中西医结合治疗腰椎间盘突出症100例

Traditional Chinese medicine (Acupuncture) and western medicine combined to treat 100 patients with Lumbar Intervertebral Disc Herniation and Protrusion

                                                Dr. Xiu Wei

                                                              1089 Budapest, Vajda Peter u, 43a

摘要 Abstract

腰椎间盘突出症是腰腿痛最常见的原因之一。亦属中医“痹症”范畴。腰椎间盘突出症中以L4-5、L5—S1 间隙发病率最高，约占90%。多个间隙同时发病者仅占5%~22%。目前治疗此症的方法主要有非手术治疗和手术治疗。笔者采用传统针灸疗法加穴位注射同时配合医疗练功等治疗腰椎间盘突出症100例,取得了满意的疗效,总有效率达92%。现报告如下。

  Lumbar Intervertebral Disc Herniation and Protrusion is one of the most common causes of low back and lower extremities pain. L4-5, L5-S1 are the highest incidence of lumbar disc herniation and protusion,  and accounted for a more than 90%. The multiple Intervertebral gap incidence, onlyabout 20%. Currently, the treatment of this disease is mainly non-surgical treatment and surgical treatment. I use traditional Chinese acupuncture(akupunktura) and acupunctural injection with medical drugs, also let the patients to do medical gymnastics etc, to treat 100 cases of lumbar disc herniation and protrusion to achieve satisfactory effect, the total effective rate of 92%.  Report as following.

临床资料

本组100例中男性68例,女性32例;年龄最小者1 9岁,最大者80岁;病程最长者1 2年,最短者半个月。病史长、年龄长者多伴有椎管狭窄。超过70%的患者是在经过了几个星期到几个月的传统西医治疗后无明显效果而来我处就诊。约10%的患者在别处经过传统的针灸疗法无明显效果而来我处。全部病例均有腰腿疼痛、很多患者有下肢麻木等症状,均经CT或核磁共振明确诊断。

Clinical data
The group of 100 patients with 68 cases of males, 32 females; the youngest patient was 19 years old, the oldest was 80 years old; The longest history was 12 years, the shortest was two weeks. Long history with old ages usually associated with spinal stenosis. Over 70% of patients who came to me already had traditional Western medical treatment from a few weeks to a few months, but had no obvious effects. Also about 10% of patients after only having acupuncture treatments, but had no significant effect who come to my office. All patients had lumbar and leg pain, many patients hadnumbness in their leg or foot, all patients were examined by CT or MRI to confirm the diagnosis.

治疗方法

Method

治疗效果

疗效评定标准:

临床治愈: 腰腿痛症状消失，腰部活动正常，直腿抬高70°以上，,能够进行正常工作活动；

好转：腰腿痛明显减轻，腰部活动功能改善；

无效：症状、体征无改善。

治疗后随访的患者2个月-3年。 本组治愈77例,占77% ,好转15例,占15% ,无效8例,占8%。总有效率92%，一般经1.5～2个疗程即可治愈。

治疗无效的病人主要原因是腰间盘突出的过大，或年龄大病史长伴有严重的或广泛的椎管狭窄的病人。大量的临床实践经验证实，除了约10% 的患者须行手术治疗外，中西医结合的综合治疗方法已取得了很好的疗效，得到临床认可和发展.

Result

Evaluation standard:
Excellent: low back and extremities pain disappear,  the normal body activities, Lasegue sign more than 70 degree, be able to do the normal work and activities.

Better: low back and extremities pain are reduced, body activities are improved.

No effective: nearly no improvement in symptoms and signs.

Follow-up after treatment of patients 2 months to 3 years. 77 cases were cured, 77%, improved in 15 cases (15%), 8 cases (8%).Total efficiency of 92%, one of the most courses can be cured, individual 1.5-2 courses.

For the patients with no effective the main reason are the lumbar disc herniation is too large, or the older patient with long history associated with severe spinal stenosis. Except approximately 10% of patients required surgical treatment, A lof of Clinical practice and experience confirmed that, the treatment methods of using traditional Chinese medicine (acupuncture) and Western medicine achieved very good clinical results.

典型病例

男性患者，33岁，牙科医生。因左侧腰4-5间盘脱出，腰5骶1间盘膨出，左侧腰腿痛伴左下肢小腿和足麻木，用西医疗法综合治疗1个半月，疗效轻微。只能站立几分钟，走几步，无法自己开车。当然更无法工作，天天卧床在家。来我处就医。使用上述中西医结合疗法治疗6-7次后，症状明显减轻，开始回诊所少量工作，继续巩固3-4次，共治疗1个半月，疼痛症状消失，麻木基本消失，恢复工作。

Case report

Male patient, 33-year-old dentist. The left L 4-5 intervertebral disc herniation, L5-S1 disc protrusion(MRI confirmed), left low back and leg pain with cruris and foot numbness, traditional western medical treatment 1 and a half months, a slight effect. He still has pain only can stand a few minutes, walking few steps, unable to drive car, Of course, unable to work. Only has to lying in the bed at home. Come to my office for medical treatment. After 6-7 times treatment, the symptoms significantly reduced, he began to return to the work for a few hours a day, continue to treat 3-4 times, totally about one and half months treatment, the pain disappeared, numbness was almost disappeared, he returns to work.

