[Clinical practice guideline of integrated traditional Chinese and western medicine：atlantoaxial dislocation (AAD) (2019)].

EDITOR'S NOTE: EDITOR'S NOTE In 2019, the clinical practice guideline of integrated traditional Chinese and western medicine atlantoaxial dislocation (ADD) was developed by the professional committee of spine medicine of the Chinese Association for Integration of Chinese and Western medicine, aiming at the major clinical problems of atlantoaxial dislocation (AAD) endangering the life center of the medulla oblongata in the field of spine surgery. More than 40 experts at home and abroad in the field of cervical spine surgery organized the first guide for the diagnosis and treatment of AAD. Guided by the principles of evidence based medicine and the consensus of experts, this guideline is based on the theory of "combination of disease and syndrome, from supervision to treatment" for the diagnosis and treatment of AAD；based on the treatment principles of "spinal cord decompression, reconstruction of atlantoaxial stability"；based on Tan technology, Goel technology, Abumi technology and other core technologies for surgical treatment. The main content includes four parts：AAD diagnosis standard, TCM syndrome differentiation, clinical classification, treatment strategy and method. It provides academic guidance to solve the clinical situation of AAD, which is "unclear definition of diagnosis and classification, confused choice of treatment strategy". ABSTRACT: Clinical Practice Guideline of Integrated Traditional Chinese and Western Medicine：Atlantoaxial Dislocation (AAD) was enacted by the academic committee of spine surgery of integrated traditional Chinese and Western medicine. The guideline's recommendations forms by evidence-based medicine and the expert consensus of Integrative Medicine. The guidement principles is "spinal cord decompression, reconstruction of atlantoaxial stability". The objective of the guideline is providing an academic suggestion. The main contents include diagnostic criteria, traditional Chinese medicine's (TCM) dialectical method, clinical classification, treatment strategies and methods.

[Precise application of Traditional Chinese Medicine in minimally-invasive techniques].

