针刺加骨肽穴位注射治疗腰椎间盘突出症的临床观察及其对血浆β-EP、CGRP的影响
|
摘要
目的:比较针刺加骨肽注射液穴位注射、单纯针刺两种方法治疗腰椎间盘突出症的临床效果;观察针刺加骨肽注射液穴位注射对血浆β-内啡肽(β-EP)、降钙素基因相关肽(CGRP)代谢的影响,探讨其治疗腰椎间盘突出症的机理。
方法:选择符合诊断标准的L4～L5、L5～S1单节段和双节段腰椎间盘突出或膨隆,且有腰腿痛症状(McGill疼痛评分中疼痛强度(PPI)评分≥2分)的患者64例,随机分为治疗组(针刺加骨肽注射液穴位注射组)和对照组(单纯针刺组),每组各32例,两组在进行针刺时的取穴及针刺方法均一样。针刺取穴为大肠俞(双侧)、关元俞(双侧)、小肠俞(双侧)、秩边(患侧)、阳陵泉(患侧)、委中(患侧)。治疗组:针刺完毕后,取双侧关元俞进行穴位注射,抽取骨肽注射液1ml,每穴注射入0.5ml。对照组:单纯按治疗组的针刺穴位和针刺方法进行针刺,不进行穴位注射。两组均为每天治疗1次,10天为1疗程,疗程间休息3天。治疗前及治疗两个疗程结束后,分别对两组用《临床疗效判断标准》、“下腰痛评分标准”(JOA评分)和McGill疼痛评分标准进行临床症状积分的评定,并测定患者体内血浆β-EP、CGRP的含量。对临床疗效判断、JOA评分、McGill疼痛评分和血浆β-EP、CGRP含量的变化进行统计学分析。
结果:(1)治疗1个疗程后,治疗组总有效率为83.9%,对照组总有效率为82.8%;2个疗程后,治疗组总有效率为90.3%;对照组总有效率为86.2%。两组均能取得较为理想的疗效,但两组在1个疗程后、2个疗程后比较,组间疗效无明显差异(P＞0.05)。(2)二个疗程治疗后,两组的JOA评分均有升高,且两组JOA评分改善指数之间比较有显著性差异(P＜0.05)。相比之下,治疗组JOA评分的改善好于对照组;二个疗程治疗后,两组的McGill疼痛评分均有降低,且两组的降低水平之间比较有非常显著性差异(P＜0.01);治疗组下降幅度大于对照组。(3)治疗前后血浆β-EP含量的变化:两组治疗后均能使血浆β-EP含量升高,两组升高幅度比较有显著差异(P＜0.05),治疗组升高幅度大于对照组;治疗前后血浆CGRP含量的变化:两组治疗后均能使血浆CGRP含量降低,两组降低的幅度比较无明显差异(P＞0.05)。
结论:(1)针刺加骨肽注射液穴位注射和单纯针刺两种方法均能明显改善腰椎间盘突出症患者的临床症状,而针刺加骨肽注射液穴位注射法更优于单纯针刺法,尤其在缓解疼痛方面。(2)腰椎间盘突出症患者疼痛缓解程度与其体内血浆β-EP、CGRP含量的变化有关,疼痛缓解程度分别与血浆β-EP含量的升高、CGRP含量的降低呈正相关。
PURPOSE
Compare the result treating protrusion of lumbar intervertebral disc with two treatment.These two treatment include the treatment of acupuncture combined with acupoint-injection of Ossotide injection and the treatment of simple acupuncture;Observe the effects Of acupuncture combined with acupoint-injection of Ossotide injection on concentration Of Plasmaβ-EP、CGRP,and discuss the mechanism of the treatment on lumbar disc herniation.
METHOD
64 cases of protrusion of lumbar intervertebral disc were selected with certain diagnostic standard.These patients were all single or double intervertebral disc protrusion which between the fourth and fifth lumbar vertebrae or between the fifth lumbar vertebrae and the first sacral vertebrae,moreover,all the patients selected had symptoms of acute lumbago and scelalgia(short-form mcgill pain questionnaire,PPI≥2).They were randomly divided into two groups:the group of acupuncture combined with acupoint-injection of Ossotide injection (Therapy group)and another of simple acupuncture(Control group);There were 32 cases in each group.The two groups applied the same points and the same method of the needling.The points were dachangshu(EX-B2,double sides),guanyuanshu(EX-B2,double sides),Zhibian(BL54,sick side),Yanglinquan(GB34,sick side),Weizhong(BL40,double side). Therapy group:After the acupuncture and when we applied the acupoint-injection,we drawed 1ml Ossotide injection.Then we inserted into the double guanyuanshu Points of the fifth lumbar Vertebrae of the Patient and inject 0.5ml injections slowly in each Point.Control group:The Patients were needled the same Points and the same method as therapy group but had no acupoint-injection.The patients of two groups were all treated once a day,and 10 times constituted a course of treatment.They had taken a rest of three days between courses. Before the first treatment and on the first day after 2 courses of treatment,we evaluated respectively the clinic symptoms of two groups with "clinicalcurative effect judge standard"、 "Lower Back Pain Assessment Standard"(JOA evaluation sheet)、"short-form mcgill pain questionnaire",then determinate the content change of blood plasmaβ-EP and CGRP in patients and analyse the result.
