| Background:Lumbar disc herniation (LDH) is a very common disease in the modern world, patients of which are mostly the young and the obese people. Men are more incline to get the disease than women. The age of the group is getting younger and younger. Most of the site of the herniation is at L5/S1segment, next came L4/5segment. It is because of the degenerative changes in lumbar intervertebral disc, and the external force, the annulus fibrosus rupture herniated nucleus irritation or compression of the cauda equina nerve roots, and further lead to the surrounding tissue inflammation, edema, microcirculation, and fibrous tissue proliferation adhesion, followed by low back pain and lower extremity sciatic radiating pain and other symptoms of disorders characterized by low back pain, commonly known as "lumbar syndrome", is a severe pain, spinal disorders, caused by low back pain the most important reason for the clinical common and often bring a lot of pain to the patient's life and work, and even cause disability, loss of ability to work, and consume large amounts of medical resources. The disease mainly manifested as low back pain, sciatica, typical sciatica performance grounds hips, thigh, lateral leg to the heel or dorsum of the foot, and radiating pain. According to clinical statistics, the disease is more common in young adults; about95%of the lumbar patients have varying degrees of low back pain,80%of patients with lower extremity pain. Especially low back pain, lumbar disc herniation of the most common symptoms, is also one of the earliest symptoms.The treatment methods about Lumbar disc Herniation are various all over the world. They can be divided into two kinds, surgical techniques and non-surgical methods. Most patients can be alleviated or cured by the non-surgical, although slowly but effectively. The surgery is mainly used for the group which has severe symptoms, even significant neurological disorder, that can't he cured by non-surgical treatment. But it has many complications, and itself is a kind of severe trauma to patients.It is Needle-knife therapy that combines traditional acupuncture needles and scalpel perfectly, to form a simple, effective, safe, less painful, low-cost, and safety treatment, which can be easily accepted by the patients. The effect of this treatment is significant in clinic.Purpose:The study aimed to assess changes of clinical symptoms, clinical signs, patients'daily life and work of through the questionnaire form before and after treatment, analyze the affectivity, safety and acceptance of needle knife therapy for patients with lumbar disc herniation, and summarize the clinical operations experience of needle knife treatment, and analysis of needle knife operating practices and other related factors.Methods:1,case of source and group:All cases are from the acupuncture department of First Affiliated Hospital in Guangzhou University of Traditional Chinese Medicine and the outpatients department of Guangdong Provincial Bank Hospital during March of2011to February of2012. The total amount is60cases.60patients were pre-numbered (1-60elect a random number), excel and completely random way in accordance with the random numbers in ascending order of1-60, and divided into the acupuncture control group and the acupuncture therapy group (n=30cases).2,Treatment:2.1Needle knife therapy group:2.1.1The choice of pin-point:According to the inquiry when the patient complained of pain area, repeated in the following practice of the touch, press, to find our the trigger points, a-shi points, the positive reaction of the hole or positive points (tenderness, cord, induration). Lumbosacral region: the spinous process of the corresponding segments of the lumbar intervertebral disc, the upper and lower articular processes, lateral recess (intervertebral foramen inside the mouth), transverse roots (intervertebral foramen outside the mouth), and sacroiliac joint. Hip:the bone margin of the greater sciatic notch the edge of the sacrum, ischial spine, ischial tuberosity, greater trochanter, lesser trochanter, the piriformis, buttocks, muscles, beginning and ending points of tensor fascia lata muscle belly and so on. Lower leg and lateral side:the fibular head, lateral side and below the calf muscle, peroneus longus muscle. According to the order of the scope of the positive points and the tolerance of patients with the first following each election points5-15.2.1.2Operation:"the strength of nano-inch, needle knife layer elastic cut thorn Law, choose suitable needle knife form China brand0.6/3to0.6/4according to the patient's body, such as, buttocks China brand0.6/3, the needle knife, leg Ministry to select the0.6/4. keep the knife body and leather pin vertical, and keep the incision line and the blood vessels and nerves of muscle fibers with the same direction. Firstly, rapid pinch into the skin:two hands holding the needle, the right hand and hold the needle handle, left hand hold the needle body, exposing the tip about0.5-lcm, fast straight pinch out2-3mm into the skin pin-point (breakthrough superficial fascia), while the left hand thumb and index finger stuck the needle body control knife; then left thumb and index finger to relax and to mention a little retreat of the needle body, lights low dropping sword resistance flu; case of resistance to influenza, and patients with no abnormal sensation (pain or hemp inductance), the power of the whole body, short speed