目的 探讨桃红饮加味治疗腰椎间盘突出症(LDH)急性期腰腿痛(血瘀证)的疗效.方法 纳入LDH急性期腰腿痛者共98例,参考随机数字表法分入治疗组与对照组各49例.对照组患者根据LDH专家共识进行常规治疗方案;治疗组于对照组基础上给予桃红饮加味内服.两组连续观察14d.比较两组疼痛评分、腰椎功能、直腿抬脚高度、下肢神经运动传导速度、临床疗效.结果 治疗14 d后,两组腰部、腿部疼痛视觉模拟量表(VAS)评分显著下降,同时治疗组下降更显著(P＜0.01);治疗14 d后,两组JOA评分与直腿抬脚高度显著提高,同时治疗组提高更显著(P＜0.01);治疗14 d后,两组腓总神经与胫神经的运动传导速度显著提升,同时治疗组提升更显著(P＜0.01);治疗14 d后,治疗组总有效率为95.92％,高于对照组的79.59％(P＜0.05).结论 桃红饮加味治疗LDH急性期腰腿痛(血瘀证)的疗效明显,能有效减少患者的疼痛,有利于腰腿功能与下肢神经运动传导速度的改善.

目的 探讨中老年膝骨关节炎患者施以隔姜灸辅助推拿的疗效及对其KSS评分的改善.方法 选取2021年8月至2022年8月本院收治的150例中老年膝骨关节炎患者按随机数字表分为两组,给予对照组(75例)患者推拿疗法,给予观察组(75例)患者隔姜灸+推拿疗法,观察患者膝关节功能、疼痛度、血清炎症以及血液流变学参数等指标水平变化情况.结果 治疗后,观察组患者KSS与VAS评分均较对照组更优(P＜0.05);观察组ESR、CRP、IL-1β及P物质水平较对照组更低(P＜0.05);观察组患者血液流变学参数各项指标水平均较对照组更小(P＜0.05).结论 中老年膝骨关节炎患者临床治疗中选用隔姜灸+推拿疗法方案,可明显缓解患者炎症与疼痛度,并可有效提升其血液流变学参数的改善效果,促进膝关节功能恢复,获得更理想治疗有效性.

ACL损伤的治疗不仅需要手术对韧带进行解剖重建,更需要完善的康复治疗体系来恢复患肢的功能.前交叉韧带重建术后的康复对患者恢复功能至关重要,康复治疗贯穿ACL损伤治疗的全过程,通过肌力、神经肌肉训练,辅以支具保护、物理治疗及心理康复,能最大限度地促进患肢功能的康复.可根据患者损伤严重程度、手术方式、移植物的选择、个人体质及对术后功能的要求等多种因素制定个体化康复计划,不仅要注重肌肉力量和关节活动度训练,还要加强本体感觉和神经肌肉训练,以提高患膝的动态稳定性.

目的:探讨中药塌渍包结合核心肌群训练治疗非特异性下腰痛患者的临床疗效.方法:纳入60例非特异性下腰痛患者,随机分为观察组和对照组2组,每组各30例,两组均予以核心肌群训练治疗,观察组辅以中药塌渍包热敷治疗.2个周期后,进行组间疗效对比.结果:治疗后,两组VAS评分和JOA评分较治疗前均有显著改善,(P＜0.05);且观察组治疗后的VAS、JOA评分显著低于对照组(P＜0.05).结论:中药塌渍包联合核心肌群训练比单纯核心肌群训练可较好地改善腰部疼痛、功能障碍,值得临床推广.

目的 探讨唑来膦酸辅以藤黄健骨胶囊对老年肾虚血瘀型原发性骨质疏松症(POP)患者的治疗效果及对其血液流变学的改善.方法 选取老年肾虚血瘀型POP患者180例,随机分为对照组和观察组,各90例.对照组采取唑来膦酸治疗,观察组采取藤黄健骨胶囊+唑来膦酸治疗.比较两组患者腰椎骨密度、VEGF水平、腰椎功能恢复情况及血液流变学等指标水平变化情况.结果 治疗后,观察组患者腰椎(L1-4)骨密度、VEGF水平以及ODI水平均高于对照组(P＜0.05);血液流变学指标水平均低于对照组(P＜0.05);血清IGF-1与IGFBP-3水平高于对照组(P＜0.05).结论 老年肾虚血瘀型POP患者临床治疗中选用藤黄健骨胶囊、唑来膦酸联合方案,可明显提高患者骨密度改善效果,有效改善血液流变学,促进腰椎功能恢复效果,进而获得更理想的治疗有效性.