The miminally-invasive techniques of traditional Chinese medicine(TCM) uses different types of acupuncture needles to treat diseased locations with special techniques. These techniques include different methods of insertion and closed incision (press cutting, sliding cutting, scrape cutting, etc.). This needling technique is based on the traditional Chinese medicine theories of Pi Bu(cutaneous), Jing Jin(sinew), Jing Luo(meridian), Wu Ti(five body structure components) and Zang Fu(organ system). Commonly used needles include: needle Dao, needle with edge, Pi needle, Shui needle, Ren needle, Gou needle, Chang Yuan needle, Bo needle and so on. The principle of this minimally-invasive technique of TCM is to achieve the greatest healing benefit with the least amount of anatomical and physiological intervention. This will result in the highest standard of health care with the lowest rehabilitative need and burden of care. In the past 20 years, through the collaborative research of several hundred hospitals across China, we systemically reviewed the best minimally invasive technique of TCM and the first line treatments for selective conditions. In 2013, the Department of Medical Affairs of the State Administration of Traditional Chinese Medicine created "Traditional Chinese Medicine Technical Manual"(General Version) and released it nationwide, its contents include: (1)Minimally invasive scar tissue release. ¹Suitable for Bi and pain syndromes of neck, shoulder, waist, buttocks and extremities. ²Degeneration causes local hypertrophy and inflammation, creating local tissue adhesion. ³There are two kind incision methods-press cutting and slide cutting. (2)Minimally invasive fascial tension release. ¹Suitable for localized fascial tension caused by trauma, overuse, or wind-cold-dampness, leading to compensatory hyperplasia. ²Long term high-stress stimulation to local fascia creates compensatory hyperplasia, Ashi points, and tissue texture changes (cords, nodules, masses). ³According to the different structural features of the needles, there are two incision methods: penetrating from the outside to the inside and pulling from inside to outside. (3)Minimally invasive decompression technique. ¹Suitable for internal pressure changes within organ cavities caused by trauma, degeneration, inflammation, such as compartment syndrome, bone marrow edema, increased intraluminal pressure in the bone marrow. ²According to the different tissues, it is categorized into soft tissue decompression, and bone decompression. (4)Minimally invasive orthopedic surgery. Applicable to some postural, developmental deformity correction, mainly through the dynamic balance method and/or static balance method. (5)Minimally invasive dissection. Suitable for fractures, tendons injury caused by deep soft tissue adhesion. (6)Minimally invasive separation. ¹Suitable for cutaneous, sinew regions, superficial adhesions due to lesions, and local post-operative incision adhesions. ²According to the structure of the needle tip, the methods are divided into sharp separation and blunt dissection. (7)Minimally invasive sustained pressure technique. ¹Suitable for neuromuscular dysfunction which causes JING(spasm) syndrome and WEI(atrophy) syndrome. ²The needle is applied with sustained pressure, without penetrating select tissue surface. This includes: nerve root sustained pressure technique; peripheral nerve sustained pressure technique; muscle sustained pressure technique; fascial contact procedure; cutaneous sustained pressure technique.(8)Minimally invasive insertion technique. ¹Suitable for systemic regulation to treat disease. ²Different organs are connected to different layers of tissue. Therefore, to treat specific conditions, specific tissues must be targeted. ³For example, back Shu points are used to treat vertigo from cervical spine issues, and spinal degeneration associated digestion issue. 4The internal organs can be regulated by the pathways that runs along the different layers of tissue. The types of stimulation include: meridian acupoint stimulation; cutaneous stimulation; fascia stimulation; mucle stimulation; periosteum stimulation. The clinical application of these techniques has enriched the drug-free therapies of traditional Chinese medicine and achieved excellent outcomes, but at the same time it also raises an important question. How can we apply these minimally invasive techniques to clinical practice so it can be safe and effective? In addition, how can practitioners, individually and further develop their understanding of this minimally invasive technique progressive manner? We make the following recommendations. (1)Clear diagnosis and precise application. Any approach has specific indications and choosing the correct technique comes from a comprehensive understanding of its advantages and disadvantages. Moreover, the accurate application of the technique depends the expertise of the practitioner. Through systematic review and clinical observation, we formulated the First Line Treatment, the Second Line Treatment, and the Third Line Treatment for specific conditions. Using the information gathered from research, practitioners can decide on which point is appropriate to use based on the stage of disease progression. For example, common conditions like the nerve ending tension pain(i.e. cutaneous nerve entrapment syndrome) is caused by stress concentration. There are two types of treatment for this condition: ¹Change in the response to stress state (i.e.non-invasive approach such as manual therapy and physiotherapy). ²Change in state of surrounding environment (i.e. invasive approach such as Pi Needle). Before tissue texture changes to pain point, cord, nodules, the former approach is effective. Once tissue texture changes, the latter approach is First Line Treatment. (2)Systematic training and disease progression training. The minimally invasive techniques of traditional Chinese medicine can treat many kinds of disease. To ensure its safety, organization, progressive development, practitioners are trained systematically and manage their treatment approach through disease hierarchy. Moreover, this technique should be conducted according to its technical difficulty, operating conditions, and expertise of the practitioner. The application of minimally invasive techniques of traditional Chinese medicine does not depend on the hospitals' administration system or the regulatory college of medical professionals. The minimally invasive techniques of TCM should be taught from easy to difficult, simple to complicated, and requires gradual progression by the practitioners. Eventually, the minimally invasive techniques of TCM's diagnostic and treatment protocol can be created. These protocols are currently available for reference: ¹Forming diagnosis and differential diagnosis for the conditions below requires expert diagnostic and application skills: cerebral palsy; cervical vertigo; cervical headache; cervical precordial pain; other spine-related diseases. ²The requirements for the diagnosis and differential diagnosis of such techniques are relatively high, and special training is required for the practitioner who performs this technique. The conditions below uses minimally invasive orthopedic surgery and dissection: scar contracture deformity; congenital developmental malformations; cervical Bi-syndrome; shoulder pain syndrome; knee Bi-syndrome; low back pain; cervical spondylosis; lumbar disc herniation; avascular necrosis of the femoral head; ankylosing spondylitis. ³There are no special requirements for the diagnosis and differential diagnosis of such techniques, and special training is required for the practitioner who performs this technique. The technical content is mainly decompression and scar tissue release. a)Muscle strain diseases: levator scapulae, splenius capitis, splenius cervicis, supraspinatus, infraspinatus, teres minor, teres major, serratus posterior superior, serratus posterior inferior, piriformis, gluteus maximus, gluteus medius, and gluteus minimus, erector spinae. b)Joint degenerative disorders: frozen shoulder, tennis elbow, tenosynovitis, knee osteoarthritis, and plantar fascitis. c)JING-JIN PI-BU pain syndrome (cutaneous nerve entrapment syndrome): occipital great nerve entrapment syndrome, occipital small nerve entrapment syndrome, great auricular nerve entrapment syndrome, suprascapular nerve entrapment syndrome, transverse cutaneous nerve of neck entrapment syndrome. (3)People-centred practice. The most attractive feature of the minimally invasive techniques of TCM is that they do not rely on expensive medical equipment and operating conditions. The key to applying this technique is the practitioners' technique, skill, and expertise. The necessary conditions required to successfully apply this technique is ¹practitioner understands disease progression and diagnosis; ²practitioners' skill in applying technique. We require patient-centered approach, which uses evidence based approach as the focus. We aim to seek the truth from facts, to understand the comprehensive picture, to include pertinent details, to be observant, to be goal oriented, from one to another, from outside to inside, from top to the bottom, compare right from left, through active movement and passive movements and weight-bearing movements, and assisted passive movements to determine instantaneous centre to diagnose stress concentration points. The operating technique is based on the response of patient's tissues to this technique. We must pay attention to diagnosis through palpation: layers, structure, texture, deformity, dislocation, movement characteristic, rhythmic changes. To achieve SHOU MO XIN HUI WU WEI: position, quantify, quantity, timing, and pattern. Accurate grasp of timeliness and dose efficiency. Can distinguish between local or systemic effects of treatment.Through comprehensive judgment of hands feeling, acupuncture needle feeling, and inspiration, to achieve the precious treatment requirements as indicated by the "Huangdi Neijing·Suwen": "Puncture the bone without damaging tendons, and puncture tendons without damaging muscles, puncture the muscle without damaging pulse, puncture pulse without damaging skin, puncture skin without damaging muscle. Puncture muscle without damage tendons, puncture tendons without damaging bone... Puncture bone without damaging tendons and it means the needle passes through the tendons and arrives at the bone and work on the bone. Puncture tendons without damaging muscles, and it means the needle passes through the muscles and arrives close to the tendon. Puncture the muscle without damaging pulse and it means the needle passes the pulse and does not touch the muscle. Puncture pulse without damaging skin and it means, the needle passes through the skin without penetrating pulse. Puncture skin without damaging muscle and it means, the disease is in the skin and the needles insert into skin but does not damage muscle. Puncture muscle without damage tendons, and it means, the needle passes through the muscle and arrive on the tendon. Puncture tendons without damaging bone."

