Clinical analysis of 43 cases of lumbar major muscle injury lumbar leg pain treated with needle knife Yao Yajie [Abstract] Objective To explore the clinical treatment and nursing effect of needle knife treatment of lumbar major muscle injury lumbar leg pain. Methods For 43 cases of lumbar leg pain treated in our hospital from January 2010 to January 2014, needle knife was performed to loosen the lesions and painful points. The total effective rate was 93% in 43 cases of lumbar muscle injury with lumbar leg pain who received two courses of acupuncture treatment and care; 23 cases (53.5%) were cured, 210 cases (23.2%) were effective, 7 cases (16.3%) were improved, and 3 cases (7%) were ineffective. Conclusion Acupuncture treatment for lumbar major muscle injury lumbar leg pain has a high cure rate and significant efficacy among non-surgical treatments, and is worth promoting in clinical practice. 【Key words】 Needle knife; lumbar leg pain; clinical treatment Accupotomology psoas major traumatic lumbocrural pain of 43 cases of clinical analysis 【abstract 】 objective to evaluate the needle Methods for from January 2010 to January 2010 in our hospital For treatment of 43 cases of lumbocrural pain, using a needle knife on the lesion site and needle knife to release the pain points. In the study of 43 cases of psoas major traumatic patients with lumbocrural pain in after two courses of needle knife therapy and nursing, the total effective rate was 93%; Including 23 cases cured, accounted for 53.5%, 210 cases were markedly effective, accounted for 23.2%, improvement in 7 cases, accounted for 16.3%, 3 The results of the study showed that the patients were not able to achieve the desired outcome. Conclusion needle knife therapy psoas major traumatic lumbocrural pain in non-operative therapy, the cure rate is high, curative effect is distinct, is worth popularizing in clinic. The incidence of low back pain has been increasing in recent years, and the trend of younger and younger age of the disease has received wide attention. Lumbar pain has brought a lot of inconvenience to people’s life and work, and brought serious social and medical problems.1 Lumbar muscle injury lumbar pain is one of the types of lumbar pain, which is easily misdiagnosed and missed due to the location of lumbar muscle in the anatomical structure, which often causes neuropathic pain in the lateral lumbar region, anterior thigh and L5. Clinically, patients with lumbar pain who have been treated by multiple methods, including treatment for intervertebral discs, with no significant effect should be considered for lumbar major muscle injury lumbar pain.2 The lumbar major muscle should be routinely examined in patients with lumbar pain. For 43 cases of lumbar leg pain treated in our hospital from January 2010 to January 2014, needle knife was performed to loosen the lesions and painful points, and satisfactory results were achieved, which are reported below. 1 Data and methods 1.1 General data Forty-three cases of lumbar and leg pain treated in our hospital from January 2010 to January 2014 were selected for this study, of which 23 were male and 20 were female; the minimum age was 34 years old, the maximum age was 54 years old, and the average age was 37.4 years old; among the cases participating in the study, there were 12 patients with anterior thigh pain, 10 patients with L5 neuropathic pain, and both 21 patients with the above symptoms, and 13 patients with transvertebral disc surgery. 1.2 Methods 1.2.1 Indirect palpation of the psoas major muscle through the abdominal wall The patient was positioned comfortably, the skin of the abdominal wall was relaxed, and the psoas major muscle pressure pain was palpated along the lumbar spine, usually at or below the level of the umbilicus (equivalent to L3). The examiner places the collecting rule on the abdominal wall with the fingertips located lateral to the lateral edge of the rectus abdominis muscle. The finger is slowly and gently pressed downward under the rectus abdominis muscle toward the remembered drop, which triggers a painful sensation if the patient has lumbar major muscle injury lumbago. 