RESULT
(1)Observation of the curative effect:Atday 10,the total effective rate in therapy group was 83.9%and the control group was82.8%;Atday20,the total effective rate in therapy group was 90.3%and control group was86.2%.Two groups have good efficacy in the treatment of LIDP,but there was no significant difference between the clinical efficacy rates of the two groups Atday10 or day20(P＞0.05).(2) After treatment of 2 courses,JOA scores were all increased in both two groups,There was significant difference between increasing degree of JOA scores of therapy group and control group(P＜0.05).The increasing tendency of JOA scores in therapy group were higher than that of control group.After treatment of 2 courses, pain scores were all descended in both two groups,There was significant difference between falling degree of pain scores of therapy group and control group(P＜0.05).The falling tendency of pain scores in therapy group were higher than that of control group.(3)The change of the concentration of Plasmaβ-EP between pre-treatment and post- treatment: after treatment of 2 courses,the concentration of Plasmaβ-EP were all increased in both two groups and the change of it in therapy group is greater than in control group.The change of the concentration of Plasma CGRP between pre-treatment and post- treatment:after treatment of 2 courses,the concentration of Plasma CGRP were all descended in both two groups and the change of it has no significant difference in two groups.
CONCLUSION
(1)Both acupuncture combined with acupoint injection of Ossotide injection and simple acupuncture could ameliorate the symptom,especially in pain relief,and the effect of therapy group was superior to control group significantly.(2) Pain relieves in lumbar intervertebral disc protrusion patients is related to the change of the concentration of Plasmaβ-EP and CGRP.The increasing tendency of the concentration of Plasmaβ-EP was positive correlation with pain alleviation.The falling tendency of the concentration of Plasma CGRP was positive correlation with pain alleviation.
方法:选择符合诊断标准的L4～L5、L5～S1单节段和双节段腰椎间盘突出或膨隆,且有腰腿痛症状(McGill疼痛评分中疼痛强度(PPI)评分≥2分)的患者64例,随机分为治疗组(针刺加骨肽注射液穴位注射组)和对照组(单纯针刺组),每组各32例,两组在进行针刺时的取穴及针刺方法均一样。针刺取穴为大肠俞(双侧)、关元俞(双侧)、小肠俞(双侧)、秩边(患侧)、阳陵泉(患侧)、委中(患侧)。治疗组:针刺完毕后,取双侧关元俞进行穴位注射,抽取骨肽注射液1ml,每穴注射入0.5ml。对照组:单纯按治疗组的针刺穴位和针刺方法进行针刺,不进行穴位注射。两组均为每天治疗1次,10天为1疗程,疗程间休息3天。治疗前及治疗两个疗程结束后,分别对两组用《临床疗效判断标准》、“下腰痛评分标准”(JOA评分)和McGill疼痛评分标准进行临床症状积分的评定,并测定患者体内血浆β-EP、CGRP的含量。对临床疗效判断、JOA评分、McGill疼痛评分和血浆β-EP、CGRP含量的变化进行统计学分析。
结果:(1)治疗1个疗程后,治疗组总有效率为83.9%,对照组总有效率为82.8%;2个疗程后,治疗组总有效率为90.3%;对照组总有效率为86.2%。两组均能取得较为理想的疗效,但两组在1个疗程后、2个疗程后比较,组间疗效无明显差异(P＞0.05)。(2)二个疗程治疗后,两组的JOA评分均有升高,且两组JOA评分改善指数之间比较有显著性差异(P＜0.05)。相比之下,治疗组JOA评分的改善好于对照组;二个疗程治疗后,两组的McGill疼痛评分均有降低,且两组的降低水平之间比较有非常显著性差异(P＜0.01);治疗组下降幅度大于对照组。(3)治疗前后血浆β-EP含量的变化:两组治疗后均能使血浆β-EP含量升高,两组升高幅度比较有显著差异(P＜0.05),治疗组升高幅度大于对照组;治疗前后血浆CGRP含量的变化:两组治疗后均能使血浆CGRP含量降低,两组降低的幅度比较无明显差异(P＞0.05)。
结论:(1)针刺加骨肽注射液穴位注射和单纯针刺两种方法均能明显改善腰椎间盘突出症患者的临床症状,而针刺加骨肽注射液穴位注射法更优于单纯针刺法,尤其在缓解疼痛方面。(2)腰椎间盘突出症患者疼痛缓解程度与其体内血浆β-EP、CGRP含量的变化有关,疼痛缓解程度分别与血浆β-EP含量的升高、CGRP含量的降低呈正相关。
PURPOSE
Compare the result treating protrusion of lumbar intervertebral disc with two treatment.These two treatment include the treatment of acupuncture combined with acupoint-injection of Ossotide injection and the treatment of simple acupuncture;Observe the effects Of acupuncture combined with acupoint-injection of Ossotide injection on concentration Of Plasmaβ-EP、CGRP,and discuss the mechanism of the treatment on lumbar disc herniation.
