目的：探讨局部封闭枕大神经治疗偏头痛的效果。方法选择86例枕大神经卡压导致头痛的患者为研究对象,均采用利多卡因+倍他米松局部封闭治疗,观察术毕即刻、术后3个月及半年的疼痛视觉模拟评分(VAS 评分)。结果末次随访时,VAS 评分均较治疗前明显改善(P <0.001)。结论局部封闭治疗枕大神经卡压所致头痛可迅速减轻疼痛,缓解症状,且疗效稳定。

OBJECTIVE To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain. METHODS From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups (sliver needle group and TCM fumigation group) according to propotion of 1:1. In sliver needle group, there were 17 males and 13 females aged from 28 to 55 years old with an average age of (45.70 +/- 4.15), treated with sliver needle; In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of (43.03 +/- 5.86), treated with TCM fumigation. Changes of force-displacement distance (FDD), specific absorption rate (S) of two groups were observed before treatment, 1 week and 3 months after treatment respectively, VAS scoring and Roland-Morris disability questionnaire (RMDQ) were used to access clinical effects. RESULTS (1) VAS score of silver needle group was 4.77 +/- 0.78, 1.99 +/- 1.08 and 2.55 +/- 0.94, respectively before treatment, at 1 week and 3 months after treatment,while VAS score in TCM fumigation group were 4.43 +/- 0.61, 2.48 +/- 0.71 and 3.05 +/- 0.86, respectively. VAS score of two groups after treatment were sigificant decrease than that of before treatment (P < 0.05). There was no sigificant differences between two groups before treatment, but sliver needle group performed well in analgesia than TCM fumigation group, and had obvious differences (P < 0.05). RMDQ score of silver needle group was 13.63 +/- 1.96, 5.87 +/- 2.33 and 6.53 +/- 2.89, respectively before treatment, at 1 week and 3 months after treatment, while RMDQ score in TCM fumigation group were 13.40 +/- 2.01, 6.90 +/- 2.31, 9.23 +/- 2.87, respectively. There was no significant differences between two groups before treatment and 1 week after treatment (P > 0.05), and had obvious differences between two groups at 3 months after treatment (P < 0.01). Both groups could obvious improve dysfunction caused by chronic low back pain, and curative effect of sliver needle groups was more endurable. (2) Following-up at 3 months after treatment, FDD of multifidus, erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased (P < 0.05); In TCM fumigation group, FDD of multifidus and erector spinae on both side were increased at 1 week after treatment (P < 0.05), but had no significant meaning at 3 months after treatment on health side (P>0.05). There was no significant meaning before treatment (P > 0.05), FDD of multifidus, erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment (P < 0.05); but no obvious meaning on health side. FDD of both side in sliver needle group were obvious increased at 3 months after treatment. (3) There was correlation among differences of FDD in multifidus and erector spinae, VAS score and differences of RMDQ, and Spearman correlation coefficient R was 0.517, 0.811, 0.746 and 0.625; There was correlation between items of soft tissue tension and sympotoms, function and life quality. Conclusion:Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back, and improve objectivity of therapeutic evaluation for chronic low back pain.

Objective:To investigate the distinction of the soft tissue tension between the normal people and the chronic lower back pain(CLBP)patients,and to research the correlations between the soft tissue tension characters and CLBP symptoms.Methods:All 30health people and 30CLBP patients were selected.The tension of both sides of the erector spinae was tested by soft tissue tension tester,and the VAS and RMDQ points were tested too.The indexes of soft tissue tension were compared between the normal patients and CLBP patients,and between the affected side and contralateral healthy side of CLBP patients.Results:The indexes of soft tissue tension were not different between the healthy side of CLBP patients and health group.Compare with normal person,the soft tissue tension of LBP patients was higher.For the LBP patients,the soft tissue tension of the affected side was higher than the normal side.There was no correlation between the soft tissue tension and VAS and RMDQ points.Conclusion:It is possible to distinguish the LBP patients from normal people with soft tissue tension test,and it can also be used to identify which is the affected side.

<正>慢性腰痛是最常见的临床症状之一,但约有85%无法得到明确的病理解剖学诊断[1],通常称为"非特异性腰痛",给临床医师的诊断和治疗带来了很大的困惑。近年来笔者采用银质针联合氨酚羟考酮片治疗此类疾病,取得满意疗效,现报道如下。资料与方法 1诊断标准参照2007年美国内科医师和疼痛协会关于慢性非特异性腰痛的临床实践指南[2]制定。慢性腰痛,病程3个月以上,伴有或不伴有下肢痛,无间歇性跛行,无神经根受累症状(神经根痛、感觉丧失、肌肉功能障碍和反射消失等)。

Objective: To assess the short and long-term efficacy of percutaneous laser disc decompression(PLDD) combine Mckenzie therapy for patients with lumbar disc herniation.Methods: 90 patients suffered from lumbar disc herniation were seperated in to two groups randomly,and treated with PLDD and PLDD combine Mckenzie therapy respectively.The clinical outcomes were measured before treatment,1 month,6 months and 1 year after treatment.The outcomes of 1 month and 1 year were used as short,and long-term efficacy.The clinical outcomes were measured by Modified Macnab Criteria and Oswestry disability index.Results: The short-term efficacy shows no significant difference in two groups.The long-term efficacy of PLDD Mckenzie was significantly better than PLDD alone.The short-term and long-term outcome of PLDD group was 65% and 60% respectively,compare with 73% and 86% of PLDD Mckenzie group.Conclusions: PLDD was identified as effective therapy for patients with Lumbar disc herniation.Mckenzie therapy postoperatively enhanced the therapeutic efficacy obviously than PLDD alone.It is important to treat the disability of lower back soft tissue among patients with lumbar disc herniation.

近五年采用牵引、正骨方法,治疗急、慢性寰枢椎半脱位300例,报告如下.

作者采用股四头肌静力收缩方法治疗髌骨软化症143例,报告如下. 1临床资料 本组143例,男46例,女97例,年龄16～48岁,病程1个月～2年.髌骨后有酸痛感,劳累后症状加重.上下台阶时膝部疼痛,酸软无力,尤以最初屈膝0°～30°明显,并伴有腿打软或跪倒的症状.