创伤性关节炎又称外伤性关节炎、损伤性骨关节炎,是骨关节炎的常见类型之一,是继发于关节创伤的骨关节炎,它是由创伤引起的以关节软骨的退化;变性和继发的关节周围骨质增生为主要病理变化,以关节疼痛、活动障碍为主要临床表现.临床上治疗比较棘手.平衡针灸学是由北京军区总医院王文远教授成功创立的传统医学与现代医学在针灸领域相结合的一门现代针灸学.平衡针灸治疗通过针刺外周神经靶点,利用传入神经通路至大脑中枢靶位,使失调紊乱的中枢系统瞬间恢复到原来的平衡状态,通过传出信息通路完成对靶向病变部位的应急性调整,达到机体恢复新的平衡.全息疗法是以中医经络学说和黄帝内经为理论依据,采用全息穴区,以不同组合经穴和不同组合治疗疾病,手法简便,对多种慢性病具有良效.把平衡针与全息疗法结合治疗创伤性关节炎,加快患者的康复进程,降低患者的费用.

目的:探讨髌骨骨折患者应用活血化瘀汤对患者膝关节功能、炎症因子的影响.方法:选择2015年3月到2017年3月西南医科大学附属中医医院接诊的髌骨骨折患者100例作为研究对象,以随机数表法分为观察组(n=53)和对照组(n=47),两组患者均采用切开复位克氏针张力带内固定,观察组加用活血化瘀汤.比较两组治疗后膝关节优良率、肿瘤坏死因子(TNF-o)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、膝关节功能Lysholm评分、视觉模拟评分法(VAS)评分及不良反应发生情况.结果:治疗后,观察组患者优良率为92.45％,显著高于对照组的72.34％(P＜0.05);治疗前,两组患者TNF-o、IL-6及IL-10水平无显著差异(P＞0.05);治疗后,两组TNF-α、IL-6及IL-10水平较治疗前均显著改善(P＜0.05),且观察组TNF-o、IL-6均明显低于对照组,IL-10水平显著高于对照组(P＜0.05);治疗前,两组患者Lysholm评分、VAS评分无显著差异(P＞0.05);治疗后,两组Lysholm评分、VAS评分较治疗前均显著改善(P＜0.05),且观察组Lysholm评分均明显高于对照组,VAS评分显著低于对照组(P＜0.05);观察组患者不良反应总发生率为1.89％,显著低于对照组的14.89％,差异具有统计学意义(P＜0.05).结论:在髌骨骨折患者中使用活血化瘀汤效果显著,可有效改善患者膝关节功能、炎症因子水平,值得推广与运用.

目的 运用正交设计研究物理疗法、手法和针灸的不同组合方案对肩周炎的治疗效果,探讨其最佳的治疗方案.方法 选择西安交通大学附属红会医院中医骨科二病区和运动损伤肩肘病区门诊及住院部2016年1月～2017年12月符合纳入标准的肩周炎患者80例,采用区组随机方法按照L8(27)的正交设计表分成八组,每组10例,采用A(物理疗法)、B(手法治疗)、C(针灸治疗)3个因素及相应的2水平(红外线和体外冲击波、关节松动术和推拿手法、普通针刺和温针透刺)进行治疗,采用直观分析和方差分析观察分析不同组合方案对肩周炎患者肩关节疼痛和功能的疗效.结果 与治疗前比较,物理疗法、手法、针灸三类治疗的不同组合均能降低肩周炎患者的视觉模拟评分法(VAS)评分,提高肩关节功能评分,差异有统计学意义(P＜0.05).肩关节疼痛VAS评分及功能评分改善的直观分析和方差分析结果显示,物理疗法、手法、针灸治疗是改善患者肩关节疼痛及功能的显著因素(P＜0.05),且物理疗法改善最大,手法治疗其次,针灸治疗最小(RA＞RB＞RC,rA＞rB＞rC);在同因素不同水平的对比观察中,体外冲击波改善比红外线更明显(K2＞K1,k2＞k1),关节松动术改善比推拿手法更明显(K1＞K2,k1＞k2),温针透刺改善比普通针刺更明显(K2＞K1,k2＞k1);体外冲击波+关节松动术+温针透刺是最佳治疗方案.结论 体外冲击波结合关节松动术和温针透刺是肩周炎患者疼痛、功能障碍有效治疗的最佳组合方案,有临床推广价值.