[Clinical results of needle Dao for the treatment of subacromial impingement syndrome].

OBJECTIVE: To study the clinical results of needle Dao for the treatment of subacromial impingement syndrome. METHODS: From September 2013 to August 2014, 90 patients with subacromial impingement syndrome were treated, including 61 females and 29 males, with the average age of (55.21±8.30) years old(ranged, 45 to 65 years old), and mean course of disease (3.49±2.98) months (ranged, 4 weeks to 7 months). Twenty-six patients had pains in left shoulder, and 64 patients had pains in right shoulder. Under local anesthesia, needle Dao was performed to release the pain point at the lower edge of the acromion and the subacromial adhesion. By observing the abduction of shoulder joint, anterior flexion and lifting, internal rotation and external rotation, shoulder pain score, the number of cases cured, markedly effective, effective and ineffective after treatment were counted, and the curative effect of needle Dao for the treatment of subacromial impingement syndrome was evaluated. RESULTS: All the patients completed the treatment successfully without obvious adverse reactions. All the patients were followed up for more than 12 months. The visual analogue scale(VAS) decreased from preoperative 7.72±5.42 to postoperative 1.35±0.78(t=15.89, P<0.01). The Constant score at the 12th month after operation increased from preoperative 58.89±15.63 to 83.17±19.11(t=28.48, P<0.01). Overall efficacy evaluation was that, 46 cases were cured, 33 cases were markedly effective, 11 cases were effective, and 0 cases were invalid. CONCLUSIONS: The advantage of needle Dao in the treatment of subacromial impingement syndrome is the minimally invasive treatment of the underlying lesions. The disadvantage is that it can not deal with the impact caused by bone abnormalities.

[Case-control study on Pi needle for the treatment of the cutaneous nerve entrapment low back pain].

