Background: Ultrasound-guided needle-knife release of the transverse carpal ligament (TCL) has the potential to treat mild-to-moderate carpal tunnel syndrome (CTS). This study aimed to compare the clinical efficacy and safety of ultrasound-guided needle-knife release of the TCL with those of glucocorticoid injection therapy. Methods: A total of 27 patients with mild or moderate CTS, involving 32 carpal tunnels, were enrolled between September 2025 and January 2026. They were randomly assigned to either the ultrasound-guided needle-knife therapy group (Group T, 17 carpal tunnels) or the ultrasound-guided glucocorticoid injection group (Group C, 15 carpal tunnels). Functional scores, Numerical Rating Scale (NRS) numbness and pain scores, Boston carpal tunnel questionnaire (BCTQ) scale scores, and 36-Item Short Form Health Survey (SF-36) scale scores were recorded and compared between groups at baseline, 1 month, and 3 months post-treatment. Clinical efficacy rates were assessed using the Kelly criteria. Results: Compared with baseline, at 1 and 3 months post-treatment, Group T showed a significant improvement in carpal tunnel function scores (P=0.011, P<0.001); a significant reduction in NRS pain scores (P=0.006, P<0.001); the NRS numbness score decreased significantly (P<0.001), with better results observed at 3 months post-treatment compared to 1 month post-treatment (P=0.014); and the Symptom Severity Scale (SSS) score of BCTQ scale decreased significantly (P=0.0179, P<0.001); the physical functioning (PF), bodily pain (BP), role physical (RP), general health (GH), role emotional (RE), and social functioning (SF) scores of SF-36 scale all increased significantly (P<0.05). Compared with baseline, in Group T, the Functional Status Scale (FSS) score of the BCTQ scale decreased significantly by 3 months after treatment (P=0.028), and the vitality (VT) and mental health (MH) scores of the SF-36 scale both increased significantly (P<0.05). Group C showed improvement in the aforementioned scores at both 1 and 3 months post-treatment compared to baseline, but the magnitude was smaller than that of Group T and did not differ significantly from baseline (P>0.05). Furthermore, the efficacy at 3 months post-treatment in the corticosteroid injection group was almost indistinguishable from that at 1 month, indicating poorer long-term efficacy. According to the Kelly criteria, the overall response rate was higher in Group T than in Group C. There were significant differences between Group T and Group C in terms of carpal tunnel function, Visual Analog Scale (VAS), NRS, BCTQ, and SF-36 scores (P<0.05). Conclusions: Ultrasound-guided needle-knife release of the TCL demonstrated superior efficacy compared to glucocorticoid injection.

Background: Cervicogenic headache (CEH) is a chronic secondary headache syndrome originating from the upper cervical spine. Although conventional treatments such as pharmacological management, nerve blocks, and radiofrequency ablation are effective for many patients, a subset remains refractory to standard therapies. Soft tissue adhesions around the atlas (C1) are a potential but often overlooked pain generator. This report describes the successful management of intractable CEH through use of ultrasound-guided needle-knife release targeting the transverse process of the atlas. Case Description: A 32-year-old male presented with a 15-year history of persistent, left-sided pulsatile headache following cervical trauma. The patient had previously undergone extensive treatments, including oral analgesics, C2 nerve blocks, pulsed radiofrequency, and "blind" (nonvisualized) needle-knife therapy, all of which failed to provide sustained relief. Physical examination revealed distinct tenderness at the posterior arch of the atlas. Under high-frequency ultrasound guidance, we identified the transverse process of the atlas and performed precise needle-knife release on the adherent soft tissues attached to the bone surface. This visualized approach allowed for the safe avoidance of critical neurovascular structures such as the vertebral artery. Following a course of six weekly sessions, the patient reported a 90% reduction in pain intensity. At the 6-month follow-up, the therapeutic effect was sustained without recurrence, and the patient's quality of life and daily functioning were significantly improved. Conclusions: This case highlights that soft tissue pathology around the C1 transverse process can be a critical etiology in refractory CEH. Conventional "blind" needle-knife therapy may fail due to safety concerns limiting the depth of release. Ultrasound-guided needle-knife therapy offers a visualized, safe, and precise minimally invasive alternative for patients unresponsive to traditional C2-targeted therapies, allowing for the effective release of deep soft tissue adhesions.