讨论

腰椎间盘突出症是腰椎间盘变性，纤维环破坏，髓核突出，或纤维坏完整但和髓核一起突出压迫或刺激椎间盘周围神经根及软组织, 产生炎症、水肿、粘连，从而产生腰部及下肢放射性疼痛或麻木。腰椎间盘突出症在某种程度上属于自限性或自愈性疾病，约80～90%的患者通过非手术治疗可获得满意疗效，只有10～15%的患者需手术治疗。除马尾神经损害持续加重的患者外，腰椎间盘突出症均以非手术治疗为首选。

腰椎间盘突出症属中医学痹证范畴，系风、寒、湿三气杂至而成。寒属阴，其性收引；湿性重浊黏滞，易阻塞气机。当寒湿之邪侵入人体后，可引起气血瘀阻，血流不畅，不 通则痛。主穴腰椎夹脊穴，介于督脉和膀胱经之间，能扶督脉之阳，助膀胱之气，针刺时实施强刺激可振奋一身之阳气，驱逐风寒湿邪，行气活血。辅以秩边、环 跳、委中、阳陵泉、悬钟、昆仑等穴位治疗，加强疏经、活血、镇痛作用。西药穴位注射能够抗炎、消肿、解痉止痛、扩张血管、改善微循环、促进神经营养作用. 迅速激发经气，疏经活血，并且可使针刺和药物的作用明显增强，因而可在短时间内显示明显的止痛效果。辅以功能锻炼和牵引这些传统的西医疗法，把各家之长灵活巧妙的运用，从而达到更好的效果。

Disscusion

Lumbar disc herniation and protrusion is intervertebral disc degeneration, the fibrous annulus destructed and the nucleus herniated or the intact fibrous annulus with nucleus protruded and oppression or stimulate the nerve root and soft tissue induced inflammation, edema, adhesions, resulting in lower back and lower extremity radiating pain or numbness. In general, about 80 – 90% of patients with satisfactory results can be treated with non-surgical treatment, only 10 -15% of patients required surgical treatment.

Lumbar disc herniation and protrusion are belong to Arthralgia areas in traditional Chinese medicine, consist of 3 chi: wind, cold and wet. Cold chi belongs to yin, wet chi is heavy and muddy viscous, easily blocked human body meridian. When these bad chi invading the human body, the good chi(energy) can not go through in the meridian, then the meridian is blocked. When the meridian is blocked, the problems appear in the body, such as pain etc.. The acupuncture(akupunktura) stimulate the stations in the meridians, to solve the block and let the chi in meridians go through, then the people is healthy.

Acupunctural(akupunkturas) injection with medical drugs can make anti-inflammatory, reduce swelling, pain, dilate blood vessels, improve microcirculation and nutrition the nerves. The acupuncture and drugs injection together can significantly enhanced treatment result, thus in a short period of time shows analgesic effect. Combined by doing medical gymnastics and other traditional Western Medicine, using these methods to achieve better results.

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中西医结合治疗膝关节骨性关节炎

Traditional Chinese medicine and western medicine combined to treat  osteoarthritis (OA)of the knee

Xiu Wei

Józsefvárosi Szakorvosi Rendelőintézet, Orthopédia

骨性关节炎（Osteoarthritis，OA），俗称“骨质增生”，又称为骨关节病、退行性关节炎、增生性关节炎等。是一种关节内紊乱综合征。该病的始发部位在软骨。以局灶性关节软骨退行性变、骨丢失、关节边缘骨赘形成及关节畸形和软骨下骨质致密（硬化）为特征。WHO统计，60岁以上的人口中，50%的人群在X线上有骨关节炎表现，其中35-50%有临床表现。65岁以上的老年人中，70%有OA症状。75岁的人口中，80%以上的人可有骨关节症状。65岁以上的OA患者中，46%严重丧失关节功能及劳动能力。53%致残率，是导致成人长期残疾的第二大病因（心血管疾病为第一位）。真正病因和发病机制尚不明了,膝关节骨关节炎病人最常诉说的症状为膝关节疼痛及僵硬感，有的病人可伴有膝关节肿胀，活动范围受限。病人常诉膝关节不能伸直，下蹲困难。还可见到大腿肌肉萎缩或关节变形。X光表现：早期表现不明显，以后可发生关节退行性改变。关节间隙狭窄，软骨下骨板致密，关节边缘及髁间嵴骨刺增生等。