OBJECTIVE: To explore a safe and effective method for the treatment of low back pain in the cutaneous nerve, and to clarify the indication of Pi needle to treat it. METHODS: From January 2003 to December 2004, 278 patients with cutaneous nerve entrapment low back pain were divided into two groups: Pi needle group and electrical stimulation group. In the Pi needle group, there were 68 males and 70 females, ranging in age from 20 to 60 years old, with an average of(41.92±10.88)years old. In the electrical stimulation group, there were 68 males and 72 females, ranging in age from 18 to 60 years old, with an average of(41.44±10.47) years old. The pain, tenderness and soft tissue tension of the two groups were measured and compared before and after treatment. RESULTS: All of the selected cases were qualified. No suspension, culling and shedding cases occurred in either group. In Pi needle group, visual analog scale(VAS) of pain decreased from 8.78±1.52 before treatment to 1.33±1.33 after treatment;and in electrical stimulation group, VASof pain decreased from 8.59±1.76 before treatment to 5.20±2.64 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. In Pi needle group, VAS of tenderness decreased from 9.12±1.24 before treatment to 1.60±1.36 after treatment;and in electrical stimulation group, VAS of pain decreased from 8.79±1.60 before treatment to 5.34±2.60 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. CONCLUSIONS: Once tissue texture changes to pain point, cord, nodules, Pi needle is the first line treatment for the cutaneous nerve entrapment low back pain.

[Stiletto needle and needle-knife for influence of gravity index in treating knee osteoarthritis].

OBJECTIVE: To explore stiletto needle and needle-knife for influence of double sufficient weight in treating knee osteoarthritis patients. METHODS: One hundred and thirteen early and medium term knee osteoarthritis patients were randomly divided into three groups, including stiletto needle group(38 cases), needle-knife group (38 cases) and voltaren group (37 cases). In stiletto needle group, there were 13 males and 25 females with an average of(55.87±7.72) years old, treated by stiletto needle once a week, and 2 weeks were a course; there were 11 males and 27 females in needle-knife group with an average of(57.11±7.07) years old, treated by acupotome once a week, and 2 weeks were a course; there were 12 males and 25 females in voltaren group with an average age of(57.62±8.08) years old, treated by votalin emulsion smearing 3 to 5 cm on painful area of knee joint, three times a day for 2 weeks; 36 patients in normal group, including 11 males and 25 females with a mean age of (55.28±7.55) years old, treated with nothing. Gravitational four lattice used to measure bipedal back and forth load before and after treatment in further observe weight-bearing situation among three groups, d value, which was the distance from center of gravity to original point, was measured as a obvervational index, JOA score was used to evaluate clinical effect. RESULTS: Five patients were fall out, including 2 patients in stiletto needle group, 2 patients in needle-knife group and 1 patient in voltaren group. Other 108 patients were followed-up from 28 to 35 d with an average of 30 d, and without untoward effect. There was significant difference in d value between treatment group and control group at 1 month after treatment(P<0.05); there was significant difference in d value among treatment group at 1 month after treatment(P>0.05), and d value was decreased before treatment than that of after treatment. There was no significant difference in JOA score among treatment group after treatment at 1 month(P<0.05); while had significant difference between groups(P>0.05) after treatment at 1 month. CONCLUSIONS: Stiletto needle, needle-knife and voltaren for the treatment of knee osteoarthritis at early and middle stage, center of gravity is closer to original point, and weight-bearing is improved. It is a easy method of four lattice to measure change of weight-bearing in KOA patients after treatment.

[Analysis of the axial stretching force of the small splint fixation system].

OBJECTIVE: To measure the axial stretching force produced by the small splint fixation system in the treatment of the fracture. METHODS: Dumbbell shaped plexiglass was machined to model the bone shaft with expanded two ends. Force transducer was set at the model fracture site to measure the stretching force produced by fracture fixation of the small splint with cloth aqueous bag that simulated the muscles and other soft tissue underneath. RESULTS: There was positive relationship between the axial stretching force produced at the model fracture site and the transverse pressing force exerted by the external plates. The ratio of which was 1/10. CONCLUSIONS: Muscle enwrapped with fascia is similar to the cloth aqueous bag system in mechanical structure. From this article, axial stretching force exists at the bone shaft fracture site when fixed by small splint which exerts the force transversely from the outside of the extrimity.

[The causes and prevention of C5 nerve root palsy after anterior cervical decompression and fusion].