Visual minimally invasive acupotomy is applicable for the diseases with the pathological characteristics of soft tissue injury, including disorders of spine, four limbs and joints, peripheral nerve compression and chronic soft tissues. The diseases with superior effect obtained are cervicogenic headache, lumbar disc herniation, carpal tunnel syndrome and flexor tendon stenosing tenosynovitis. Under the guidance with ultrasound, visual minimally invasive acupotomy is advantaged at preoperative diagnosis, intraoperative guidance and postoperative evaluation in clinical practice so that it is precise, safe and reliable in clinical treatment. Visual minimally invasive acupotomy is essentially a kind of "ultra-minimally invasive" technique in treatment, focusing on the self-rehabilitation of the body induced by external treatment measures. It is highly complementary to the repair and reconstruction of minimally invasive surgery of modern medicine in clinical application.

A simple and feasible rabbit model of carpal tunnel syndrome (CTS) was established using an animal experimental study. Twenty-four New Zealand white rabbits were randomized into a normal group (Group C), a glucose injection model group (Groups N-M) and an ultrasound-guided injection model group (Groups U-M). Each group consisted of 8 rabbits.Electrophysiological and ultrasound examinations were performed before sampling. Hematoxylin-eosin (H&E) staining and electron microscopy were performed to observe the neuropathological changes. During electrophysiological testing 1 week after modeling, the amplitudes of the sensory nerve conduction velocity (SNCV), distal motor latency (DML) and compound muscle action potential (CMAP ) in the U-M group were significantly different compared to the C group and the N-M group (P < 0.05). Five weeks after modeling, the amplitudes of the SNCV, DML and CMAP in the U-M group and the C group were significantly different (P < 0.05). These differences were statistically significant compared to the DML and CMAP in the N-M group (P < 0.05), and the changes in these parameters were more significant than the results 1 week after modeling (P < 0.05). The difference in CMAP amplitude between the N-M group and C group was statistically significant (P < 0.05), but the other parameters were not significantly different (P > 0.05). Compared to the original modeling method, four injections of 0.3 ml of 10% glucose solution under ultrasound guidance reduced the time required to establish the disease model and increased the stability of the model. Therefore, this technique is a simple and feasible method for establishing a model of rabbit carpal tunnel syndrome.

Background:There is a lack of effective clinical options for treating mild-to-moderate cubital tunnel syndrome (CuTS) that does not fulfill the surgical indications, as more conservative treatments are ineffective. In this study, we investigated the anatomical characteristics of a CuTS caused by ligament compression to propose a new procedure for incising Osborne's ligament with a needle knife. We evaluated the safety and efficacy of Osborne's ligament release under the guidance of ultrasound. Methods:The study involved an anatomical examination of the cubital tunnel in 25 adult specimens to summarize the anatomical characteristics of the cubital tunnel. We examined the feasibility of using a needle knife to incise Osborne's ligament. A comparison was made between the non-ultrasound-guided and ultrasound-guided procedures to assess the benefit of ultrasound guidance. Results:The ultrasound-guided group (group U) consisted of 25 specimens, 3 of which displayed nerve or blood vessel injuries; meanwhile, the non-ultrasound-guided group (group N) consisted of 24 specimens, 6 of which displayed nerve injury. The effective rate of ligament release in group U was 80.00% while that in group N was 79.23%. The mean thickness of Osborne's ligament was 0.050±0.026 mm, the mean width was 17.92±3.07 mm, and the mean actual length was 36.02±5.04 mm. The actual length of Osborne's ligament was greater in males than in females (P=0.02); however, no statistically significant difference was found in terms of thickness or width between males and females or between the right and left hands. The contents of the cubital tunnel primarily consisted of the ulnar nerve and superior ulnar collateral artery. Nerves and blood vessels were predominantly present in the middle of Osborne's ligament. Conclusions:Ultrasound-guided needle knife for incising Osborne's ligament is safe and effective. This can be a novel treatment option for CuTS that does not fulfill surgical indications.

