电针夹脊穴及阿是穴治疗腰椎间盘突出症的临床研究
|
摘要
1研究目的
腰椎间盘突出症又称腰纤维环破裂症,是一种疼痛剧烈的脊椎疾病,由于椎间盘发生退行性变,或外力作用引起腰椎间盘内外力平衡失调,均可使纤维环突然破裂,导致腰椎间盘的髓核突出,压迫或刺激了神经根、硬膜囊、血管及马尾神经等,进一步导致周围组织炎症、水肿、微循环障碍和纤维组织增生粘连,继而出现腰腿痛,甚至出现神经功能障碍的一种疾病。本研究采取简单随机、对照方法设计研究方案,对电针夹脊穴及阿是穴治疗腰椎间盘突出症进行科学的疗效评价,通过观察电针夹脊穴及阿是穴对腰椎间盘突出症疼痛的缓解,探讨一种简单的治疗方法以减轻腰椎间盘突出症对患者带来的痛苦,同时为电针夹脊穴及阿是穴治疗腰椎间盘突出症提供理论依据。
2研究方法
2.1病例来源及分组
所有病例来源于香港大学中医临床教研中心,将诊断为腰椎间盘突出症的患者60例随机分为治疗组(针刺夹脊穴及阿是穴)30例及对照组(常规针刺组)30例,进行临床研究。
2.2治疗
(1)取穴治疗组取夹脊穴及阿是穴,夹脊穴：病变部位的椎体及下一椎体的夹脊穴；阿是穴：病变部位的椎体水平棘突旁开3寸以内寻找2个深层压痛点；循经配穴及辨证配穴：与对照组相同。对照组：腰痛及坐骨神经痛常规穴位,主穴：肾俞、大肠俞、腰阳关；循经配穴：足太阳经型：环跳、阳陵泉、秩边、承扶、殷门、委中、承山、昆仑；足少阳经型：环跳、阳陵泉、风市、膝阳关、阳辅、悬钟、足临泣。辨证配穴,寒湿型：腰阳关；血瘀型：水沟；肾阳虚型：命门；肾阴虚型：三阴交。(2)操作方法治疗组操作：用75%酒精皮肤常规消毒夹脊穴及阿是穴,用0.25×50mm不锈钢毫针快速进针,直刺40mm；环跳穴、秩边穴及承扶穴用0.25×75mm不锈钢毫针快速进针,直刺70mm；殷门穴用0.25×60mm不锈钢毫针快速进针,直刺50mm；阳陵泉穴、风市穴、委中穴及承山穴用0.25×50mm不锈钢毫针快速进针,直刺40mm；昆仑穴用0.25×40mm不锈钢毫针快速进针,直刺30mm；足临泣穴用0.25×25mm不锈钢毫针快速进针,直刺20mm。腰阳关穴及命门穴用0.25×40mm不锈钢毫针快速进针,斜刺30mm；水沟穴用0.25×25mm不锈钢毫针快速进针,直刺15mm；三阴交穴用0.25×40mm不锈钢毫针快速进针,直刺35mm。以上各穴每穴针刺1针,各穴都以患者局部有酸麻胀为得气感,得气后留针用KWD-808I型治疗仪选用30分钟连续密波加电。对照组针刺操作,用75%酒精皮肤常规清毒,肾俞及腰阳关穴用0.25×40mm不锈钢毫针快速进针,斜刺30mm；大肠俞穴用0.25×50mm不锈钢毫针快速进针,直刺40mm,其余操作同治疗组相同。两组患者均隔日治疗1次,3次为一疗程,疗程之间休息2天,于3个疗程结束后填写量表进行分析。
2.3疗效评价体系及观察指标
研究中所采用的临床评价体系为：国家中医药管理局1994年颁布的《中医病证诊断疗效标准》、“腰痛疗效分级表”、“简式Mcqill疼痛问卷”及“Oswestry功能障碍指数”。治疗前后密切监测不良反应。
3研究结果
3.1两组临床疗效比较
治疗后两组的临床症状均有改善,治疗组愈好率93.33%,对照组愈好率80%,说明经过治疗两组患者都取得了良好的效果；治疗组治愈17例,好转11例,未愈2例,愈好率93.33%；对照组治愈12例,好转12例,未愈6例,愈好率80%。两组愈好率比较,治疗组优于对照组(P<0.05)。
3.2两组腰痛疗效评价比较结果
在治疗前两组评分差异无统计学意义(p>0.05)；治疗后两组的腰痛疗效评分均发生了显著的变化,组内治疗前后评分t检验,显示差异具有统计学意义(P<0.05),说明经过治疗两组患者都取得了良好的效果；组间比较治疗组评分优于对照组,且差异具有统计学意义(P<0.05),说明治疗组效果优于对照组。
3.3两组对疼痛疗效的比较结果
在治疗前两组的疼痛分级指数(PRI)感觉项总分、情感项总分及总分,视觉模拟定级(VAS),现有痛强度(PPI)各项指标经统计学分析,差异无统计学意义,(P＞0.05)；治疗后两组的PRI感觉项总分,PRI情感项总分,PRI总分,VAS,PPI各项指标分别与治疗前比较,差异有显著性意义,(P<0.05,P<0.01,P<0.001),说明两组对腰椎间盘突症均有良好的治疗效果,都能很好地改善腰椎间盘突出症患者的腰痛情况；两组治疗后治疗组PRI感觉项总分,PRI情感项总分,PRI总分,VAS均优于对照组,差异显著,(P<0.05),而PPI差异不明显, (P>0.05),说明治疗组改善腰椎间盘突出症患者的腰痛情况优于对照组。
3.4治疗前后两组患者功能障碍测定比较结果
在治疗前两组患者Oswestry功能障碍评分无显著差异,经统计学比较,(P>0.05)；经治疗后治疗组和对照组患者评分均发生了显著变化,Oswestry功能障碍评分显著下降,说明两种治疗方法均能改善腰椎间盘突出症患者的腰痛症状及改善患者的生活质量,经统计学比较均有统计学意义,(P<0.01或P<0.05)；而治疗组与对照组比较,差异显著(P<0.05)说明在改善腰痛症状及提高患者生活质量方面,治疗组优于对照组。
4研究结论
本临床研究显示：电针夹脊穴及阿是穴为主治疗腰椎间盘突出症的临床疗效优于常规穴位针刺治疗。采用电针夹脊穴及阿是穴治疗腰椎间盘突出症为临床上切实可行的治疗方法,值得临床推广及进一步深入研究。
1. Research purposes
Lumbar Intervertebral Disc Herniation also known as Lumbar Anular Disruption, is a spinal disease which causes severe pain. The degeneration of lumbar intervertebral disc or the external force cause the imbalance of the intervertebral disc which in turn leads to the rupture of the annulus fibrosus, resulting in the protrusion of the lumbar intervertebral disc nucleus pulposus. This protrusion causes the compression or stimulation of the nerves, blood vessels and Cauda equine etc, further leads to the inflammation in the surrounding tissue, edema, microcirculation and adhesion of fibrous tissue hyperplasia and in turn causes low back pain or even neurological barriers. This study adopts a simple, randomized, controlled study programs designed for the scientific evaluation of efficacy of EA of Jiaji and Ashi points in the treatment of Lumbar Intervertebral disc herniation. By observing the relief of pain through the treatment of EA of Jiaji and Ashi points, we can investigate a easy way to alleviate the pain that caused by this disease and to provide a theoretical basis in the treatment of Lumbar Intervertebral disc herniation by using EA of Jiaji and Ashi points.
2. Research methods
2.1 The source of the cases and grouping
All cases from Hong Kong University Chinese Medicine Clinical Research Centre, will be diagnosed with lumbar intervertebral disc herniation.60 patients were randomly divided into treatment group (acupuncture Jiaji and Ashi points 30) and the control group (conventional treatment group=30) in this clinical research.
2.2 Therapy
(1) Acupoints selection The treatment group taking Jiaji and Ashi points, Jiaji:lesion site of the vertebral body and its lower vertebrae Jiaji; Ashi point:the level of spinous process vertebral lesions adjacent to open 3 inches or less to find 2 point of deep tenderness; acupoints along meridians selection: Bladder Meridian of foot-Tai Yang, BL:Zhibian, Chengfu, Yinmen, Weizhong, Chengshan, Kunlun; Gall bladder Meridian of foot-Shao Yang, GB:Huantiao, Fengshi, Yanglingquan, Xiyangguan, Yangfu, Xuanzhong, Zulinqi. Selection with Syndrome Differentiation, cold dampness:Yaoyangguan; Blood Stasis:Shuigou; Yang deficiency of kidney:Mingmen; Ying deficiency of kidney:Sanyinjiao. Control group:regular acupoints of lowback pain and sciatica, main acupoints: Shenshu, Dachangshu, Yaoyangguan; acupoints along meridians selection and Selection with Syndrome Differentiation:the same as control group.
