Professor Yan Juntao’s academic experience of treating sinews for shoulder periarthritis（hereinafter referred to as “frozen shoulder”） is introduced. According to Professor Yan, the main pathogenesis of frozen shoulder in traditional Chinese medicine is “sinew impediment”, and its onset is caused by a combination of factors. In the clinic, all causative factors should be identified and considered. Treatment of sinews and staged treatment are recommended. The treatment concept of “mastering all methods of treatment for treatment” is highlighted. It is advocated that Tuina massage should be a combination of dynamic and static manipulations, that Tuina exercise should be applied with syndrome differentiation, and that modern rehabilitation should be integrated into the theoretical framework and clinical diagnosis and treatment of frozen shoulder. His innovation is unique and advantageous.

目的 评价不同类型医院不同医生使用脊柱微调手法治疗神经根型颈椎病的临床疗效.方法 从10家不同类型医院推拿科挑选20名医生进行脊柱微调手法培训,考核合格后用本手法治疗神经根型颈椎病患者,每周3次,共4周,共收集了273例病例,然后分析不同医院医生治疗前后患者疼痛评分(VAS)、颈椎功能障碍指数评分(NDI)、健康调查简表(SF-36)评分变化情况,以及治疗后临床疗效和组间VAS、NDI、SF-36的差异.结果 各医院患者治疗前比较,三个观察指标VAS、NDI、SF-36等评分差异均没有统计学意义;而治疗后三个指标VAS、NDI、SF-36等评分均明显低于治疗前,差异有统计学意义(P<0.05).岳阳医院(A组)与4家三、二级中医院(B组)、5家社区医院(C组)治疗后相比,VAS、NDI、SF-36等评分差异及各组之间临床疗效结果差异均无统计学意义(P>0.05).结论 脊柱微调手法治疗神经根型颈椎病安全有效,手法简便快捷,操作流程标准规范,经过培训,手法操作者的临床使用具有同质性,值得广泛推广.

肩关节周围炎简称肩周炎,是指肩关节及其周围的肌腱、韧带、腱鞘、滑囊和关节囊等软组织的急慢性损伤,或退行性病变,导致局部慢性炎症渗出,产生粘连,限制了肩关节活动,引起肩部疼痛、活动功能障碍的病症.本文以国医大师、各省市名中医为研宄对象,从理、法、术三方面对手法治疗肩周炎经验的文献进行梳理,总结其方法共性,提炼其核心治疗理念,旨在传承名中医学术思想、特色手法,提高手法治疗肩周炎的临床效果.

目的:评价脊柱微调手法治疗腰椎间盘突出症的价值.方法:从4家综合性医院推拿科选取腰椎间盘突出症患者随机分为试验组(131例)和对照组(130例).试验组采用脊柱微调手法,对照组采用传统推拿手法进行治疗,每周治疗3次,共4周,然后评价两组患者临床疗效及ODI、SF-36的变化.结果:试验组临床有效率为94.66％,显效率为87.78％;对照组有效率90.76％,显效率73.07％,两组相比差异有统计学意义(P＜0.05).在ODI比较上,两组患者治疗前差异无统计学意义(P=0.07),治疗后有统计学意义(P=0.00),且试验组优于对照组(P=0.03).在SF-36比较上,两组患者治疗前差异无统计学意义(P＞0.05),治疗后均有统计学意义(P＜0.05),且试验组在改善患者躯体功能(P=0.001)、躯体疼痛(P=0.000)、总体健康感(P=0.013)和社会功能(P=0.001)方面优于对照组.结论:脊柱微调手法治疗腰椎间盘突出症临床显效率优于传统推拿手法,能更有效的改善腰椎间盘突出症患者疼痛及腰椎功能障碍,提高其生活质量,值得推广.

目的:系统评价推拿手法治疗肩痛的疗效.方法:计算机检索PubMed、Embase、Web of Science、知网(CNKI)、维普(VIP)和万方(WanFang)数据库,对检索到的具有随机对照试验(RCT)的数据进行Meta分析.结果:共纳入11篇RCT,1100例肩痛患者.Meta分析结果显示,推拿手法治疗肩痛,在视觉模拟评分(VAS)、肩关节功能活动度、上肢肌力评分、生活能力评定方面疗效均优于对照组(P<0.0001).结论:当前证据表明,推拿在改善肩痛患者疼痛、恢复肩关节功能方面具有一定的临床疗效.