Osteoporosis is a common orthopedic disease which is associated with hyper-activated osteoclastogenesis. Daphnetin is a natural coumarin derivative isolated from Genus Daphne, which possesses antiarthritis effect. However, the role of daphnetin in osteoclastogenesis has not been illustrated. This study aimed to investigate the effects of daphnetin on receptor activator of NF-κB ligand (RANKL)-induced osteoclastogenesis in vitro. Our results showed that the osteoclast formation was significantly suppressed by daphnetin treatment in bone marrow-derived macrophages (BMMs), which was illustrated by reduced number of tartrate-resistant acid phosphatase positive multinucleated osteoclasts and decreased expression levels of tumor necrosis factor receptor-associated factors (TRAF6), c-Fos, nuclear factor of activated T cells c1, and cathepsin K. RANKL caused significant induction effects in reactive oxygen species (ROS) generation and nicotinamide adenine dinucleotide phosphate oxidase activity, whereas the induction was dramatically reduced after pretreatment with daphnetin. In addition, daphnetin prevented the RANKL-induced activation of NF-κB and Akt/GSK-3β pathways in BMMs. These findings indicated that daphnetin exhibited an inhibitory effect on RANKL-induced osteoclastogenesis in vitro. The effect of daphnetin might be mediated by inhibiting ROS signal transduction, as well as preventing the activation of NF-κB and Akt/GSK-3β signaling pathways. These findings indicated that daphnetin might be considered as a new therapeutic approach for the osteoporosis treatment.

Objective To discuss the effect of low-frequency pulsed electromagnetic field (ELF-PEMFs) combined with-whole-body vibration(WBV) on the bone mineral density,bone microstructure and the biological mechanics performance inhindlimb unloading osteoporosis rats.Methods Forty female 4 months aged SD rats were randomly divided into five groups:blank group,control group,ELF-PEMFs group,WBV group,low-frequency pulsed electromagnetic field combined with wholebody-vibration(ELF-PEMFs + WBV) group.The blank group was the normal control which comprise the healthy rats.The controlgroup was the disused osteoporosis model.Except for the blank group,thehind limb unloading rats were kept for six weeks.No intervention were provided to the blank group and the control group,other three groups were treated with physical therapy.The bodyweight of rats in each group was record.Bone mineral density was measured by Dual energy X-ray absorptiometry.The right femurs was analyzed by Micro-CT and the left femur was tested through a biomechanical machine.Results After 8 weeks of continuous treatment,the ELF-PEMFs group,WBV group,ELF-PEMFs+WBV group were significantly increased in weight and bonedensity (PELF-PEMFs=0.015,PWBV=0.016,PELF-PEMFs+WBV=0.007),(tELF-PEMFs=5.956,PELF-PEMFs=0.000;tWBV=6.127,PWBV=0.000;tELF-PEMFs+WBV=4.639,PELF-PVMFs+WBV=0.000).The difference was statistically significant (F=0.091,P=0.018).The ELF-PEMFs +WBV group was significantly higher in bone formation index.The items of BV/TV,Tb.N,Tb.Th and SMI in Micro-CT analysis increased,while Tb.Sp and Conn.D index decreased significantly.Trabecular bone structure of all the three groups was improved,however the ELF PEMFs +WBV group was better than the other two groups (vs.ELF-PEMF group,PBV/TV=0.041,PTb.N=0.026,PTb.Th=0.009,PConn.D=0.030,PTb.Sp=0.045,PSMI=0.032;VS.WBV group,PBv/Tv=0.018,PTb.N=0.004,PTb.Th=0.022,PConn.D=0.042,PTb.Sp=0.039,PSMI=0.049).The maximum load,energy absorption and bone stiffness index in biomechanicalperformance test were improved.The combination treatment group were significantly improved (F=0.167,P=0.038).Conclusion Low-frequencypulsed electromagnetic field combined with whole body vibration therapy can improve bone mineral density,bone microstructureand the biological mechanics performance.They have synergistic effect and the combination therapy is better than single treatment.