(2) Methods of operation Operation of reatment group:75% ethanol with regular skin disinfection Jiaji and Ashi points 0.25 X 50mm stainless steel needle quickly puncture, puncture perpendicularly 40mm; Huantiao, Zhibian and Chengfu 0.25 x 75mm stainless steel needle quickly puncture, puncture perpendicularly 70mm, Yinmen 0.25x 60mm stainless steel needle quickly puncture, puncture perpendicularly 50mm, Yanglingquan, Fengshi, Weizhong and Chengshan 0.25x 50mm stainless steel needle, quickly puncture, puncture perpendicularly 40mm; Kunlun 0.25x 40mm stainless steel needle, quickly puncture, puncture perpendicularly 30mm; Zulinqi 0.25x 25mm stainless steel needle quickly puncture, puncture perpendicularly 20mm. Yaoyangguan and Mingmen 0.25x 40mm stainless steel needle quickly puncture; puncture obliquely 30mm, Shuigou 0.25x 25mm stainless steel needle quickly puncture, puncture perpendicularly 15mm. Sanyinjiao 0.25x 40mm stainless steel needle quickly puncture, puncture perpendicularly 35mm.
Puncture each acupoint above with 1 needle and puncture 2 needles for Ashi points. Patient should feel locally tingling sense of expansion, this is called "De Qi". After "De Qi", remain needles for 30 minutes using KWD-8081 type instrument with continuous electricity current. Operation of control group,75% ethanol with regular skin disinfection Shenshu and Yaoyangguan 0.25x 40mm stainless steel needle quickly puncture, puncture obliquely 30mm; Dachangshu 0.25x50mm stainless steel needle quickly puncture, puncture perpendicularly 40mm, other operation remains the same as treatment group. Two groups of patients were treated every other day,3 times as a course of treatment,2 days rest between each course of treatment; Effects were recorded and analysed at the end of the 3 courses of treatments.
2.3 Assessment of therapeutic effect and observed indicators Study used in the clinical evaluation system are:State Administration of Traditional enacted in 1994, "low back pain classification table effect," "simplified Mcqill Pain Questionnaire" and "Oswestry dysfunction index". Close monitoring of adverse reactions before and after treatment.
3. Study Results
3.1 Comparison of the Clinical curative effects of the two groups There were clinical improvements in both groups after the treatment. The curative rate in Treatment group was 90% while in Control group was 80%, indicating that the therapeutic effects in both groups were good. As for Treatment group,17 cases were cured,10 cases showed improvement, while 3 cases showed no effect, therefore, the curative rate was 90%. As for Control group,12 cases were cured,12 cases showed improvement while 6 cases showed no effect and the curative rate was 80%. The Treatment group had better curative rate than the Control group (P>0.05).
3.2 Comparison of the clinical efficacy in low back pain of the two groups Before treatment, the difference between the two groups was not statistical significant as (P>0.05). However, there was a significant change after the treatment as the difference became statistical significant. T-test was undergone before and after the treatment in the groups, the result was (P<0.05), indicating that both groups had achieved good clinical effect after the treatment. The score in the Treatment group was better than that in the Control group and the difference was statistical significant (P<0.05), indicating that the Treatment group was better than the Control group.
3.3 Comparison of Pain treatment of the two groups Before treatment, statistical analysis showed that the difference was not statistical significant as (P>0.05), in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS) and Present Pain Intensity(PPI). There was a change in the indicators after treatment. The difference became statistically significant in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS) and Present Pain Intensity(PPI), they were (P<0.05, P<0.01, P<0.001) respectively. It meant that both groups had good therapeutic effect in improving lumbar intervertebral disc herniation symptoms. They could reduce the low back pain of the patients. Also, the Treatment group had higher score than the Control group in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS), which was (P<0.05). The PPI was not significant as (P>0.05). This result showed that the Treatment group is better than the Control group in reducing the low back pain symptoms of the lumbar intervertebral disc herniation patients.
3.4 Comparison of Dysfunction effects before and after treatment of the two groups
Before treatment, the two groups had no significant difference in the Oswestry Dysfunction Index as (P>0.05). There was obvious change after treatment as Oswestry Dysfunction Index was descended. It indicated that these two treatment methods could both improve the low back pain symptoms and the quality of life of the lumbar intervertebral disc herniation patients as (P<0.01 or P<0.05). In comparing the effect in the Treatment group and the Control group, the difference was significant as (P<0.05), indicating that the Treatment group was better than the Control in improving the low back pain symptoms and the quality of life of the lumbar intervertebral disc herniation patients.
4 Conclusions
This clinical study showed that electro acupuncture mainly in Jiaji points and Ashi points were better than other conventional acu points in treating lumbar disc herniation. Using electro acupuncture in Jiaji points and Ashi points were curative in this disease and it was highly recommended in clinical use and further investigations.
腰椎间盘突出症又称腰纤维环破裂症,是一种疼痛剧烈的脊椎疾病,由于椎间盘发生退行性变,或外力作用引起腰椎间盘内外力平衡失调,均可使纤维环突然破裂,导致腰椎间盘的髓核突出,压迫或刺激了神经根、硬膜囊、血管及马尾神经等,进一步导致周围组织炎症、水肿、微循环障碍和纤维组织增生粘连,继而出现腰腿痛,甚至出现神经功能障碍的一种疾病。本研究采取简单随机、对照方法设计研究方案,对电针夹脊穴及阿是穴治疗腰椎间盘突出症进行科学的疗效评价,通过观察电针夹脊穴及阿是穴对腰椎间盘突出症疼痛的缓解,探讨一种简单的治疗方法以减轻腰椎间盘突出症对患者带来的痛苦,同时为电针夹脊穴及阿是穴治疗腰椎间盘突出症提供理论依据。
2研究方法
2.1病例来源及分组
所有病例来源于香港大学中医临床教研中心,将诊断为腰椎间盘突出症的患者60例随机分为治疗组(针刺夹脊穴及阿是穴)30例及对照组(常规针刺组)30例,进行临床研究。
2.2治疗
(1)取穴治疗组取夹脊穴及阿是穴,夹脊穴：病变部位的椎体及下一椎体的夹脊穴；阿是穴：病变部位的椎体水平棘突旁开3寸以内寻找2个深层压痛点；循经配穴及辨证配穴：与对照组相同。对照组：腰痛及坐骨神经痛常规穴位,主穴：肾俞、大肠俞、腰阳关；循经配穴：足太阳经型：环跳、阳陵泉、秩边、承扶、殷门、委中、承山、昆仑；足少阳经型：环跳、阳陵泉、风市、膝阳关、阳辅、悬钟、足临泣。辨证配穴,寒湿型：腰阳关；血瘀型：水沟；肾阳虚型：命门；肾阴虚型：三阴交。(2)操作方法治疗组操作：用75%酒精皮肤常规消毒夹脊穴及阿是穴,用0.25×50mm不锈钢毫针快速进针,直刺40mm；环跳穴、秩边穴及承扶穴用0.25×75mm不锈钢毫针快速进针,直刺70mm；殷门穴用0.25×60mm不锈钢毫针快速进针,直刺50mm；阳陵泉穴、风市穴、委中穴及承山穴用0.25×50mm不锈钢毫针快速进针,直刺40mm；昆仑穴用0.25×40mm不锈钢毫针快速进针,直刺30mm；足临泣穴用0.25×25mm不锈钢毫针快速进针,直刺20mm。腰阳关穴及命门穴用0.25×40mm不锈钢毫针快速进针,斜刺30mm；水沟穴用0.25×25mm不锈钢毫针快速进针,直刺15mm；三阴交穴用0.25×40mm不锈钢毫针快速进针,直刺35mm。以上各穴每穴针刺1针,各穴都以患者局部有酸麻胀为得气感,得气后留针用KWD-808I型治疗仪选用30分钟连续密波加电。对照组针刺操作,用75%酒精皮肤常规清毒,肾俞及腰阳关穴用0.25×40mm不锈钢毫针快速进针,斜刺30mm；大肠俞穴用0.25×50mm不锈钢毫针快速进针,直刺40mm,其余操作同治疗组相同。两组患者均隔日治疗1次,3次为一疗程,疗程之间休息2天,于3个疗程结束后填写量表进行分析。
2.3疗效评价体系及观察指标
研究中所采用的临床评价体系为：国家中医药管理局1994年颁布的《中医病证诊断疗效标准》、“腰痛疗效分级表”、“简式Mcqill疼痛问卷”及“Oswestry功能障碍指数”。治疗前后密切监测不良反应。
3研究结果
3.1两组临床疗效比较
治疗后两组的临床症状均有改善,治疗组愈好率93.33%,对照组愈好率80%,说明经过治疗两组患者都取得了良好的效果；治疗组治愈17例,好转11例,未愈2例,愈好率93.33%；对照组治愈12例,好转12例,未愈6例,愈好率80%。两组愈好率比较,治疗组优于对照组(P<0.05)。
3.2两组腰痛疗效评价比较结果
在治疗前两组评分差异无统计学意义(p>0.05)；治疗后两组的腰痛疗效评分均发生了显著的变化,组内治疗前后评分t检验,显示差异具有统计学意义(P<0.05),说明经过治疗两组患者都取得了良好的效果；组间比较治疗组评分优于对照组,且差异具有统计学意义(P<0.05),说明治疗组效果优于对照组。
3.3两组对疼痛疗效的比较结果
在治疗前两组的疼痛分级指数(PRI)感觉项总分、情感项总分及总分,视觉模拟定级(VAS),现有痛强度(PPI)各项指标经统计学分析,差异无统计学意义,(P＞0.05)；治疗后两组的PRI感觉项总分,PRI情感项总分,PRI总分,VAS,PPI各项指标分别与治疗前比较,差异有显著性意义,(P<0.05,P<0.01,P<0.001),说明两组对腰椎间盘突症均有良好的治疗效果,都能很好地改善腰椎间盘突出症患者的腰痛情况；两组治疗后治疗组PRI感觉项总分,PRI情感项总分,PRI总分,VAS均优于对照组,差异显著,(P<0.05),而PPI差异不明显, (P>0.05),说明治疗组改善腰椎间盘突出症患者的腰痛情况优于对照组。
3.4治疗前后两组患者功能障碍测定比较结果
在治疗前两组患者Oswestry功能障碍评分无显著差异,经统计学比较,(P>0.05)；经治疗后治疗组和对照组患者评分均发生了显著变化,Oswestry功能障碍评分显著下降,说明两种治疗方法均能改善腰椎间盘突出症患者的腰痛症状及改善患者的生活质量,经统计学比较均有统计学意义,(P<0.01或P<0.05)；而治疗组与对照组比较,差异显著(P<0.05)说明在改善腰痛症状及提高患者生活质量方面,治疗组优于对照组。
4研究结论