OBJECTIVE: To analyze the causes of muscular paralysis due to C5 nerve root injury after anterior cervical decompression and fusion (ACDF) and explore its prevention way. METHODS: From January 2005 to December 2015, 310 patients underwent ACDF in our hospital. Of them, 9 cases occurred muscular paralysis due to C5 nerve root injury after operation. The clinical data of 9 patients were retrospectively analyzed. There were 8 males and 1 female, aged from 51 to 84 years with an average of 64 years. Two cases underwent internal fixation and intervertebral fusion with one segment, 6 cases with two segments, 1 case with three segments. Simple deltoid muscle weakness, pain, numbness happened in 7 cases, simultaneously biceps brachii muscle weakness, pain, numbness in 2 cases. Muscle strength was 0 grade in 1 case, 1 grade in 3 cases, 2 grades in 4 cases, 3 grades in 1 case. RESULTS: The follow up time of 9 patients was more than 12 months and the longest was 24 months with an average of 14 months. Muscle strength of 7 patients recovered to 4-5 grades. Recovering time after operation was directly proportional to the degree of injury, those patients with muscle strength level more than 2, usually could have significant improvement within 3 weeks. The JOA score improved from 10.89±1.89 preoperatively to 8.92±1.91 postoperative C5 nerve root palsy to 14.48±2.10 at final follow up, with significant difference(P<0.05). CONCLUSIONS: More complicated factors result in C5 nerve root injury after ACDF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory prognosis. Strict control of the operation indication, selection of the right surgical segment with accurate manipulation, control of the distraction of intervertebral space and the width of the multilevel anterior cervical corpectomy, are main methods to prevent the complication.

[Factor analysis of muscular paralysis due to nerve root injury after posterior lumbar interbody fusion (PLIF)].

OBJECTIVE: To analyze the reasons of muscular paralysis due to nerve root injury after PLIF. METHODS: From January 2001 to January 2012, 1 250 cases underwent PLIF in our hospital, after operation, 29 cases occurred muscular paralysis due to nerve root injury. There were 10 males and 19 females with an average age of 61 years, 12 cases with one-segment, 14 cases with two-segment, 3 cases with three-segment. The clinical data of 29 patients were retrospectively analyzed including PODx (preoperative diagnosis), surgery procedure, postoperative symptoms and so on. RESULTS: The follow-up time was more than 1 year and the longest was 2.5 years with an average of 1 year and 7 months. Twenty-three patients obtained satisfactory results and muscle strength recovered to 4-5 levels,3 patients was poor and final muscle strength recovered to 0-2 levels. Recovering time after operation was directly proportional to the degree of injury,those muscle strength level was more than 2, usually could have significant improvement within 2 weeks. CONCLUSION: More complicated factors result in the reasons of nerve root injury after PLIF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory effect.

[Effects of acupotomy lysis on local soft tissue tension in patients with the third lumbar vertebrae transverse process syndrome].

OBJECTIVE: To explore the mechanism of acupotomy lysis in treatment of the third lumbar vertebrae transverse process syndrome. METHODS: One hundred and eighty patients were randomly assigned into an acupotomy group and an electroacupuncture (EA) group, 90 cases in each group. The acupotomy group was treated with acupotomy on the tip of the 3rd lumbar vertebrae transverse process (tender point) combination with massage manipulation of hyperflexion and hyperextension on the waist, once a week for 3 weeks. The EA group was treated with EA at bilateral Shenshu (BL 23), Yaoyangguan (GV 3), Ashi point (local tender point) and ipsilateral Weizhong (BL 40), 3 times a week for 3 weeks. The 500 g pressure displacement and the energy absorption ratio were measured by JZL-II soft tissue tension meter and the clinical effect was evaluated by JOA low back pain scale before treatment, after treatment and 6 months after treatment. RESULTS: After treatment and at follow-up visit, the 500 g pressure displacement in the acupotomy group increased significantly (both P < 0.01), but it was decreased significantly in the EA group (P < 0.05, P < 0.01). The energy absorption ratio in the acupotomy group after treatment and at follow-up visit increased significantly (both P < 0.01), and in the EA group, there was no significant difference after treatment as compared with that before treatment (P > 0.05), but it was increased significantly at follow-up visit (P < 0.01). The total therapeutic level distribution in the acupotomy group was better than that in the EA group after treatment and 6 months after treatment (P < 0.05, P < 0.01). CONCLUSION: Acupotomy therapy can significantly increase the 500 g pressure displacement and the energy absorption ratio of the local soft tissue around the third lumbar vertebrae transverse process, decrease the local soft tissue tension so as to alleviate pain. The clinical effect of the acupotomy is superior to that of electroacupuncture.

