J. Acupunct. Tuina. Sci. (2008) 6: 87-89 DOI: 10.1007/s11726-008-0087-z
Clinical Study
Clinical Study of Acupoint Injection in Treating Lumbar Intervertebral Disc Protrusion WU Yao-chi(๑ྒћ), ZHANG Bi-meng(Ρਭ), ZHANG Jun-feng(ࢍ)ע, ZHOU Jing-hui (ᄻ݉) Sixth People Hospital, Shanghai Jiaotong University, Shanghai 200233, P. R. China
ႫྑંԅġڔГ༱สᅟ౽ᄭ९྅ᅲ૭ѻᄁԅংҕ९໒dֺ ֺ֥ġߜ 156 ै྅ᅲ ē ૭ѻᄁܱრ഻דݯนڔГᆦ 80 ैďࢶͬᅟ౽ྡĐۤճზᆦ 76 ैďปಓഭB12 ᅟ౽ྡĐ ϰဈ༱สᅟ౽གಊ࠼ٔອࠋխތޣ༱ԅֺ֥dࠒ ࠒڴġڔГᆦပ໒น 86.3%ēճზᆦ ပ໒น 78.9%ē०ᆦ९໒ΑࠀP<0.01ēЕ࿓ပහޙ༰࿉࿌dࠒ ࠒৢġ qࢶͬrᅟ౽ྡ༱ สᅟ౽ᄭ९྅ᅲ૭ѻᄁԅংҕ९໒ੜມغဟปಓഭB12 ༱สᅟ౽d ߏڑҭഃწĢ྅ළĢᅲ૭ྭส AbstractObjective: To investigate the clinical efficacy of point injection in treating lumbar intervertebral disc protrusion. Methods: One hundred and fifty-six patients with lumbar intervertebral disc protrusion were randomly allocated to an observation group of 80 cases (mecobalamin injection) and a control group of 76 cases (vitamin B12 injection). Injection at Jiaji (Ex-B 2) points corresponding to the spinal segments of the pressed nerve roots was performed. Results: The efficacy rate was 86.3% in the observation group and 78.9% in the control group. There was a statistically significant difference in curative effect between the two groups (P<0.01). Conclusion: The results indicate that the clinical curative effect of acupoint injection of mecobalamin is significantly better than that of point injection of vitamin B12 in treating lumbar intervertebral disc protrusion. Key WordsHydro-acupuncture; Low Back Pain; Intervertebral Disc Displacement CLC NumberR246.2 Document CodeA Lumbar intervertebral disc protrusion is a syndrome induced by the protrusive nucleus pulposus compressing the lumbar and sacral nerves, due to the breakage of anulus fibrosus caused by degeneration of intervertebral disc. It commonly occurs at the L4-5 and L5-S1 in adults. In the authors’ special department of lumbar intervertebral disc protrusion, the patients are treated with acupuncture methods, and they have lots of clinical experience. Acupoint injection of Mecobalamin at Jiaji (Ex-B 2) has good clinical effect. The results were reported as follows.
1Clinical Data 1.1Inclusive criteria According to diagnostic criteria in Shanghai Routine Regulations in Treatment of TCM Diseases Author: WU Yao-chi(1961-),male, chief physician
issued by Shanghai Bureau of Public Health, 156 cases of lumbar intervertebral disc protrusion were selected. The cases were confirmed by CT scan or MRI, and aging 25-65 years old. All cases stopped other treatments one month before using the authors’ treatment, willing to accept the treatment, and would not use other treatments in the treatment of acupoint injection. 1.2Exclusive criteria Patients with lumbar spondylolisthesis, patients with collagen diseases or other acute or chronic infection treated with glucocorticosteroid, and patients with worse condition or severe complications in the treatment. 1.3General data There were 91 males and 65 females at an average age of 39.4 years, and disease duration of 1 month to
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J. Acupunct. Tuina. Sci. (2008) 6: 87-89
3 years. All 156 cases were randomly allocated into an observation group (n=80, treated with Mecobalamin) and a control group (n=76, treated with vitamin B12) by a random number table.
2Therapeutic Methods 2.1Observation group Jiaji (Ex-B 2) corresponding to the spinal segments of the pressed nerve roots (L1-2, L2-3, L3-4, L4-5, or L5-S1, confirmed by MRI or CT scan) were injected with 500 μg of mecobalamin injection with a 5 mL disposable injector. After the needle was lifted and inserted lightly to induce qi arrival, the drug was injected. Patients with single side of intervertebral disc protrusion were treated with acupoints of that side, and patients with both sides of intervertebral disc protrusion and middle protrusion were treated with acupoints of both sides. One or two acupoints were selected in each treatment, the treatment was done once every other day, and 15 treatments made up a treatment course. 2.2Control group Except for the drug changed by vitamin B12 (0.5 mg), the treatment was the same as that in the observation group.
3
Therapeutic Effects
3.1Criteria of therapeutic effects According to the criteria in Shanghai Routine Regulations in Treatment of TCM Diseases issued by Shanghai Bureau of Public Health, and the evaluating criteria of lumbar score by Japan Orthopaedics Association.