本临床研究显示：电针夹脊穴及阿是穴为主治疗腰椎间盘突出症的临床疗效优于常规穴位针刺治疗。采用电针夹脊穴及阿是穴治疗腰椎间盘突出症为临床上切实可行的治疗方法,值得临床推广及进一步深入研究。
1. Research purposes
Lumbar Intervertebral Disc Herniation also known as Lumbar Anular Disruption, is a spinal disease which causes severe pain. The degeneration of lumbar intervertebral disc or the external force cause the imbalance of the intervertebral disc which in turn leads to the rupture of the annulus fibrosus, resulting in the protrusion of the lumbar intervertebral disc nucleus pulposus. This protrusion causes the compression or stimulation of the nerves, blood vessels and Cauda equine etc, further leads to the inflammation in the surrounding tissue, edema, microcirculation and adhesion of fibrous tissue hyperplasia and in turn causes low back pain or even neurological barriers. This study adopts a simple, randomized, controlled study programs designed for the scientific evaluation of efficacy of EA of Jiaji and Ashi points in the treatment of Lumbar Intervertebral disc herniation. By observing the relief of pain through the treatment of EA of Jiaji and Ashi points, we can investigate a easy way to alleviate the pain that caused by this disease and to provide a theoretical basis in the treatment of Lumbar Intervertebral disc herniation by using EA of Jiaji and Ashi points.
2. Research methods
2.1 The source of the cases and grouping
All cases from Hong Kong University Chinese Medicine Clinical Research Centre, will be diagnosed with lumbar intervertebral disc herniation.60 patients were randomly divided into treatment group (acupuncture Jiaji and Ashi points 30) and the control group (conventional treatment group=30) in this clinical research.
2.2 Therapy
(1) Acupoints selection The treatment group taking Jiaji and Ashi points, Jiaji:lesion site of the vertebral body and its lower vertebrae Jiaji; Ashi point:the level of spinous process vertebral lesions adjacent to open 3 inches or less to find 2 point of deep tenderness; acupoints along meridians selection: Bladder Meridian of foot-Tai Yang, BL:Zhibian, Chengfu, Yinmen, Weizhong, Chengshan, Kunlun; Gall bladder Meridian of foot-Shao Yang, GB:Huantiao, Fengshi, Yanglingquan, Xiyangguan, Yangfu, Xuanzhong, Zulinqi. Selection with Syndrome Differentiation, cold dampness:Yaoyangguan; Blood Stasis:Shuigou; Yang deficiency of kidney:Mingmen; Ying deficiency of kidney:Sanyinjiao. Control group:regular acupoints of lowback pain and sciatica, main acupoints: Shenshu, Dachangshu, Yaoyangguan; acupoints along meridians selection and Selection with Syndrome Differentiation:the same as control group.
(2) Methods of operation Operation of reatment group:75% ethanol with regular skin disinfection Jiaji and Ashi points 0.25 X 50mm stainless steel needle quickly puncture, puncture perpendicularly 40mm; Huantiao, Zhibian and Chengfu 0.25 x 75mm stainless steel needle quickly puncture, puncture perpendicularly 70mm, Yinmen 0.25x 60mm stainless steel needle quickly puncture, puncture perpendicularly 50mm, Yanglingquan, Fengshi, Weizhong and Chengshan 0.25x 50mm stainless steel needle, quickly puncture, puncture perpendicularly 40mm; Kunlun 0.25x 40mm stainless steel needle, quickly puncture, puncture perpendicularly 30mm; Zulinqi 0.25x 25mm stainless steel needle quickly puncture, puncture perpendicularly 20mm. Yaoyangguan and Mingmen 0.25x 40mm stainless steel needle quickly puncture; puncture obliquely 30mm, Shuigou 0.25x 25mm stainless steel needle quickly puncture, puncture perpendicularly 15mm. Sanyinjiao 0.25x 40mm stainless steel needle quickly puncture, puncture perpendicularly 35mm.
Puncture each acupoint above with 1 needle and puncture 2 needles for Ashi points. Patient should feel locally tingling sense of expansion, this is called "De Qi". After "De Qi", remain needles for 30 minutes using KWD-8081 type instrument with continuous electricity current. Operation of control group,75% ethanol with regular skin disinfection Shenshu and Yaoyangguan 0.25x 40mm stainless steel needle quickly puncture, puncture obliquely 30mm; Dachangshu 0.25x50mm stainless steel needle quickly puncture, puncture perpendicularly 40mm, other operation remains the same as treatment group. Two groups of patients were treated every other day,3 times as a course of treatment,2 days rest between each course of treatment; Effects were recorded and analysed at the end of the 3 courses of treatments.
2.3 Assessment of therapeutic effect and observed indicators Study used in the clinical evaluation system are:State Administration of Traditional enacted in 1994, "low back pain classification table effect," "simplified Mcqill Pain Questionnaire" and "Oswestry dysfunction index". Close monitoring of adverse reactions before and after treatment.
3. Study Results
3.1 Comparison of the Clinical curative effects of the two groups There were clinical improvements in both groups after the treatment. The curative rate in Treatment group was 90% while in Control group was 80%, indicating that the therapeutic effects in both groups were good. As for Treatment group,17 cases were cured,10 cases showed improvement, while 3 cases showed no effect, therefore, the curative rate was 90%. As for Control group,12 cases were cured,12 cases showed improvement while 6 cases showed no effect and the curative rate was 80%. The Treatment group had better curative rate than the Control group (P>0.05).
3.2 Comparison of the clinical efficacy in low back pain of the two groups Before treatment, the difference between the two groups was not statistical significant as (P>0.05). However, there was a significant change after the treatment as the difference became statistical significant. T-test was undergone before and after the treatment in the groups, the result was (P<0.05), indicating that both groups had achieved good clinical effect after the treatment. The score in the Treatment group was better than that in the Control group and the difference was statistical significant (P<0.05), indicating that the Treatment group was better than the Control group.
3.3 Comparison of Pain treatment of the two groups Before treatment, statistical analysis showed that the difference was not statistical significant as (P>0.05), in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS) and Present Pain Intensity(PPI). There was a change in the indicators after treatment. The difference became statistically significant in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS) and Present Pain Intensity(PPI), they were (P<0.05, P<0.01, P<0.001) respectively. It meant that both groups had good therapeutic effect in improving lumbar intervertebral disc herniation symptoms. They could reduce the low back pain of the patients. Also, the Treatment group had higher score than the Control group in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS), which was (P<0.05). The PPI was not significant as (P>0.05). This result showed that the Treatment group is better than the Control group in reducing the low back pain symptoms of the lumbar intervertebral disc herniation patients.
3.4 Comparison of Dysfunction effects before and after treatment of the two groups
Before treatment, the two groups had no significant difference in the Oswestry Dysfunction Index as (P>0.05). There was obvious change after treatment as Oswestry Dysfunction Index was descended. It indicated that these two treatment methods could both improve the low back pain symptoms and the quality of life of the lumbar intervertebral disc herniation patients as (P<0.01 or P<0.05). In comparing the effect in the Treatment group and the Control group, the difference was significant as (P<0.05), indicating that the Treatment group was better than the Control in improving the low back pain symptoms and the quality of life of the lumbar intervertebral disc herniation patients.