METHOD
64 cases of protrusion of lumbar intervertebral disc were selected with certain diagnostic standard.These patients were all single or double intervertebral disc protrusion which between the fourth and fifth lumbar vertebrae or between the fifth lumbar vertebrae and the first sacral vertebrae,moreover,all the patients selected had symptoms of acute lumbago and scelalgia(short-form mcgill pain questionnaire,PPI≥2).They were randomly divided into two groups:the group of acupuncture combined with acupoint-injection of Ossotide injection (Therapy group)and another of simple acupuncture(Control group);There were 32 cases in each group.The two groups applied the same points and the same method of the needling.The points were dachangshu(EX-B2,double sides),guanyuanshu(EX-B2,double sides),Zhibian(BL54,sick side),Yanglinquan(GB34,sick side),Weizhong(BL40,double side). Therapy group:After the acupuncture and when we applied the acupoint-injection,we drawed 1ml Ossotide injection.Then we inserted into the double guanyuanshu Points of the fifth lumbar Vertebrae of the Patient and inject 0.5ml injections slowly in each Point.Control group:The Patients were needled the same Points and the same method as therapy group but had no acupoint-injection.The patients of two groups were all treated once a day,and 10 times constituted a course of treatment.They had taken a rest of three days between courses. Before the first treatment and on the first day after 2 courses of treatment,we evaluated respectively the clinic symptoms of two groups with "clinicalcurative effect judge standard"、 "Lower Back Pain Assessment Standard"(JOA evaluation sheet)、"short-form mcgill pain questionnaire",then determinate the content change of blood plasmaβ-EP and CGRP in patients and analyse the result.
RESULT
(1)Observation of the curative effect:Atday 10,the total effective rate in therapy group was 83.9%and the control group was82.8%;Atday20,the total effective rate in therapy group was 90.3%and control group was86.2%.Two groups have good efficacy in the treatment of LIDP,but there was no significant difference between the clinical efficacy rates of the two groups Atday10 or day20(P＞0.05).(2) After treatment of 2 courses,JOA scores were all increased in both two groups,There was significant difference between increasing degree of JOA scores of therapy group and control group(P＜0.05).The increasing tendency of JOA scores in therapy group were higher than that of control group.After treatment of 2 courses, pain scores were all descended in both two groups,There was significant difference between falling degree of pain scores of therapy group and control group(P＜0.05).The falling tendency of pain scores in therapy group were higher than that of control group.(3)The change of the concentration of Plasmaβ-EP between pre-treatment and post- treatment: after treatment of 2 courses,the concentration of Plasmaβ-EP were all increased in both two groups and the change of it in therapy group is greater than in control group.The change of the concentration of Plasma CGRP between pre-treatment and post- treatment:after treatment of 2 courses,the concentration of Plasma CGRP were all descended in both two groups and the change of it has no significant difference in two groups.
CONCLUSION
(1)Both acupuncture combined with acupoint injection of Ossotide injection and simple acupuncture could ameliorate the symptom,especially in pain relief,and the effect of therapy group was superior to control group significantly.(2) Pain relieves in lumbar intervertebral disc protrusion patients is related to the change of the concentration of Plasmaβ-EP and CGRP.The increasing tendency of the concentration of Plasmaβ-EP was positive correlation with pain alleviation.The falling tendency of the concentration of Plasma CGRP was positive correlation with pain alleviation.
引文
[1]胡有谷.腰椎间盘突出症(第3版)(M).北京:人民卫生出版社,2004:85-109.
[2]胡有谷.腰椎间盘突出症(第3版)(M).北京:人民卫生出版社,2004:241-261.
[3]杨艺,针灸治疗腰椎间盘突出症78例(J),上海针灸杂志,2006,25(6):17.
[4]张军,高秀兰,孙树春.神经根型颈椎病根性痛的解剖学基础和发病机理的研究.中国中医骨伤科杂志(J),1999,1(1):49.
[5]刘强.脊柱疾病的现代诊断与治疗(M).北京:中国医药科技出版社,2002:222.
