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To investigate the lumbar traction and small needle-knife combination of both the clinical treatment of lumbar disc herniation conservative treatment. Methods: 320 cases of lumbar disc herniation in patients with lumbar traction with small needle-knife treatment, observation, a return visit. Results: The lumbar disc herniation in clinical practice can be conservative treatment, efficacy sure. Conclusion: The lumbar traction and small needle-knife combine the two, for lumbar disc herniation is a very effective treatment.
Keywords: Lumbar Traction small needle-knife treatment of lumbar disc herniation
Materials and methods
Clinical data: lumbar disc herniation causing low back pain, chronic lower extremity pain, numbness and other symptoms, is a common disease in clinical orthopedics, clinical governance alone waist or leg, is unlikely to work. Our hospital from a large number of clinical treatment found that lumbar traction with needle-knife treatment, better effect. Our hospital from November 2004 ~ May 2006 in patients with lumbar disc herniation were treated with 320 cases, 175 cases were male and female 145 cases; aged 28 to 76 years, mean 47.3 years old; Occupation: 230 cases of manual workers, teachers, 43 cases, medical workers in 16 cases, the driver 26 cases, military personnel, 6; duration up to 17 years, a minimum of 3 days; lower back pain and chief complaint were 121 cases of lower limb pain and 54 patients with chief complaint of numbness of both lower extremity pain, lower back pain have numbness were 145 cases. 320 cases of lumbar intervertebral disc by CT scan revealed a bulging and highlight the different levels were 305 cases (95.3%), 3 cases diagnosed by myelography in lumbar disc herniation (0.9%), 12 cases diagnosed by MRI lumbar disc prominent (3.8%).
Diagnostic criteria symptoms include:
① a chronic lumbar strain history or history of trauma.
② low back pain with sciatica, is the main symptom of this disease, increased abdominal pressure, pain increased.
③ lower extremity numbness (or skin hypoesthesia), mostly limited to outside leg, foot, foot rim.
④ limp.
Signs of diagnostic criteria include:
① scoliosis: Most patients have varying degrees of scoliosis, scoliosis more suddenly to the healthy side.
② tenderness with Fangshe Tong: deep pressure with the thumb beside the spinous process, there is tenderness in the affected part to the ipsilateral lower extremity radiation.
③ psoas spasm, spinal deformation and activities restricted.
Routine examination:
① straight leg raising test was positive, strengthening test positive.
② Kernig test positive.
③ sit-ting abdominal test positive.
④ femoral nerve traction test: L2 ~ 3 and the disc at L3 ~ 4 positive, L4 ~ 5, and L5 ~ 6 disc Department negative.
Special examination:
① CT lumbar scan to determine the location and degree of prominence to assist in inspections.
② MRI scan lumbar spine to determine the location and degree of prominence, exclude spinal canal is narrow, to help diagnose.
③ spinal angiography to determine the location and degree of prominence to assist in diagnosis.
Treatment: one lumbar traction. After a clear diagnosis of the first multi-function with YHZ-lumbar traction bed to be 5 ~ 15 times lumbar traction, traction of 280 to 500 Newton. This traction is based on symptoms, age and body mass from small to big.
Symptoms of heavy, older, poor health have begun to reduce the traction force should be to facilitate patient adaptation; mild symptoms, young adults, physical-well-the beginning of a larger force can be used traction, traction power, an increase of 10 per day to 20 Newton, to the final regulation to be maintained when the best traction traction. Mild symptoms and a daily one times, in serious cases can also be 2 times a day, every 30 minutes, 5 to 30 times as a course of treatment.
The second is selecting the site. Traction five times more than normal, waist or leg symptoms are significantly alleviated, but still a sense of activity does not ease the pain or night, could the patient's lumbar spinous process, transverse process, sacrum beside the gluteal muscles, piriformis, ischium After the middle leg and other parts of nodules along the nerve root and sciatic nerve to find a clear positive reaction towards the tender point, once the election 6 to 9 months. 3 is a small needle-knife treatment.