4 Conclusions
This clinical study showed that electro acupuncture mainly in Jiaji points and Ashi points were better than other conventional acu points in treating lumbar disc herniation. Using electro acupuncture in Jiaji points and Ashi points were curative in this disease and it was highly recommended in clinical use and further investigations.
引文
[1]胡有谷.腰椎间盘突出症[M].第2版.北京：人民卫生出版社,1999.2.
[2]蒋谷人.英汉现代医学药学词海[M].哈尔滨：黑龙江科学技术出版社,1991.851.
[3]李世俊.新汉英医药学词汇[M].哈尔滨：黑龙江科学技术出版社,1993.1300.
[4]编纂委员会.汉英医学大词典[M].北京：人民卫生出版社,1987.1382.
[5]Stodieck LS,Beel JA, Luttges MW. Structural properties of spinal nerve roots protein composition[J]. Exp Neurd,1986,91:41
[6]Marker K, Ryde vik B, Ha msson T, et al. Edema for mation in spinal nerve roots induced by experimental grade decom pression[J]. Spine,1989,14:579
[7]Paker W W, Watanabe R. The intrinsic vasculature of the lumbosacral spinal nerve roots[J]. Spine,1985,10:508
[8]Marker K, Rydevik B. Pathophysiology of sciatica[J]. Orthop clin North Am.1991,22:233
[9]Patterson CAV, Clsson Y. Bood supply of spinal nerve roots, an experimental study in the rat[J].Acta Neuropathol,1989,78:455
[10]Hasue M, Kunogi J, Konnos, etal. Classification by position of dorsa root ganglia in the Lumbosacral region[J]. Spine,1998,14:1261
[11]Mc Carron RF, Marc W, Hudgins PG. The Inflammatory Effect of Nucleus Pulposus: A Possible Element in the Pathogenesis of Low-back Pain [J]. Spine,1987,12: 760-764.
[12]Kirkaldy-willis WH. The reaction of Structural pathology to the never root [J]. Spine,1984,9:49～52.
[13]Racs GB, Sabonghy M, Guintaulas J, Rline WM. Intractable pain therapy using a new epidural catheter [J]. JAMA,1982,248:579～581.
[14]Boumphery FRS, Bell GR, Modic M, et al.Computeel tomography scanning after chymopapain injection for herniated nucleus pulposus:A prospective study [J]. Clin Orthop,1987,219:220～226.
[15]裘法祖.外科学.腰椎间盘退变和突出症[M].北京：人民卫生出版社,1991.843-849.
[16]Yamashita T, Minakiy, Oota I, et al. Mechno sensitive afferent units in the lumbar inter vertebral disc and adjacent muscle [J]. Spine,1993,18:2252～ 2258.
[17]Matshall LL, Trethwie ER, Curtain CC. Chemical radiculitis:a clinical, physiologyical and immunological study [J].Clin Orthop,1977,129:61.
[18]Olmarker K, Rydevik B, Nordborg C. Autologus nucleus pulposusinduces neurophysiologic and histologic changes in procine causda equina nerve roots [J]. Spine,1993,18:1425.
[19]McCarron RF, Wimpee MW, Hadkins PG, et al. The inflammatory effect of nuleus pulposus:A possible element in the pathogenesis of low back pain [J]. Spine,1987,12:760.
[20]徐宏光,王辉,靳松,等.腰椎间盘突出症髓核内一氧化氮和白介素-6的检测意义[J].颈腰痛杂志1999,20(1)：3-4
[21]Evans CH, Stefanovic-Racic M, Lancaster J, et al. Nitric oxide and its role in orthopaedic disease [J]. Clin Orthop.1995,312:275～294.
[22]Stadler J, Stefanovic-Racic M, Billiar, et al. Articular chondrocytes synthesize nitric oxide in response to cytokines and lip polysaccharide[J]. Immunol,1991,147:3915～3920.
[23]Sanders KM, Ward SM. Nitric oxide as a mediator of nonadrenergic,noncholinergic, neurotransmission [J]. Am J Physiol,1992,262:379～383.
[24]Hoch RC, Rodriguez R, Manning T, et al. Effects of accidental trauma on cytokine and endotoxin production [J]. Crit Care Med,1993,197:1556～1562.
[25]Gronbld M, Virri I, Tolonen I, et al. A controlled immunohistochemical study of inflammatory cells in disc herniation tissue [J]. Spine,1994,19 (24): 2745-2751.
[26]Kang ID, Georgescu HI, Lori MI, et al. Herniated lumber intervertebral discs spontaneously produce matrix metalloproteinase, nitric oxide interleukill-6 and pnstaglandin EZ [J]. Spine,1996,21 (3): 271-277.
[27]Tels S, Pichard CF, Teffrey AS. High levels of inflammatory phospholipase AZ activity in lumber disc herniations [J]. Spine,1990,15:674～678.
[28]Vadas SE, Oryzabsju W. Influence of plasma proteins on actioity of proinflammatory enzyme phospholipase [J]. Inflammation,1986,10:183～193.
[29]Nygaard OP, Mcllgren SI, Osrerud B. The inflammatory properties of contained and noncontained lumber disc herniation [J]. Spine,1997,21 (1):22～26.
[30]Saal JS. The role of inflammation in lumber pain [J]. Spine,1995,20:1821～ 1826.
[31]Ferreira SH, Loreuzetti BB. Prostaglandin hyperalgesia, IV:A metabolic process[J]. Prostaglandins,1981,21:789
[32]Willberger RE, Wittenberg RH. Prostagladin release from disc and facet joint tissue[J]. Spine,1994,19:268～270
[33]Kang JD, Georgescu HI, Larkin L,et al. Herniated lumber intervertebral discs spontaneously produce matrix metal loproteinases, nitric oxide, inter leuk-6,and PGE2[J]. Spine,1996,21:271-277
[34]O'Donrell JL,O'Donrell AL. Prostaglandin E2 content in herniated lumbar disc disease [J]. Spine,1996,21:165～166
[35]Olmarker K, Iwabuchi M, Larsson K, et al. Tumor necrosis factor alpha and nucleus-pulposus induced nerve root injury[J]. Spine,1998,23:2538～2544
[36]Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equine nerve roots. Spine,1993,18:1425～1432
[37]Chen Cy, Cavanaugh JM, Song Z, et al. Autografted nucleus pulposus induced lumbar nerve root functional and molecular changes[J].Trans Intl Soc Study Lumbar Spine,1999:31
[38]Aoki Y, Rydevik B, Kikuchi S, et al. Local application of disc-related cytokines on spinal nerve roots [J]. Spine,2002,27(15):1614～1617
[39]Weiler C, Nerlich AG, Bachmeier BE, et al. Expression and distribution of tumor necrosis factor alpha in human lumbar intervertebral discs:a study in surgical specimen and autopsy controls [J]. Spine,2004,30(1):44～54
[40]Kato T, Haro H, Komon H,et al. Sequential dynamics of inflammatory cytokine angiogenesis inducing factor and matrix degrading enzymes during spontaneous resportion of the heriated disc[J]. Orthop Research,2004,22 (4):885～900
[41]Ariga k. Miyamoto S. Nakase T, et al. The relationship between apoptosis of enoplate chondrocytes and aging and degeneration of the intervertebral disc [J]. Spine,2001,26 (22):2414～2420
[42]Karppinen J, Korhonen T, Malmivaara A, et al. Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to mange, sever sciatica [J]. Spine,2003,28(8):750～754
[43]Korhonen T,Karppinen J, Paimela L, et al. The treatment of disc herniation-induced sciatica with infliximab:one-year follow-up results of FIRST II, a randomized controlled trial [J]. Spine,2006,31(24):2759～2766
[44]Taiwo YO, Levine JD. Effects of cyclooxygenase products of arachidonic acid metabolism on cutaneous nociceptive threshold in the rat[J]. Brain Res,1990,537:372～374
[45]Beiche F, Scheuerer S, Brune K, et al. Up-regulation of cyclooxygenase-2mRNA in the rat spinal cord following peripheral inflammation[J]. FEBS Lett,1996,390:165～169
[46]Taiwo YO, Levine JD. Indomethacin blocks central nociceptive effects of PGF2[J]. Brain Res,1986,373:81-84
[47]David J, John E, Michael A. Peripheral hyperalgesia in experimental neuropathy:mediation by 2-adrenoreceptors on post-ganglionic sympathetic terminals [J]. Pain,1995,60:317～327
[48]Penington JB, McCarron RF, Gerald SL. Identication of IgG in the canine inter vertebral disc [J]. Spine,1988,13:909～912.
[49]Iris S, Panaiotis K, Dimities K. IgG and IgM concentration in the prolapsed humen inter vertebral disc and sciatica etiology [J]. Spine,1994,19:1320～ 1323.
[50]Boden SD, Davis DO, Dina TS, et al. Abonromal Magnetic-resonance scans of the lumbar spine in asymptomic subject [J]. J Bone Joint Surg (Am),1990,72 (3):403-408.
