Surgical Design Principles And Clinical Study Of "T" Shaped Needle Knife Overall Release Surgery In The Treatment Of Cervical Spondylosis

ObjectiveThrough using the basic theory of Accupotomy to study the pathogenesis of cervical spondylosis and its pathological structure,and then design the "T"-shaped knife overall release surgery.To observe the clinical efficacy of this method in the treatment of cervical spondylosis,and evaluate the clinical application value of "T" needle knife overall release surgery.Methods1.According to the theory of Body bowstring mechanics anatomical system and Mechanical Pathology "Mesh Theory" of the basic theory of Accupotomy,referenting from the composition of the structure and force mode of Bow and arrow,combining the biomechanics with human anatomy to reconstruct the Motion model of the System of cervical Bowstring mechanical anatomy,And analyzing the pathogenesis and pathology of cervical spondylosis,designing the "T" needle knife overall release surgery on its basis.2.Dividing the 60 patients with cervical spondylosis from Huangjiahu Hospital's needle knife Section of Hubei Traditional Chinese Medicine(from September 2014-December 2016)into tender point group(30 cases)And surgery group(30 cases)randomly according to the ratio of 1:1,by using a random number table.The tender point group use the tender point for theneedle knife treatment site,while the surgery group using the "T"-shaped knife overall release surgery.Observing the clinical efficacy of the two groups before the operation,2 weeks and 3 months after operation.Using the clinical evaluation scale(CASCS)and simplified McGiLL pain scale(SF-MPQ)as the evaluation indexes,and assess the short-term and long-term efficacy of the two groups based on SPSS20.0 software for data processing.Results1.System model of cervical Bowstring mechanical anatomyBow:occipital bone,cervical vertebrae,scapula.String:soft tissue attached to the bow.(1)Muscle:trapezius muscle,scapula muscle,rhombus muscle,erector spinae,occipital muscle,clip muscle,half spine muscle,cervical cleft muscle,neck circumference,intertrochanteric muscle,Sternocleidomastoid muscle,scalene muscle.(2)ligament:ligamentum nuchae,supraspinous ligament,interspinous ligament,yellow ligament,intercostal ligament,joint capsule ligament,anterior longitudinal ligament and posterior longitudinal ligament.(3)Fascia:neck fascia,visceral fascia and cervical vascular sheath.(4)Auxiliary device:neck nerves,blood vessels.2.Cervical spondylosis' three-dimensional network-like pathological framework,the first part is the chronic strain of the superficial soft tissue(ligamentum nuchae,interspinous ligament,trapezius muscle and some others)of the System model of cervical Bowstring mechanical anatomy ligament due to improper posture and other factors,resulting in soft tissue abnormalities.If the human body is not timely repaired,being damaged for a long time,would cause the joint injury of deep soft tissue surrounding,such as the trapezius muscle,head and neck clip muscle,cervical pillow muscle,scapular muscle and other soft tissue with the order of shallow todeep,And finally form the three-dimensional network-like pathological framework with soft tissue coverage as the surface,the starting and ending point of soft tissue as the point(Bowstring junction),and the path of soft tissue as the line(the stress concentration of the string).3.The design of the "T"-shaped needle knife is based on the Material basis of System model of cervical Bowstring mechanical anatomy,and the treatment site of the three-dimensional network-like pathological framework.The horizontal line "T" are five points,which are in the lower edge of the occipital line,the midpoint is occipital protuberance,the other points are2.5cm,5cm far away from the center line of the upper linet;The vertical line are 6 points,which are the vertex of the C2~C7 spinous processs.Putting the horizontal line 5 points and vertical points 6 points together,is the shape of the letter "T",which we call it "T" shaped knife knife overall release surgery.4.The follow-up visit of after 3 months of the two group of patients indicates that the effective rate of surgery group was 80.00% and the total effective rate was 96.67%,which is significantly higher than that of tender point group,and the difference was statistically significant(P<0.05).Comparison of the SF-MPQ scores of the two groups bofore surgery,3months after surgery and 2 weeks after surgery:2 weeks after surgery of the tender point group's SF-MPQ scores were significantly lower than those of the”bofore surgery”(P <0.05),and the difference was statistically significant(P<0.05);The SF-MPQ scores of 3 months after surgery compared to the 2weeks after surgery,? <0.05,and the difference was statistically significant.2weeks after surgery of the surgery group's SF-MPQ scores were significantly lower than those of the”bofore surgery”(P <0.05),and the difference was statistically significant(P <0.05);The SF-MPQ scores of 3 months after surgery compared to the 2 weeks after surgery,?