目的:观察泉州正骨推手手法联合刃针疗法治疗气滞血瘀型腰背肌筋膜疼痛综合征(MPS)的临床疗效.方法:选取气滞血瘀型腰背MPS患者 80 例,随机分为对照组和观察组,每组 40 例.对照组接受常规西药治疗,观察组接受泉州正骨推手手法联合刃针疗法治疗.两组患者均连续治疗两周.比较两组患者视觉模拟评分法(VAS)评分、日本骨科协会评估治疗分数(JOA评分)、健康调查量表 12(SF-12)评分,评估两组患者临床疗效.结果:治疗后,两组患者 VAS 评分均较治疗前降低(P<0.05),JOA、SF-12 评分均较治疗前升高(P<0.05);观察组 VAS 评分低于对照组(P<0.05),JOA、SF-12 评分均高于对照组(P<0.05).观察组总有效率为 90.00%(36/40),高于对照组的 77.50%(31/40),差异有统计学意义(P<0.05).结论:泉州正骨推手手法联合刃针疗法治疗气滞血瘀型腰背MPS疗效确切,可有效缓解患者疼痛症状,提高其腰部功能和生活质量.

Background:This systematic review aimed to evaluate the effectiveness and safety of ultrasound-guided acupotomy (UGAT) therapy in the treatment of patients with knee osteoarthritis (KOA). Methods:We conducted online researches in the databases including PubMed, the Cochrane Library, EMBASE, China national knowledge infrastructure, China biomedical literature database, and Wan Fang data. All data were collected until January 1, 2022. Relevant randomized controlled trials on the effectiveness of UGAT for the treatment of KOA were included. Meta-analyses were carried out by RevMan 5.3 software. Evidence quality was evaluated by the grading of recommendations, assessment development, and evaluation. Results:Eight studies including 543 participants were analyzed in this study. The pooled analysis indicated that UGAT was significantly more efficient than the control group in decreasing the visual analogue scale score (mean difference = -0.81, 95% confidence interval (CI) = [-1.15, -0.47], P < .00001, 8 studies), improving knee function on the Lysholm knee score (mean difference = 8.26, 95% CI = [1.56, 14.97], P = .02, 2 studies), and increasing clinical effective rate (relative risk = 1.14, 95% CI = [1.06, 1.23], P = .0005, 6 studies). For adverse events, UGAT was also associated with lower incidence of adverse event (odds ratio = 0.27, 95% CI = [0.12, 0.63], P = .002, 4 studies) compared to traditional acupotomy. Conclusion:Current evidence suggested that UGAT therapy was effective and safe in the clinical treatments of KOA, thus could be suggested in the clinical managements of KOA. However, considering the unsatisfactory quality of the available trials, more large-scale, and better quality randomized controlled trials were recommend in future.

Review question / Objective: Our network meta-analysis aims to compare the clinical efficacy of four different traditional Chinese exercise therapy treatments for patients with degenerative lumbar instability and provide evidence for the selection of a more effective exercise regimen.Condition being studied: Degenerative lumbar instability (DLI) is defined as translation and rotation between the functional units of the spine (FUS) beyond INPLASY 1 International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY PROTOCOL Network meta-analysis of four kinds of traditional Chinese exercise therapy in the treatment of degenerative lumbar instability: protocol for a systematic review

目的:观察泉州正骨推手治疗腰背肌筋膜疼痛综合征的临床疗效.方法:选取我院2022年6月～2022年12月收治的80例腰背肌筋膜疼痛综合征患者,采用随机数字表法分为治疗组和对照组,每组各40例.对照组采用传统理筋手法,治疗组在对照组基础上加用泉州正骨推手手法,连续治疗2周.分别于治疗前后、治疗后1个月、随访时比较两组患者视觉模拟量表(VAS)评分及日本骨科协会(JOA)评分,并评价临床疗效.结果:治疗后、治疗后1个月两组VAS评分均较治疗前降低(P＜0.05),且治疗组VAS评分较对照组下降更明显(P＜0.05);治疗后、治疗后1个月两组JOA评分均较治疗前提升(P＜0.05),且治疗组VAS评分较对照组提升更明显(P＜0.05);治疗组总有效率为95.00％,高于对照组的82.50％(P＜0.05).结论:与单纯传统理筋手法相比,泉州正骨推手结合理筋手法治疗腰背肌筋膜疼痛综合征的疗效更显著.

"气至"包含"气至针下"及"气至病所".针对肌源性疾病,结合患者症状体征,找到病灶的激痛点,触诊激痛点下的结节或紧绷肌带,触手按压固定或拇食指钳住,刺手持针,针尖沿触手拇指甲边缘刺入紧绷肌带,较易使"气至针下".若激痛点除表现肌肉疼痛外,可诱发可识别的引传症状,在针刺激痛点下的结节或紧绷肌带,使针感沿引传痛的部位感传,做到"气至病所".针对神经源性疾病,结合患者症状体征,判断病灶神经节段,有针对性针刺刺激神经根、神经干、外周神经卡压点,使针感沿神经走行的方向放射至肢体末端,做到"气至病所".