[51]Satoh D, Konno S, Nishiyama K, et al. Presence and distribution of antigenaotibody romplexes in the herniated nucleus pulposus [J]. Spine,1999, 24 (19):1980-1984.
[52]Yoshizawa H, Kobayashi S, Morita T. Chronic nerve root compression: Pathophysiologic mechanism of nerve root dysfunction [J]. Spine,1995,20(4): 397-407.
[53]Lisak RP, Bealmear B. Interleukin-1 alpha, but not interleukin-lbeta, is a comitogen for neonatal Schwann cells in vitro and acts ainterleukin-1 receptors [J]. J Neuroimmunol,1994,55 (2):171 ～ 177.
[54]Lisak RP, Bealmear B. Antibodies to interleukin-1 inhibits cytokineinduced proliferation of neonatal rat Schwann cells in vitro [J]. J Neuroimmunol,1991,31 (2):123～132.
[55]Olmarker K, Blomquist J, Stromberg J et al. Inflammatogenic properties of nucleus pulposus [J]. Spine,1995,20 (6):665～669.
[56]Kawakami M, Weinstein JN, Chatani KI, et al. Experimental lumbar radicaulopathy: Behavioral and histologc changes in a model of radicular pain after spinal nerve root irritation with chromic gut ligatures in the rat [J]. Spine,1994,19(156):1795-1802.
[57]Meeting report:Inflammation and hyperalgesia:highlighting the team effort [J]. TIPS,1993,14:287-290.
[58]Watkins LR, Maier SF, Goehler LE. Immune activation:the role of pro-inflammatory cytokines in inflammation, illness responses and athological pain states [J]. Pain,1995,63:289～302.
[59]Lee SC, Dickson DW, Bronsnan CF. Interleukin-1, nitric oxide and reactive astrocyte[J]. Brain Behave Imnmune,1995,9 (4):345～354.
[60]Holthuthen H, Arndt JO. Nitric oxide evokes pain in human on intracutaneous injection [J]. Neurosci Lett,1994,165:71-74.
[61]Whithe DM. Mechanism of prostaglandinE2 induced substance Prelease from cultured sensory neuros [J]. Neurosci,1996,70 (2):561～565.
[62]司军强,李之望.P物质对大鼠DRG神经元胞体膜的作用[J].生理学报,1996,48(1)：8-14.
[63]Trotti D, Voltera A, Lehre KP, et al. Arachidonic acid inhibits a purified reconstituted glutamate transporter directay via the water phase and not via phospholipid membane [J]. J Bio Chem,1995,270:9890～9895.
[64]方永江,韩劢兵,易荣等.针刺配合运动疗法治疗腰椎间盘突出症30例观察[J].云南中医中药杂志,2009,30(2)：43-44.
[65]徐涛,杨忠华,王霖.针刺药并用治疗腰椎间盘突出症56例临床观察[J].新中医,2009,41(12)：86-88.
[66]刘岚,刘累耕,吕鸣、冉维君.电针结合中药治疗阳虚寒凝型腰椎间盘突出症疗效观察[J].中国针灸,2009,29(8)：626-628.
[67]唐华生.循经取穴治疗腰椎间盘突出症对照观察[J].中国针灸,2008,28(6)：582-584.
[68]王秀刚.针灸疗法治疗52例腰椎问盘突出症的临床分析[J].亚太传统医药,2008,4(9)：39～40.
[69]罗培安,严晓春.夹脊穴温针法治疗腰椎间盘突出症33例临床观察[J].中医中药,2008,5(14)：92-93.
[70]高红,朱红莲.针灸治疗腰椎间盘突出症120例临床观察[J].中国现代医药杂志,2007,9(7)：71.
[71]袁琳.针灸辨证结合神灯照射治疗腰椎间盘突出症[J].浙江中西医结合杂志,2007,17(6)：386.
[72]薛平武.次髎穴深刺为主治疗腰椎间盘突出症临床观察[J].中国针灸,2007,27(3)：182-184.
[73]李守栋.电针治疗腰椎间盘突出症60例临床观察[J].陕西中医,2006,27(11)：1422-1450.
[74]李良平.电针配合牵引治疗腰椎间盘突出症60例[J].浙江中医杂志,2006,41(4)： 225.
[75]薄智云.腹针无痛治百病[M].科学普及出版社,2006年11月。
[76]苏小霖,张日霖,彭明霞.腹针治疗腰椎间盘突出症216例疗效观察[J].医学理论与实践,2008,21(3)：309～310.
[77]曾燕芬.腹针治疗腰椎间盘突出症67例临床观察[J].上海针灸杂志,2007,26(9)：16-17.
[78]陈海云,赵帅,孔畅等.孙氏手法合蒲氏腹针治疗腰椎间盘突出症30例疗效观察[J].新中医,2007,39(7)：53～54.
[79]李红华,杨颖,党亚梅.腹针疗法对腰椎间盘突出症疼痛的治疗效果观察[J].针灸临床杂志,2007,23(1)：11～12.
[80]王育庆,唐了香,潘长青.腹针疗法对腰椎间盘突出症患者疼痛的改善作用[J].中国临床康复,2005,9(38)：122-123.
[81]朱文斌.腹针治疗腰椎间盘突出症128例[J].河南中医,2005,25(12)：66-67.
[82]祝晓惠.腹针加正骨手法治疗腰椎间盘突出症的临床研究[J].现代中西医结合杂志,2005,14(5)：145-146.
[83]郭万刚,马林儒,弓利风等.腹针为主治疗腰椎间盘突出症50例疗效观察[J].中国针灸,2003,23(3)：145-146.
[84]唐福宁,黄承军,陈日新等.热敏灸治疗腰椎间盘突出症临床研究[J].江西中医学院报,2009,21(1)：25～27.
[85]董斌,王涛,谢宗亮等.灸腰阳关穴治疗腰椎间盘突出症疗效对照研究[J].颈腰痛杂志,2009,30(2)：175-176.
[86]赵学田,张喜娟.温针灸治疗腰椎间盘突出症50例对照研究[J].福建中医药,2008,39(1)：30,53.
[87]宋南昌,欧阳龙阳,何勇等.针灸治疗腰椎间盘突出症30例[J].中国针灸,2008,增刊：105-106.
[88]何兴伟,黄建华,曾利元.温针灸治疗腰椎间盘突出症疗效观察.中国针灸,2007,27(4)：264-266.
[89]从国红,方昕.新灸法治疗腰椎间盘突出症的体会[J].中国厂矿医学,2007,20(6)：674-675.
[90]赵敏,李雪,候艳丽.电针加穴位注射治疗腰椎间盘突出症疗效观察[J].人民军医,2009,52(4)：225～226.
[91]邹然,徐芸,张红星.电针加穴位注射对腰椎间盘突出症镇痛效应的临床观察[J].中国骨伤,2009,22(10)：759-761.
[92]畲玲玲,黄国付,张晓民.电针配合穴位注射治疗腰椎间盘突出症55例[J].湖北中医杂志,2009,31(4)：52-53.
[93]王焕爱,赵华.针灸和药物穴位注射治疗腰椎间盘突出症42例[J].中国民间疗法,2009,17(6)：31-32.
[94]陈兴奎.温针配合穴位注射治疗腰椎间盘突出症疗效观察[J].现代中西医结合杂志,2008,32(17)：4991-4992.
[95]王晓愿.穴位注射合针刺疗法治疗腰椎问盘突出症130例[J].江西中医药,2008,39(6)：72-73.
[96]卢静,王瑛.针刺配合刺血拔罐治疗腰椎间盘突出症63例[J].针灸临床杂志,2007,23(3)：16-17.
[97]苏建华,陈清玉.刺血拔罐法治疗腰椎间盘突出症110例[J].陕西中医,1999,20(5)：28.
[98]汪崇淼.刺络拔罐法在腰椎间盘突出症治疗中的应用[J].上海针灸杂志,1998,17(2)：20.
[99]孙作露,唐善珠.刺血拔罐法治疗腰椎间盘突出症的临床疗效观察[J].中国针灸,1997,第12期：727～728.
[100]李道丕.小针刀配合整脊治疗腰椎间盘突出症疗效观察[J].上海针灸杂志,2009,28(7)：403-405.
[101]李天发.小针刀辅以手法治疗腰椎间盘突出症90例[J].中医药临床杂志,2008,20(3)：294-295.
[102]李健运.小针刀治疗腰椎间盘突出症64例[J].中国中医急症,2008,17(11)：1620-1621.
[103]康哲峰.小针刀为主治疗腰椎间盘突出症100例疗效观察[J]。现代医学仪器与应用,2008,20(3)：13-15.
[104]马新平,姜燕.毫针、火针配合正骨手法治疗腰椎间盘突出症疗效观察[J].中国中医急症,2009,18(3)：375～376.
[105]杨丽艳,卢得健,李艳慧.火针治疗腰椎间盘突出症疗效观察[J].中国针灸,2009,29(6)449-451.
[106]旷秋和.火针配合针刺治疗腰椎间盘突出症疗效观察[J].中国康复医学杂志,2008,23(5)：454-455.
