According to Chinese medicine, the atlantoaxial joint is a composite joint composed of tendons and bones, and the stability of the joint depends on the ‘tendon-bone balance’ involving tendons, ligaments, atlas and axis. Multiple causes of ‘tendon off-position, joint subluxation’ will lead to joint ‘tendon-bone imbalance’, which will evolve into atlantoaxial subluxation (AAS), endangering human health. Chinese therapeutic massage (tuina) is a very effective treatment for AAS in adults, but conventional manipulations are prone to ineffectiveness or accidents due to neglect of the causal relationship of the ‘tendon-bone imbalance’ and inappropriate manipulations. Compared with conventional manipulations, the rational choice of modified manipulations under the guidance of ‘tendon-bone balance’ theory is more effective and less risky, and more worthy of clinical promotion. From the ‘tendon-bone balance’ theory, we considered the shortcomings of conventional manipulations, and introduced several modified manipulations that have their own strengths in ‘tendon smoothing’ and ‘bone setting’, in order to provide new ideas for treatment of AAS in adults.

目的:分析一指禅推法治疗早中期膝关节骨性关节炎的临床作用机制.方法:采用随机对照的研究方法,将60例KOA早中期患者随机分为治疗组和对照组.治疗组采用一指禅推法治疗,对照组采用(攘)法治疗.两组均通过VAS标尺、M-Tone压痛测试值、WOMAC量表等评定疗效.结果:两组患者膝关节VAS评分组内不同时间点、组间、交互效应均有差异;内外膝眼压痛值组内不同时间点差异均有统计学意义.两组患者WOMAC总分、WOMAC疼痛积分组内不同时间点差异均有统计学意义,且治疗时间与治疗方法间存在交互作用,两组在不同时间变化趋势不同,其中治疗组较明显.结论:一指禅推法和(攘)法治疗膝关节骨性关节炎均有效,均能减轻疼痛;一指禅推法镇痛作用明显,能明显缓解内膝眼疼痛.

目的 探讨(攘)法对早中期膝骨性关节炎(KOA)患者股四头肌肌张力的影响.方法 选择2012年6月～2014年5月上海中医药大学附属岳阳中西医结合医院推拿科收治的早中期KOA患者60例,采用随机数字表法将其分为两组,各30例.治疗组接受(攘)法治疗,对照组采用按揉手法治疗,每次20 min,每周3次,疗程4周.治疗前及治疗4周后对两组进行健康状况调查问卷(SF-36)评分;治疗前、治疗2周后及治疗4周后对两组进行视觉模拟评分(VAS)、骨关节炎指数(WOMAC)评分及股直肌、股外侧肌肌张力的测定.结果 治疗4周后两组SF-36总分及躯体功能、躯体角色、身体疼痛、情感角色、活力、精神健康、社会功能、总体健康等维度评分均较治疗前显著升高(P＜0.05).两组治疗2周与4周后VAS、WOMAC疼痛积分、股直肌、股外侧肌位移均较治疗前明显改善(P＜0.05);治疗组治疗4周后VAS、WOMAC疼痛积分、股直肌位移、股外侧肌位移与治疗2周后比较,差异均有统计学意义(P＜0.05).治疗组治疗前后VAS差值与股直肌位移前后差值呈正相关(r=0.524,P=0.001).结论 单位时间内对膝关节股四头肌肌群行大面积攘法能有效改善早中期KOA患者膝关节疼痛与股直肌肌张力,提高患者的生活质量,且单位时间内膝关节疼痛改善程度与股直肌肌张力变化具有明显相关性.

极外侧型腰椎间盘突出症是指椎间孔与椎间孔外腰椎间盘突出症,椎间盘突出或脱出位于椎弓根内、外缘之间或椎弓根外缘以外,压迫相应的神经根而引起的一系列症状和体征,在腰椎间盘突出症中占2.6%~11.2%[1]不等.属于腰椎间盘突出症中较少见的类型[2].现将我科2012-06-2012-07 诊治的1 例极外侧型腰椎间盘突出症误诊为腰三横突综合征,现报告如下.

