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.

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.

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.

Background: This systematic review program is designed to provide an assessment of the effectiveness and safety of needle-knife therapy for the treatment of carpal tunnel syndrome (CTS). Methods: A cumulative search till October 2018 will be conducted in the following 8 databases: PubMed, EMBASE, Cochrane Controlled Trials Register, MEDLINE, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, and Wanfang Database, with no language or Publication status restrictions. All randomized controlled trials (RCT) for carpal tunnel syndrome will be considered eligible. The primary outcomes will include changes in the Boston carpal tunnel questionnaire (BCTQ) and visual analogue score (VAS), as well as safety and adverse events. Study inclusion, data extraction, and quality assessment will be done independently by 2 reviewers. If no substantial heterogeneity is detected, a meta-analysis will be performed. Continuous results will be expressed as mean differences or standard average differences, while binary data will be expressed as relative risks. The deviation risk and data synthesis will be assessed using the Review Manager software. Results: This study will provide a high-quality synthesis of BCTQ and VAS to assess the effectiveness and safety of acupotomy for carpal tunnel syndrome patients. Conclusion: This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with carpal tunnel syndrome. PROSPERO registration number: CRD42018108787.