[6]张伯勋,王岩.现代颈肩腰腿痛诊断与治疗学(M).北京:人民军医出版社,2004:483,488.
[7]徐玉渊.中西医结合治疗颈肩背腰腿痛(M).北京:中国医药科技出版社,1998:356-359.
[8]李泽恩.骶管注射灯盏细辛液治疗腰椎间盘突出症及对IgG、IgM的影响(D).福建中医学院硕士学位论文,2006:1-52.
[9]SatohD,KonnoS,Nishiyama K et al.presence and distribution of antige- Nantibody Complexes in the herniated nucleus PulPosus.SPine,1999,24(19):1980-1984.
[10]罗跃嘉.简化McGill疼痛评分表的临床应用评价(J).中国康复,1992,(04).
[11]周德祥.针灸治疗腰痛古代文献分析(J).中国民间疗法,2000,8(2):4-5.
[12]孙宇峰.电针加穴位注射丹参注射液治疗腰椎间盘突出症的临床研究(D).黑龙江中医药大学硕士学位论文,2007:1-56.
[13]田海燕.电针加穴位注射治疗腰椎间盘突出症50例(J).江西中医药杂志,2006,10(37):49.
[14]韩济生.中枢神经肽之间的相互作用(J).生物学通报,1996,31(2):1.
[15]吴耀持,张彩虹,江崇森等.针刺对大鼠实验性神经根压迫症模型超微结构的影响(J).针刺研究,2000,25(3):188-191.
[16]阮经文.浅谈穴位注射临床应用(J).针灸临床杂志,1998,14(7):48.
[17]林振原.电针加穴位注射治疗腰椎间盘突出症的临床观察和电生理分析(D).福建中医学院硕士学位论文,2006:1-40.
[18]李家泰主编.临床药理学(M).北京:人民卫生出版社,1998:28-47.
[19]胡蕴玉.骨诱导及骨愈合分子生物学研究进展.中华骨科杂志(J),1997,17:17.
[20]张永刚,卢世壁,王继芳·骨引导与骨诱导·中华创伤杂志(J),1996,12:333.
[21]MohnaS,BaylinkDJ· Bonegrowth·afctors.ClinOrthoP,1991,263:30.
[22]SnadbegrMMAio,VuvioELGeneexPressionduringbonerePalLClinorthOP·1993,289:292.
[23]万世勇,孙福样,丁铁健,等.骨宁注射液辅助治疗骨不连45例疗效观察.齐齐哈尔医学院学报(J),1999,20(5):470.
[24]胡有谷.腰椎间盘突出症(M).第3版.北京:人民卫生出版社,200:485-100.
[25]BuckwaiterJA.Agingnaddegenerationofthehumanintevrertebraldise.spine(J),1995,20:1307-1314.
[26]胡有谷·腰椎间盘突出症(M).第3版.北京:人民卫生出版社,2004:116.
[27]朱换平,许晓英.骨生长因子局部注射促进骨愈合的研究进展.甘肃中医学院学报(J),2003,20(1):57.
[28]陈岩,胡有谷,齐宗华.转化生长因子β与推间盘细胞Ⅰ型胶原基因调控的关系.中国矫形外科杂志(J),2000,7(2):151.
[29]王炯.TGF,β-EP的生物学效应及其在某些疾病中的作用.国外医学免疫学分册(J),1995,(1):18.
[30]张玲玲,孟祥伟,迟宝荣.干扰素的基础研究与临床应用.中国全科医学(J),2004,7(22):1715.
[31]夏缓IL-6、IL-8与呼吸系统感染.临床中老年保健(J),2001,4(4):291.
[32]姜鸣炜.骨肽针穴位注射治疗第三腰椎横突综合征的临床观察(J).四川医学2004,25(1):13.
[33]胡有谷.腰椎间盘突出症(M).第3版.北京:人民卫生出版社,2004:184-185.
[34]Mixter WJ,Barr JS.RuPture of the intervertebral disc with involvement of the spinal canal(J).New Eng J Med,1934,211:211.
[35]Brown,M.D.The pathoPhysiology of disc disease.Orthop Clin Narn 1971,2:359.
[36]Spencer DL.Anatomy and significance of fixation of the lumbosacral nerve roots insciatica.Spine1983,8:672.
[37]Piperno M,Hellio-le-Graverand MP,Reboul Petal.PhosPholiPase AZ activity in Herniated lumbar discs.Clinical correlations and inhibition by Piro-xieam.SPine,1997SeP 15,22(18):2061-2065.
[38]Narlor A,HaPPey F,Turner RL,etal,Enzymic and immunological activity in the Internertebral disc.Orthop clip NorthAm,1975,6:51.
