| Background:Lumbar spinal stenosis disease (UK:Lumbar spinal stenosis syndrome, referred to as:the LSSS) is clinically led to one of the common causes of back pain or waist, and leg pain. Caused by lumbar degeneration, congenital, and caused by trauma, spine fracture and dislocation or spinal canal stenosis caused by lumbar spinal surgery. One of the most rare degenerative lumbar spinal stenosis. Degenerative lumbar spinal stenosis disease is increased with age, intervertebral disc degeneration is prominent, small joint hyperplasia, yellow ligament hypertrophy caused luminal volume narrow spinal canal or nerve root canal sagittal diameter smaller, stimulate or oppressed cauda equina nerve or nerve root and cause a series of clinical symptoms, the serious influence the quality of life of elderly patients.With CT and MRI in clinical practice, can clearly see the vertebral, canal contents, specific, circumstances have a intuitive impression of narrow, plays a key role in diagnosis of lumbar spinal stenosis disease, in clinic, we found that many patients with lumbar spinal stenosis disease from the analysis on image data belong to severe stenosis, clinical signs and symptoms are very light, and many patients with symptoms and signs arc very heavy, narrow wasn’t too badly on imaging, imaging and symptoms are not unified. We also found that integrated traditional Chinese and western medicine conservative treatment to the curative effect of different degree of stenosis. Clinical imaging in narrow, however, only the doctor’s sight, the lack of scientific basis, we use computer software for stenosis degree, the narrow degree of different grouping, narrowed to analyze the imaging and clinical manifestations of how relationship. At the same time, in the same integrated conservative treatment, based on the analysis of imaging relationship between therapeutic effect and narrow degree provides objective information for conservative treatment of Chinese and western medicine.Objective:1. Using software to calculate the narrow segment of the vertebral canal sagittal diameter and area of dural sac. By observing the patients VAS, JOA score before treatment, analyzing imaging stenosis degree correlation with the severity of clinical symptoms.2. Observe VAS imaging stenosis degree and patients, the JOA curative effect to improve the situation, analysis of integrated traditional Chinese and western medicine conservative treatment curative effect with narrow degree of correlation imaging.Methods:1. Observed in October2011-December2012in the third affil iafed hospital orthopedic hospital of Beijing university of Chinese medicine into treatment group of60eases of lumbar spinal stenosis patients, using software to calculat the narrow segment of the vertebral canal sagittal diameter and area of dural sac. According to Verbiest taxonomy:central lumbar spinal canal sagittal diameter12-15mm for the exception,10-12mm for narrow, less than10mm for absolute stricture. We will lumbar sagittal diameter between12-15mm as I degrees of stenosis, the sagittal diameter between10-12mm as Ⅱ degrees of stenosis, the sagittal diameter less than10mm as Ⅲ degree of stenosis. According to Bolender taxonomy:normal dural sac area is180+50was, narrow,100-130was for early100was less than can be diagnosed cervical stenosis. We will lumbar dural sac area in100-100was classified as mild stenosis, the dural sac area in80-80was classified as moderate stenosis, the dural sac area smaller than80was classified as severe stenosis. Grouping patients according to the above two methods, by observing the VAS, JOA score before treatment, analyzing imaging stenosis degree correlation with the severity of clinical symptoms.2. All patients were treated with the same scheme, observation imaging VAS, degree of stenosis and patients JOA improvement, curative effect analysis of integrated traditional Chinese and western medicine conservative treatment efficacy and the narrow degree of correlation imaging.Treatment:All the patients were taken the same integrated traditional Chinese and western medicine conservative treatment scheme, specific as follows:1. The semiconductor laser irradiation:find the sensitive points in the waist of the patient, the patient in the prone position, the semiconductor laser probe disinfection, adjusted to500MW, alignment sensitive point,10min each time,1times a day. Acupuncture therapy on the day without laser irradiation, the next day to continue.2. The traditional Chinese medicine wet hot:according to syndrome differentiation of traditional Chinese medicine, qi stagnation and blood stasis type ShenTongZhuYuTang addition and subtraction; Qi deficiency and blood stasis type with positive also five soup addition and subtraction; cold dampness Closed-resistance with Duhuojisheng Decoction; deficiency of the liver and kidney in Jinkui Shenqi pill. The drug into the bag sealed, placed in a pot for steaming out to30min, patients can withstand temperatures prevail, apply to the waist sensitive point,20min each time,2times a day. Acupuncture therapy on the day is not external, next to.3. The Chinese medicine by iontophoresis:guyouling liniment rubbed on the patient waist, iontophoresis device attached to the same place exposure, daily20min,2times a day.Acupotomy on pause, next to.4. Manipulation:take leg ministry muscle relaxation techniques, leg ministry acupoint massage and lumbar lateral oblique pulling method. Every15min, every other day for1times.5.Small needle knife:the patient in the prone position, the waist muscles relaxed, his hands placed on both sides of the body. To find the most sensitive points or Ashi point2-3, at the waist anesthesia needle, disinfection, after stimulation, peeling, release:a needle a sterile dressing, and rest in bed for more than2h. Treatment of1times a week, according to the patient’s symptoms to improve the situation, most treatment3times.treatment cycle:For3weeks,3weeks after VAS, JOA score.Statistical software:SPSS13.0.1. Collected studies in patients with segmental sagittal diameter of the spinal canal stenosis and the epidural space, as well as the treatment of former VAS, JOA scoring, using SPSS13.0Spearman rank correlation analysis:grouping sagittal diameter of the spinal canal, the epidural area classification and treatment of former VAS, JOA scoring is relevant. P>0.05the difference is not statistically significant.2. According to the sagittal diameter of the spinal canal and the epidural area different points of law, is divided into three groups, analysis of the curative effect between the groups using rank sum test whether there is a difference, using Spearman rank correlation analysis of the effect of whether there is a difference in the group, to analyze the severity of spinal stenosis and whether there is a correlation between therapeutic effect. P>0.05the difference is not statistically significant.Results:1. using Spearman rank correlation analysis of segmental sagittal diameter of the spinal canal stenosis, the epidural space after grouping and treatment of former VAS, JOA scoring, p greater than0.05, the difference is not statistically significant.2.using rank sum test analysis of sagittal diameter of the spinal canal, the epidural space across groups and its effect, p is greater than0.05, the difference is not statistically significant; using Spearman rank correlation analysis of sagittal diameter of the spinal canal, the epidural area within the Group and its effect, p is greater than0.05, the difference is not statistically significant.Conclusion:1.sagittal diameter of the spinal canal, the epidural space with its treatment of former VAS, JOA scoring no statistical differences, namely Imaging stenosis associated with clinical manifestations of gravity without being.2.the sagittal diameter of the spinal canal, the epidural space and its efficacy is no statistical differences, stenosis of imaging and therapeutic effect without being related. |
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