对X线图像评价椎弓根螺钉水平面位置的探讨

目的:探讨椎弓根螺钉水平面位置的X线图像判断方法。方法:选用12具脊柱标本(T11~L5)在C型臂X线机透视下测量各节段与螺钉水平面位置相关的7个参数:椎弓根水平面成角,椎弓根狭窄处横径,椎弓根中心轴椎后方(PAPP)距正位成像椎弓根阴影中心的水平距离,椎弓根中心轴椎前方距正位成像椎弓根阴影中心的水平距离,直径6mm螺钉在PAPP进钉水平面内的最大允许偏离角度,PAPP距关节突关节中央(胸椎)或关节间隙中央(腰椎)的水平距离,PAPP距上关节突外缘的水平距离。以此作为客观依据对实验性三种水平面位置(好、可、差)螺钉共240枚进行X线评价。结果:经方差分析,7个位置参数在各节段的差异均有显著性意义(P<0.05);X线图像法判断的敏感性为84%～95%,特异性为93%～96%,预估值为85%～92%,与40例经CT扫描证实的螺钉位置进行比较,其诊断价值与实验结果相近。结论:以各节段椎弓根螺钉水平面位置参数为依据的X线评价法是一种简单、相对可靠的判断方法。     

云纹图法(MT)诊断颈肩腰腿痛的初步应用

<正>云纹图法(Moire topography,MT),又称云纹照相法(Moire photography),是一种简便有效的脊柱侧凸学校普查方法。2013年10月²014年3月,在针灸科运用MT对颈肩腰腿痛患者作筛查,拓展了MT在背部疾病诊断中的临床应用范围。1材料和方法1.1 MT设备、场地设置与判断标准,与脊柱侧凸学校     

脊柱局部正骨推拿对颈肩腰腿痛患者VAS 评分及睡眠质量的影响

目的:分析脊柱局部正骨推拿对颈肩腰腿痛患者视觉模拟评分(VAS)评分及睡眠质量的影响。方法:选取我院2017年5月—2019年1月收治的颈肩腰腿痛患者144例,根据治疗方法不同均分为两组。对照组给予常规药物治疗,观察组在对照组基础上给予脊柱局部正骨推拿治疗,分析两组患者的疗效、VAS评分、主要关节功能(CASCS)评分、睡眠质量及复发率情况。结果:观察组的疗效优于对照组,差异有统计学意义(P0.05)。两组治疗前VAS评分、CASCS评分组间比较,差异无统计学意义(P0.05)。观察组治疗后的CASCS评分为(91.27±6.36)分,高于对照组的(74.15±5.18)分,VAS评分为(1.28±0.28)分,低于对照组的(2.48±0.33),差异有统计学意义(P0.05)。观察组的睡眠质量优36例,良18例,中16例,差2例;对照组的睡眠质量优16例,良26例,中18例,差12例;观察组的整体睡眠质量优于对照组,差异有统计学意义(P0.05)。观察组的复发率为6.94%,低于对照组的18.06%,差异有统计学意义(P0.05)。结论:脊柱局部正骨推拿应用于颈肩腰腿痛可减轻患者疼痛程度,改善主要关节功能,提高睡眠质量,且复发率低。     

中药喷熏在颈肩腰腿痛症的临床应用

笔者在临床应用中药喷熏的方法来治疗颈肩腰腿痛症患者，以观察其疗效，现报告如下。     

宾椎神经与颈肩腰腿痛之间的相关性

随着椎管内手术的开展以及免疫组化技术的广泛应用，人们对颈肩腰腿痛的发病机理有了进一步的认识。颈腰椎的盘源性疼痛，不仅是由于神经根受机械性压迫及其无菌性炎症所引起，而且与椎管内富含感觉纤维的组织尤其是硬脊膜、后纵韧带、椎间盘受刺激有非常重要的关系。     

放散式冲击波循经取穴治疗颈肩腰腿痛的临床疗效观察

目的探讨放散式冲击波循经取穴在治疗颈肩腰腿痛中的临床疗效。方法将2000例病例分为A(1100例)组和B(900例)组,A组应用放散式冲击波治疗疼痛区域同时,配合中医经络理论循经取穴治疗与疼痛部位相关经络及穴位,B组单纯应用放散式冲击波治疗疼痛部位,比较两组患者治疗前后的视觉模拟评分(VAS)、睡眠质量指数(PSQI)及临床疗效。结果两组治疗后VAS及PSQI各项评分较治疗前明显下降,有统计学差异,P0.05,两组相比较,冲击波循经取穴组治疗疗效优于单纯冲击波治疗组,P0.05。结论放散式冲击波循经取穴在治疗颈肩腰腿痛可提高临床疗效,值得推广。     