目的:评价和筛选脊柱微调手法关键参数,为制定《脊柱微调手法操作规范》提供依据.方法:采用德尔菲法对全国18位专家进行问卷征询.结果:筛选获得核心关注问题,并经德尔菲专家咨询获得重要性较高的16个问题条目,占总条目的64％;两轮问卷专家积极系数100％,专家权威度分别为0.741、0.833,专家协调系数分别为0.446、0.847.结论:本次研究中,专家的积极性和权威性较高,得出建议的可信度和协调程度较好.专家对脊柱微调手法治疗颈椎病的手法适应证的认定、手法操作特征认定、手法处方的认定较为关注,其与传统推拿相比,在安全性和便捷性方面具有优势.此项研究为进一步明确脊柱微调手法的实施细则创造条件.

目的 探讨坐位调膝法治疗髌股关节疼痛和屈伸不利的临床疗效.方法 将1 300例髌股关节病患者按照真实世界研究方法分成治疗组1 000例和对照组300例,治疗组运用坐位调膝法,对照组采用温针治疗.采用HSS评分系统和VAS评分系统,观察患者治疗前后各项指标分值.结果 经过治疗后,两组各项观察指标分值均得到提升,关节外侧、内侧VAS疼痛评分也明显降低,且观察组所得疗效更为显著(P＜0.05).结论 坐位调膝法对髌股关节病的治疗效果较好,能够缓解关节疼痛,改善关节活动度,改善关节功能.

目的:借助于数据挖掘技术总结龚利推拿治疗膝骨关节炎的选穴规律.方法:2016年10月～2017年10月在上海中医药大学附属岳阳中西医结合医院膝关节推拿门诊就诊的膝骨关节炎患者30例, 共计300诊次的推拿处方资料, 对所采集的腧穴及其所属经脉特点进行分析, 运用描述、关联和聚类分析等数据分析技术, 分别研究其外在特征和内在联系.结果:膝眼为使用频率最高的腧穴;腧穴主要分布在膝关节周围.通过关联性分析发现"膝眼 (经外) 、鹤顶 (经外) 、阴陵泉 (脾) 、血海 (脾) "是相关性最高的组合.聚类分析研究发现腧穴有3个有效聚类群.结论:龚利主任临床治疗KOA的经脉和腧穴使用的内在规律多选用足三阴三阳经脉;推拿处方以膝眼 (经外) 、鹤顶 (经外) 、阴陵泉 (脾) 、血海 (脾) 、阳陵泉 (胆) 、阿是穴 (经外) 等为主.

Objective To investigate the application value of acoustic radiation force impulse(ARFI) elastography in diagnosing myofascial pain syndrome(MPS) of shoulder.Methods Forty patients with MPS of shoulder and 50 healthy individuals were enrolled as MPS group and control group respectively.The tensive part(pain points)of shoulder muscle in the MPS group and the venter musculi of descending part of musculi trapezius in the control group were detected using ARFI elastography and regular two-dimensional(2D) ultrasound.The image of regular 2D ultrasound was recorded.Elasticity image and sheer wave velocity(SWV) were acquired by virtual touch tissue imaging(VTI) and virtual touch tissue quantification(VTQ) of ARFI respectively.Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency of SWV for MPS.Results The image of VTI was darker in the MPS group compared to the control group.SWV value of the MPS group was higher than that of the control group(2.57±0.62 m/s vs.1.55±0.62 m/s;P<0.05).The result of ROC curve showed that the sensitivity,specificity,and the area under curve were 82.5%,88.0% and 0.882,respectively,when the diagnostic threshold of SWV was 2.12 m/s.Conclusion ARFI can be taken as the potential approach to diagnosing MPS of shoulder.The SWV value obtained by VTQ technology of ARFI can be applied to the auxiliary diagnosis of MPS of shoulder.

Objective To study the clinical pathway about massage therapy on protrasion of the lumbar in-tervertebral disci .Methods 100 patients were left hospital from massage department from May ,2008 to Dec.2008 and received massage therapy by conventional mode were as control group .80 patients received massage therapy by clinical pathway mode were as treatment group .Length of hospital stay ,medical costs ,expenses for medicine and treat-ment costs of patients in two groups were compared .Results The length of hospital stay in treatment group was shor-ter than that in control group (P<0.05).There was no significant difference between two groups on medical costs , expenses for medicine and treatment costs (P>0.05).Conclusion The number of days hospitalized patients can be significantly reduced by carrying of the clinical pathway .

