Observe The Clinical Effect Of Blood-letting In The Treatment Of Lumbar Disc Herniation Based On The Musculoskeletal Ultrasound

Objective: Through musculoskeletal ultrasonography observing the changes of multifidus and the clinical effect of Lumbar Disc Herniation patients after the comprehensive treatment of Blood-letting by Collateral Puncture until “Blood-letting and Pathogenic Qi Expelling",which based on the guidance therapeutic philosophy of “Yi Tong Wei Yong”.Methods: Seventy-four patients with subacute phase lumbar disc herniation who met the inclusion criteria were randomly divided into observation group(basic treatment +acupuncture + "Blood-changing pathogenic Elimination" Blood-letting by Collateral Puncture therapy)and control group(basic treatment + acupuncture),with 37 cases in each group.Both groups received a 4-week course of treatment.CSA and the rate of thickness change under resting and motor functions of multifidus muscle at L4/5 level under musculoskeletal ultrasound were collected before and after treatment,as well as VAS score and JOA score.Finally,the data were statistically analyzed.Results:1.Baseline comparison:A total of 70 cases were included,35 cases in each group.After software statistics,there was no significant difference between the two groups in gender,age,course of disease and body mass index of baseline data(P>0.05).Before treatment,there were no significant differences in CSA of multifidus muscle,thickness change rate of multifidus muscle,VAS score and JOA score between healthy and affected sides(P>0.05).Intra-group comparison between the two groups showed that CSA of multifidus muscle on the affected side was lower than that on the healthy side before treatment(P<0.05).The two groups were consistent at baseline,and the comparison conditions were satisfied.2.Therapeutic results:(1)Observation results of multifidus muscle cross-sectional area at L4/5 level: Intra-group comparison: The CSA of the healthy and affected multifidus muscles in both groups was increased compared with that before treatment(P<0.01).Comparison between groups: the difference of CSA on the healthy and affected side was statistically significant(P<0.05),and the difference of CSA in the observation group was smaller;The difference of CSA before and after treatment in the healthy side was no statistical significance(P > 0.05),but the difference in the affected side was statistically significant(P<0.01),the difference value in the observation group was larger than that of compare group,and the amount of CSA in the observation group increased more after treatment.(2)The change rate of multifidus thickness A-P% at L4/5 level observation results:Comparison within the group before and after treatment: the A-P% of the observation group and the control group were increased compared with those before treatment(P<0.01).Comparison between groups after treatment: The difference in A-P% of the affected side multifidus muscle between the groups was statistically significant(P<0.01),and the A-P% of the observation group after treatment was better than that of the control group.(3)Results of Visual Analogue Score(VAS): comparison between groups after treatment:VAS score of the two groups showed statistically significant difference(P< 0.05),and VAS score of the observation group was lower than that of the control group.Intra-group comparison before and after treatment: VAS score after treatment was significantly lower than before(P< 0.01).(4)Japanese Orthopedic Association Back Pain Evaluation Questionnaire(JOA)score measurement results: Comparison between the two groups after treatment: there was statistically significant difference in JOA score between the two groups(P<0.01).The improvement of JOA score in the observation group was better than that in the control group.Intra-group comparison before and after treatment: the improvement of JOA score after treatment was significantly better than that before treatment(P< 0.01).(5)Efficacy evaluation results: after treatment,the total effective rate of the observation group was 93.94%,and that of the control group was 84.85%.The efficacy of the experimental group was better than that of the control group(P < 0.01).Conclusions:1.The comprehensive treatment of Blood-letting by Collateral Puncture until “Blood-letting and Pathogenic Qi Expelling",which based on the guidance therapeutic philosophy of “Yi Tong Wei Yong” and general acupuncture therapy can improve the symptoms,signs and daily living ability of LDH patients,but the former treatment strategy has better effect.2.The comprehensive treatment of Blood-letting by Collateral Puncture until “Blood-letting and Pathogenic Qi Expelling" is more effective than general acupuncture therapy in treating LDH,and the effect of improving pain symptoms is obvious.3.Musculoskeletal ultrasound can objectively reflect the morphological changes of multifidus before and after treatment,which can be used for clinical treatment evaluation of LDH patients.4.The comprehensive treatment of Blood-letting by Collateral Puncture until “Blood-letting and Pathogenic Qi Expelling" and general acupuncture therapy both have effects on the increase of multifidus muscle strength in LDH patients,but the former has better effect on increasing the muscle strength of multifidus muscle on the affected side,and is more beneficial to improve the imbalance of muscle strength of multifidus muscle on both sides of the diseased segment.