[39]Satoh D,KonnoS,Nishiyama Ketal.Presence and distribution of antigen- antibody complexes in the herniated nucleus PulPosus.SPine,1999,24(19):1980-1984.
[40]BoumPhery FRS,Bell GR,Modic M,etal.Computeel tomograPhy Scanning after cbymopapain injection for herniated nucleus PulPosus:A prospective study.ClinOrthoP,1987,219:220-226.
[41]Murphy RW.Nerve roots and spinal nerves in degenerative disc disease(J).ClinOrthop 1977:129:61.
[42]Marshall L,etal.Chemical radieulitis:a clinical physiogieal and immunological study(J).Jbone Joint Surg.1958:40:1401.
[43]Marshall L,Trethewie ER.Chemical irration of nerve root in disc prolapse(J).Lancet 1973:2:320.
[44]Saal JS.High levels of inflammatory PhosPholoPase AZ activity in lumbar herniations.Spine 1990,15:674.
[45]张红星,黄国付,张唐法.电针夹脊穴对腰椎间盘突出症镇痛作用研究及其对血浆β-内啡肽的影响(J).中国中医骨伤科杂志,2006,14(3):11.
[46]蕾亚锋,跌打膏对慢性腰痛患者血浆β-内啡肽的影响.中国现代应用药学,1998,13(5):6.
[47]王新华,张一罗,刘数孝,等.硬膜外镇痛对慢性腰腿痛患者血浆β-内啡肽含量的影响(J).中华麻醉学杂志,1993,13:131-132.
[48]肖晓山,陈造宏,李明友.中华麻醉学杂志(J),2001,6:6.
[49]钟秀会,李呈敏.湖北农业大学学报(J),1996,19(4):4.
[50]陈启盛等.用针对大鼠β-内啡肽含量的影响(J).科学通报,1983,28(5):312-315.
[51]孟宪松等,猪外周血液中β-内啡肽与针刺免疫(J).中兽医医药杂志,1992,5:12-16.
[52]曲连东等.穴位接种猪TGE苗家兔β-EP与免疫活性细胞动态研究(J).中兽医药杂志,1994,3:3-6.
[53]严伟星等.β-EP对细胞免疫功能的调节(J).南通医学院学报,1994,14(2):132-134.
[54]王利力等.血浆CGRP与三叉神经痛发病关系的临床观察(J).辽宁中医杂志,2006,33(5):514-515.
[55]郑恒兴等.足底伤害性刺激条件下大鼠腰骶髓SP、CGRP、L-ENK样神经成分的变化(J).神经解剖学杂志,1996,12:27-32.
[56]Cridland RA,HenryJL.Intrathecal administration of CGRP in the rat attenustes a facilitation of flick reflex induced by either substance P ornoxious cutaneous stimulation.Neurosci Lett,1989,102:241-246.
[57]Bennett AD Chastain KM,Hulsebosch CE.Alleviation of mechanical and thermal allodynia by CGRPS-37 in a rodent model of chronic central Pain.Pain,2000,86:163-175.
[58]贺石生等.自体髓核移植后大鼠腰髓背角痛觉相关物质的变化(J).中国矫形外科杂志,2002, 10(9):892-894.
[59]宋雪松等.背根神经节压迫对大鼠痛行为及脊髓背角内降钙素基因相关肤的影响(J).中华麻醉学杂志,2004,1:44-47.
[60]Weinstein J,ClaverieW,GibsonS.The Pain of discography-SPine,1988,13:1344-1348.
[61]Sameshima KJ.Substance P like immunoreactivity in cerebrosPinal fluid in lumbar disc hernition.JJpn Orthop Assoc,1995,69:191-197.
[62]吴闻文等.腰推间盘源性疼痛机理的临床研究(J).中国矫形外科杂志,2003,11(21):1459-1462.
[63]赵阴环等.注射用骨肽治疗类风湿性关节炎疗效观察(J).中国保健2007,15(6):62.
[1]霍传江,跗勤德,王玉.针刺治疗腰椎间盘突出症76例体会.针灸临床杂志,2001,17(7):23.
[2]何樟明.针灸治疗腰椎间盘突出症96例临床疗效观察(J).针灸临床杂志,2002,18(8):10.
[3]张玉和.圆利针治疗腰椎间盘突出症80例(J).针灸临床杂志,2005,21(4):15.
[4]黄移生,彭易雨.圆利针加环跳齐刺为主治疗腰椎间盘突出症80例(J).中国针灸,2005,25(4):280.
[5]洪建云.深部夹脊刺治疗腰椎间盘突出症的疗效观察(J).针灸临床杂志,2005,21(4):33.
[6]李峰厚,葛纪,蒋晓林.针刺加超短波治疗腰椎间盘突出症的临床观察(J).针灸临床杂志,2005,21(1):34.