目的 观察四步法治疗屈伸受限型急性腰扭伤的临床疗效并探讨其作用机制.方法 随机将80例屈伸受限型急性腰扭伤患者随机分为治疗组与对照组各40例.治疗组行四步法治疗,对照组行针刺治疗.两组治疗前后患者进行视觉模拟量表(VAS)评分、腰椎活动度评分及临床疗效比较.结果 两组治疗第1、3次后VAS评分与治疗前比较均改善(均P＜0.01),且治疗组治疗第1、3次后VAS评分均优于对照组(均P＜0.01).治疗组经第1、3次治疗后腰椎活动度评分较治疗前明显改善(P＜0.01);对照组经第1次治疗后腰椎活动度评分较治疗前有改善,但差别不大(P＞0.05),经第3次治疗后腰椎活动度评分较治疗前改善(P＜0.01).治疗组经第1、3次治疗后腰椎活动度评分均优于对照组(均P＜0.01).两组总有效率均为100％(P＞0.05),但治疗组整体临床疗效优于对照组(P＜0.01).结论 四步法能明显缓解患者疼痛,改善屈伸受限型急性腰扭伤患者的屈伸功能,从而达到治疗急性腰扭伤的目的,该方法简单,操作安全,疗效满意.

目的:观察针刀松解术联合南少林站桩功锻炼治疗早期膝骨关节炎的临床疗效.方法:将60例早期膝骨关节炎患者随机分为2组,每组30例.南少林站桩功组采用针刀松解术联合南少林站桩功锻炼治疗,股四头肌锻炼组采用针刀松解术联合股四头肌肌力锻炼治疗.针刀松解术每周治疗1次,共治疗2次;针刀松解术后第2天分别开始南少林站桩功锻炼和股四头肌肌力锻炼,连续锻炼2周.分别于治疗前、治疗结束后,采用膝部疼痛视觉模拟量表(visual analogue scale,VAS)评价患膝疼痛程度,采用西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分评价患膝功能,并于治疗结束后按照自拟标准评价总体疗效.结果:①膝部疼痛VAS评分.治疗前2组患者的膝部疼痛VAS评分比较,差异无统计学意义[(4.54±1.03)分,(4.64±1.22)分,t=0.759,P=0.451];治疗结束后南少林站桩功组的膝部疼痛VAS评分低于股四头肌锻炼组[(1.75±0.77)分,(2.35±1.31)分,t=-5.976,P=0.000],2组患者的膝部疼痛VAS评分均较治疗前降低(t=13.360,P=0.000;t=6.020,P=0.000).②WOMAC评分.治疗前2组患者的WOMAC评分比较,差异无统计学意义[(25.42±5.63)分,(25.56±5.29)分,t=-0.686,P=0.493];治疗结束后南少林站桩功组的WOMAC评分低于股四头肌锻炼组[(13.28±5.40)分,(16.75±4.33)分,t=-0.725,P=0.000],2组患者的WOMAC评分均较治疗前降低(t=-23.456,P=0.000;t=-23.745,P=0.000).③总体疗效.治疗结束后,南少林站桩功组治愈9例、显效14例、有效5例、无效2例,股四头肌锻炼组治愈2例、显效5例、有效17例、无效6例;南少林站桩功组的总体疗效优于股四头肌锻炼组(R南少林站桩功组=22.28,R股四头肌锻炼组=38.72,Z=-3.819,P=0.000).结论:针刀松解术联合南少林站桩功锻炼治疗早期膝骨关节炎,可以有效减轻膝关节疼痛,改善膝关节功能,总体疗效优于针刀松解术联合股四头肌肌力锻炼.

腰骶部慢性骨筋膜间隔综合征[1](chronic lum-bosacral osteofascial compartment syndrome, CLOCS)是引起下腰部疼痛的主要原因之一.CLOCS往往是因长期姿势不良、过度劳累或急性损伤未及时处理迁延日久后,引起腰骶部筋膜间隔(LOC)压力升高,危害此空间内组织的循环和功能,导致以下腰痛为主要症状的疾病.现大多学者认为防治CLOCS的有效方法是尽早行LOC切开减压术[2-4].LOC切开减压术虽疗效确切、治疗效果好,但创伤大、手术费用高.针刀疗法是一种闭合性松解术,可降低LOC压力,相较LOC切开减压术具有创伤小,治疗费用低的特点.笔者运用针刀治疗CLOCS取得满意疗效,现报告如下.