目的 观察脊柱微调手法治疗腰椎间盘突出症急性期的临床疗效.方法 将36例腰椎间盘突出症急性期患者随机分为实验组和对照组,各18例;对照组给予甘露醇+地塞米松静脉滴注及中药热敷治疗,实验组在对照组基础上结合脊柱微调手法治疗.观察两组治疗前后疼痛VAS评分和Oswestry功能障碍指数(ODI)评分变化情况.结果 治疗后,两组疼痛VAS评分均较治疗前显著降低(P＜0.01),但两组疼痛VAS评分降幅无显著性差异(P＞0.05);两组ODI评分均较治疗前显著降低(P＜0.01),且实验组ODI评分降幅大于对照组(P＜0.05).结论 脊柱微调手法可有效改善腰椎间盘突出症急性期疼痛和功能障碍.

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.

目的:研究腰椎间盘突出症临床路径现状,为进一步研究临床路径打下基础.方法:应用计算机使用高级检索功能检索重庆维普中文科技期刊数据库,检索词是题名或关键词为"腰椎间盘突出症"并且题名或关键词为"临床路径",时间是1989年-2009年.同时检索PubMed数据库,检索词为"Lumbar disc herniation ,Clinical pathways,Clinical pathway",结果:维普数据库检索到文献22篇,根据路径特点可分为医疗管理类临床路径和护理管理类临床路径,医疗管理类临床路径又分为手术类和非手术类,护理管理类临床路径又可分为健康教育类和临床护理类.PubMed数据库检索到文献8篇,但是经审查0篇符合腰椎间盘突出症临床路径研究的要求.结论:通过实施临床路径,可以明显地减少患者住院天数、降低住院费用、提高健康教育内容的掌握程度和患者满意度.推拿治疗腰椎间盘突出症疗效显著,目前国内外还没有腰椎间盘突出症推拿科临床路径的报道,开展腰椎间盘突出症推拿科临床路径研究具有重大意义.

随着社会经济不断发展,医学正从单纯的疾病治疗转向预防-保健-治疗-康复"四位一体"的新模式[1].以老年病、残疾作为治疗对象的新兴学科--康复医学得到飞速发展.但与其相适应的情况来看,康复医学人才尤其是康复治疗师目前我国奇缺[2,3].

Objective:To observe and evaluate the clinical efficacy of modified three-step massage therapy,including convulsion relief,regulation and collateral unblocking,in the treatment of prolapsed lumbar intervertebral discs at L4-5 and L5～S1 segments.Methods:345 subjects were randomized into two groups:massage group in which 126 cases were treated with modified three-step massage therapy and comprehensive group in which 219 cases were treated with routine medicines and physical therapies.Results:In massage group,18 cases were cured,99 cases improved and 9 cases failed,and the total effective rate was 92.86%;in comprehensive group,25 cases were cured,175 cases improved and 19 cases failed,and the total effective rate was 91.32%;there was no difference between the two group(P 0.05).Conclusion:This modified three-step massage therapy is rather effective for prolapsed lumbar intervertebral discs at L4-5 and L5～S1 segments.

ObjectiveTo study the effects of Chinese massage on knee extension velocity and electromyogram in sarcopenia. MethodsFifteen sarcopenia patients were treated for 8 weeks by isometric exercise of Chinese massage and Chinese massage manipulation. Knee extension velocity and electromyogram (EMG) were measured before and after treatment. ResultThe results of the clinical study in the sarcopenia patients revealed that after treatment knee extension velocity significantly increased, and Durat and rising time in EMG obviously decreased. ConclusionChinese traditional rehabilitation maneuver, isometric exercise of Chinese massage along with Chinese massage manipulation, can prevent and treat sarcopenia by facilitating knee extension velocity and enhancing muscles synchronize contraction.

本课题在对急性脑梗塞病人进行常规药物治疗的基础上,观察了推拿、针刺及未加推拿和针刺时患者神经功能缺损程度评分及日常生活活动(ADL)量表的变化并作比较;结果显示:早期推拿、针刺治疗急性脑梗塞具有较好的临床疗效,为应用推拿、针刺防治急性脑梗塞提供了进一步的依据.

In order to explore influence of static training on β endorphin and POMC genetic expression in rats, 168 rats were randomly divided into six groups: high load (A), medium load (B), low load (C) group, dynamic training (D) group, banding (E) group and normal (F) group. Six weeks later, the instant contents of hypothalamus, hypophysis, plasma β endorphin and hypothalamus POMC mRNA were respectively determined after tranquility and motion. The results showed that both static training and dynamic training could enhance the transcript level of hypothalamus POMC gene, but the static training had elevated the central β endorphin content and its interpretation level after tranquility and motion. The conclusion is that the trigger of internal β endorphin genetic expression might be one of the internal mechanisms in effect of the static training.