Objective To further expound and prove the clinical effect of lumbar disc herniation with Three-steps Massage Therapy,and research the value of popularization and application in the community and rural basic medical institutions.Methods The study adopted three popularizing models.180 cases with herniated lumbar disc were selected,90 cases from municipal hospital,45 cases from district hospital and 45 from community health center.The trials were randomly divided into Three-steps Massage Therapy group,traction treatment group and traditional massage therapy group.Compare the clinical efficacy among the three hospitals.ODI(Oswestry disability index) and VAS(visual analogus scale) were used as the observation index sign for quantitative curative effects.Results The total effective rates of Three-steps Massage Therapy group,traction treatment group and traditional massage therapy group were respectively 85.00%,60.00% and 83.33%,with obvious statistical differences between the three groups(P0.05).The ratio of cure with Three-step Massage Therapy has no statistical difference among three different hospitals(P0.05).Conclusion Three-steps Massage Therapy is quite effective for lumbar disc herniation,and suitable for base hospitals.

Objective:To study the effect and mechanism of eye acupuncture on the changes of nervous functional defects and cerebral infarct areas and cerebral tissue morphological alternation and myocyte apoptosis and protein expression of related gene P53 in rats with acute cerebral ischemia.Methods:The present experiments were performed with intraluminal suture perforated middle cerebral artery(MCA) to establish focal cerebral ischemia models in SD rats,underwent 2 hours of MCAO and followed by 24 hour reperfusion,the changes of nervous functional defects were detected;underwent 2 hours of MCAO followed by 24 hour reperfusion,cerebral infarct areas and cerebral tissue morphological alternation were detected by using HE staining and Apoptotic cell was detected by using TUNEL method,P53 immunoreactivity was examined by using immunohistochemical method.Result:Eye acupuncture may lower the changes of nervous functional defects and cerebral infarct areas;may increase the number of TUNEL positive cells and P53 positive cells in the ischemic peripheral cortex.Conclusion:It proved the curative effect of eye acupuncture in rats with acute cerebral ischemia and the neuroprotective effect of eye acupuncture is partly related to its inhibition of myocyte apoptosis.

目的:从神经缺损评分、脑梗塞程度、脑组织形态学变化、细胞凋亡及凋亡相关基因P53蛋白表达方面探讨推拿、针刺对急性脑缺血的治疗作用及作用机理.方法:用线栓法制成SD大鼠大脑中动脉阻塞再灌注模型,各组动物分别于脑缺血2h、再灌注24h进行神经缺损评分;在阻塞2h,再灌注24h后,应用HE染色、TUNEL染色及免疫组织化学法分别对缺血对照组、缺血加推拿组、缺血加针刺组、缺血加针刺加推拿组及假手术组大鼠脑梗塞程度,脑组织神经细胞死亡与凋亡的分布及P53免疫反应阳性细胞进行观察.结果:推拿,针刺均可减少神经缺损评分、降低脑梗塞程度、减少缺血所致脑神经细胞的死亡及DNA双链断裂(TUNEL阳性),减少梗死周边区皮层P53数量.结论:推拿、针刺对急性脑缺血有较好的治疗作用,其作用机理可能与可抑制细胞凋亡有关,从而保护脑神经细胞.

目的: 探讨中西医结合治疗颈髓损伤导致截瘫后期的治疗效果.方法: 10例颈髓损伤后遗期患者以短杠杆微调手法结合骶管静脉滴注或交感神经封闭术为主的方法治疗, 并于治疗前后进行肢体功能, 膀胱功能及自发性痛痉挛控制等评分评定.结果: 10例患者治疗后肢体功能和膀胱功能与治疗前比较, 均有较大的提高, 差异有显著性(P＜0.02, P＜0.05); 自发性痛痉挛治疗前后比较差异无显著性(P＞0.05), 但患者临床症状改善, 痛苦减轻.结论: 在颈髓损伤后期的康复治疗上, 把中西医理论和方法结合起来, 可明显改善患者的生活质量.