笔者在临床上采用针刺加穴位注射的方法治疗膝关节骨性关节炎取得了满意的疗效 摘  要  采用西药药物穴位注射加中医传统针刺疗法和红外线灯穴位照射治疗膝关节骨性关节炎。对 40 例患者治疗后，绝大多数患者症状体征明显改善。西药药物穴位注射既有针刺的疗效又有药物的疗效，再加上理疗，多方协同作用，更有利于调整机体的功能，以达到治疗的目的。关键词  穴位注射;膝关节;骨性关节炎;针刺疗法(akupunktura)

Abstract     Using Glucosamine sulfate and Vitamin C to give the injection into the acupuncture points, and with traditional acupuncture niddle and infred lamp for somr certain points, treating OA. In the group of 40 patients, most of them have been cured or much better.The drugs have its own function, injected to  the acupuncture(akupunktura) points to keep long  stimulating, and also infred lamp, several methods work on the body  at the same time, in order to get better effects.

Key words   Acupuncture(akupunktura) points injection,  knee,  osteoarthritis(OA),  Acupuncture

临床资料

40例患者中,男性15例,女性25例。年龄最小40岁，最大78岁。单膝患病35例，双膝患病5例。病程最短者两个月，最长则二十年。95%以上均接受过各种理疗,温泉等不同的西医保守治疗。治疗方法：

    1，取穴：曲池、血海、阳陵泉、阴陵泉、足三里、委中、三阴交、肾俞、内外膝眼、健膝等穴位。注射穴位每次选用3-4个穴位，其余为针刺穴位。

    2，药物：硫酸氨基葡萄糖（glucosamine sulfate），维生素C(Vitamin c),1 % 利多卡因(lidocain1%)

    3，操作：选取穴位后，应用25G的注射针头找准穴位，将针刺入皮下组织，得气后回抽。如无回血则注入药物。每个穴位注射药量大约为0.5-2ml。约10次为一个疗程，每间隔二～三日注射一次。85%的患者治疗了一个疗程，15%的患者治了两个疗程。

    4，理疗：红外线灯照射相关穴位。

    疗效标准： 临床痊愈：治疗后疼痛消失，功能恢复正常，随访半年无复发；显效：药症状基本消失，功能明显改善；有效：经治疗后疼痛减轻；无效：经治疗后症状无改善。

    治疗结果：临床痊愈16例，占40%; 显效15例，占37.5%; 有效6例，占15%; 无效3例，占7%,总有效率92.5%。

典型病例

    某女，53岁，秘书工作。主诉:双膝间断疼痛近两年加重两周。临床检查:右膝肿胀,有明显压痛,膝关节活动范围减小，不能完全下蹲。x光片显示膝关节骨性关节炎改变。在曲池、肾俞、血海、足三里等穴位进行药物注射治疗，配合其余穴位针刺疗法，及医疗练功等。经一个疗程治疗，疼痛消失，功能恢复正常。随访半年，无复发。

讨论

    膝关节骨性关节炎是临床多发病。在中医学上属于痹证范畴。所以，在治疗中补肾是一重要环节。故穴注肾俞，补益肾气强壮筋骨。脾胃为后天之本，气血生化之源。配以足阳明胃经之合穴足三里，补益气血，键脾除湿。曲池穴是根据生物全息学说的理论而选穴。

    硫酸氨基葡萄糖(Glucosamine sulfate）是软骨细胞生物代谢必需的生理物质。软骨细胞利用氨基葡萄糖合成大分子的粘多糖，这些蛋白聚糖构成软骨基质重要的组成部分，与Ⅱ型胶原纤维一起维持软骨的形态和功能。该药既能抗炎止痛，又能延缓膝OA发展的作用。被认为是第一个改变OA病情的药物和慢作用药，又因体外实验证实其对软骨代谢的良好作用，也称为软骨保护剂。

维生素C（Vitamin C ）为抗氧化剂，对合成Ⅱ型胶原发挥作用，所以对合成关节软骨有利。

还有一重要因素与患者的临床疗效关系密切。如果患者发病时间较短，在 1-2 年内，其X光表现只为关节间隙有一定程度狭窄（已表明只有部分关节软骨磨损），其临床治愈率高，疗效好。如发病时间长，超过 10 年以上，X光骨性关节炎的改变明显，关节间隙明显狭窄，骨质增生，变形，介乎于手术适应与保守治疗之间的阶段。穴位注射既有针刺穴位的机械性刺激，又有药物的化学性刺激。二者协同作用，更有利于调整机体的功能，以达到治疗目的。

Conclusion & Discussion:

Osteoarthritis of the knee is a high incidence disease. It is a “bi Zheng” range according to the traditional Chinese medicine. So it is important step to make the kidney to be tonic, Then we should give the injection to Shenshu acupuncture point. Puncture Zusanli to keep the “Qi and Blood” to be tonic and to strengthen the spleen and reduce the moisture. According to holographic mechanism we also choose Quchi point. Glucosamine sulfate is the neccessary material for chondrocyte metablism. Chondrocyte use glucosamine to compose mucopolysaccharide which plays important roles in composing cartilage matrix.  Mucopolysaccharide and collangen fibril type II together build the function and structure frames of cartilage. Glucosamine sulfate is not only anti-inflamation and stop pain but also slow down the development of OA. Vitamin c is an oxidant, and play a role in composing the collagen fibril type II. There is another important reason to influence the clinical result of the patient. If patients have only 1-2 years history of disease, then the treatment is easier and getting better result than the patients who suffered from more than 10 years of this problem. Acupuncture point injection have both mechanistic stimulation and drug’s chemistic stimulation, two function combined together to get better treatment result than the single traditional niddle treatment.‘,“,“,’publish‘,’closed‘,’open‘,“,’113′,“,“,’2013-03-08 08:56:40′,’2013-03-08 08:56:40′,“,0,’http://akupunktura-drxiu.hu/?p=113′,0,’post‘,“,0),(131,1,’2013-03-08 08:54:11′,’2013-03-08 08:54:11′,‘

中西医结合治疗腕关节骨折术后周围软组织粘连1例

„Traditional Chinese medicine (Acupuncture)(Akupunktura) and western medicine combined to treat a patient of around joint soft tissue adhesion after carpal fractures (case report)“ Dr. Xiu Wei 1089 Budapest, Vajda Peter u, 43a

Case report: The female patient, In July, 2010 she was robbed and fall down,with right carpal distal radius intra-articular comminuted fracture. Treated with open reduction and internal fixation, she was discharged from the hospital with external plaster cast .But 3 – 4 weeks after because of the fracture place re-dislocation, she had to have the second operation, using external fixator to treat this dislocation.  After removing the external fixation, her carpal movement was severely limited. Then she got rehabilitation treatment such as medical gymnastics, physiotherapy in the hospital. From Oct. 2010 – Feb.2011 more than four month continuous rehabilitation treatment, she had no significant change in her carpal movement. The patient is right-hand user, she could not use her right hand to put food in her mouth, could not clean the anus with right hand, could not do the house works. The patient was very suffering. The doctor also suggested that she should start to train using her left hand. Whe the patient came to me, by examination, her right carpal movement: Dorsalflexion 20 degree, volarflexion 0 degree, radial and ulnar deviation 0 degree, forearm supination and pronation 0 degree. Because of the long time fixation and limited mobility of the forearm and wrist, also Sudeck syndrome performed by RTG. After two courses of treatment in 3 Months with traditional Chinese acupuncture(akupunktura) and Western medicine, the patient had great improvement, the movement in her carpal and forearm close to normal, she can eat and do housework with her right hand, the function almost like normal. Her right carpal and forearm movement: Dorsalflexion 50 degree, volarflexion 60 degrees, radial deviation 20 degree, ulnar deviation 40 degree, forearm supination 70 degree, pronation 60 degree. The patient is very satisfied, and after 1 year follow up, her carpal movement is almost totalyl normal. Method: Discussion: Around joint soft tissue adhesion, the  pathological changes are slow circulation and stasis in the venous and lymphatic tube, tissue edema.  Exudation of serous fibrin, can get formation of adhesions, and even the muscles contracture in the area of joint capsule, synovialplica as well as muscles and ligaments. During the treatment, stimulate the acupuncture points can play promoting blood circulation and removing blood stasis and smoothing flow of the meridians, while acupuncture injection with medicine both give the drug effects and acupuncture(akupunktura) effect. Plus medical gymnastics, physiotherapy, those methods together play multi-function, to harmony the body in good situation, to soften the scar tissue and free the adhesions. pentoxifylline can expand the peripheral blood vessels, to promote the local blood circulation, and to improve the nutrition of the joints and surrounding soft tissues. Glucosamine in the body is decomposed into amino acid, can be converted into galactose, can be converted into chondroitin, can promote to produce proteoglycans and collagen, Supply the synovial fluid, lubricate the joints, and provide the necessary materials to the cartilage in healing of the injured joints. In human body, 1/3 of total protein  is consist of by Collagen, they generate connective tissue and Constitute the body skeleton, Determines the elasticity of the skin, such as bones, blood vessels, ligaments, and contribute to the healing human wounds. Calcitonin directly inhibits osteoclast absorbing the bone, to reduce the bone releasing calcium, to promote the bone absorbing calcium from the blood, so the serum calcium becomes low. Calcium gluconate supplies calcium, together with Calcitonin often use in the treatment of osteoporosis.