<0.05,and the difference was statistically significant.And the SF-MPQ scores of surgery group compared tothe tender point group's,?<0.05,and the difference was statistically significant.Comparison of the total CASCS scores of the two groups bofore surgery,3 months after surgery and 2 weeks after surgery:Both of the group's total CASCS scores were significantly improved by preoperative,postoperative 2 weeks and 3 months follow-up.And the surgery group's total CASCS scores of postoperative 2 weeks and 3 months follow-up were significantly improved compared to the tender point group.While coming to the subjective symptom score of CASCS,3 months after surgery of the tender point group compared to 2 weeks after surgery,?>0.05,and the difference wasn't statistically significant,but 3 months after surgery of the surgery group compared to 2 weeks after surgery,?<0.05,and the difference was statistically significant.Conclusion1.The underlying cause of the formation of cervical spondylosis is the force imbalance of the System model of cervical Bowstring mechanical anatomy.As to the pathological process,the first part is the chronic strain of the superficial soft tissue(ligamentum nuchae,interspinous ligament,trapezius muscle and some others)of the System model of cervical Bowstring mechanical anatomy ligament due to improper posture and other factors,resulting in soft tissue abnormalities.If the human body is not timely repaired,being damaged for a long time,would cause the joint injury of deep soft tissue surrounding,such as the trapezius muscle,head and neck clip muscle,cervical pillow muscle,scapular muscle and other soft tissue with the order of shallow to deep.The injuried soft tissue get self-compensation and self-regulationthrough through the adhesion,scar,contracture and congestion.if the compensatory fails,the body will start the second set of compensatory system:hardening,calcification and ossification,which is the bone hyperplasia on X-ray.And if it still can not replace the abnormal stress of the string,Itfinally form the three-dimensional network-like pathological framework with soft tissue coverage as the surface,the starting and ending point of soft tissue as the point(Bowstring junction),and the path of soft tissue as the line(the stress concentration of the string),which cause the force imbalance of the System model of cervical Bowstring mechanical anatomy.resulting the symptoms and signs of soft tissue pain,stiffness and nerve and vascular compression.So we can get the distribution of cervical pain tenderness,developing standardized clinical procedures,promoting the standardization development of Accupotomy.2.Analysing from the system model of cervical Bowstring mechanical anatomy and thethree-dimensional network-like pathological framework of cervical spondylosis,the early cervical spondylosis should be categoried into the chronic soft tissue injury.Therefore,in the early treatment of cervical spondylosis,we must follow the occurrence and the development of the law of chronic soft tissue injury disease,and use the treatment.of chronic soft tissue injury disease.In the progress of cervical spondylosis,the body start the second set of compensatory system which is hardening,calcification and ossification to further compensate for abnormal stress,that is,imaging on the stage of bone hyperplasia,and we must also restory the balance of soft tissue force of System model of cervical Bowstring mechanical anatomy.Then we can preliminary glimpse the classification of cervical disease diagnosis and treatment research of Accupotomy.And its scientific design and clinical operation of the specification,should be further studied.3.Analysing from the clinical data of tender point group and operation group,the two treatment methods have obvious curative effect on improving the clinical symptoms of cervical spondylosis.From the clinical efficacy,CASCS total score and MPQ points of the evaluation analysis,"T"-shaped knife overall release surgery are significantly better than the tenderpoint group,which is same condition of the short-term or long-term efficacy.Even though the long-term efficacy was better than that of short-term,the subjective symptom points of CASCS shows that,there wasn't any change between patients' subjective judgment of long-term and short-term efficacy,suggesting that we can not rely too much on objective examination and clinical signs,but to pay more attention to the patient's subjective symptoms to improve the degree,in regard with the treatment of cervical spondylosis.