| Background of researchLumbar Disc Syndrome, LDS is due to poor long-term posture, trauma and other reasons, led to structural changes in the lumbar spine mechanics, causing the occurrence of lumbar intervertebral disc structure damage or degeneration, fibrous ring rupture and expand, prominent nucleus nerve root cauda equina nerves, blood vessels produce mechanical and inflammatory stimuli, demonstrated by a series of clinical disease, caused by lumbar disc herniation clinical lumbago main reason, the disease seriously affect the patient’s daily life, learning and work. Epidemiological investigation, said Chinese population incidence rate of about 0.95%, the incidence in men than women in general. Lumbar disc herniation in the lumbar 4-5, lumbar sacral a gap of 5 to the highest incidence of about 90% to 96%. On the onset of the disease by life, the influence of various work factors, such as occupational habits, poor posture, lack of exercise and physical protection exercise. With the changes in the social mode of operation, the number of people engaged in copywriting and other mental increased incidence of lumbar disc herniation.Treatment for lumbar disc herniation is mainly divided into conservative treatment and surgical treatment of two categories. Conservative treatment including intravenous and oral medication, traction therapy, manipulative, rehabilitation and other modern therapy, in addition to traditional acupuncture, the applicator in terms of low back pain spasm pain also plays an important role; Surgical treatment includes a variety of approach of lumbar discectomy and internal fixation. Currently foreign academics believe that if patients receiving conservative treatment after 3 months, still not alleviate the symptoms of nerve root before surgery is recommended in patients taking the way, but the current situation of excessive use of early surgical treatment of prevalent, despite receiving some patients After the surgery still left waist and leg pain and numbness and other neurological symptoms. Due to lumbar disc pathology outcome after gradually being recognized, and promote the natural absorption of the disc and nerve root inflammation and other conservative treatment is increasingly becoming the treatment of choice. Many modern medicine, the efficacy of different treatment methods and treatment of this disease. Clinical studies since the eighties of the last century, the use of acupuncture and a variety of methods for treatment of lumbar disc herniation after another, academia for the efficacy of acupuncture has become the consensus of the disease in recent years, a variety of foreign rehabilitation technology into the country, to broaden the waist Combined treatment of disc herniation channels, various therapies to accelerate the healing process more of the disease. But the use of acupuncture and joint sliding technique for lumbar disc herniation few reports on the clinical, the clinical efficacy of a single application and combination of relatively no unified conclusion.ObjectiveThis topic by using the way of clinical epidemiology and clinical research methodology, clinical randomized controlled studies to lumbar three needles acupuncture, SNAGS rehabilitation therapy, lumbar three needles acupuncture combined with SNAGS rehabilitation therapy (comprehensive therapy) in comparison, observe the differences in clinical efficacy of these therapy and mechanism of the clinical efficacy in lumbar disc herniation, provide the basis for clinical treatment of LDS.MethodsThis clinical study in patients with lumbar disc herniation, patient source was from Keelung Zhengxiang Rehabilitation Clinic in Taiwan, collection time was from January 2014 to March 2015, all cases met the filter criteria,90 cases were collected, including 30 cases for lumbar three needles group,30 cases for SNAGS rehabilitation group,30 cases for combination therapy group. TCM diagnostic criteria of lumbar disc herniation is referring to "The Standard of TCM Syndrome Diagnostic Efficacy" by State Administration of Traditional Chinese Medicine in 1994. Western diagnosis criteria of lumbar disc herniation is referring to the 2012 People’s Republic of China Health Industry Standard GB/T 1.1-2009 rules develop a "diagnosis of lumbar disc herniation" of the mandatory provisions of the relevant content. All patients met inclusion criteria in accordance with the design requirements of the treatment were observed. Course of treatment for a total of three courses, three times a week, two weeks for a course of treatment.Efficacy of specific projects include:Roland-Morris back pain scale, simplify McGill Pain Scale, biochemical indicators (interleukin-6, calcitonin gene-related peptide and apoptosis inhibitory factor). The evaluation criteria for Roland-Morris back pain scale and the "Chinese disease diagnosis and efficacy standards," the evaluation criteria as the reference standard.ResultsLumbar three needles acupuncture treatment group, SNAGS rehabilitation therapy group, the combination therapy group, gender, age, duration of distribution of TCM syndromes, Roland-Morris back pain scale score, McGill pain scale score, interleukin -6, calcitonin gene-related peptide (CGRP), apoptosis inhibitory factor (Fas/APO-1) content was analyzed were not statistically significant, indicating that the clinical baseline data were comparable among the three groups.①Roland-Morris back pain scale score comparisonsThe combination therapy group Roland-Morris back pain scale scores have less than that SNAGS rehabilitation therapy group, the difference was statistically significant After two weeks of treatment. (P<0.05); after four weeks of treatment, the amount of back pain combined therapy group table score than the lumbar three needles acupuncture group, SNAGS rehabilitation therapy group had decreased significantly different between groups (P<0.05). Tip: In patients with lumbar disc herniation improve Roland-Morris back pain rating scale, the short-term efficacy of combination therapy is superior to SNAGS rehabilitation, and after 4 weeks of treatment, combination therapy was significantly better than a single lumbar three needles acupuncture therapy or a single SNAGS rehabilitation.