1.2.2 Acupuncture treatment method The patient is placed in the prone position, and the point is fixed at 4~5 cm of the paracentral opening between L2/3 , L3/4 and L4/5 cones in combination with the lumbar transverse process diagnosis. Sterile cavity towels were routinely disinfected with iodophor, and infiltration anesthesia was performed without anesthesia or 5% lidocaine. Apply type I 3 needle knife at the fixed point of vertical needle into the lumbar transverse process (L2/3, L3/4, L4/5 intercone paracentesis corresponding to L3, L4, L5 transverse process, respectively), adjust the direction so that the needle knife slide over the upper edge of the transverse process, slowly explore and deep about 0.5 cm can be touched thickened and resistant lumbaris major fascia, knife line parallel to the direction of muscle fibers cut 3 ~ 4 knife, severe cases can be cross-cut, feel loose out of the needle knife. After observing whether there is blood leakage, cotton balls can be used for pressure or external band-aids. 1.3 Efficacy observation After acupuncture treatment, acupuncture is performed once in 7 days, and 7 days is a course of treatment, after two courses of treatment. Patients with complete disappearance of pain symptoms and complete recovery of function were cured; patients with basic disappearance of pain symptoms and complete recovery of function were considered effective; patients with general recovery of pain symptoms and function were considered improved; patients with no improvement of pain symptoms and function were considered invalid cases, (cured + effective + improved) *100% = effective rate. 1.4 Statistical treatment The data in this study were statistically processed using SPSS19.0. t-test was used for measurement data between groups, and chi-square test was used for counting data between groups, and differences were considered statistically significant at P < 0.05. 2 Results Table 1 Evaluation of the effect of acupuncture treatment in 43 cases (n/%) Number of cases Cured Effective Improved Ineffective Effective 43 23 (53.5) 10 (23.2) 7 (16.3) 3 (7) 40 (93) Note: The difference is statistically significant, P < 0.05 From Table 1, it can be seen that 43 cases of patients with lumbar major muscle injury with low back pain received two courses of acupuncture treatment and care. After receiving two courses of acupuncture treatment and care, the total effective rate was 93%; among them, 23 cases were cured, accounting for 53.5%, 210 cases were effective, accounting for 23.2%, 7 cases were improved, accounting for 16.3%, and 3 cases were invalid, accounting for 7%. 3 Discussion 3.1 Anatomical location of the psoas major muscle The psoas major muscle is relatively hidden and difficult to reach, but it plays a decisive role in pain.3 The upper part of the psoas major muscle is attached to the lumbar vertebrae and intervertebral discs, and the lower tendon is attached to the lesser trochanter of the femur. It is also useful in walking and running. It is located in the deep sulcus between the vertebral body and the transverse narrowing of the lumbar segment of the spine, with the upper muscle fibers penetrating to the lowermost part of the mediastinum and the posterior aspect of the diaphragm, in the form of myotomes at the vertebral body and disc margins of the vertebrae, attached to the L1-L4 vertebral body and the anterior and inferior margins of the transverse process. 3.2 Clinical manifestations and diagnosis of the disease 3.2.1 Clinical manifestations The main manifestations of lumbar major muscle injury lumbago are the patient's lateral lumbar pain, femoral nerve and L5 neuropathic pain, and functional impairment with hip and knee extension and posterior extension. Patients often have varying degrees of lumbar and lower extremity hypermobility at the onset, resulting in lateral lumbar pain and stronger anteromedial pain in the lower extremities4, leading to sleepless nights, only being able to flex the knees and hips to relieve pain, and obstruction of posterior extension of the patient's lumbar region. After X-ray, frontal and lateral lumbar spine films, CT examination, and routine blood and urine examination, there was no positive reaction, and the diagnostic criteria for herniated disc in the upper lumbar segment could not be met. The lumbar major muscle needs to be innervated by the muscle branches of the lumbar plexus, so when the patient rotates the lumbar region or over-extends the thighs, it is easy to cause pulling injury to one side of the lumbar major muscle. After the lumbar major muscle is congested, swollen or even spasming, its compression of some adjacent nerves can cause lumbar and leg pain, and it can also cause abdominal pain and perineal pain, so it is very easy to cause misdiagnosis. 