I. Introduction
Small needle knife is a kind of medical apparatus similar to acupuncture which is made of metal material and resembles needle and knife in shape. It is based on the ancient nine needles, sharp needles, etc., combined with modern medical surgical scalpel and the development of the product of the organic combination with soft tissue loosening surgery, so far nearly 20 years of history, in recent years there is a trend of further development, and for the world to pay attention to.
Small needle treatment is a kind of closed relaxation between the surgical method and non-surgical treatment. It is formed on the basis of the incisional surgical method combined with the acupuncture method. The operation of small needle knife therapy is characterized by stabbing deep into the treatment site to the lesion to easily cut, peel and other different ways of stimulation, in order to achieve the purpose of pain relief and dispel the disease. The indications are mainly soft tissue injury lesions and bone and joint lesions. The advantage of small needle treatment is that the treatment process is simple and not restricted by any environment or conditions. The treatment incision is small, without sutures, the damage to human tissue is also small, and it is not easy to cause infection, no adverse reactions, no obvious pain and fear of the patient, and generally do not need to be hospitalized, the treatment time is short, the course of treatment is short, the patient is easy to accept.
Second, the basic content.
1. Needle
At the beginning of the creation of small needle knife therapy, there are more schools, small needle knife is also mostly self-made, its shape and length slightly different, generally about 10-15 cm, the diameter of 0.4-1.2 mm ranging. Divided into three parts: hand-held handle, needle body, needle knife. Needle blade width is generally equal to the diameter of the needle body, sharp edge. Also is the use of surgical small size blade conversion, some are converted from dental probes. Small needle knife must be autoclaved, or sterilized by alcohol immersion before application. After nearly two decades of clinical application, communication and integration, the vast majority of physicians have now given up the use of self-made small needle knife, but the use of Mr. Zhu Hanzhang first promoted the use of Hanzhang brand needle knife, there are 1-4 models, the diameter is 1 mm, only the length is different, which is more commonly used is the type 4 and type 3. Because the sterilization is more troublesome, and the blade will become blunt after many uses, but also need to sharpen the needle, more trouble; therefore, most physicians now prefer to use the Hanzhang brand disposable needle knife.
2.Operating methods.
(1) The choice of body position is based on the principle that it is convenient for the doctor to operate and the patient feels comfortable in his own position when being treated. Such as in the neck treatment, more use of sitting position (elderly patients or patients with a tendency to needle sickness should choose prone position); head can be selected according to the position of the disease supine position or low head position.
(2) After choosing a good position and selecting a good treatment point, make local aseptic disinfection, that is, first disinfect with povidone iodine, the doctor wears sterile gloves, and finally confirm the needle entry site and carry out treatment. For large joint parts of the body or parts where the operation is more complicated, sterile cavity wipes can be applied to prevent contamination during the operation. To reduce the pain caused by the local operation, local anesthesia can be made to block the nerve nociceptive conduction. The following injectable drug formulations are commonly used.
a. 1% nufocaine 2-5 ml/each entry point.
b. 2% lidocaine about 5 ml/each injection point.
c. 2% lidocaine 2.5 ml, chloroquine – A1 ml, mecobalamin needle 500 micrograms, saline 5 ml, mixed and injected into 3-5 treatment points respectively.
(3) Commonly used stripping methods are.
a, along the muscle fibers, or tendon distribution direction to do shovel stripping – that is, the tip of the needle knife closely against the tissue to be stripped to do in and out propulsion action (not up and down lifting insert), so that the lateral adhesion of tissue fibers break off, loosening.
b. Do horizontal or fan-shaped oscillating action of the tip of the needle knife, so that the longitudinal adhesion of tissue fibers break off and loosen.
c, do oblique or undirected needle knife tip paddling action, so that no certain pattern of adhesion of tissue fibers to break loose.
The stripping action depends on the condition of the adhesions and the adoption, pay attention to the various stripping actions, do not amplitude too large, so as not to scratch important tissues such as blood vessels, nerves, etc..
(4) each time each treatment point generally cut stripping 2-5 times can be out of the needle, the general treatment 1-5 times can be cured, the time between the two depending on the situation 5-7 days ranging.
(5) The application of small needle knife indications.
a. The patient feels painful symptoms at a certain place.
b.The doctor can touch the sensitive pressure pain at the lesion.
c, palpation can be felt under the skin with strips or pieces or ball-shaped hard, nodules.
d. There is a ringing sound at the lesion with finger plucking.
III. Clinical application
Small needle knife can treat nearly 500 kinds of diseases in the clinic, among which the minimally invasive treatment of soft tissue surgery in orthopedics and traumatology is the most famous and easily accepted by patients.
1, cervical spondylosis (except spinal cord type)
2, external upper humeral ankylitis (tennis elbow).
3, flexor tendon stenosis tenosynovitis (popping fingers).
4, heel pain (heel spur).
5, the third lumbar transverse synovial syndrome.
6, chronic lumbar muscle strain.
7, lumbar intervertebral disc herniation.
8, osteoarthritis of the knee joint.
9, frozen shoulder (including shoulder impingement syndrome).
10.Carpal tunnel syndrome.
IV. Precautions.
1, because small needle knife therapy is operated under non-direct vision treatment, if unfamiliar with human anatomy, especially local anatomy, improper technique, easy to cause injury, so the doctor must be familiar with the deep anatomical knowledge of the treatment site, in order to improve the accuracy of the operation and improve the efficacy.
2, the selection of the treatment point must be accurate, that is, the choice of the point as a treatment point must find the center of the pain point into the needle, into the needle to maintain vertical (non-pain points to take the point can be flexible choice of needle approach), such as skewed into the needle easy in the deep wrong lesion site, easy to damage non-lesion tissue.
3, pay attention to the operation of no in, especially when doing deep treatment, important joints such as knee, hip, elbow, neck and other parts of the joint deep cut especially when the attention. If necessary, it can be done locally with sterile wipes, or in a sterile operating room. For other parts of the body, just pay attention to the aseptic operation can be.
4, small needle knife into the needle method should be fast and quick, so as to reduce the pain caused by the needle. In the deeper part of the spade stripping, horizontal stripping, longitudinal stripping and other methods of peeling operation, the technique should be light, otherwise it will aggravate the pain, or even damage the surrounding tissue. When doing longitudinal stripping at the joint, be careful not to damage or cut ligaments and tendons.
5.Postoperative local massage can be done for some treatment points with less trauma to promote blood circulation and prevent postoperative bleeding adhesions.
6.For some cases, the short-term effect is very good, but after 1-2 months or some longer time, the pain recurs and the original disease state is restored, especially for the parts with large load such as knee joint, shoulder and elbow joint, lumbar region, etc. The following factors should be noted: the patient’s habitual life, walking posture, work posture, etc. cause recurrence; surgery has released the local adhesions, but the postoperative trauma caused by the lack of local movement and adhesions; local attack by wind, cold and dampness again. Therefore, special attention should be paid to life and living.