[Analysis of curative effect of the intervertebral space lavaging for the treatment of incisions deep infections at early stage after posterior lumber internal fixation].

OBJECTIVE: To explore the reason,diagnose outline,therapeutic tool of the incisions deep infections at early stage after lumber internal fixation. METHODS: From January 2001 to December 2011, 10 patients with incisions deep infections at the early stage after the posterior lumber internal fixation were treated with intervertebral space lavaging. There were 1 male and 9 females with an average age of 63 years, and an average infection started at the 6th day after operation. The main clinical features including backleg pain aggravating, fervescence, fresh seepage from the wound, and blood inflammatory index increased, etc. According to whether the wound could heal at the first treatment stage as a evaluation standard of curative effect. RESULTS: Ten cases were followed up with an average period of 17 months. The wounds of 9 cases healed at the first stage and no recurrence and complications were found. One case underwent debridgement of many times with the therapic period of 7 months,at last,after taking out the vertebral pedicle bolt,the wound healed,and no recurrence after follow-up of 18 months. CONCLUSION: The deep wound infections after the lumber internal fixation should receive intervertebral space lavaging as soon as possible. The method can finally remain internal fixations and obtain satisfactory effects, but avoiding too much tissue cutting and tube setting in the deep intervertebral space are the keys to the successful fixation.

[Case-control study on stiletto needle and Dichofenac Diethylammon for the treatment of knee osteoarthritis pain].

OBJECTIVE: To investigate therapeutic effects of stiletto needle and Dichofenac Diethylammon in treating knee osteoarthritis pain at early and medium-term. METHODS: Sixty-seven patients with early and medium-term knee osteoarthritis were randomly divided into two groups, 34 cases in stiletto needle group (treatment group) and 33 cases in Dichofenac Diethylammon (control group). Among them, 60 patients finished treatment and followed-up for 1 months (7 cases fall off totally, 4 cases in treatment group and 3 cases in control group). In treatment group, there were 5 males and 25 females with a mean age of (55.90 +/- 9.34) years (ranged, 40 to 68 years), the course of disease for 0.25 to 1 year, mean (0.87 +/- 0.34) years, treated by stiletto needle once a week, and 3 weeks were a course. In control group, there were 6 males and 24 females with a mean age of (58.67 +/- 7.39) years (ranged, 40 to 70 years), the course of disease for 0.25 to 2 years, mean (0.93 +/- 0.60) years, treated by Dichofenac Diethylammon, three times a day for 3 weeks. Soft tissue displacement and banana area were tested by soft tissue tension tester, pressure value were measured by pressure measuring instrument, VAS score were recorded by pain visual analog scale record, HSS scoring and effects were used to evaluated and statistical analyzed. RESULTS: There were significant differences in tissue displacement, banana area, pressure value, VAS scoring and HSS scoring between two groups before and after treatment, and tissue displacement, pressure value, HSS scoring in treatment group were higher than control group, while banana area and VAS scoring were lower than control group. According to HSS scoring and VAS scoring, 3 cases were healed, 8 cases were markedly improved, 18 cases were effective and 1 case was effectiveless in treatment group;while 1 case was healed, 4 cases were markedly improved, 20 cases were effective and 5 cases were effectiveless in control group. There was no significant meaning in therapeutic effects. CONCLUSION: Stiletto needle for knee osteoarthritis pain can effectively reduce high tension of local soft tissue ,alleviate symptom of pain, and improve knee function.

[Influence of aqueous extract of Aralia echinocaulis Hand.-Mazz on the expression of fracture healing-related factor receptors].

OBJECTIVE: To investigate the influence of aqueous extract of Aralia echinocaulis Hand.-Mazz on the expression of fracture healing-ralated factor receptors. METHODS: Single factor model was set up in SD rat. Selecting 14 and 28 days in the experiment. Immunohistochemistry was employed to determine the expression of Fibroblast growth factor receptor 2 (FGFR2), Fms-like tyrosine kinase (Flt-1) and Fetal licer kinase (Flk-1) at 14 and 28 days after model establishing. RESULTS: The expression of Flt-1 and Flk-1 at 14 days (the latter was more remarkable) were obviously promoted in High dose group of aqueous extract of Aralia echinocaulis Hand.-Mazz, and higher than that in normal group and model group. The expression of FGFR2 in the high dose group of Aralia echinocaulis Hand -Mazz was also promoted visibility, close to that in the compare group (traditional Chinese medicine), but higher than than in the model group. There was no significant difference among them. At 28 days, the expression of FGFR2, Flt-1 and Flk-1 in all groups decreased except normal group, and got higher expression in model groups than each control groups. CONCLUSION: Aqueous extract of Aralia echinocaulis Hand.-Mazz can promote angiogenesis in fracture healing, improve the activity and aggregation of fibroblasts, osteoblasts and chondrocytes. It also helps to quicken ossification in the cartilage and promote fracture healing.