Cure: pain in loin and leg disappeared, the straight-leg raising test is above 70°, and the patient could work normally. Improvement: pain in loin and leg were relieved, and the moving function of the low back was improved. No effect: symptoms and signs had no change. Improvement index = (score after treatment – score before treatment) / score after treatment Improvement rate = (score after treatment – score before treatment) / (normal score - score before treatment) × 100% 3.2Treatment results As showed in the tables 1 and 2, there were significant differences between the observation and control groups in the effective rate, improvement index, and improvement rate (P<0.01), indicating that the clinical curative effect of acupoint injection of mecobalamin wais significantly better than that of point injection of vitamin B12 in treating lumbar intervertebral disc protrusion.
4Discussion In lumbar intervertebral disc protrusion, breakage of anulus fibrosus, and the protrusive nucleus pulposus compressing the lumbar and sacral nerves root lead to lower back pain, and radiating pain and numbness of legs. It belongs to the category of pain of low back and leg in TCM, and was then called pain of low back and feet, hucklebone pain and leg wind in ancient literature. It is usually caused by overstrain, traumatic injury, sprain, or invasion of pathogenic wind, cold and dampness when qi, blood, kidney and liver are deficient.
Table 1. Comparison of therapeutic effects between the two groups (Cases) Group
N
Cure
Improvement
No effect
Effective rate (%)
Observation group
80
30
39
11
86.31)
Control group
76
19
41
16
78.9
Note: compared with the control group, 1) P<0.01 Table 2. Comparison of the improvement index and rate between the two groups Groups
N
Score before treatment
Score after treatment
Improvement index
Improvement rate (%)
Observation group
80
856
1528
0.440.291)
45.912.21)
Control group
76
820
1228
0.330.26
29.513.1
Note: compared with the control group, 1) P<0.01 ƽ
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J. Acupunct. Tuina. Sci. (2008) 6: 87-89
Acupoint injection is a commonly used method for treating lumbar intervertebral disc protrusion. It can promote local blood circulation to clear blood stasis, eliminate the swelling, and stop pain, meanwhile, relieve muscular spasm to decrease the internal pressure of the intervertebral disc and relieve the pressure of nucleus pulposus on the nerve roots. Injury of lumbar and sacral nerve root is very common in spinal surgery. In lumbar intervertebral disc protrusion, and lumbar spinal stenosis, under some stimulation, the lumbar and sacral nerve exhibits swelling, congestion, and degeneration, which induce various clinical symptoms. The main content of mecobalamin injection is methyl vitamin B12, whose activity is the most one in blood, and can enter nerve cell to promote the anabolism of nucleic acid, protein, and phospholipids to advance the recovery of injured nerve by regenerating the axon and accelerating axoplasm transport. Acupoint injection at the Jiaji (Ex-B 2) points corresponding to the spinal segments of the compressed nerve roots may inhibit the local PGE2 and 5-HT, and enhance SOD activity to improve congestion, edema and inflammation of the nerve root. Pain manifested in lumbar intervertebral disc protrusion is caused by the inflammation induced by the pressure of nerve root. And PGE2 is one of the strongest inflammation mediators. When cells accepted some mechanical and chemical stimulation, phosphatidase A2 in the cell membrane is activated to release arachidonic acid, and produced PGE2 by some enzymes. PGE2 can induce inflammation to expand the local blood vessel, and increase the permeability of the blood capillary and exudation of white blood cell. PGE2 also can induce pain and increase the sensitivity of receptor on other algogenic substance.
5-HT is a kind of vasoactive peptides, which can expand blood vessel, and increase the permeability of small vein. In inflammation, the blood platelet releases 5-HT once contacting collagen, thrombin, and ADP. Japan Orthopaedics Association established the scoring criteria evaluating lumbar diseases in 1984 [1]. It includes symptoms, clinical examination, and movement of daily life, and the total score is 29 points. In addition, there is an item for evaluating the function of the bladder for patients with bladder dysfunction, and two items for evaluating self-satisfaction and mental status. The criteria are very simple without any special examining instrument. The improvement index and rate can be calculated based on the scores before and after treatments. The effective rate was 86.3% in the observation group treated with mecobalamin injection, whereas, it was 78.9% in the control group treated with vitamin B12. There was a significant difference (P<0.01), indicating that the clinical curative effect of acupoint injection of mecobalamin was significantly better than that of point injection of vitamin B12 in treating lumbar intervertebral disc protrusion.
References [1] Shanghai Bureau of Public Health. Shanghai Routine Regulations on Treatment of TCM Diseases. 2nd Edition, Shanghai: Shanghai Medical University of TCM Publisher, 2003: 393-394. [2]YUE Shou-wei. Non-operative Treatment of Lumbar Intervertebral Disc Protrusion. Ji’nan: Shandong Science and Technology press, 2003: 132. Translator: CUI Xue-jun (Ӂ༰ࢋ) Received date: May 5, 2007
Ɣ Related Link Ɣ
z ZHANG Zhong-yi. Observations on the Curative Effect of Acupuncture and Massage on Lumbar Intervertebral Disc Protrusion. Shanghai Journal of Acupuncture and Moxibustion, 2002, 21(3):15-16. z YAO Zhi-fang, LIN Yuan. Observations on the Curative Effect of Acupuncture and Moxibustion on Lumbar Intervertebral Disc Protrusion. Shanghai Journal of Acupuncture and Moxibustion, 2007, 26 (2): 25-26.
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