Background: Tarsal tunnel syndrome (TTS) is a condition in which the tibial nerve (TN) (or its terminal branches) is compressed by the flexor retinaculum (FR) and the deep fascia of the abductor hallucis muscle at the tarsal tunnel, causing symptoms that negatively impact the patient's quality of life, including numbness, a sensation of a foreign object, coldness, and pain. FR release via microtrauma using needle -knife has proven to be effective in China and is widely used by clinicians. The traditional acupotomy, however, is the "blind knife" treatment, which cannot guarantee patient safety due to risk of injury to important structures, particularly the neurovascular bundle. Compared with the conventional treatments, ultrasound -guided percutaneous FR release possesses noteworthy advantages including high efficacy and safety. Methods: Percutaneous release of the FR was performed on 51 formalin-fixed specimens. The specimens were divided into two groups: an ultrasound -guided acupotomy pushing group comprising 20 legs (group U) and a nonultrasound-guided acupotomy pushing group comprising 31 legs (group N). After high -frequency ultrasound exploration, those with clear vascular imaging were included in group U; otherwise, they were included in group N. The FR was released percutaneously, soft tissue was dissected layer by layer, and anatomical data were recorded. Results: There no cases of injury in group U (0%) and four in group N (12.9%). Among the different intervention methods, there were no significant differences in tissue injury types ( chi 2 =2.80; P=0.09). The percentage of released FR in group U was 80.00% while that in group N was 61.29% ( chi 2 =1.977; P=0.16), which did not represent a significant difference between the two groups. However, group U had a significantly greater release length than that in the group N ( t =3.359; P=0.002), indicating that the flexor release length guided by ultrasound is significantly greater than the unguided one. Conclusions: Ultrasound -guided percutaneous release of the FR using a needle -knife can provide greater length and percentage of released FR while maintaining a comparable safety rate to the unguided procedure.

Carpal tunnel syndrome (CTS) is a condition caused by compression of the median nerve in carpal canal. In recent years, due to popularity of electronic devices such as computers, the incidence of CTS has shown a rapid rising trend. Its treatment methods include surgical treatment and conservative treatment. For mild to and moderate CTS, conservative treatment is preferred. Acupotomy, as an innovative and unique treatment method, could relieve pressure in carpal canal by releasing transverse ligament of wrist and promote local blood circulation to treat CTS, and has characteristics of less trauma, short course of treatment and low cost, which is more acceptable to patients. In addition, the combination of needle-knife and other therapies also has a good effect. However, traditional needle-knife therapy has certain limitations in operation, and its safety problems can be effectively solved with the help of ultrasound technology. Therefore, ultrasus-guided needle-knife therapy for CTS has become a current research hotspot, but its long-term therapeutic effect still needs to be further verified.

Background This study aimed to compare the effectiveness and safety of the percutaneous first extensor compartment performed by acupotomy procedure with or without ultrasonic (US) guidance. Methods The percutaneous release was performed with an acupotomy on 40 wrists of cadavers, which was divided into US guidance operation and blind operation. Each arm was dissected and assessed regarding the amount of release and the extent of neurovascular and tendon injury. An analysis of finite biomechanical elements based on wrists specimen data is analyzed to observe the stress of the first extensor tendon compartment. A prospective study observed the pain visual analogue score(VAS) and Patient-Rated Wrist Evaluation (PRWEB) changes after the ultrasound guidance or blind acupotomy treatment in 30 dQD patients. Results The success rate in the ultrasound-guided technique was 85%, and the blind technique was 70% in the cadaver study, both techniques without neurovascular injury. There was no statistically significant difference between the two groups in measuring the distance from the incision marks to the blood vessels and nerves (P > 0.05). According to the biomechanical analysis, the tendon friction rubs when the wrist is upright. When the wrist is flexed, the tendon and tendon sheath is stressed in the bone ridges. In this prospective study, both ultrasound guidance and blind acupotomy treatment achieved well improvements in pain and function (P < 0.05), but the results with no statistically significant between groups (P > 0.05). Conclusion Both blind and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can get a good result. US-guided techniques can improve the success rate during acupotomy operations, especially for beginners and followers.