加强科研实践,提高对颈腰痛的诊疗水平：——写在第9届颈腰痛会议之后

加强科研实践，提高对颈腰痛的诊疗水平──写在第９届颈腰痛会议之后全国颈腰痛研究会名誉理事长周秉文瑞典知名学者Ｎａｃｈｅｍｓｏｎ（１９８４）曾说，８０年代是腰背痛向我们挑战的年代，那么我们说９０年代就是我们向颈肩痛进攻的时代。我们的学术会议已开过９次，...     

腰背部软组织损伤对重度骨质疏松患者经皮椎体成形术疗效的影响

目的 分析腰背部软组织损伤对重度骨质疏松性椎体压缩骨折(severe osteoporotic vertebral compression fractures,SOVCF)患者经皮椎体成形术(percutaneous vertebroplasty,PVP)后治疗效果的影响.方法 对2016年6月至2020年6月在中日友...     

公共保健操对颈肩综合征针刀术后患者康复效果的影响

目的探讨公共保健操(公健操)对颈肩综合征针刀术后患者康复效果的影响。方法将门诊颈肩综合征针刀手术患者120例随机分为干预组和对照组各60例。对照组术后给予常规护理,在此基础上干预组教会患者公健操锻炼方法,发放光碟及书面资料,督促患者坚持锻炼,每日2次,每次15min。于术前及术后1个月采用日本矫形外科学会评分量表(JOA)以及视觉疼痛量表(VAS),对两组患者术后康复效果进行评估。结果两组VAS、JOA评分比较,干预主效应均P<0.01。结论坚持公健操锻炼能提高颈肩综合征针刀术后患者的康复效果。     

颈椎后部结构对颈脊柱运动稳定性影响的实验研究

在１５例新鲜颈椎标本上定量地研究了颈椎后部结构切除对其前屈，后伸和左，右侧弯运动的影响，包括与单开门术式相关的椎板及部分黄韧带，与颈椎神经根减压术有关的单侧或双侧小关节内侧半等结构。研究表明两侧椎板和部分黄韧带切除对颈椎运动无显著性影响，即颈椎单开门术不会造成颈椎的不稳；单侧小关节内侧半切除后颈椎运动无明显改变，但双侧小关节内侧半切除则会产生节段的换稳，其前屈，后伸和侧弯运动将分别增加３３％，７４     

CT导引下注射丹参混合液治疗腰椎间盘性腰腿痛

目的探讨CT引导下脊神经根周围注射丹参混合液治疗腰腿痛的疗效。方法CT导引下注射丹参混合液治疗腰腿痛患者63例,其中腰间盘突出45例,膨出退行性变18例。比较术前与术后3个月及6个月的视觉模拟量表（VAS）评分,分析其疗效。结果51例疼痛明显缓解,术前平均VAS评分为7.60±2.00,术后1个月平均为3.85±1.60,术后6个月平均为4.05士1.70。术前与术后2次随访结果比较,VAS评分差异均有统计学意义;术后1个月与6个月的VAS评分差异无统计学意义。单纯腰间盘突出组与腰间盘膨出退行性变组的VAS评分差异也无统计学意义。结论CT导引下脊神经根周围注射丹参混合液治疗腰腿痛安全、有效。     

椅背整复青壮年肩关节前脱位

<正>肩关节前脱位是临床常见的脱位,多发于20～50岁,男性居多,治疗方法很多。2005年至2007年急诊收治的肩关节前脱位青壮年患者68例,运用椅脊整复法治疗,均获得成功,现将治疗体会报告如下。1临床资料手牵足蹬法复位失败的肩关节前脱位患者68例,男45例,女23例;年龄25～46岁,平均36岁;跌伤34例,车祸伤24例,投掷伤10例;左肩25例,右肩43例,喙突下脱位35例,盂下脱位25例,锁骨下脱位8例。伤后2h内就诊48例,2h～2d就诊15例,3～10d就诊5例。68例患者均在急诊复位,复位前经X线确诊并排除并发症。2治疗方法     

Sickness absence and concurrent low back and neck–shoulder pain: results from the MUSIC-Norrtälje study