目的:观察泉州正骨推手手法治疗胸椎小关节紊乱症的有效性、安全性.方法:选取2019年3月至2020年5月就诊的胸椎小关节紊乱症患者共70例,按随机数字表法随机分为治疗组、对照组各35例.对照组给予常规治疗,治疗组予以泉州正骨推手手法治疗.记录并比较视觉模拟评分法(VAS)、行为疼痛测定表(the 6-point Behavioral Rating Scale,BRS-6),并比较两组治疗前后的临床疗效.结果:治疗后两组的V A S评分、B R S-6评分均明显低于治疗前,且治疗组明显低于对照组,差异有统计学意义(P＜0.05);治疗组治疗后的临床疗效明显高于对照组,差异有统计学意义(P＜0.05).结论:泉州正骨推手手法应用于胸椎小关节紊乱症,能缓解疼痛、提高临床疗效.

目的 探讨南少林理筋弹拨手法联合刃针治疗腰背肌筋膜炎的临床疗效.方法 收集符合腰背肌筋膜炎诊断标准和纳入标准的患者80例,分配至治疗组、对照组,治疗组采用南少林理筋弹拨手法配合刃针治疗,对照组口服双氯芬酸钠50 mg每天2次、盐酸乙哌立松50 mg每天3次.采集患者的基本数据,评估治疗前后患者视觉疼痛模拟评分(VAS)及疼痛分级指数(pain rating index,PRI)、现有疼痛强度(present pain intensity,PPI).对比2组的VAS评分及PPI、PRI指数.结果 2组患者治疗前后VAS评分、PPI、PRI指数比较,差异均有统计学意义.2个疗程治疗后治疗组的愈显率、总有效率均明显高于对照组.结论 南少林理筋弹拨手法联合刃针可明显地缓解疼痛,有效治疗腰背肌筋膜炎.

目的:探讨腰骶部慢性骨筋膜间隔综合征患者与健康人之间的腰骶部骨筋膜间隔压力值的区别,为该病的临床诊断及疗效评估提供客观依据.方法:应用CYY-1型自动筋膜压测量仪测量患者组与健康组的腰骶部竖脊肌骨筋膜室内压.结果:腰骶部慢性骨筋膜间隔综合征患者的腰骶部竖脊肌骨筋膜间隔内压为37.45±13.28mmHg,高于健康人的14.55±12.53mmHg,差异有统计学意义(P＜0.01).结论:患者组的腰骶部竖脊肌骨筋膜间隔内压明显超过临界标准30mmHg,该测量结果可以为本病的临床诊断及疗效评估提供客观依据.

Objective:To explore the clinical efficacy and MRI outcome tendency of conserva-tive treatment in herniation of cervical disc patient. Methods:60 patients with herniation of cervical disc were treated by conservative treatment from January 2010 to July. The efficacy and the change of herniation tissue were observed. Results: The effective rate was 95.0%. The difference of the change of herniation tissue after MRI in prior treatment and 6 months of post treatment was signifi-cant (P<0.05). Conclusion:The conservative treatment in herniation of cervical disc can effectively improve the clinical symptoms, and the intervertebral disc tissue can natural reabsorption.

目的:探讨腰椎间盘突出症术后复发的保守治疗.方法:对21例腰椎间盘突出症术后复发患者进行综合保守治疗,观察其疗效.结果:显效15例,好转2例,无效4例,总有效率81%.结论:腰椎间盘术后复发,采用综合疗法仍可收到较满意的疗效,术后复发病人应首选保守治疗.

目的:观察巨大型腰椎间盘突出症保守治疗的效果;方法:对66例巨大型腰椎间盘突出症患者采用推拿配合硬膜外注射、牵引、理疗、药物等综合保守治疗;结果:66例患者中治愈38例(57.6%),好转22例(33.3%),无效6例(9.1%),总有效率90.9%;结论:部分巨大型腰椎间盘突出症患者可经保守疗法治愈或好转,提示腰椎间盘突出症治疗应个体化,不应按突出大小绝对划分手术和保守适应症.

神经根型颈椎病是因颈椎间盘、椎间关节、韧带等组织的退行性改变刺激和压迫颈神经根而出现的颈肩部疼痛伴上肢放射性麻痛的综合证候群.我科自2007年10月以来采用颈部推拿配合颈椎牵引及水突穴注射治疗重症神经根型颈椎病,取得较满意疗效,现报道如下.

目的:观察短杠杆微调手法结合水突穴位注射治疗重症神经根型颈椎病的临床疗效.方法:采用短杠杆微调手法结合水突穴位注射治疗重症神经根型颈椎病32例,疗程3周.结果:短杠杆微调手法结合水突穴位注射治疗重症神经根型颈椎病治愈率为59.4%,总有效率96.9%.结论:短杠杆微调手法结合水突穴位注射治疗重症神经根型颈椎病疗效可靠,是一种值得临床推广的治疗方法.