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Extracorporeal Shock Wave Treatment (ESWT) of Syndrome of Lumbar Rami Posterior Nervorum Spinalium in Clinical Study

Author: FanTao
Tutor: LiYiKai；HuangGuoZhi
School: Southern Medical University,
Course: Traditional Chinese Medicine
Keywords: Extracorporeal Shock Wave (ESW) Syndrome of lumbar rami posterior nervorum spinalium clinical study
CLC: R651.3
Type: Master's thesis
Year: 2011
Downloads: 83
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Abstract

[Background]The study of the relationship between lumbar rami posterior nervorum spinalium and low back pain:A lot of experimental researches about the causes and mechanisms in low back pain have been done at domestic and abroad.Based on related findings from Mark, Mooney, Maigne JY, Tao Pu, Miao Hua, Jiang Weizhuang etc., we consider that lumbar rami posterior nervorum spinalium were related to non-specificity lumbago occurrence. Since 1987, zhujiang hospital had carried on the thorough application dissection and the clinical research in the relationships between lumbar rami posterior nervorum spinalium and low back pain, summarised the rules and distributions of lumbar rami posterior nervorum spinalium. With the application of the rules of nerves’ distribution, we summarized the methods of diagnosis location and preliminarily solved original localization of the ache. By application of percutaneous puncture and deep frozen of Posterior rami of spinal nerves and Radiofrequency Electrocogulation lumbar rami posterior nervorum spinalium, we achieved a significant therapeutic effect and counter-evidenced the existence of syndrome of lumbar rami posterior nervorum spinalium. Based on the cognition of dissection of lumbar rami posterior nervorum spinalium and centrums’ relationship, many scholars thought that the various syndromes of lumbar rami posterior nervorum spinalium might be caused by the disorder of lumbar rami posterior nervorum spinalium which were in charge of the tissue. Lumbar rami posterior nervorum spinalium distributes between the muscle, the ligament, the bone, as well as the fiber fascia. Due to the characteristic dissection of lumbar rami posterior nervorum spinalium, which decided the tendency to be easily stimulated by Mechanical pulls and oppression. When tissue around canals get injured, with the inflammation changes or pathological changes,then the canals which were distorted,narrowed,locked or even extruded the passing nerves. After the nerves got the machinery oppression damage, the high permeability of capillary vascular in the nerves causes edema. Thus leading the increase of nerve pressure, affecting carriage of the nutrition to the nerve root, creating the blood congestion or the ischemia, which caused the ache of the waist, the sacrum, the buttocks, and the thigh.The study in extracorporeal shock wave treatment of the bone and arthrosis algesic diseases:Chaussy adopted extracorporeal shockwave lithotripsy (ESWL) to treat the kidney stone, and obtained success in 1980,which provided a new non-operative treatment for patients with urinary stone. Presently, it had already surpassed 3 million records choosing extracorporeal shock-wave to treat kidney stone, and obtained a significant treatment effect. Based on extracorporeal shock-wave’s clinical practice, it has been discovered that extracorporeal shock-wave could not only smash the stone, but also had the obvious treatment result to the bone and arthrosis algesic diseases. At recent years, the shock-wave was getting more and more widespread in orthopedics application. Extracorporeal shock-wave was applied on a wide range in the bone and arthrosis algesic diseases, comparied with crush stone. It had already applied in the treatment of the bone and arthrosis algesic diseases, such as Periarthritis, Tennis Elbow, syndrome of lumbar rami posterior nervorum spinalium, Bone Spur, nonunion, Periostitis, Tendinitis and so on. Its curative effect obtains the full affirmation. Increasily more medical establishments are adopting ESWT to treat all kinds of the bone and arthrosis algesic diseases.It is a new noninvasive method that the ESWT was applied to treat the bone and arthrosis algesic diseases. Dr Huang Guozhi confirmed that the treatment obtained the good effect. Moreover, with the clinical observation, the curative effect was reliable. Presently, the functional mechanism of ESWT is still not clear. At present, we consider that there are various special functions of ESWT as follows:①the effects of mechanic;②the effects of electrical stimulus and air compression;③the effects of assuaging pain. We believe that it is the multi-factors for ESWT treating lumbar rami posterior nervorum spinalium. The shock-wave in the fluid electrical energy quantity transformation and the transmission process causes the different densities between the various organizations and the pulling force, separating the adhesion, extending the luan shrinks, accelerating micro cycle in the simulating organization, improving the partial organization circulation. It damages the ache receptor to interrupt conduction of the ache signal, which enables to establish the latent transmission ache signal, as well