In Sweden, musculoskeletal disorders, in particular low back disorders (LBD) and neck–shoulder disorders (NSD) constitute by far the most common disorders, causing sick leave and early retirement. Studies that compare sickness absence in individuals with LBD and individuals with NSD are lacking. Moreover, it is likely that having concurrent complaints from the low back region and the neck–shoulder region could influence sickness absence. The purpose of the present study was to explore potential differences in sickness absence and in long-term sickness absence during a 5-year period, 1995–2001, among individuals with (1) solely LBD, (2) solely NSD, and (3) concurrent LBD and NSD. The present study was based on 817 subjects from the MUSIC-Norrtälje study, whom were working at baseline and whom at both baseline and follow-up reported LBD and/or NSD. Three groups were identified based on pain and pain-related disability at both baseline and follow-up: (1) solely LBD, (2) solely NSD, and (3) concurrent LBD and NSD. Subjects who did not give consistent answers at both the baseline and follow-up occasions were assigned a fourth group: (4) migrating LBD/NSD. Two outcomes were analysed: (1) prevalence of sickness absence, and (2) long-term sickness absence among those with sickness absence days. Logistic regression analysis was used to calculate odds ratios (OR) for sickness absence in the different disorder groups, taking into account confounding factors such as gender, age and other non-musculoskeletal-related disorders. In the group concurrent LBD and NSD, 59% had been sickness absent between baseline and follow up, compared to 42% in the group solely LBD, 41% in the group solely NSD, and 46% in the group migrating LBD/NSD. No difference in sickness absence was found between the group solely LBD compared to the group solely NSD [OR 0.65 (0.36–1.17)]. The adjusted OR for sickness absence in the group concurrent LBD and NSD compared to subjects with solely LBD or solely NSD was [OR 1.69 (1.14–2.51)]. The adjusted OR for having long-term sickness absence was 2.48 (95% CI = 1.32–4.66) for the group concurrent LBD and NSD. In the present study, having concurrent LBD and NSD were associated with a higher risk for sickness absence and also long-term sickness absence. This suggests that, when research on sickness absence and return to work after a period of LBD or NSD is performed, it is important to take into consideration any concurrent pain from the other spinal region. The study also implies that spinal co-morbidity is an important factor to be considered by clinicians and occupational health providers in planning treatment, or in prevention of these disorders.     

Stress biomarkers' associations to pain in the neck, shoulder and back in healthy media workers: 12-month prospective follow-up

Physiological and psychological mechanisms have been proposed to link stress and musculoskeletal pain (MSP), and a number of stress biomarkers in patients with chronic pain have shown to be associated with stress-related disorders as well as health and recovery. The aim was to study if similar results might be found in a working population, in stress and computer intensive occupations with mild/moderate pain in neck, shoulder and back. The questions were if there are: (1) associations between self rated neck, shoulder and back pain (VAS) on one hand and stress-related (catabolic), recovery related (anabolic) variables, cardiovascular/lifestyle factors and immune markers on the other hand. (2) associations between long term changes in pain and stress marker values (6 month period). (3) predictive values in stress biomarkers for pain (12 month period) A study group with 121 media workers, 67 males (average 45 years) and 53 females (average 43 years), at three news departments of a media company was recruited. Pain occurrence and pain level in neck, shoulder, upper and low back were self-rated at three times with a 6-month interval towards the last month. Stress biomarker sampling was performed, at the same intervals. An additional similar questionnaire with momentary ratings focusing on “at present” i.e. within the same hour as stress biomarker sampling was performed. There were no changes in medicine intake or computer working hours during the 12 month study period. The total pain level and prevalence of pain decreased between baseline and 12 months′ follow-up. The rate of participation was 95%. Cross-sectional analyses on differences in stress biomarkers in groups of “no pain” and “pain” showed less beneficial stress biomarker levels (P < 0.05) in the “pain” group after age and gender adjustments in: S-DHEA-S and P-endothelin, S-insulin and P-fibrinogen. Analyses of each gender separately, adjusted for age, revealed in males differences in S-insulin, saliva cortisol 3, and P-endothelin. Furthermore, tendencies were seen in BMI, P-fibrinogen, and S-testosterone. In the female “pain” group a less beneficial P-BNP level was found. Longitudinal analysis of changes in pain levels and stress biomarkers within an interval of 6 months showed beneficial changes in the following stress markers: P-NPY, S-albumin, S-growth hormone and S-HDL when pain decreased, and vice versa when pain increased. Linear regression analyses showed statistically significant predicting values at the initial test instance for pain 12 months later in lower S-DHEA-S and S-albumin and higher B-HbA1c and P-fibrinogen. In stepwise regression and after age and gender adjustments, the associations with S-DHEA-S remained statistically significant. The present study shows that individuals in working life with a high level of regenerative/anabolic activity have less pain than other subjects, and that decreased regenerative/anabolic activity is associated with increasing pain. The levels of NPY, albumin, GH and HDL increased when pain decreased and vice versa. Low DHEA-S predicted pain 12 months later. These findings might contribute to increased knowledge about strategies to prevent further progression of neck/shoulder/back pain in persons who are “not yet in chronic pain”.     