目的 探讨超声引导针刀松解术在四肢末端病中的安全性和准确性.方法 于北京大学医学部人体解剖学教研室选取福尔马林固定过的人体标本20具,研究时间为 2019年 3月至 2022年6月.将标本分为传统操作组及超声引导组,每组 10 具,并在同一入路途径下进行针刀松解操作,传统操作组在非可视条件下进行针刀松解操作,超声引导组在高频探头引导下进行操作.针刀松解操作后留针,逐层解剖,观测针刀路径,比较桡骨茎突狭窄性腱鞘炎、屈指肌狭窄性腱鞘炎、腕管综合征、踝管综合征 4 种疾病传统操作及超声引导下操作的成功率、准确性、损伤率.结果 超声引导组中腕管综合征的操作成功率高于传统操作组,差异有统计学意义(P＜0.05);超声引导组中屈指肌狭窄性腱鞘炎、腕管综合征、踝管综合征的操作松解效率均高于传统操作组,差异有统计学意义(P＜0.05);超声引导组操作损伤率低于传统操作组,差异有统计学意义(P＜0.05).结论 超声引导下针刀松解技术在四肢末端病操作的安全性及准确性高,值得临床推广.

Objective:This study aimed to determine the safety and accuracy of ultrasound-guided acupotomy percutaneous loosening of the transverse carpal ligament.Methods:The 100 upper limb specimens were equally divided into the ultrasound-guided acupotomy group (U) and the nonultrasound-guided acupotomy group (N). For the U group, we simulated ultrasound-guided acupotomy loosening of the transverse carpal ligament in a human specimen, and for the N group, we performed the loosening of the transverse carpal ligament through the same approach under nonultrasound-guided conditions. The safety and accuracy of the two methods were compared through measurement.Results:In the ultrasound-guided group, the injury rate of nerves, blood vessels and tendons caused by needle-knife release was 0%. In the non-ultrasound-guided group, the rate of nerve, blood vessel and tendon damage was 6 percent, 12 percent and 20 percent, respectively. χ 2 test (Fisher exact test) was performed for the nerve and blood vessel damage rates in the two groups (PN  > 0.05, PA  < 0.05), the difference in nerve damage rates was not statistically significant, but the difference in blood vessel damage rates was statistically significant. Pearson's χ 2 test was performed on the tendon injury rates of the two groups (PF  < 0.05), and the difference was statistically significant. In the ultrasound-guided group, the proportion of acupotomy marks greater than or equal to half of the width of the transverse carpal ligament was 86%, and the non-ultrasound-guided group was 36%. The accuracy of the two surgical methods was tested by Pearson's χ 2 test (PL  < 0.05), and the difference was statistically significant. According to the measurement, the ultrasound-guided acupotomy technology had high safety and accuracy.Conclusion:In this study, we designed a new method for cutting the transverse carpal ligament under ultrasound guidance, which is different from surgery. These results indicate that this is a safe and accurate method of interventional treatment of carpal tunnel syndrome.

目的:探索并观察超声引导下针刺蝶腭神经节治疗过敏性鼻炎的临床疗效.方法:14例过敏性鼻炎患者均采取超声引导下针刺蝶腭神经节治疗,超声引导下进针,有针感后出针,每次治疗均为双侧治疗.每7d治疗1次,6次治疗为1个疗程.比较治疗前后及治疗6个月后的临床疗效、鼻炎症状评分及视觉模拟量表(VAS)评分.结果:治疗后评价有效率为57％(8/14),6个月后有效率为43％(6/14),显效率为14％(2/14).与治疗前相比,治疗后及6个月后鼻炎症状评分及VAS评分均降低,差异有统计学意义(P＜0.01).结论:超声引导下针刺蝶腭神经节可能成为治疗过敏性鼻炎的一个新术式.