as changing the cell’s chemical environment, forming the free radical, producing the analgetic material to alleviate the ache. So we can achieve the goal of the treatment. In the process of the treatment, the most influential factors are located accurately. There are three common locations for the ESWT in the clinic as follows:①combining the body surface dissection symbol with the pain spot localization:the localization basis by the body surface dissection symbol with the pain spot as the impact spot, at the same time, according to the distribution of blood vessel, the nerve dissection line, avoiding important blood vessels and nerves;②ultrasound localizations:the disease of parenchyma;③X-ray localizations:the localizations of the bone and the calcified issues; the C-arm X-ray television perspective rotary system, the C-arm paired X-ray tube, and the X-ray prospects were generally adopted in the clinic.[Objective] After the clinical study about ESWT of syndrome of lumbar rami posterior nervorum spinalium, we could provide the basis theory for the diagnosis of lumbar rumus posterior nervorum spinalium. Meanwhile we can observe its clinical effects, comparing the different orientations with ESWT of syndrome of lumbar rami posterior nervorum spinalium, finding a new and remarkable way for the treatment of the low back pain and promoting the application in the clinical.[Method]Sixty patients with the syndromes of lumbar rami posterior nervorum spinalium were participated in this study. The numbers were representative and satisfied the conditions of the statistics. They were randomly selected into X-ray orientation group and pain-point orientation group (30 cases in each group) by the random table. Two groups met a criterion to the diagnosis standards of lumbar rami posterior nervorum spinalium, excluding the patients with the hemoglutination function barrier, taking the antifreeze pharmacological treatment recently, partial skin ulcer, the pregnancy or the breast-feeding period woman, the congested heart failure, the malignant tumor and the energetic. They also have the good compliance without falling off. The group of X-ray orientation:17 males,13 females; age 22-65, the mean age was 43.2±0.59 years; the courses differed from 5 to 26 days. There are 19 cases with the waist injury history. The ache points distributed in lumbosacral, paravertebral muscles, the buttocks, sacroiliac and so on. The pain spot orientation:18 males,12 females; age 19～67, the mean age was 45.6±0.78 years; the courses differed from 3 to 29 days. There are 16 cases with the waist injury history. The ache point distributes in lumbosacral, paravertebral muscles, the buttocks, sacroiliac and so on. There are comparability and no differences between the two groups (P>0.05). The two groups then received extracorporeal shock wave treatment with X-ray orientation and pain-point orientation respectively to observe the clinical effect of the treatment.[Treatment] The HK.SWT300 shock-wave orthopedics therapeutic equipment was applied to treatment, which produced by Shenzhen Hui Kang medical instrument Limited Company. Operating voltage 7-10KV, lashing energy 0.12-0.2mJ/cm; lashed 1000-1500 every course, lashing frequency 60-80/minutes; the treatment is separated by 3-5 days, and the course of the treatment are 3. (We defined the scores of the prior treatment and the scores of the final treatment respectively to the scores of the prior treatment and the scores after treatment. We recorded respectively to the first and second scores after treatment as well). Before the treatment, we must guarantee it without the contraindication by measuring the systolic blood pressure, the pulse and so on. We also introduced briefly the treatment principle and possible responses.X-ray orientation:we could observe the lesions under the X-ray on the surveillance meter. Then based on the anatomical features and the methods of the dorsal spinal radical orientation, we can figure out the level of its injury and place a metal marker on the injury level of transverse processes. We used this position as the treatment point, when it marked accurately with a marker-pen. After the treatment spot at the short-wave launcher, we regulated the emitter at the root of the dorsal spinal radical.The pain spot orientation:Based on the anatomical features and orientation of the dorsal spinal radical, we could mark accurately to assure the injury position. The partial point had the tenderness and emitted to the ache regions of the complaint. So this location was the spot of the treatment. After the treatment spot at the short-wave launcher and the pain point centered, we adjusted the emitter to focus on the root of the dorsal spinal radical.After breaking 30 minutes and with no special illness, the patient can be off. No serious complications had been reported in the most of patients. Only a few patients had the partial pain, and taking the sterilization pain-killer if necessary.