Reduction mammaplasty: a way helping females with neck,shoulder and back pain symptoms

Summary This study documents that the excessive weight of the female breast can lead to, or increase, existing pain symptoms of the neck, shoulder and upper trunk. Consequently, a reduction mammaplasty has to be considered as a mainly medical indication in women with permanent musculoskeletal pain symptoms in their medical history since surgery reduces the pain symptoms, increases the capacity to work, improves self-confidence and life conditions. The various technical procedures for reduction mammaplasty with a low postoperative complication rate give excellent results in correctly selected patients.     

循经刮痧治疗颈肩筋伤效果观察

目的探讨循经刮痧对颈肩筋伤患者疼痛、症状及生活质量的影响。方法将90例颈肩筋伤患者按就诊先后分为经验刮痧组和循经刮痧组各45例。经验刮痧组按照传统经验选择疼痛部位的穴位及阿是穴进行刮痧;循经刮痧组根据不同辨证分型,按经络学说及远近配穴原则进行刮痧。干预前后采用视觉模拟评分法(VAS)、田中靖久症状量表和SF-36量表进行效果评价。结果两组刮痧干预前后VAS评分比较,差异无统计学意义(P0.05);两组症状评分及SF-36评分比较,差异有统计学意义(P0.05,P0.01)。结论刮痧能减轻颈肩筋伤患者即时疼痛,循经刮痧在改善颈椎功能、提高生活质量方面效果优于经验刮痧。     

Ten-year survey reveals differences in GP management of neck and back pain

Purpose

Clinical guidelines provide similar recommendations for the management of new neck pain and low back pain (LBP) but it is unclear if general practitioner’s (GP) care is similar. While GP’s management of LBP is well documented, little is known about GP’s management of neck pain. We aimed to describe GP’s management of new neck pain and compare this to GP’s management of new LBP in Australia between April 2000 and March 2010.

Methods

All GP–patient encounters for a new (i.e. first visit to any medical practitioner) neck pain or LBP problem were compared in terms of treatment delivered, referral patterns and requests for laboratory and imaging investigations.

Results

General practitioners in Australia have managed new neck pain and LBP problems at a rate of 3.1 and 5.8 per 1,000 GP–patient encounters, respectively. GP’s primarily utilised medications, in particular non-steroidal anti-inflammatory drugs, to manage new neck and LBP problems and referred approximately 25% of all patients for imaging. Patients with new neck pain are more frequently managed using physical treatments and were referred more often to allied health professionals and specialists. In comparison, patients with new LBP were managed more frequently with medication, advice, provision of a sickness certificate and ordering of pathology tests.

Conclusions

This is the first time GP management of a new episode of neck pain has been documented using a nationally representative sample and it is also the first time that the management of back and neck pain has been compared. Despite guidelines endorsing a similar approach for the management of new neck pain and LBP, in actual clinical practice Australian GPs manage these two conditions differently.     

肿瘤误诊为颈腰腿痛疾病6例分析

颈腰腿痛是骨伤科的常见病和多发病,也正因为如此,在临床工作中,往往在惯性思维的影响下,将大部分的颈腰腿痛都归结为颈椎病、腰椎间盘突出、腰肌劳损等病名,而忽视了对每例患者疾病特点的分析,忽视了必要的鉴别诊断,导致误诊。     

Treatment of neck and shoulder pain in whip-lash syndrome patients with intracutaneous sterile water injections

Ten whip-lash syndrome patients treated with intracutaneous triggerpoint injections with sterile water for pain relief were followed for 2 months. Pain intensity was evaluated with the Visual Analogue Scale (VAS). Eight patients became free from pain (VAS 0) and two patients improved to VAS 2 immediately after the treatment. Nine patients remained free from pain, three of them after one treatment, while six patients needed 2-4 treatments. One patient responded only a few hours after each of three treatments. Remarkably, with the relief of pain mobility was normalised in all patients. The method is suggested to be a first choice in the treatment of not only whip-lash patients but also for most acute and chronic musculo-skeletal triggerpoint pain syndromes.