目的:探讨锌转运蛋白ZIP8在骨关节炎患者中的表达及其对软骨细胞生长及基质金属蛋白酶(MMPs)表达的影响.方法:收集20例骨关节炎患者(OA组)和20例非骨关节炎患者(对照组)血清和软骨组织;采用原子吸收分光光度计测定患者血清和软骨组织中锌离子的表达水平;MTT方法检测软骨细胞的生长活力;采用小RNA干扰沉默ZIP8基因的表达;实时荧光定量PCR方法检测ZIP8及金属基质蛋白酶MMP3、MMP9、MMP12和MMP13等基因的mRNA表达水平;蛋白免疫印迹检测ZIP8及MMP3、MMP9、MMP12和MMP13等蛋白的表达水平.结果:OA组的血清和软骨组织中的锌离子浓度明显高于对照组(P＜0.01).OA组软骨组织中ZIP8的mRNA(P＜0.05)和蛋白(P＜0.01)表达水平显著高于对照组.ZIP8小RNA干扰片段可以有效的沉默ZIP的基因表达(P＜0.01);沉默ZIP8的表达促进骨关节炎患者来源的软骨细胞的生长(P＜0.05),并且降低基质金属蛋白酶包括MMP3,MMP9,MMP12和MMP13的表达水平(P＜0.05).结论:ZIP8与骨关节炎密切相关,沉默ZIP8的表达可以提高软骨细胞的生长活力,并且抑制基质金属蛋白酶的表达,为骨关节炎的治疗提供了新的靶点.

腰椎管狭窄症又称腰椎椎管狭窄综合征。表现多为缓发性、持续性的下腰和腿痛，间歇性跛行，腰部过伸活动受限。间歇性跛行是其特征性症状，即当站立和行走时腰腿痛或麻木无力，跛行逐渐加重，甚至不能继续行走，下蹲休息后缓解，若继续行走其症状又出现，骑自行车无妨碍。笔者运用推拿结合中药治疗腰椎管狭窄症取得显著疗效，介绍如下。

目的 分析炎性因子(IL-1β与TNF-α)对内质网应激(ERS)的影响以及与骨关节软骨细胞凋亡的关系,探讨相关分子机制.方法 收集正常与OA患者骨关节软骨组织各20例,RT-PCR法检测软骨组织中炎性因子IL-1β、TNF-α及ERS相关因子GRP78、CHOP的mRNA水平.Western blot法检测体外培养软骨细胞中GRP78、CHOP、ATF4和caspase-3表达,TUNEL法检测细胞凋亡.结果 与对照组相比,OA患者骨关节软骨组织中IL-1β、TNF-α与GRP78、CHOP的mRNA表达水平均显著上调(P＜0.01),IL-1β与GRP78、CHOP的高表达呈显著正相关(P＜0.05).体外实验表明,IL-1β(2 ng/L)作用下,软骨细胞GRP78、CHOP、ATF4表达水平及细胞凋亡水平较对照组均显著增高(P ＜0.01);TNF-α作用下,GRP78、caspase-3表达水平及细胞凋亡水平较对照组显著上调(P＜0.01).结论 2 ng/L及更高浓度的IL-1β可激活ATF4-CHOP介导的ERS反应而诱导软骨细胞凋亡.

目的:观察康复锻炼治疗膝骨性关节炎的临床效果.方法:采用随机分组将60例膝骨性关节炎(KOA)患者分为实验组和对照组,每组各30例,两组均给予药物治疗及关节腔注射,实验组加行康复锻炼治疗,5w为一疗程.使用疼痛VAS评分和膝关节LKSS评分进行前后对比.结果:实验组和对照组治疗后疼痛VAS评分均明显减轻(P＜0.05),膝关节LKSS评分明显增高,两组改善程度结果实验组优于对照组(P＜0.05).结论:康复锻炼可有效缓解患者的关节疼痛,加强膝关节的稳定性,促进膝关节功能恢复.

[Objective]with the combination of the supeuficial view on bronchus asthma in chinese and western medicine and acupoint sticking therapy,the paper disscusses the prominent effect on bronchus asthma treated with acupoint sticking.[Method]Acupoint Sticking in dog—days (the hottest season in a year) was used to treat 30cases of bronchus asthma,selecting the acupoints of Lung - shu,heart - shu and diaphragmshu ( pairs of side).[Result]12 cases cured(40% ),14 cases effective(46.67% ),no effect 4 cases( 13. 33),and total effective percentage 86.67%.[Conclusion]acupoint sticking therapy is prominently effective in treating bronchusasthma and worth applying in clinic.

寰枢椎错缝又称寰枢关节半脱位.是临床上较常见的、高发的疾病.临床上多以突然出现头晕眼花、恶心呕吐为主,常在头颈部旋转时加重,颈项部强痛活动受限,可伴有头痛、心慌、耳鸣.其发病率逐年增高,发作时天旋地转,且易反复发作.笔者用推拿结合中药治疗寰枢椎错缝取得了显著疗效,介绍如下.