Objective:The present study aimed to assess the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife.Methods:The author performed percutaneous A1 pulley release in 84 cadaveric hands fixed with 10% formalin. The cadaveric hands were divided into three groups: 28 hands in each group (group U: ultrasound-guided needle knife pushing group, group N: non-ultrasound-guided needle knife pushing group, group T: classical needle knife operation puncture group). Percutaneous A1 pulley release was performed, the soft tissue was dissected layer by layer, and the relevant anatomical data were measured.Results:The injured cases were as follows: group U, 29 (20.7%); group N, 36 (25.7%); and group T, 28 (20.0%). There is no significant difference between different tissue injury types in different intervention methods. The missed release cases were as follows: group U, 8 (5.7%); group N, 4 (2.9%); and group T, 13 (9.3%). The percentage of released A1 pulley were as follows: group U, 71.4% ± 30.7%; group N, 66.0% ± 20.3%; and group T, 61.0% ± 30.4%. The percentage of released A1 pulley of the three groups were compared: group U > group N > group T, and there was statistical difference between the three groups. The full release rates of the three groups were compared: group U(31.4%) > group N(15.7%) > group T(13.6%), and there were significant difference in the full release of A1 pulley between group U and group T, group N.Conclusion:Based on the cadaver specimen, the length and percentage of released A1 pulley is longer by ultrasound-guided percutaneous A1 pulley release using a needle-knife. and there was no statistical difference in the injury rate between the three techniques.Type of Study and Clinical Relevance:Clinical anatomic study. To test the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife in cadaveric hands, and provide an anatomically based support in clinic.

Background De Quervain’s disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis. This study aimed to evaluate the safety and efficacy of percutaneous first extensor compartment releases performed on embalmed cadaveric models by acupotomy operation with or without US guidance. Methods Percutaneous release was performed with an acupotomy on 59 wrists of cadavers; 23 wrists were operated with US guidance, and 39 wrists were operated without US guidance. Each arm was dissected and assessed regarding the amount of release as well as the extent of neurovascular and tendon injury. Anatomical structures were also observed in this study. Results Twenty cases (87%) were successfully released with ultrasound-assisted techniques, and 27 cases (75%) were successfully released with blind techniques. No neurovascular injury occurred in any arm, regardless of technique. No significant tendon injury was seen in any arm. Although minor surface scratches were visualized in 11 cases, they occurred in 3 cases (13.04%) with ultrasound assistance and in 8 cases (22.22%) with blind techniques. There was no statistically significant difference between the two groups in the measurement of the distance from the incision marks to the blood vessels and nerves. A fibrous septum and bony protrusions were found in the first dorsal compartment, which may be anatomical factors affecting the success of treatment. Conclusion Both traditional and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can be performed for all wrists. US-guided techniques can improve the success rate and reduce damage during acupotomy operations.

OBJECTIVE:To explore safety and accuracy of four-point acupotomy for the treatment of tarsal tunnel syndrome regarding release of ankle tunnel flexor retinaculum to provide an anatomical basis of clinical treatment.METHODS:Twenty-nine adult specimens (15 males and 14 females) fixed with 10% formalin, aged from 47 to 98 years old with an average age of (81.10±11.14) years old, 29 on the right side and 29 on the left side, which were selected for the study from September 2020 to October 2020. Simulate the operation of loosening flexor retinaculumt with a needle knife on the human specimen, and place the specimen on the frog position of lower limbs with medial malleolus upward to determine the center of medial malleolus. Choose 4 different positions near the flexor retinaculum to insert the needle so that the needle body was perpendicular to skin and cutting edge direction was perpendicular to the running direction of the flexor retinaculum. The needle knife penetrates the skin and explores slowly. When the flexor retinaculum was reached, the needle tip may touch the tough tissue. At this time, the cutting is loosened for 4 times. After acupotomy release operation was completed, make a lateral incision on the skin surface along acupotomy direction, open the area of the exposed flexor retinaculum, dissecting layer by layer, observe and record the needle knife and its surrounding anatomical structure. The length of acupotomy cutting marks of flexor retinaculum was measured by electronic vernier caliper. The safety and accuracy of acupotomy loosening of ankle canal flexor retinaculum were evaluated by observing the number and degree of ankle canal contents such as tendons and nerves injured by needle knife. The safety is to count the number of cases of acupotomy injury to the contents of the ankle canal, and to calculate the injury rate, that is, the number of injury cases/total cases × 100%. The effective release was defined as the release length L ≥ W/2(W is the width of the flexor retinaculum, defined as 20 mm).RESULTS:For safety, there were no acupotomy injuries to nerves or blood vessels in 58 cases, 26 cases injuried to posterior tibial tendon which 17 of these tendon injury cases, the tendon was penetrated and severely injured, and flexor digitorum longus tendon was injured in 12 cases. Among these cases, tendon was penetrated and severely injured in 4 cases, and total injury rate was 32.14%. No nerve and vessel injury on c3 and c4 point. For accuracy, 58 specimens were successfully released. The length Lc of releasing trace for acupotomy was (10.40±1.36) cm, and length range 6.38 to 12.88 cm. Among all cases, the length of releasing trace was ≥10 mm in 37 cases. The overall success rate of release was 100.00%. Layered structure of ankle tube flexor retinaculumt:fiber diaphragm from flexor retinaculum divides contents of ankle tube into different chambers inward, and fiber diaphragm meets here to synthesize a complete flexor retinaculum at the midpoint of the line between the medial malleolus tip and calcaneal tubercle(above the neurovascular course).CONCLUSION:Four-point needle-knife method of releasing flexor retinaculum for the treatment of tarsal tunnel syndrome is performed at the attachment of the two ends of flexor retinaculum;the tendon, but not the nerves and blood vessels, is easily damaged. It is safe to insert needle on the side of calcaneus. The extent of release is relatively complete, but due to the "layered" structure of the flexor retinaculum, classic surgical technique could only release one layer of flexor retinaculum when a needle is inserted at the edge of the bone and cannot achieve complete release of the full thickness of the flexor. Therefore, it remains to be determined whether the desired effect can be achieved clinically.