[Effects of tension relaxation by small needle knife on muscle tension and nerve endings after compression of gracilis muscle in rats].

OBJECTIVE: To determine the effect of tension relaxation by small needle knife on the muscle tension and morphology changes of nerve terminals when sustained pressure was applied to muscular tissue. METHODS: Rat gracilis muscles were exposed to pressure in vivo at 70 kPa for 2 hours. Sixty rats were divided into three groups: normal, control and experiment group respectively. In all rats except the six normal ones, the lower legs were considered as the control group, and the right left as experiment group. At day 1, 2 and 3, 9 rats from the two groups were randomly selected and sacrificed in order to determine the muscle tension change. At the same time, muscle histology and morphology changes of nerve terminals were observed. RESULTS: Abnormal tension increased in muscles under compression of 70 kPa. At the 1st and 2nd days, there were no significant differences between the two groups. Compared with control group, the tension was lower in experiment group, and there was statistically significant difference (P < 0.01) between the two groups. Exposure of striated muscle tissue to intensive and prolonged compression may pathologically alter its microstructure. Histological evaluation showed that this stiffening accompanied extensive necrotic damage. The changes could not be found in the nerve terminals. CONCLUSION: Deep muscle tissue that undergoes prolonged compression may significantly increase its stiffness during acute injury. Tension relaxation applied by small needle knife can effectively reduce the mechanical load which is harmful to the whole tissue.

[Effects of small needle knife on the substance P in the dorsal root ganglion and spinal cord of rats].

OBJECTIVE: To study the mechanism of synthesis of substance P (SP) in the dorsal root ganglion (DRG) and the release of it in the dorsal horn of the spinal cord of rats after compression of skeletal muscle, and to observe the influence of small needle knife. METHODS: Sustained pressure of 70 kPa was applied to rats, muscular tissues for 2 hours. The rats were divided into three groups: normal, control and experiment group respectively. In all rats except the six normal ones, the lower legs were compressed once one day. The left leg was considered as the control group, the right left was experiment group, which were divided into the 1st day, the 2nd day and the 3rd day within the two groups. Experiment group was treated with small needle knife after the muscular tissue was compressed. After completing the stimulation, the DRG related to the muscle and part of spinal cord were removed for the qualification of SP-like immunoreactivity using immunohistochemistry. The dark brown stains on the DRG and on the REXed laminae I and II in the dorsal horn of the spinal cord were counted by Image-Pro Plus software. RESULTS: SP-like immunoreactivity in the side treated by the small needle knife was enhanced comparing with the counterpart in DRG in normal group (P < 0.01). The integrated optical density of SP like immunoreactivity of the DRG in the experiment group were significantly reduced compared with the control group (P < 0.05). However, the release of SP from spinal cord in experiment group was lower than that in the control group at the 1st day and the 3rd day (P < 0.01), with the opposite result of the 2nd day. CONCLUSION: Based on the fact that SP is a nociceptive neurotransmitter, the present study suggests that tension relaxation by small needle knife reduces expression of SP in the DRG, and shows no effects on the release of SP from the spinal cord in short-term (3 days).

[Randomized control clinical study on third lumbar transverse process syndrome treated by knife needle].

OBJECTIVE: To evaluate the therapeutic effects of knife needle on third lumbar transverse process syndrome. METHODS: From 2007.3 to 2007.12, patients were divided into treatment group and control group according to the random digits table, 34 and 35 patients respectively. Patients in both groups were separately treated for 3 weeks, with knife needle in treatment group and electroacupuncture in control group. In treatment group, 12 patients were male and 22 patients were female, the average age was (42.33 +/- 7.86) years. In control group, 16 patients were male and 19 patients were female, the average age was (44.73 +/- 10.34) years. The changes of biomechanics, local tension and tenderness index were observed and recorded respectively before and after the therapy, and the results obtained from two groups were then compared with each other. The JOA score was used to evaluate the clinical effect. RESULTS: Sixty patients finished the clinical observation. The treatment efficacy was evaluated according to the JOA score in 60 cases. The soft tissue tension in treatment group was lower than that in the control group (P=0.00004). Excellent result was found in 18 cases, good in 9 cases, fair in 3 cases and poor in 0 case. CONCLUSION: Tension relaxation by needle knife can effectively improve the clinical symptoms and signs of third lumbar transverse process syndrome.