thorn, breaking the trigger point of tension in the fascia, and quickly retraced; knife resistance flu sustained, may continue to short the speed thorns, until the loss of resistance force to the bone surface, a course of treatment are made of four weeks, and once a week. Follow-up one month after the end of treatment.2.2Acupuncture control group:2.2.1Acupoints:take the A-shi hole, waist Jiaji,Shenshu Dachangshu, ring jump, Venezuela,biguan,xuehai and Kunlun. Clinical disease can be equipped with the acupoint addition and subtraction Yaoyangguan Geshu, Vital Chi room, Yanglingquan Taichong.2.2.2Operation: firstly, use needle pinch the points, such as, ring jump can be perpendicularly2.5inch, and the other points perpendicularly1-1.5inch to get gas underwent small amplitude lifting and thrusting, twisting. Secondly, use electric needle, choosing the Bomi wave to electric for30min. Three times a week, four weeks for treatment. Follow-up one month after the end of treatment. Two groups of patients before treatment, At the time of the treatment of medium-term (two weeks after treatment), treatment and follow-up (1-month follow-up after treatment), in accordance with the assessment standards of the Japanese Orthopaedic Association (JOA) low back pain disorders treatment (see Appendix), fill in the clinical treatment of patients with lumbar disc herniation observed table (see Appendix).By reference to low back pain disorders treatment assessment standards of Japanese Orthopaedic Association (JOA), assessment of lumbar disc herniation in patients with clinical symptoms, signs and daily living in patients, according to the diagnostic efficacy standards promulgated by the State Administration of Traditional Chinese Medicine disease assessment (Nanjing University Press,1994), visual analogue rating method (vas) on lumbar disc herniation in patients with functional activity, efficacy, and pain were analyzed.Results:1,The study of efficacy and safe on needle-knife therapy for lumbar disc herniation clinical:In this study,60patients were randomly divided into acupuncture control group and the acupuncture therapy group,30cases in each group. Before treatment, there is no difference among the patient's gender, age, height, weight, duration and clinical symptoms, and clinical signs.According to the State Administration of Traditional Chinese Medicine Disease Diagnosis and Efficacy Standards Assessment (Nanjing University Press,1994) to Investigation and Analysis, acupuncture control group after treatment, the total effective rate was76.67%, before and after the patient's own treatment of patients with functional activities, pain improved, the clinical efficacy, the difference was statistically significant (P<0.05). The total effective rate of needle-knife treatment group was93.33%. Needl knife therapy can effectively reduce the clinical symptoms of patients, such as, low back pain, leg pain, numbness and gait improved significantly in patients with clinically positive signs and sensory disturbances, and improve patient quality of life and ability to adapt, before and after treatment, the differences statistical was significant (P<0.05).After4weeks of treatment, the efficacy of the two groups of patients with lumbar disc herniation, was statistically different (P<0.05). The efficacy of needle-knife therapy in patients with lumbar disc herniation was significantly better than acupuncture; and can maintain long effect than acupuncture group.Needle acupuncture therapy can significantly relief patients'low back pain, numbness, and sensory disturbances, which is better than the acupuncture treatment.At the time of treatment, patients treated with needle knife therapy feel stranger propagated sensation than acupuncture therapy, and the sensation can maintain longer. The difference was statistical significant (p<0.05). Thus, more patients prefer to choose needle knife therapy.Before and after treatment the vital side-effect of the30patients in needle knife group was no significant difference, and no nerve and blood vessel damage or other adverse events occurred.2,research on relationship between sex, age, body mass index, TCM syndrome and protruding parts with lumbar disc herniation:In a study of60cases of lumbar disc herniation, more men suffer form lumbar disc herniation than women.People of35-50years old or overweight, obese have more occurrence of lumbar disc herniation.In the study of60cases of lumbar disc herniation, TCM syndrome is liver and kidney deficiency type, the majority of the prominent parts is the L5/S1disc.3,with small needle-knife treatment-related factorsThe effect of needle knife treatment of lumbar disc herniation in this study of30cases has no relationship with the patient's gender, age, body mass index, TCM syndrome and protruding parts.Conclusion:1,The efficacy of needle-knife therapy in patients with lumbar disc herniation is significantly, the total effective rate was93.33%, significantly better than acupuncture.2,Needle-knife therapy has a strong stimulation, and can maintain longer time.3,Needle-knife therapy can be used by majority patients suffered from lumbar disc herniation, no matter what gender, age, body mass index, TCM syndrome, or protruding parts. 4,Needle-knife therapy for treating lumbar disc herniation is a safe and effective method, and the recurrence rate is low, it is worth the promotion and application in clinic.
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