[Effect Evaluation standard] 1、VAS value compare2、VAS value effect compare3、Lumbar function quantification value compare4、Lumbar function quantification value effect compare[The methods of statistics]With the SPSS 13.0 statistics software, we adopted the two independent samples T-test for the prior treatment in two groups, if the data does not meet the normal distribution, the use of Wilcoxon signed rank test. As the Score before the treatment for covariate, taking repeated measurements analysis of covariance to compare whether the differences between two groups of patients after treatment, if the data does not meet the normal distribution, the use of Multi-analysis of related samples Friedman test whether the differences between the two treatment methods,and calculate the difference between each group before and after treatment, and use Mann-Whitney test to compare the difference between the two groups whether the differences. Using Mann-Whitney test to compare efficacy of two comprehensive. P <0.05,the differences is significance.[Result]1、VAS value compareThere are no difference between X-ray orientation group and pain-point orientation group in the prior treatment (P>0.05). The VAS scores of the first treatment, the second treatment, and the third treatment are significantly higher than prior treatment in the X-ray orientation group (P<0.01). there are the same in the pain-point orientation group (P<0.01). that two groups are valid, and with the increasing number of treatment effect is more obvious..The gap between VAS scores of the first time prior treatment and post-treatment of the X-ray orientation group is increased than that of the pain-point orientation group, but the difference is not statistically significant(P>0.05), The gap between VAS scores of the second time prior treatment and post-treatment of the X-ray orientation group is increased clearly than that of the pain-point orientation group, with the difference is statistically significant (P<0.01). The gap between VAS scores of the third time prior treatment and post-treatment of the X-ray orientation group is increased more clearly than that of the pain-point orientation group, with the difference is statistically significant (P<0.01). The treatment effect of the way of X-ray orientation extracorporeal shock wave treatment of syndrome of lumbar rami posterior nervorum spinalium is obviously better than the way of the pain-point orientation. And with the increasing number of treatments,The treatment effect of the way of X-ray orientation is obviously better than the way of the pain-point orientation.2、VAS value effect compareThe cure rate of X-ray orientation group was 73% which was significantly higher than that of the pain-point orientation group (30%) (P<0.05); The overall effective rate was also significantly higher in the X-ray group (93%) than in the pain-point group (73%)(P<0.01).3、Lumbar function quantification value compareThere are no difference between X-ray orientation group and pain-point orientation group in the prior treatment (P> 0.05). The Lumbar function quantification scores of the first treatment, the second treatment, and the third treatment are significantly higher than prior treatment in the X-ray orientation group (P<0.01). there are the same in the pain-point orientation group (P<0.01). that two groups are valid, and with the increasing number of treatment effect is more obvious.The gap between the lumbar function quantification scores of the first time prior treatment and post-treatment of the X-ray orientation group is increased than that of the pain-point orientation group, but the difference is not statistically significant(P>0.05), The gap between the lumbar function quantification scores of the second time prior treatment and post-treatment of the X-ray orientation group is increased clearly than that of the pain-point orientation group, with the difference is statistically significant (P<0.01). The gap between the lumbar function quantification scores of the third time prior treatment and post-treatment of the X-ray orientation group is increased more clearly than that of the pain-point orientation group, with the difference is statistically significant (P<0.01). The treatment effect of the way of X-ray orientation extracorporeal shock wave treatment of syndrome of lumbar rami posterior nervorum spinalium is obviously better than the way of the pain-point orientation. And with the increasing number of treatments,The treatment effect of the way of X-ray orientation is obviously better than the way of the pain-point orientation.4、Lumbar function quantification value effect compareThe cure rate of X-ray orientation group was 77% which was significantly higher than that of the pain-point orientation group (33%) (P<0.01); The overall effective rate was also significantly higher in the X-ray group (94%) than in the pain-point group (77%)(P<0.01).[Conclusion]Both X-ray orientation and pain-point orientation ESWT of syndrome of lumbar rami posterior nervorum spinalium are effective treatment. With the increasing number of treatments,The treatment effect of the way of X-ray orientation was obviously better than the way of the pain-point orientation. The treatment effect of the way of X-ray orientation extracorporeal shock wave treatment of syndrome of lumbar rami posterior nervorum spinalium was obviously better than the way of the pain-point orientation.

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