[7]唐飞.电针配合推拿治疗腰椎间盘突出症(J).针灸临床杂志,2005,21(10):36.
[8]朱海林.电针配合推拿治疗腰椎间盘突出症47例临床观察(J).针灸临床杂志,2005,21(5):39.
[9]周道平.针刺牵引配合斜扳法治疗腰椎间盘突出症68例观察(J).针灸临床杂志,2005,21(5):16.
[10]王新玲,宋连会.温针治疗腰椎间盘突出症临床疗效观察(J).针灸临床杂志,2005,21(10):11.
[11]陈波.粗银针结合灸法治疗腰椎间盘突出症[J].针灸临床杂志,2000,16(1):20.
[12]谢新群,谢文庆.短刺温针灸治疗腰椎间盘突出症170例(J).中国民间杂志.2003.11(3):12.
[13]董友金.针灸配合中药治疗腰椎间盘突出症80例(J).针灸临床杂志,2005,21(3):18.
[14]杨参平,胡建镇..针药结合治疗腰椎间盘突出症121例(J)..针灸临床杂志,2005,21(10):19.
[15]俞冬生.温针结合牵引治疗腰椎间盘突出症36例临床观察(J).针灸临床杂志,2005,21(8):39.
[16]谢雪榕,左松影,余幼河.温针结合牵引治疗腰椎间盘突出症85例疗效观察(J).针灸临床杂志,2005,21(11):41.
[17]关键敏.针灸疗法结合牵引治疗腰椎间盘突出症疗效观察(J).针灸临床杂志,2005,21(7):13.
[18]沈士军.针灸和经络倒平疗法治疗腰椎间盘突出症121例(J).针灸临床杂志,2005,21(10):21.
[19]刘育才,刘正.拔伸踩压法及针灸治疗腰椎闻盘突出症512例临床体会(J).四川中医2005,23(5):93.
[20]常英.针药配合推拿治疗腰椎间盘突出症148例(J)针灸临床杂志,2005,21(8):18.
[21]程继军,费建中,张晨光.针药结合推拿治疗腰椎间盘突出症疗效观察(J).上海针灸杂志,2005,24(9):17.
[2]胡有谷.腰椎间盘突出症(第3版)(M).北京:人民卫生出版社,2004:241-261.
[3]杨艺,针灸治疗腰椎间盘突出症78例(J),上海针灸杂志,2006,25(6):17.
[4]张军,高秀兰,孙树春.神经根型颈椎病根性痛的解剖学基础和发病机理的研究.中国中医骨伤科杂志(J),1999,1(1):49.
[5]刘强.脊柱疾病的现代诊断与治疗(M).北京:中国医药科技出版社,2002:222.
[6]张伯勋,王岩.现代颈肩腰腿痛诊断与治疗学(M).北京:人民军医出版社,2004:483,488.
[7]徐玉渊.中西医结合治疗颈肩背腰腿痛(M).北京:中国医药科技出版社,1998:356-359.
[8]李泽恩.骶管注射灯盏细辛液治疗腰椎间盘突出症及对IgG、IgM的影响(D).福建中医学院硕士学位论文,2006:1-52.
[9]SatohD,KonnoS,Nishiyama K et al.presence and distribution of antige- Nantibody Complexes in the herniated nucleus PulPosus.SPine,1999,24(19):1980-1984.
[10]罗跃嘉.简化McGill疼痛评分表的临床应用评价(J).中国康复,1992,(04).
[11]周德祥.针灸治疗腰痛古代文献分析(J).中国民间疗法,2000,8(2):4-5.
[12]孙宇峰.电针加穴位注射丹参注射液治疗腰椎间盘突出症的临床研究(D).黑龙江中医药大学硕士学位论文,2007:1-56.
[13]田海燕.电针加穴位注射治疗腰椎间盘突出症50例(J).江西中医药杂志,2006,10(37):49.
[14]韩济生.中枢神经肽之间的相互作用(J).生物学通报,1996,31(2):1.
[15]吴耀持,张彩虹,江崇森等.针刺对大鼠实验性神经根压迫症模型超微结构的影响(J).针刺研究,2000,25(3):188-191.
[16]阮经文.浅谈穴位注射临床应用(J).针灸临床杂志,1998,14(7):48.
[17]林振原.电针加穴位注射治疗腰椎间盘突出症的临床观察和电生理分析(D).福建中医学院硕士学位论文,2006:1-40.
[18]李家泰主编.临床药理学(M).北京:人民卫生出版社,1998:28-47.
[19]胡蕴玉.骨诱导及骨愈合分子生物学研究进展.中华骨科杂志(J),1997,17:17.
[20]张永刚,卢世壁,王继芳·骨引导与骨诱导·中华创伤杂志(J),1996,12:333.