[107]吴桂红.火针配合中药外敷治疗腰椎间盘突出症35例[J].上海针灸杂志,2006,25(10)：35.
[108]王祖林.推拿配合火针治疗腰椎间盘突出症76例[J].江苏中医药,2003,24(6)：45.
[109]张桐亮,武银锋,王骁宙.乌龙驱风剂治疗痛症466例临床观察[J].中国现代医生,2008,46(13)：89,131.
[110]朱跟葵.挑治、穴位敷药治疗腰椎间盘突出症120例.中国针灸,2007,27(3)：172.
[111]许延生,梁秀兰,罗试计.中药内服外敷加牵引按摩治疗腰椎间盘突出症168例[J].河南中医,2006,26(1)：63.
[112]吴耀持,张一峰.电针结合药敷治疗腰椎间盘突出症160例[J].上海针灸杂志,2001,20(4)：18-19.
[113]王炫京,王小平.药针治疗腰椎间盘突出症43例[J].中国针灸,2002,22(2)：85.
[114]缪金华.走罐加手法等综合治疗腰椎间盘突出症100例[J].中国针灸,2001,21(4)：249.
[115]任日业,李京乐.穴位埋线治疗腰椎间盘突出症[J].中国针灸,2001,21(3)：157.
[116]李昌生.浮针治疗腰椎间盘突出症疗效观察[J].中国针灸,2001,21(9)520-530
[117]何希俊.眼针治疗腰椎间盘突出症68例[J].上海针灸杂志,2000,19(3)：31
[118]黄彰海,孙文颖,刘显,等.创伤痛大鼠下丘腰背内侧核神经元放电变化及电针效应[J].第一军医大学学报.1996,16(1)：9-11.
[119]曾玲,胡世风,玉小玲,等.刺激额叶皮层对丘脑腹后外侧核痛放电的影响及其与电针的关系[J].广西医科大学学报.1995,12(2)：202-208.
[120]尤浩军,袁斌,唐敬师.抑制大鼠脑皮层SI区对电针抑制持续性痛反立的影响[J].中国神经科学杂志.19999,15(4)：301-305.
[121]金春玉,王洁,东贵荣.针刺对急性脑梗死小鼠疼痛反应神经元影响[J].针灸临床杂志.2002.18(6)：53-55.
[122]吴红鑫,周雷,薛峥,等.电针抗大鼠急性炎症性内脏痛的肠神经机制[J].针刺研灸,1999,24(2)：138-142.
[123]雷亚宁,胡道松,茹立强.电针杭内脏牵拉痛肠神经机制的研究[J].针刺研究.1994.19(3-4)：69～70.
[124]夏勇,贵丽娟.针刺对下肢胫后神经躯体感觉诱发电位(SEPs)痛成分的影响[J].北京中医药大学学报.1994,17(6)：23-25.
[125]阮怀珍,李希成,黎海蒂等.电针抑制P物质引起的痛反应和脊髓c-fos表达[J].针刺研究1997.22(1-2)：58-59.
[126]薛光甫,林传友,曹福元,等.针刺大鼠“曲池”穴区SP和NPY免疫阳性神经的影响[J].同济医科大学学报.1997,26(4)：266-270.
[127]孙文颖,李晓文,萎之聪,等.电针“夹脊穴”抑制创伤痛诱发脊髓FOS蛋白表达[J].针刺研究.1996,21(1)：60-64.
[128]娄之聪,刘屈,李晓文,等.电针夹脊穴抑制创伤痛诱发的束旁核FOS蛋白的表达[J].第一军医大学学报.1996,16(2)：87～89.
[129]韩济生.针刺镇痛频率特异性的进一步证明[J].针刺研究.2001,26(3)：224～227.
[130]王贺春,万有,王韵,等.不同穴位电针治疗大鼠慢性冲经源性疼痛的疗效比较[J].针刺研究.2002,27(3)：180～182.
[131]国家中医药管理局.中华人民共和国中医药行业标准·中医病症诊断疗效标准(ZY)[M].南京：南京人学出版社,1994：206.
[132]王启才.针灸治疗学.全国高等中医药院校规划教材[M].中国中药出版社.,2003年1月。
[133]缪鸿石.康复医学理论与实践[M].上海科学技术出版社,2000年,1167～1168。
[134]郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志.2002,12(1)：13-15。
[135]金百仁.阿是穴是对腧穴特异性的挑战[J].针刺临床杂志.1995,11(2)：6-7.
[136]吴材林.论阿是穴在按摩临床的应用[J].按摩与导引.2002,18(2)：2-3.
[137]章小平,林雪霞,李海潮.阿是穴止痛机理的探讨[J].针刺临床志.2003,19(7)：57.
[2]蒋谷人.英汉现代医学药学词海[M].哈尔滨：黑龙江科学技术出版社,1991.851.
[3]李世俊.新汉英医药学词汇[M].哈尔滨：黑龙江科学技术出版社,1993.1300.
[4]编纂委员会.汉英医学大词典[M].北京：人民卫生出版社,1987.1382.
[5]Stodieck LS,Beel JA, Luttges MW. Structural properties of spinal nerve roots protein composition[J]. Exp Neurd,1986,91:41
[6]Marker K, Ryde vik B, Ha msson T, et al. Edema for mation in spinal nerve roots induced by experimental grade decom pression[J]. Spine,1989,14:579
[7]Paker W W, Watanabe R. The intrinsic vasculature of the lumbosacral spinal nerve roots[J]. Spine,1985,10:508
[8]Marker K, Rydevik B. Pathophysiology of sciatica[J]. Orthop clin North Am.1991,22:233
[9]Patterson CAV, Clsson Y. Bood supply of spinal nerve roots, an experimental study in the rat[J].Acta Neuropathol,1989,78:455
[10]Hasue M, Kunogi J, Konnos, etal. Classification by position of dorsa root ganglia in the Lumbosacral region[J]. Spine,1998,14:1261
[11]Mc Carron RF, Marc W, Hudgins PG. The Inflammatory Effect of Nucleus Pulposus: A Possible Element in the Pathogenesis of Low-back Pain [J]. Spine,1987,12: 760-764.
[12]Kirkaldy-willis WH. The reaction of Structural pathology to the never root [J]. Spine,1984,9:49～52.
[13]Racs GB, Sabonghy M, Guintaulas J, Rline WM. Intractable pain therapy using a new epidural catheter [J]. JAMA,1982,248:579～581.
[14]Boumphery FRS, Bell GR, Modic M, et al.Computeel tomography scanning after chymopapain injection for herniated nucleus pulposus:A prospective study [J]. Clin Orthop,1987,219:220～226.
[15]裘法祖.外科学.腰椎间盘退变和突出症[M].北京：人民卫生出版社,1991.843-849.
[16]Yamashita T, Minakiy, Oota I, et al. Mechno sensitive afferent units in the lumbar inter vertebral disc and adjacent muscle [J]. Spine,1993,18:2252～ 2258.
[17]Matshall LL, Trethwie ER, Curtain CC. Chemical radiculitis:a clinical, physiologyical and immunological study [J].Clin Orthop,1977,129:61.
[18]Olmarker K, Rydevik B, Nordborg C. Autologus nucleus pulposusinduces neurophysiologic and histologic changes in procine causda equina nerve roots [J]. Spine,1993,18:1425.
[19]McCarron RF, Wimpee MW, Hadkins PG, et al. The inflammatory effect of nuleus pulposus:A possible element in the pathogenesis of low back pain [J]. Spine,1987,12:760.
[20]徐宏光,王辉,靳松,等.腰椎间盘突出症髓核内一氧化氮和白介素-6的检测意义[J].颈腰痛杂志1999,20(1)：3-4
[21]Evans CH, Stefanovic-Racic M, Lancaster J, et al. Nitric oxide and its role in orthopaedic disease [J]. Clin Orthop.1995,312:275～294.
[22]Stadler J, Stefanovic-Racic M, Billiar, et al. Articular chondrocytes synthesize nitric oxide in response to cytokines and lip polysaccharide[J]. Immunol,1991,147:3915～3920.
[23]Sanders KM, Ward SM. Nitric oxide as a mediator of nonadrenergic,noncholinergic, neurotransmission [J]. Am J Physiol,1992,262:379～383.
[24]Hoch RC, Rodriguez R, Manning T, et al. Effects of accidental trauma on cytokine and endotoxin production [J]. Crit Care Med,1993,197:1556～1562.
[25]Gronbld M, Virri I, Tolonen I, et al. A controlled immunohistochemical study of inflammatory cells in disc herniation tissue [J]. Spine,1994,19 (24): 2745-2751.
[26]Kang ID, Georgescu HI, Lori MI, et al. Herniated lumber intervertebral discs spontaneously produce matrix metalloproteinase, nitric oxide interleukill-6 and pnstaglandin EZ [J]. Spine,1996,21 (3): 271-277.
[27]Tels S, Pichard CF, Teffrey AS. High levels of inflammatory phospholipase AZ activity in lumber disc herniations [J]. Spine,1990,15:674～678.
