⅰwere increased continually in each group,but the rises of the expression of collagen-Ⅰin the electroacupuncture groups were significantly lower than that of group A,P<0. 05;At 28th days after injury,the expression of collagen-Ⅰin the electroacupuncture groups were showing a decreasing trend,but the expres-sion of collagen-Ⅰin group A was increased continually,P<0.05,group B>group C>group D.Conclusions The electroacupuncture treat-ment could inhibit excessive fibrosis of skeletal muscle to prevent scar formation by reducing the expression of collagen-Ⅰ,which is beneficial to skeletal muscle repair.The curative effect of combined tsusanli and ouch point group is better than tsusanli or ouch point group separately, the two points have a synergistic effect.

目的:探讨电针对家兔急性钝器伤后D-二聚体(D-Dimer)和凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT)的影响作用.方法:将18只新西兰大白兔随机分为3大组,即空白组、模型组、电针组;每组6只动物.电针组在常规治疗的基础上,于伤后24h开始电针治疗.在造模前、造模后第1天、第4天、第7天分别对各组动物进行耳中动脉采血,测定D-Dimer和TAT的含量.结果:造模后第1天,模型组和电针组的D-Dimer、TAT的含量高于空白组(P＜0.05);造模后第4天,模型组的D-Di-mer、TAT含量高于电针组(P＜0.05),而电针组又高于空白组(P＜0.05);造模后第7天,模型组和电针组的D-Di-mer、TAT的含量呈下降趋势,但仍高于空白组(P＜0.05).结论:电针弱刺激可以有效减少家兔急性钝器伤后D-Dimer和TAT的升高,防止高凝状态的形成.

The anti-fatigue ability decline is one of the most important clinical symptoms of chronic exertional compartment syndrome (CECS). The percentage change of type-I and II skeletal-muscle fiber is an important reason for anti-fatigue ability decline after intracompartmental pressure increase. There is a close relationship between CaN-NFAT or PPAR/PGC-1 signaling pathways and muscle fiber type conversion. Studies have confirmed that Traditional Chinese medicine can protect the body tissue by activing CaN-NFAT or inhibiting PPAR/PGC-1 signaling pathways. Therefore, we wrote the review in order to better analyze the research progress in this field.

Background: Our preliminary studies indicated that electroacupuncture (EA) at the ST36 and Ashi acupoints could promote regeneration of the rabbit gastrocnemius (GM) by improving microcirculation perfusion, promoting the recovery of myofiber structures, and inhibiting excessive fibrosis. However, the effects of EA on recovery of the electrophysiological properties of the GM after contusion are not yet clear. Thus, the purpose of this study was to investigate the effects of EA at the Zusanli (ST36) and Ashi acupoints with regard to recovery of the electrophysiological properties of the rabbit GM after contusion.Methods: Forty-five rabbits were randomly divided into three groups: normal, contusion, and EA. After an acute GM contusion was produced (in rabbits in the contusion and EA groups), rabbits in the EA group were treated with electrostimulation at the ST36 and Ashi acupoints with 0.4 mA (2 Hz) for 15 min. The contusion group received no EA treatment. At different time points (7, 14, and 28 days) after contusion, we performed surface electromyography (EMG) and measured the nerve conduction velocity (NCV) of the GM and the GM branch of the tibial nerve. We also examined acetylcholinesterase (AchE) and Agrin expression in the neuromuscular junction (NMJ) via immunohistochemistry.Results: Compared with the contusion group, the EMG amplitude and NCV in rabbits in the EA group were significantly higher at all time points after contusion. AchE and Agrin expression in the EA group were significantly higher than those in the contusion group.Conclusions: Our results showed that EA at the ST36 and Ashi acupoints effectively promoted recovery of the electrophysiological properties of the rabbit GM after contusion. The effects of EA were realized by promotion of the regeneration of myofibers and nerve fibers, as well as acceleration of NMJ reconstruction by upregulation of AchE and Agrin expression in the motor endplate area.

目的:探讨家兔腓肠肌拉伸试验设备和夹具的选择.方法:分别采用目前常用的BOSE 3330动态力学测试平台、CMT 5205、ZWICK/Z005万能材料试验机以及气动夹具、冰冻夹具、机械加压夹具交替进行家兔腓肠肌拉伸试验.结果:CMT 5205、ZWICK/Z005万能材料试验机能够准确检测腓肠肌极限载荷、屈服载荷、杨氏模量等生物力学性能;BOSE 3330因其量程限制,无法检测腓肠肌极限载荷、屈服载荷大小.而机械加压夹具夹持稳定,未出现腓肠肌夹持损伤或断裂现象,基本避免拉伸过程中产生腓肠肌试样滑移等造成的误差;冰冻夹具因夹持力小,冷冻难以阻挡腓肠肌滑移;气动夹具因夹持力过大而使腓肠肌产生夹持部位损伤,甚至肌纤维断裂.结论:家兔腓肠肌拉伸试验的设备应选择CMT 5205、ZWICK/Z005,夹具以机械加压夹具为佳.

Objective:To explore the effects of electroacupuncture on expressions of transforming growth factor-β1(TGF-β1)and vimentin and the mechanism of inhibiting fibrosis and promoting muscle fibers regeneration after acute blunt contusion in rabbits.Method: Sixty rabbits were randomly divided into model group(group A,n=15),Ashixue group(group B,n=15),Zusanli(ST36) group(group C,n=15),Ashixue+Zusanli group(group D,n=15).Electroacupuncture groups were treated within 24h after contusion once every other day. Immunohistochemical method was used to detect TGF-β1and vimentin on the 7th d, 14th d and 28th d after modelling.Result:As extension of time after injury, the expressions of TGF-β1in electroacupuncture groups declined significantly compared with group A. The expressions of TGF-β1in group D was the lowest and had differences with other electroacupuncture groups(P0.05). The level of vimentin in group A showed a downward trend over time. But the trend was contrary on the day 14 and showed upward trend among three treatment groups.The results showed that group D had a potence of increasing the expression of vimentin and the expression was lower in group B and group C(P0.05), but which was still significantly higher than group A(P0.05). Expressions of vimentin in group B and group C had no statistical significance.Conclusion:The mechanism of electroacupuncture on inhibiting the skeletal muscle fibrosis and promoting skeletal muscle regeneration may be related to inhibiting the expression of TGF-β1and raising the expression of vimentin;electroacupuncture at Ashixue or Zusanli acupoints are all beneficial for repairing the damaged skeletal muscle, and the effects of these two acupoints are synergic.