【作者】 王胜；

【导师】 孙忠人；

【作者基本信息】 黑龙江中医药大学 ， 针灸推拿学， 2002， 博士

【摘要】 本文系统地综述了腰椎间盘突出症(LIDP)的中、西医研究进展，提出了LIDP为经络病，以足太阳膀胱经病为主，治疗上应注重经络辨证的原则。根据导师孙忠人教授在神经损伤再生修复研究领域取得的相关成果，突出辨病与经络辨证、局部取穴与远道取穴及中西医理论的有机结合，制订出新的电针治疗LIDP腧穴处方。从临床与实验入手，在临床疗效、疼痛综合评分、临床电生理、神经递质、β-内啡肽、病理组织学及超微结构等方面进行研究。结果表明：①电针治疗组临床疗效及疼痛综合评分均明显优于对照组(P＜0.01，P＜0.05)，临床治愈率53.1％，愈显率81.3％，总有效率93.8％。②电针治疗组明显改善LIDP患者EMG异常率(P＜0.05)，显示电针对神经根损伤的电生理特性有良性调节作用。③电针治疗LIDP，具有松解粘连，缓解压迫，减轻或消除神经根炎症水肿，促进神经根损伤再生修复及镇痛作用。④电针治疗LIDP以膨出型、突出型为主要适应证。⑤马蹄形硅胶管片作为压迫物的改进，对神经根压迫模型的稳定有一定积极意义。⑥提高中枢5-HT、β-EP和外周β-EP水平，降低外周5-HT、NE和中枢NE水平，与针刺镇痛相关。⑦电针治疗后，神经根损伤区Schwann细胞增生、功能活跃，周围毛细血管增多扩张，是电针抑制受损神经根脱髓鞘和轴突变性进程、促进神经纤维再生修复的基础。其在分子基因水平的表达及确切机制尚待进一步研究。更多还原

【Abstract】 The article reviewed Tradional Chinese Medicine (TCM) and western medicine advances on Lumbar Intervertebral Disc Protrusion (LIDP) research systematically,put forward LIDP is a disease of meridian, and the main meridian is the Bladder Channel of Foot-Tai-Yang, on treatment should according to the TCM Syndrome differentiation theory of Meridian. According to tutor Prof. SunZhongren’s relative results in the field of nerve injury and nerve repair, emphasized the organic combination of disease and the TCM syndrome differentiation theory of Meridian, combination of the Distant-Local points, TCM and western medicine, devised new acupointsprescription of Electroacupuncture (EA) to cure LIDP. On the base of clinic and experiments, researches were carried on clinical curative effect, complex evaluation of pain, clinical electric physiology, nerve transmitter, P -EP, pathology and histology and ultramicrostructure.The results showed that: (1) Clinical curative effect and complex evaluation of the EA group was superior to the control group (P<0.01, P <0.05), the cured rate was 53.1%, the obvious cured rate was 83.1%, the total effective rate was 93.8%. (2)The EA group improved abnormal EMG rate of LIDP patients significantly (P < 0.05), showed EA has benign regulation to electric physiology feature of nerve root injury. (3) On treatment of LIDP, EA has effect of relax adherence, moderate oppression, relieve or eliminate inflammatory edema of nerve root, improve repairment of injury nerve root and analgesic effect. (4)The main indication of EA in treatment of LIDP is the ectatic and the bulgy. (5)The improvement of horseshoe silicon tubular as oppression has positive significance in stability of nerve root oppression model. (6)Improve central level of 5-HT, P -EP, peripheral level of P -EP, reduce peripheral level of 5-HT, NE and central level of NE, related to acupunctural analgesia. (7) After EA treatment, Schwann cells hyperplasia, hyperfunction peripheral vascular increase expansion in area of nerve root injury is the base of EA inhibite the process of injury nerve root demyelinate and axon degeneration, improve never repair. The expression and the definite mechanism in molecular gene level should be further investigated.更多还原