[21]MohnaS,BaylinkDJ· Bonegrowth·afctors.ClinOrthoP,1991,263:30.
[22]SnadbegrMMAio,VuvioELGeneexPressionduringbonerePalLClinorthOP·1993,289:292.
[23]万世勇,孙福样,丁铁健,等.骨宁注射液辅助治疗骨不连45例疗效观察.齐齐哈尔医学院学报(J),1999,20(5):470.
[24]胡有谷.腰椎间盘突出症(M).第3版.北京:人民卫生出版社,200:485-100.
[25]BuckwaiterJA.Agingnaddegenerationofthehumanintevrertebraldise.spine(J),1995,20:1307-1314.
[26]胡有谷·腰椎间盘突出症(M).第3版.北京:人民卫生出版社,2004:116.
[27]朱换平,许晓英.骨生长因子局部注射促进骨愈合的研究进展.甘肃中医学院学报(J),2003,20(1):57.
[28]陈岩,胡有谷,齐宗华.转化生长因子β与推间盘细胞Ⅰ型胶原基因调控的关系.中国矫形外科杂志(J),2000,7(2):151.
[29]王炯.TGF,β-EP的生物学效应及其在某些疾病中的作用.国外医学免疫学分册(J),1995,(1):18.
[30]张玲玲,孟祥伟,迟宝荣.干扰素的基础研究与临床应用.中国全科医学(J),2004,7(22):1715.
[31]夏缓IL-6、IL-8与呼吸系统感染.临床中老年保健(J),2001,4(4):291.
[32]姜鸣炜.骨肽针穴位注射治疗第三腰椎横突综合征的临床观察(J).四川医学2004,25(1):13.
[33]胡有谷.腰椎间盘突出症(M).第3版.北京:人民卫生出版社,2004:184-185.
[34]Mixter WJ,Barr JS.RuPture of the intervertebral disc with involvement of the spinal canal(J).New Eng J Med,1934,211:211.
[35]Brown,M.D.The pathoPhysiology of disc disease.Orthop Clin Narn 1971,2:359.
[36]Spencer DL.Anatomy and significance of fixation of the lumbosacral nerve roots insciatica.Spine1983,8:672.
[37]Piperno M,Hellio-le-Graverand MP,Reboul Petal.PhosPholiPase AZ activity in Herniated lumbar discs.Clinical correlations and inhibition by Piro-xieam.SPine,1997SeP 15,22(18):2061-2065.
[38]Narlor A,HaPPey F,Turner RL,etal,Enzymic and immunological activity in the Internertebral disc.Orthop clip NorthAm,1975,6:51.
[39]Satoh D,KonnoS,Nishiyama Ketal.Presence and distribution of antigen- antibody complexes in the herniated nucleus PulPosus.SPine,1999,24(19):1980-1984.
[40]BoumPhery FRS,Bell GR,Modic M,etal.Computeel tomograPhy Scanning after cbymopapain injection for herniated nucleus PulPosus:A prospective study.ClinOrthoP,1987,219:220-226.
[41]Murphy RW.Nerve roots and spinal nerves in degenerative disc disease(J).ClinOrthop 1977:129:61.
[42]Marshall L,etal.Chemical radieulitis:a clinical physiogieal and immunological study(J).Jbone Joint Surg.1958:40:1401.
[43]Marshall L,Trethewie ER.Chemical irration of nerve root in disc prolapse(J).Lancet 1973:2:320.
[44]Saal JS.High levels of inflammatory PhosPholoPase AZ activity in lumbar herniations.Spine 1990,15:674.
[45]张红星,黄国付,张唐法.电针夹脊穴对腰椎间盘突出症镇痛作用研究及其对血浆β-内啡肽的影响(J).中国中医骨伤科杂志,2006,14(3):11.
[46]蕾亚锋,跌打膏对慢性腰痛患者血浆β-内啡肽的影响.中国现代应用药学,1998,13(5):6.
[47]王新华,张一罗,刘数孝,等.硬膜外镇痛对慢性腰腿痛患者血浆β-内啡肽含量的影响(J).中华麻醉学杂志,1993,13:131-132.
[48]肖晓山,陈造宏,李明友.中华麻醉学杂志(J),2001,6:6.
[49]钟秀会,李呈敏.湖北农业大学学报(J),1996,19(4):4.
[50]陈启盛等.用针对大鼠β-内啡肽含量的影响(J).科学通报,1983,28(5):312-315.
[51]孟宪松等,猪外周血液中β-内啡肽与针刺免疫(J).中兽医医药杂志,1992,5:12-16.
[52]曲连东等.穴位接种猪TGE苗家兔β-EP与免疫活性细胞动态研究(J).中兽医药杂志,1994,3:3-6.