[28]Vadas SE, Oryzabsju W. Influence of plasma proteins on actioity of proinflammatory enzyme phospholipase [J]. Inflammation,1986,10:183～193.
[29]Nygaard OP, Mcllgren SI, Osrerud B. The inflammatory properties of contained and noncontained lumber disc herniation [J]. Spine,1997,21 (1):22～26.
[30]Saal JS. The role of inflammation in lumber pain [J]. Spine,1995,20:1821～ 1826.
[31]Ferreira SH, Loreuzetti BB. Prostaglandin hyperalgesia, IV:A metabolic process[J]. Prostaglandins,1981,21:789
[32]Willberger RE, Wittenberg RH. Prostagladin release from disc and facet joint tissue[J]. Spine,1994,19:268～270
[33]Kang JD, Georgescu HI, Larkin L,et al. Herniated lumber intervertebral discs spontaneously produce matrix metal loproteinases, nitric oxide, inter leuk-6,and PGE2[J]. Spine,1996,21:271-277
[34]O'Donrell JL,O'Donrell AL. Prostaglandin E2 content in herniated lumbar disc disease [J]. Spine,1996,21:165～166
[35]Olmarker K, Iwabuchi M, Larsson K, et al. Tumor necrosis factor alpha and nucleus-pulposus induced nerve root injury[J]. Spine,1998,23:2538～2544
[36]Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equine nerve roots. Spine,1993,18:1425～1432
[37]Chen Cy, Cavanaugh JM, Song Z, et al. Autografted nucleus pulposus induced lumbar nerve root functional and molecular changes[J].Trans Intl Soc Study Lumbar Spine,1999:31
[38]Aoki Y, Rydevik B, Kikuchi S, et al. Local application of disc-related cytokines on spinal nerve roots [J]. Spine,2002,27(15):1614～1617
[39]Weiler C, Nerlich AG, Bachmeier BE, et al. Expression and distribution of tumor necrosis factor alpha in human lumbar intervertebral discs:a study in surgical specimen and autopsy controls [J]. Spine,2004,30(1):44～54
[40]Kato T, Haro H, Komon H,et al. Sequential dynamics of inflammatory cytokine angiogenesis inducing factor and matrix degrading enzymes during spontaneous resportion of the heriated disc[J]. Orthop Research,2004,22 (4):885～900
[41]Ariga k. Miyamoto S. Nakase T, et al. The relationship between apoptosis of enoplate chondrocytes and aging and degeneration of the intervertebral disc [J]. Spine,2001,26 (22):2414～2420
[42]Karppinen J, Korhonen T, Malmivaara A, et al. Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to mange, sever sciatica [J]. Spine,2003,28(8):750～754
[43]Korhonen T,Karppinen J, Paimela L, et al. The treatment of disc herniation-induced sciatica with infliximab:one-year follow-up results of FIRST II, a randomized controlled trial [J]. Spine,2006,31(24):2759～2766
[44]Taiwo YO, Levine JD. Effects of cyclooxygenase products of arachidonic acid metabolism on cutaneous nociceptive threshold in the rat[J]. Brain Res,1990,537:372～374
[45]Beiche F, Scheuerer S, Brune K, et al. Up-regulation of cyclooxygenase-2mRNA in the rat spinal cord following peripheral inflammation[J]. FEBS Lett,1996,390:165～169
[46]Taiwo YO, Levine JD. Indomethacin blocks central nociceptive effects of PGF2[J]. Brain Res,1986,373:81-84
[47]David J, John E, Michael A. Peripheral hyperalgesia in experimental neuropathy:mediation by 2-adrenoreceptors on post-ganglionic sympathetic terminals [J]. Pain,1995,60:317～327
[48]Penington JB, McCarron RF, Gerald SL. Identication of IgG in the canine inter vertebral disc [J]. Spine,1988,13:909～912.
[49]Iris S, Panaiotis K, Dimities K. IgG and IgM concentration in the prolapsed humen inter vertebral disc and sciatica etiology [J]. Spine,1994,19:1320～ 1323.
[50]Boden SD, Davis DO, Dina TS, et al. Abonromal Magnetic-resonance scans of the lumbar spine in asymptomic subject [J]. J Bone Joint Surg (Am),1990,72 (3):403-408.
[51]Satoh D, Konno S, Nishiyama K, et al. Presence and distribution of antigenaotibody romplexes in the herniated nucleus pulposus [J]. Spine,1999, 24 (19):1980-1984.
[52]Yoshizawa H, Kobayashi S, Morita T. Chronic nerve root compression: Pathophysiologic mechanism of nerve root dysfunction [J]. Spine,1995,20(4): 397-407.
[53]Lisak RP, Bealmear B. Interleukin-1 alpha, but not interleukin-lbeta, is a comitogen for neonatal Schwann cells in vitro and acts ainterleukin-1 receptors [J]. J Neuroimmunol,1994,55 (2):171 ～ 177.
[54]Lisak RP, Bealmear B. Antibodies to interleukin-1 inhibits cytokineinduced proliferation of neonatal rat Schwann cells in vitro [J]. J Neuroimmunol,1991,31 (2):123～132.
[55]Olmarker K, Blomquist J, Stromberg J et al. Inflammatogenic properties of nucleus pulposus [J]. Spine,1995,20 (6):665～669.
[56]Kawakami M, Weinstein JN, Chatani KI, et al. Experimental lumbar radicaulopathy: Behavioral and histologc changes in a model of radicular pain after spinal nerve root irritation with chromic gut ligatures in the rat [J]. Spine,1994,19(156):1795-1802.
[57]Meeting report:Inflammation and hyperalgesia:highlighting the team effort [J]. TIPS,1993,14:287-290.
[58]Watkins LR, Maier SF, Goehler LE. Immune activation:the role of pro-inflammatory cytokines in inflammation, illness responses and athological pain states [J]. Pain,1995,63:289～302.
[59]Lee SC, Dickson DW, Bronsnan CF. Interleukin-1, nitric oxide and reactive astrocyte[J]. Brain Behave Imnmune,1995,9 (4):345～354.
[60]Holthuthen H, Arndt JO. Nitric oxide evokes pain in human on intracutaneous injection [J]. Neurosci Lett,1994,165:71-74.
[61]Whithe DM. Mechanism of prostaglandinE2 induced substance Prelease from cultured sensory neuros [J]. Neurosci,1996,70 (2):561～565.
[62]司军强,李之望.P物质对大鼠DRG神经元胞体膜的作用[J].生理学报,1996,48(1)：8-14.
[63]Trotti D, Voltera A, Lehre KP, et al. Arachidonic acid inhibits a purified reconstituted glutamate transporter directay via the water phase and not via phospholipid membane [J]. J Bio Chem,1995,270:9890～9895.
[64]方永江,韩劢兵,易荣等.针刺配合运动疗法治疗腰椎间盘突出症30例观察[J].云南中医中药杂志,2009,30(2)：43-44.
[65]徐涛,杨忠华,王霖.针刺药并用治疗腰椎间盘突出症56例临床观察[J].新中医,2009,41(12)：86-88.
[66]刘岚,刘累耕,吕鸣、冉维君.电针结合中药治疗阳虚寒凝型腰椎间盘突出症疗效观察[J].中国针灸,2009,29(8)：626-628.
[67]唐华生.循经取穴治疗腰椎间盘突出症对照观察[J].中国针灸,2008,28(6)：582-584.
[68]王秀刚.针灸疗法治疗52例腰椎问盘突出症的临床分析[J].亚太传统医药,2008,4(9)：39～40.
[69]罗培安,严晓春.夹脊穴温针法治疗腰椎间盘突出症33例临床观察[J].中医中药,2008,5(14)：92-93.
[70]高红,朱红莲.针灸治疗腰椎间盘突出症120例临床观察[J].中国现代医药杂志,2007,9(7)：71.
[71]袁琳.针灸辨证结合神灯照射治疗腰椎间盘突出症[J].浙江中西医结合杂志,2007,17(6)：386.
[72]薛平武.次髎穴深刺为主治疗腰椎间盘突出症临床观察[J].中国针灸,2007,27(3)：182-184.
[73]李守栋.电针治疗腰椎间盘突出症60例临床观察[J].陕西中医,2006,27(11)：1422-1450.
[74]李良平.电针配合牵引治疗腰椎间盘突出症60例[J].浙江中医杂志,2006,41(4)： 225.
[75]薄智云.腹针无痛治百病[M].科学普及出版社,2006年11月。
[76]苏小霖,张日霖,彭明霞.腹针治疗腰椎间盘突出症216例疗效观察[J].医学理论与实践,2008,21(3)：309～310.
[77]曾燕芬.腹针治疗腰椎间盘突出症67例临床观察[J].上海针灸杂志,2007,26(9)：16-17.
[78]陈海云,赵帅,孔畅等.孙氏手法合蒲氏腹针治疗腰椎间盘突出症30例疗效观察[J].新中医,2007,39(7)：53～54.