②McGill Pain Scale score comparisonsThe three groups McGill pain scale scores between two groups, the difference was not statistically significant after two weeks of treatment (P> 0.05); 4 weeks after treatment, lumbar three needles acupuncture group, McGill Pain Scale combination therapy group score and score SNAGS rehabilitation therapy group was statistically significant reduction (P<0.05). Tip:After two weeks of treatment, all three therapies for patients with lumbar disc herniation McGill Pain Scale scores influence is insignificant, after 4 weeks of treatment, a single EA, SNAGS rehabilitation and acupuncture and comprehensive rehabilitation therapy were SNAGS may improve pain patients with lumbar disc herniation nature, strength, and lumbar three needles acupuncture group, the clinical efficacy of combination therapy group were significantly higher than SNAGS comprehensive rehabilitation therapy.③Interleukin-6 expression in terms of quantityAfter two weeks of treatment, the peripheral blood of three groups of interleukin-6 expression between groups, the difference was not statistically significant (P>0.05); after four weeks of treatment, interleukin-6 content in the combination therapy group than SNAGS rehabilitation therapy group significantly reduced, the difference was statistically significant (P<0.05). Tip:interleukin-6 disc tissue reacts with a certain relationship between local inflammation, which can cause inflammation and promote the process of disc herniation. After two weeks of treatment, the expression of three treatments for lumbar disc herniation in the peripheral.blood of interleukin-6 little difference. After four weeks of treatment, in contrast to the three aspects of therapy, combination therapy can significantly reduce the peripheral blood interleukin-6 content, and its significant effect than a single SNAGS rehabilitation.④The expression of Calcitonin Gene-Related Peptide (CGRP)After two weeks of treatment:combination therapy group, three-pin waist EA group, SNAGS rehabilitation therapy group calcitonin gene-related peptide (CGRP) content were not statistically significant compared with before treatment (P>0.05). After four weeks of treatment:three groups of calcitonin gene-related peptide (CGRP) were decreased compared to the previous treatment, the difference was statistically significant (P<0.05). Tip:In the short-term treatment, a single acupuncture treatment, SNAGS rehabilitation therapy and combination therapy for patients with lumbar disc herniation down calcitonin gene-related peptide (CGRP) content ineffective; after four weeks of treatment, lumbar three needles acupuncture group, SNAGS rehabilitation therapy group, the combination therapy group, which may be reduced in patients with lumbar disc herniation expression of calcitonin gene-related peptide (CGRP).⑤The expression of (Fas/APO-1)After two weeks of treatment:combination therapy group, three-pin waist EA group, SNAGS rehabilitation therapy group apoptosis inhibitory factor (Fas /APO-1) compared to pre-treatment change is not obvious, the difference was not statistically significant (P> 0.05). After four weeks of treatment:the waist three-pin EA group, apoptosis three groups SNAGS rehabilitation therapy group inhibitor (Fas/APO-1) than before treatment was statistically significant reduction (P<0.05); the combination therapy group apoptosis inhibitory factor (Fas/APO-1) than before treatment significantly decreased, the difference was statistically significant (P<0.01). After four weeks of treatment, the apoptosis inhibitor combination therapy group (Fas/APO-1) than the lumbar three needles acupuncture group, SNAGS rehabilitation therapy group was significantly reduced (P<0.05). Tip:Apoptosis plays an important role in the lumbar disc degeneration in patients with lumbar disc herniation, the peripheral blood of Fas/APO-1 content was significantly increased. After four weeks of treatment, the combination therapy may be reduced in patients with Fas/APO-1 content and its efficacy is superior to simple SNAGS acupuncture treatment or rehabilitation therapy.⑥The efficacy assessment of treatmentLumbar three needles acupuncture group, SNAGS rehabilitation therapy group, the combination therapy group therapy by Kruskal Wall is H rank sum test, H=2.80, P=0.027, the clinical efficacy of the three groups was statistically significant (P<0.05), which, lumbar three needles acupuncture group, the total effective number of 21 people, the total effective rate was 72.41%; SNAGS rehabilitation therapy group, the total effective number of 20 people, the total effective rate was 68.97%; the combination therapy group, the total effective number of 26 people, the total effective rate was 86.67%. Tip:For ease back pain in patients with lumbar disc herniation, lumbar activity to improve function, improve the quality of life of patients, the combination therapy group was significantly better than the lumbar three needles acupuncture group and SNAGS rehabilitation therapy group.ConclusionLumbar disc herniation in the clinical cause great distress to the patient, seriously affecting the quality of the quality of people’s lives and work, and how quickly and effectively improve the symptoms and accelerate the recovery process, is a key issue in clinical treatment.Preliminary results of this research show that lumbar three needles acupuncture combined with SNAGS rehabilitation therapy for treatment of lumbar disc herniation has excellent clinical results. Such combination therapy acupuncture therapy can be anti-inflammatory and analgesic effects spasm and lumbar facet joint dynamic physiological slide technology organic integration, by reducing inflammation and edema, promoting inflammatory substances transport and degradation, improve blood circulation in peripheral tissues vertebral alleviate oppression and lysis of adhesions, improve tissue nutrition disorders and recovery of nerve tissue excitability played in effect. Lumbar three needles acupuncture combined with rehabilitation therapy SNAGS safe, easy to operate, is a safe, efficient, rapid onset, lasting effect, without any side effects of therapy. |
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