腰椎间盘突出症(lumbar disc herniation,LDH)是临床上的一种常见病、多发病[1],临床上以腰痛及下肢放射痛或麻木为主要表现,患者常因疼痛或运动功能障碍而引起生活质量下降,严重者甚至丧失日常生活能力.针刀松解黄韧带可有效缓解LDH的临床症状,改善患者腰椎功能活动,临床疗效较为显著[2-4].本研究小组在前期解剖试验的基础上[5-7],设计了超声引导下针刀松解黄韧带的治疗腰椎间盘突出症的新入路,现对采用新入路的40例患者进行疗效评估,报道如下.

目的:探讨颈源性头痛(CEH)的影像表现及临床意义.方法:收集2013年5月至2019年9月中日友好医院针灸科门诊68例CEH患者的影像检查结果并进行统计分析.结果:68例患者均完成X线及CT检查,67例同时完成MRI检查,其中,颈椎体旋转移位15例(22.06％),颈椎曲度异常47例(69.12％),椎间孔狭窄12例(17.65％),过伸位椎体不稳39例(57.35％),过屈位椎体不稳13例(19.12％),过屈位寰枕间隙异常41例(60.29％),寰齿侧间隙不对称24例(35.29％),C2棘突偏斜32例(47.06％),不同程度的颈椎间盘突出65例(97.01％),神经根袖水肿20例(29.41％);过屈位寰枕间隙正常、狭窄、消失3个组之间的VAS评分差异有统计学意义(P＜0.01);影像上表现异常种数与VAS评分之间无显著相关性.结论:影像检查可为CEH的诊治提供依据,但其单独诊断的意义不大.

目的:系统评价针刀治疗踝管综合征(TTS)的有效性.方法:检索国内外医学数据库,查找针刀治疗TTS的随机对照试验(RCT).纳入治疗组采用针刀治疗、对照组采用非针刀疗法.采用RevMan 5.3软件进行Meta分析,TSA0.9软件进行试验序贯分析.结果:共纳入5项随机对照试验、315例患者.治疗组的总有效率[RR=1.16,95％C1(1.06,1.26),P＜0.01]及治愈率[RR=1.70,95％C1(1.35,2.15),P＜0.01]均优于对照组.试验序贯分析显示,累计的Z值同时穿过了传统界线,未跨过TSA界值,其累计的信息量也未达到预期信息量.结论:针刀治疗TTS,在一定程度上优于非针刀治疗.受本研究纳入文献的质量和数量的限制,假阳性结论概率高,尚需进一步验证.