[Assessment of flexibility in adolescent idiopathic scoliosis by curved planar reformation using multi-slice spiral CT scanning].

OBJECTIVE: To investigate the role of curved planar reformation (CPR) using multi-slice spiral CT scanning to evaluate the coronal and sagittal plane in scoliosis so as to affirm the features of supine coronal and sagittal plane in idiopathic scoliosis. METHODS: Thoracic and lumbar spine multi-slice spiral CT scanning was undertaken on 45 patients with adolescent idiopathic scoliosis (AIS), all female, age 10 - 18. CPR was used to reconstruct the spine coronal and sagittal planes respectively. The values of main curve and compensate curve Cobb angles were obtained and compared with those obtained by X-ray films. RESULTS: The average CPR coronal main curve Cobb angle was smaller by 10.17 degrees than that obtained by standing position film. The average CPR coronal compensate curve Cobb angle was smaller by 6.97 degrees than that obtained by standing position film. For scoliosis coronal flexibility assessment, fulcrum-bending method offered better surgical correction result than other methods. Only the post-operational Cobb angle was different between the 10 - 14 year-old group and 15 - 18 year-old group. Bending film showed differences in correction rate and flexibility rate between the main thoracic group and main lumbar/thoracolumbar group. The correction rate and flexibility rate of main curve and compensate curve of the 10 - 14 year-old group were significantly higher than those of the 15 - 18 year-old group. In the sagittal plane, the CPR thoracic kyphotic angle (T5-T12) and upper thoracic curve kyphosis of the main thoracic group were both smaller than those of the main lumbar/thoracolumbar group. The CPR thoracic kyphotic angle (T5-T12) of the 10 - 14 year-old group was significantly smaller than that of the 15 - 18 year-old group. Correlation analysis showed that the CPR main curve flexibility and bending film flexibility were positively corrected with the surgical correction rate. CONCLUSION: CPR using multi-slice spiral CT scanning is able to obtain multiple three-dimensional assessment by one scanning and is helpful in scoliosis curve type diagnosis and scoliosis 3D analysis.

[Vertebra morphology measurement in adolescent idiopathic scoliosis population].

OBJECTIVE: To measurement the vertebra morphology using multi-planar reformations method of multi-slice spiral CT (MSCT) in AIS girls, and To compare with age and gender-matched controls in order to affirm the morphology results of abnormal development of the anterior and posterior elements in AIS. METHODS: Thoracic and lumbar spine multi-slice spiral CT was undertaken on 52 girls with AIS between the age of 10 and 18 years from June 2004 to May 2008 in Peking Union Medical College Hospital and Beijing Shijitan Hospital, and 54 age and gender-matched non-IS controls. Multiple measurements (including the anterior column and posterior column) of each thoracic and lumbar vertebra were obtained using the 3D-MPR technique. The patients and control were divided into 10-14 years old group and 15-18 years old group. The corresponding vertebral anterior height, vertebral posterior height, transverse distance, vertebra central width, vertebra anterior-posterior distance, area of pedicle, pedicle height, pedicle width, and upper-lower facet distance were compared. RESULTS: Compared with the controls, the 10-14 years old group girls' spine had longer anterior column height, relative shorter posterior column (there are difference from thoracic 2-11 and lumbar 1-3, P < 0.05), relative longer anterior-posterior vertebral distance, vertebral wedging changes in vertebral, distinct vertebral and pedicle asymmetry on the concave and convex side, and upper-lower facet distance asymmetry on the concave and convex side. The difference between the anterior and the posterior column ratio was significantly different from that in the controls (P < 0.01). But there hadn't the same difference in 15 - 18 years old group. CONCLUSIONS: There are differences in coronal plane vertebra wedging changes in AIS patient. There are high vertebra height, relative shorter posterior column, relative longer anterior-posterior vertebral distance, and relative slender vertebra in 10 - 14 years old AIS patients. This may lead to the initial and progression of scoliosis.