Patients were prone position, the small abdominal pad 20cm thick cotton pillow, hold up the waist, in order to facilitate entry of small needle-knife. At selected points on the mark after the strict aseptic disinfection and local anesthesia, the use of Professor Zhu Hanzhang Invention No. 1 4 Small needle-knife, in the interspinous ligaments and supraspinous ligament at the number of transverse cutting knife, the other points both blood vessels and nerves in the direction parallel to the gluteal muscle - Piriformis - ischial tuberosity feed must be carried out to explore, such as the patient feels a sense of when the discharge to avoid the knife and then brought into the non-discharge flu may to cut peel.
Treatment completed, the incision again after disinfection with the Band-Aid paste 2 ~ 3 days, during which the wound can not see water, to prevent infection. Needle-knife treatment of 10 ~ 15 days one time, according to symptom improvement, treatment 1 ~ 3 times. Reposted elsewhere in the Research Papers Download http://www.hi138.com
Clinical criteria:
① cured: Waist-Leg pain, numbness and tenderness, Fangshe Tong disappeared, straight leg raising test negative, waist, back to normal functional activities, can enter the workforce.
② markedly: Waist-Leg pain, numbness and tenderness, Fangshe Tong significantly reduced, straight leg raising test and lumbar functional activities significantly improved life can take care of themselves.
③ Effective: only part of the waist, leg pain and numbness symptoms reduced, straight leg raising, lumbar functional activity improved slightly. ④ invalid: Symptoms and signs unchanged or increased.
Results
320 patients, the lumbar traction therapy at least in 5 times, the greatest number of 20 times, at least by a needle-knife treatment times, the greatest number of 3 times.
In which 230 cases of cured, the symptoms completely disappeared without relapse and resume their normal work, accounting for 72% of those cured of the 230 patients were followed up for 6 months to 2 years, 230 patients, 68 cases were reviewed for CT, lumbar intervertebral disc nucleus pulposus was also satisfied that the basic, accounting for 30% of cure, review MRI 2 cases, accounting for 1% of cure, other patients without CT or MRI for review;
markedly 67 cases, most of the symptoms disappear, only the outside leg paresthesia, accounting for 21% of the total; improvement in 20 cases, some of its symptoms, life can take care of themselves, accounting for 6%; ineffective in 3 cases, no significant improvement in their symptoms, accounting for 1%. Improvement of patients, most of them for various reasons, unable to adhere to treatment; and three cases of invalid caught by MRI examination revealed spinal stenosis, of which 1 case treated by surgical incision in the surgery when the nucleus and hard ridge see the highlights membrane adhesion, and to the nerve root compression deformation of adhesion, and the other two cases of failure to get in touch, treatment is unknown.
Discussion
Lumbar disc herniation caused by low back pain and lower extremity pain, numbness and other symptoms are mainly due to bulging or prominent nucleus and local edema and compression of sciatic nerve root or sciatic nerve trunk entrapment caused by the spasm. This symptom in the past to focus only on the waist of the treatment, but mostly sustained traction, lumbar symptoms can be better, but markedly slower, lower extremity is difficult to alleviate the symptoms.
The timing and size of the traction force is also essential, such as the mismatch between the two will also affect the efficacy. This requires the surgeon with extensive clinical experience, and in practice to continuously explore and summarized. Different patient should be treated differently, such as the age of large and severe contracture of degeneration, it would take to gradually increase the traction and extended traction time, after several traction before they can achieve an effective therapeutic dose, to guard against a sudden strong traction and prolonged traction caused by a new of iatrogenic injury.
The combination of lumbar traction with needle-knife treatment of lumbar disc disease, using multi-dimensional intermittent traction, can promote the nucleus of the reduction and edema subsided, playing the role of massage; and needle-knife treatment of loosening of the facet joints, transverse process, intervertebral foramen, spine ligament, interspinous ligaments and muscles of the trunk nerve root compression, so the nerve has also played a role in loosening. Therefore, the lumbar traction and the needle-knife both organically integrated, enabling fast recovery in patients with lumbar disc herniation, is an effective treatment. Law is best used in conjunction with the Chinese and Western medicine, especially traditional Chinese medicine, can improve the efficacy and shorten the course of treatment. Differential recovery taking medicine pills, can increase long-term efficacy and reduce recurrence rate.
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