[79]李红华,杨颖,党亚梅.腹针疗法对腰椎间盘突出症疼痛的治疗效果观察[J].针灸临床杂志,2007,23(1)：11～12.
[80]王育庆,唐了香,潘长青.腹针疗法对腰椎间盘突出症患者疼痛的改善作用[J].中国临床康复,2005,9(38)：122-123.
[81]朱文斌.腹针治疗腰椎间盘突出症128例[J].河南中医,2005,25(12)：66-67.
[82]祝晓惠.腹针加正骨手法治疗腰椎间盘突出症的临床研究[J].现代中西医结合杂志,2005,14(5)：145-146.
[83]郭万刚,马林儒,弓利风等.腹针为主治疗腰椎间盘突出症50例疗效观察[J].中国针灸,2003,23(3)：145-146.
[84]唐福宁,黄承军,陈日新等.热敏灸治疗腰椎间盘突出症临床研究[J].江西中医学院报,2009,21(1)：25～27.
[85]董斌,王涛,谢宗亮等.灸腰阳关穴治疗腰椎间盘突出症疗效对照研究[J].颈腰痛杂志,2009,30(2)：175-176.
[86]赵学田,张喜娟.温针灸治疗腰椎间盘突出症50例对照研究[J].福建中医药,2008,39(1)：30,53.
[87]宋南昌,欧阳龙阳,何勇等.针灸治疗腰椎间盘突出症30例[J].中国针灸,2008,增刊：105-106.
[88]何兴伟,黄建华,曾利元.温针灸治疗腰椎间盘突出症疗效观察.中国针灸,2007,27(4)：264-266.
[89]从国红,方昕.新灸法治疗腰椎间盘突出症的体会[J].中国厂矿医学,2007,20(6)：674-675.
[90]赵敏,李雪,候艳丽.电针加穴位注射治疗腰椎间盘突出症疗效观察[J].人民军医,2009,52(4)：225～226.
[91]邹然,徐芸,张红星.电针加穴位注射对腰椎间盘突出症镇痛效应的临床观察[J].中国骨伤,2009,22(10)：759-761.
[92]畲玲玲,黄国付,张晓民.电针配合穴位注射治疗腰椎间盘突出症55例[J].湖北中医杂志,2009,31(4)：52-53.
[93]王焕爱,赵华.针灸和药物穴位注射治疗腰椎间盘突出症42例[J].中国民间疗法,2009,17(6)：31-32.
[94]陈兴奎.温针配合穴位注射治疗腰椎间盘突出症疗效观察[J].现代中西医结合杂志,2008,32(17)：4991-4992.
[95]王晓愿.穴位注射合针刺疗法治疗腰椎问盘突出症130例[J].江西中医药,2008,39(6)：72-73.
[96]卢静,王瑛.针刺配合刺血拔罐治疗腰椎间盘突出症63例[J].针灸临床杂志,2007,23(3)：16-17.
[97]苏建华,陈清玉.刺血拔罐法治疗腰椎间盘突出症110例[J].陕西中医,1999,20(5)：28.
[98]汪崇淼.刺络拔罐法在腰椎间盘突出症治疗中的应用[J].上海针灸杂志,1998,17(2)：20.
[99]孙作露,唐善珠.刺血拔罐法治疗腰椎间盘突出症的临床疗效观察[J].中国针灸,1997,第12期：727～728.
[100]李道丕.小针刀配合整脊治疗腰椎间盘突出症疗效观察[J].上海针灸杂志,2009,28(7)：403-405.
[101]李天发.小针刀辅以手法治疗腰椎间盘突出症90例[J].中医药临床杂志,2008,20(3)：294-295.
[102]李健运.小针刀治疗腰椎间盘突出症64例[J].中国中医急症,2008,17(11)：1620-1621.
[103]康哲峰.小针刀为主治疗腰椎间盘突出症100例疗效观察[J]。现代医学仪器与应用,2008,20(3)：13-15.
[104]马新平,姜燕.毫针、火针配合正骨手法治疗腰椎间盘突出症疗效观察[J].中国中医急症,2009,18(3)：375～376.
[105]杨丽艳,卢得健,李艳慧.火针治疗腰椎间盘突出症疗效观察[J].中国针灸,2009,29(6)449-451.
[106]旷秋和.火针配合针刺治疗腰椎间盘突出症疗效观察[J].中国康复医学杂志,2008,23(5)：454-455.
[107]吴桂红.火针配合中药外敷治疗腰椎间盘突出症35例[J].上海针灸杂志,2006,25(10)：35.
[108]王祖林.推拿配合火针治疗腰椎间盘突出症76例[J].江苏中医药,2003,24(6)：45.
[109]张桐亮,武银锋,王骁宙.乌龙驱风剂治疗痛症466例临床观察[J].中国现代医生,2008,46(13)：89,131.
[110]朱跟葵.挑治、穴位敷药治疗腰椎间盘突出症120例.中国针灸,2007,27(3)：172.
[111]许延生,梁秀兰,罗试计.中药内服外敷加牵引按摩治疗腰椎间盘突出症168例[J].河南中医,2006,26(1)：63.
[112]吴耀持,张一峰.电针结合药敷治疗腰椎间盘突出症160例[J].上海针灸杂志,2001,20(4)：18-19.
[113]王炫京,王小平.药针治疗腰椎间盘突出症43例[J].中国针灸,2002,22(2)：85.
[114]缪金华.走罐加手法等综合治疗腰椎间盘突出症100例[J].中国针灸,2001,21(4)：249.
[115]任日业,李京乐.穴位埋线治疗腰椎间盘突出症[J].中国针灸,2001,21(3)：157.
[116]李昌生.浮针治疗腰椎间盘突出症疗效观察[J].中国针灸,2001,21(9)520-530
[117]何希俊.眼针治疗腰椎间盘突出症68例[J].上海针灸杂志,2000,19(3)：31
[118]黄彰海,孙文颖,刘显,等.创伤痛大鼠下丘腰背内侧核神经元放电变化及电针效应[J].第一军医大学学报.1996,16(1)：9-11.
[119]曾玲,胡世风,玉小玲,等.刺激额叶皮层对丘脑腹后外侧核痛放电的影响及其与电针的关系[J].广西医科大学学报.1995,12(2)：202-208.
[120]尤浩军,袁斌,唐敬师.抑制大鼠脑皮层SI区对电针抑制持续性痛反立的影响[J].中国神经科学杂志.19999,15(4)：301-305.
[121]金春玉,王洁,东贵荣.针刺对急性脑梗死小鼠疼痛反应神经元影响[J].针灸临床杂志.2002.18(6)：53-55.
[122]吴红鑫,周雷,薛峥,等.电针抗大鼠急性炎症性内脏痛的肠神经机制[J].针刺研灸,1999,24(2)：138-142.
[123]雷亚宁,胡道松,茹立强.电针杭内脏牵拉痛肠神经机制的研究[J].针刺研究.1994.19(3-4)：69～70.
[124]夏勇,贵丽娟.针刺对下肢胫后神经躯体感觉诱发电位(SEPs)痛成分的影响[J].北京中医药大学学报.1994,17(6)：23-25.
[125]阮怀珍,李希成,黎海蒂等.电针抑制P物质引起的痛反应和脊髓c-fos表达[J].针刺研究1997.22(1-2)：58-59.
[126]薛光甫,林传友,曹福元,等.针刺大鼠“曲池”穴区SP和NPY免疫阳性神经的影响[J].同济医科大学学报.1997,26(4)：266-270.
[127]孙文颖,李晓文,萎之聪,等.电针“夹脊穴”抑制创伤痛诱发脊髓FOS蛋白表达[J].针刺研究.1996,21(1)：60-64.
[128]娄之聪,刘屈,李晓文,等.电针夹脊穴抑制创伤痛诱发的束旁核FOS蛋白的表达[J].第一军医大学学报.1996,16(2)：87～89.
[129]韩济生.针刺镇痛频率特异性的进一步证明[J].针刺研究.2001,26(3)：224～227.
[130]王贺春,万有,王韵,等.不同穴位电针治疗大鼠慢性冲经源性疼痛的疗效比较[J].针刺研究.2002,27(3)：180～182.
[131]国家中医药管理局.中华人民共和国中医药行业标准·中医病症诊断疗效标准(ZY)[M].南京：南京人学出版社,1994：206.
[132]王启才.针灸治疗学.全国高等中医药院校规划教材[M].中国中药出版社.,2003年1月。
[133]缪鸿石.康复医学理论与实践[M].上海科学技术出版社,2000年,1167～1168。
[134]郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志.2002,12(1)：13-15。
[135]金百仁.阿是穴是对腧穴特异性的挑战[J].针刺临床杂志.1995,11(2)：6-7.
[136]吴材林.论阿是穴在按摩临床的应用[J].按摩与导引.2002,18(2)：2-3.
[137]章小平,林雪霞,李海潮.阿是穴止痛机理的探讨[J].针刺临床志.2003,19(7)：57.