[53]严伟星等.β-EP对细胞免疫功能的调节(J).南通医学院学报,1994,14(2):132-134.
[54]王利力等.血浆CGRP与三叉神经痛发病关系的临床观察(J).辽宁中医杂志,2006,33(5):514-515.
[55]郑恒兴等.足底伤害性刺激条件下大鼠腰骶髓SP、CGRP、L-ENK样神经成分的变化(J).神经解剖学杂志,1996,12:27-32.
[56]Cridland RA,HenryJL.Intrathecal administration of CGRP in the rat attenustes a facilitation of flick reflex induced by either substance P ornoxious cutaneous stimulation.Neurosci Lett,1989,102:241-246.
[57]Bennett AD Chastain KM,Hulsebosch CE.Alleviation of mechanical and thermal allodynia by CGRPS-37 in a rodent model of chronic central Pain.Pain,2000,86:163-175.
[58]贺石生等.自体髓核移植后大鼠腰髓背角痛觉相关物质的变化(J).中国矫形外科杂志,2002, 10(9):892-894.
[59]宋雪松等.背根神经节压迫对大鼠痛行为及脊髓背角内降钙素基因相关肤的影响(J).中华麻醉学杂志,2004,1:44-47.
[60]Weinstein J,ClaverieW,GibsonS.The Pain of discography-SPine,1988,13:1344-1348.
[61]Sameshima KJ.Substance P like immunoreactivity in cerebrosPinal fluid in lumbar disc hernition.JJpn Orthop Assoc,1995,69:191-197.
[62]吴闻文等.腰推间盘源性疼痛机理的临床研究(J).中国矫形外科杂志,2003,11(21):1459-1462.
[63]赵阴环等.注射用骨肽治疗类风湿性关节炎疗效观察(J).中国保健2007,15(6):62.
[1]霍传江,跗勤德,王玉.针刺治疗腰椎间盘突出症76例体会.针灸临床杂志,2001,17(7):23.
[2]何樟明.针灸治疗腰椎间盘突出症96例临床疗效观察(J).针灸临床杂志,2002,18(8):10.
[3]张玉和.圆利针治疗腰椎间盘突出症80例(J).针灸临床杂志,2005,21(4):15.
[4]黄移生,彭易雨.圆利针加环跳齐刺为主治疗腰椎间盘突出症80例(J).中国针灸,2005,25(4):280.
[5]洪建云.深部夹脊刺治疗腰椎间盘突出症的疗效观察(J).针灸临床杂志,2005,21(4):33.
[6]李峰厚,葛纪,蒋晓林.针刺加超短波治疗腰椎间盘突出症的临床观察(J).针灸临床杂志,2005,21(1):34.
[7]唐飞.电针配合推拿治疗腰椎间盘突出症(J).针灸临床杂志,2005,21(10):36.
[8]朱海林.电针配合推拿治疗腰椎间盘突出症47例临床观察(J).针灸临床杂志,2005,21(5):39.
[9]周道平.针刺牵引配合斜扳法治疗腰椎间盘突出症68例观察(J).针灸临床杂志,2005,21(5):16.
[10]王新玲,宋连会.温针治疗腰椎间盘突出症临床疗效观察(J).针灸临床杂志,2005,21(10):11.
[11]陈波.粗银针结合灸法治疗腰椎间盘突出症[J].针灸临床杂志,2000,16(1):20.
[12]谢新群,谢文庆.短刺温针灸治疗腰椎间盘突出症170例(J).中国民间杂志.2003.11(3):12.
[13]董友金.针灸配合中药治疗腰椎间盘突出症80例(J).针灸临床杂志,2005,21(3):18.
[14]杨参平,胡建镇..针药结合治疗腰椎间盘突出症121例(J)..针灸临床杂志,2005,21(10):19.
[15]俞冬生.温针结合牵引治疗腰椎间盘突出症36例临床观察(J).针灸临床杂志,2005,21(8):39.
[16]谢雪榕,左松影,余幼河.温针结合牵引治疗腰椎间盘突出症85例疗效观察(J).针灸临床杂志,2005,21(11):41.
[17]关键敏.针灸疗法结合牵引治疗腰椎间盘突出症疗效观察(J).针灸临床杂志,2005,21(7):13.
[18]沈士军.针灸和经络倒平疗法治疗腰椎间盘突出症121例(J).针灸临床杂志,2005,21(10):21.
[19]刘育才,刘正.拔伸踩压法及针灸治疗腰椎闻盘突出症512例临床体会(J).四川中医2005,23(5):93.
[20]常英.针药配合推拿治疗腰椎间盘突出症148例(J)针灸临床杂志,2005,21(8):18.
[21]程继军,费建中,张晨光.针药结合推拿治疗腰椎间盘突出症疗效观察(J).上海针灸杂志,2005,24(9):17.