3.2.2 Diagnosis The examination can be performed by indirect palpation of the psoas major muscle through the abdominal wall, with the patient in a comfortable position, relaxing the skin of the abdominal wall, and palpating the psoas major muscle pressure pain along the lumbar spine, which is usually located at or below the level of the umbilicus (equivalent to L3). The examiner places the collecting rule on the abdominal wall with the fingertips located lateral to the lateral edge of the rectus abdominis muscle. The finger is pressed slowly and gently downward under the rectus abdominis muscle toward the remembered drop, triggering a painful sensation if the patient has lumbar macromuscular injury lumbar pain. Femoral nerve tension test may be positive. 3..3 Acupuncture treatment The advantage of acupuncture treatment is that it is less locally traumatic, and patients do not affect their normal work and life after undergoing the procedure, nor do they experience significant discomfort.5 Patients who do not achieve healing after 1 acupuncture session may undergo a second acupuncture session after 7 d, and appropriate antibiotic therapy is administered according to medical advice. An elastic lumbar brace is required for lumbar immobilization after acupuncture treatment, and patients should avoid twisting and bending of the lumbar region for about 2 weeks during the recovery period. The patient should be monitored for infection at the site of the needle knife to prevent complications. Appropriate lower limb and lumbar back muscle training was performed according to the recommendations of the medical staff to aid recovery. The total effective rate of the 43 patients with lumbar muscle injury and low back pain in this study was 93% after receiving two courses of acupuncture treatment and care; 23 cases (53.5%) were cured, 210 cases (23.2%) were effective, 7 cases (16.3%) were improved, and 3 cases (7%) were ineffective, which shows that acupuncture is effective in the treatment of lumbar muscle injury and low back pain. It is worth promoting in the clinic. 3..4 Post-needle knife treatment care After performing needle knife surgery, nursing staff should cover the needle hole with a sterile dressing and press it for 2 min afterwards to prevent blood leakage and also to effectively prevent infection at the location of the needle hole. If localized swelling and pain occur after surgery, local cold compresses should be applied to help dissolve the stasis and reduce swelling. Patients should actively recuperate in bed after surgery, using the supine position. During the recovery period, the diet should be light, choosing easily digestible and fiber-rich foods, and avoiding cold and spicy foods. Lumbar muscle injury low back pain, as a special kind of acute low back pain, is rare in the clinic, but as long as a reasonable diagnosis is made, the diagnosis can be confirmed to avoid misdiagnosis. With the continuous development of medical diagnostic technology, medical workers overly and unilaterally believe in the results of physical examination, ignoring the importance of clinical diagnosis, which often brings certain obstacles to the diagnosis and treatment of lumbar muscle injury low back pain, and also affects the development of non-surgical treatments for low back pain. Therefore, for the treatment of lumbar major muscle injury lumbago, we should first focus on the actual clinical diagnosis, combine the clinical diagnosis and physical examination results organically, actively play the non-surgical treatment of acupuncture, combine the characteristics of human anatomy, from superficial to deep, and follow the basic principle of overall and local three-dimensional treatment to better play the active role of acupuncture in the treatment of lumbar major muscle injury lumbago. [Reference] [1] Zhang Xuemei. Literature study on the standardization of technical operation of acupuncture knife in the treatment of third lumbar transverse process syndrome and acute lumbar sprain [D]. Beijing University of Traditional Chinese Medicine, 2010. [2] Qi Yue. Clinical efficacy of acupuncture with blood pricking therapy in the treatment of lumbar and leg pain[D]. Beijing University of Traditional Chinese Medicine, 2014. [3] Yang Lifang. Research on the identification and application of skeletal muscle pain points for lumbar and leg pain [D]. Guangzhou University of Traditional Chinese Medicine,2013.[4]Li Y,Shen B. Successful endoscopic needle knife therapy combined with topical doxycycline injection of chronic sinus at ileal pouch- anal anastomosis.[J]. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland,2012,144:. [5]Zeng Gui-Gang,Zhang Xiu-Fen,Quan Wu-Cheng,Fu Yong-Yun,Tan Wei-Lan,Qin Yi,Liu Qing-Guo.[Effects of needle knife relaxing therapy on tension of local soft tissue and pain of osteoarthritis of the knee]. [J]. Zhongguo Zhenjiu,2008,284:.