Observation Of MRI Of Paraspinal Muscles In Patients With Lumbar Disc Herniation Treated With Internal Heating Dry Needle Therapy

Objective To explore the clinical efficacy mechanism of internal heating dry needle therapy in treating the patients with lumbar disc herniation. The changes of the cross-sectional area and fat infiltration area of the paravertebral muscles before and after internal heating dry needle treatment with MRI in patients with lumbar disc herniation was evaluated. The local pain threshold of lumbar parietal muscles and the pain Score and quality of life score were measured and compared with lumbar traction treatment.Methods(1) Subjects: 60 patients with lumbar disc herniation were randomly divided into two groups: one group of patients was given lumbar traction and another group of patients were treated with internal heating dry needle therapy. 20 patients without lumbar disc herniation were selected as the healthy control group.(2) Treatment: internal heating dry needle therapy: The waist is divided into upper lumbar, lower lumbar and sacrococcygeal and each part of was given one treatment, each treatment interval 5 days.Lumbar traction: each treatment time is 20 minutes and the traction weight is 1 / 3-1 / 2 of the patient’s body weight. The course lasts for 10 days, twice a day.(3) Evaluation index: Before treatment, the patients in the treatment group and the healthy control group were examined by lumbar MRI. The second lumbar MRI was followed up for 3 months after treatment. The muscle cross-sectional area of the multifidi muscle, erector spinae, psoas muscle, and the area where the fat infiltrated area was measured and the ratio of the area to the vertebral area was calculated. The VAS score, SF-36 and PPT of the patients was evaluated 1 day before treatment, 7 day, 1 month and 3 months after the end of treatment. Compare the between groups and groups.(4) Data analysis: The general data and clinical data of the patients were statistically described. The measurement data were expressed as mean 士 standard deviation (x±s). Single factor repeated measurement of variance analysis, t test and Spearman rank correlation test were used through SPSS 17.0, with P <0.05 for the difference was statistically significant.Results(1) The ratio of cross-sectional area of the paraspinal muscles to the vertebral body:before treatment, The ratio of cross-sectional area of the multifidi muscle, erector spinae,psoas muscle to the vertebral area were lower in the two treatment groups than in the control group (P <0.05). After treatment, the ratio of cross-sectional area of the multifidi muscle, erector spinae, psoas muscle to the vertebral area in the patients with internal heating dry needle therapy was significantly higher than that before treatment (P <0.05).However, the ratio of cross-sectional area of the psoas muscle to the vertebral area was still lower than that of the control group (P <0.05). The ratio of cross-sectional area of the multifidi muscle, erector spinae, psoas muscle to the vertebral area in the patients with lumbar traction treatment group was slightly higher than that before treatment, but still smaller than that of control group (P<0.05).(2)The ratio of fatty infiltration area to the vertebral body: Before treatment, in the treatment groups the ratio of fat area to pyramidal area in the multifidi muscle, erector spinae and psoas muscle was significantly higher than that in control group (P <0.05).After treatment, in the group treated with internal heating dry needle therapy the ratio of fat area to vertebral area was significantly lower than that before treatment (P <0.05), but the ratio of the fat area to the vertebral area was higher than that in the control group (P< 0.05). In the group treated with lumbar traction treatment the ratio of fat area to vertebral area was no significance change than before (P>0.05).(3)vas,ppt,sf-36: There were no significant differences in vas, ppt and sf-36 between the two groups before treatment(P>0.05). At 7 days, 1 month and 3 months after treatment,the vas of the patients treated with internal heating dry needle therapy were significantly lower and lower, the ppt and sf-36 scores of the patients treated with internal heating dry needle therapy were significantly higher and higher (P<0.05) . At 7 days, 1 month and 3 months after treatment, the vas of the patients treated with lumbar traction were significantly lower, the ppt and sf-36 were significantly higher than before treatment(P<0.05) . But there was no significant difference in vas, ppt and sf-36 of the patients treated with lumbar traction at 7 days, 1 month and 3 months after treatment(P>0.05).(4) the correlation between the difference of VAS, PPT and the chance of the degree of muscle atrophy: There was a positive correlation before and after treatment in the internal heating dry needle therapy between the difference of VAS and PPT with the difference of vertebral muscle (erector spinae, multifidi muscle, psoas muscle) and vertebral area ratio (P <0.05).Conclusion Internal heating dry needle therapy can increase the cross-sectional area of the multifidi muscle, erector spinae, psoas muscle in patients with lumbar disc herniation,reduce fat infiltration in the muscle tissue, improve paralysis muscle atrophy, and can reduce the pain of patients, improve the tenderness threshold and the quality of life of patients.