【Overview】 Third Lumbar Trans-verse Process Syndrome (TLPSS) is a low back pain or lumbosacral pain caused by acute and chronic injury to the tip of L3 transverse process. The lumbar transverse process is the attachment point of the anterior layer of the thoracolumbar fascia and is connected by the intertransverse muscle and intertransverse ligament between the transverse processes; it is also the starting point of the lumbar square muscle and the transverse spine muscle, and the internal oblique muscle and the transverse abdominal muscle also start here through the tendon membrane; the muscle and fascia play an important role in lumbar stability and motility. The posterior branch of the L1-3 spinal nerve crosses the myofascia of the transverse process and runs dorsal to the transverse process. The posterior lateral branch of the L2 spinal nerve runs just inferior to the L3 transverse process. Therefore, the occurrence of L3 transverse process syndrome is related to its anatomical and biomechanical characteristics. L3 is the apex of lumbar lordosis and the center of lumbar activity, which becomes the fulcrum of the lumbar activity lever and should bear the greatest pressure, while the L3 transverse process is the longest and widest, with a thick tip; the anterior layer of thoracolumbar fascia attached to the L3 transverse process is also the most abundant and becomes bundled. Therefore, the soft tissues attached to the L3 transverse process form a special structure with the L3 transverse process as the center and the posterior lateral branch of the muscle-fascia-L2 spinal nerve. When the lumbar force is exerted, especially when the force is unbalanced, the paravertebral muscles on one side contract, which, due to the lever effect, inevitably causes the opposite side of the transverse process to pry up, resulting in acute and chronic injury to the tissue at the tip of the L3 transverse process, bleeding and exudation, and sterile inflammation; after a long time, fibrosis occurs around the tip of the L3 transverse process, forming scar adhesions, fascial thickening and tendon membrane contracture, which can cause nerve and vascular bundle compression, resulting in lower back pain or lumbar hip pain. Wang Linqing, Department of Orthopedics, Lanzhou Hospital of Traditional Chinese Medicine and Traumatology [Western diagnosis] (a) Clinical manifestations: 1. Some patients may have pain radiating along the ipsilateral erector spinae muscle (the first spinal muscle) to the thigh, or with supra-knee pain, but few have pain radiating beyond the knee to the calf; a few show medial femoral pain or lower abdominal pain, but no pressure pain. 2. Physical signs The affected erector spinae muscle is spastic, and there is obvious limited pressure pain at the tip of L3 transverse process. In the early stage, the gluteal muscles are plump and internally Ъ【following the danger to L2-4 closed foraminal innervation）; in severe cases, gluteal muscle spasm can be seen in the late stage, and the gluteus medius muscle can be palpated with cords, with pressure pain. (B) Imaging: X-ray examination can be seen on one or both sides of the third lumbar vertebrae transverse process is too long or tilted backward. (iii) Differential diagnosis The difference between this disease and lumbar disc herniation is that ① the pain does not increase when coughing or sneezing. (2) The location of the pressure point is different, as the disease is located at the tip of the L3 transverse process, while the latter is the diseased vertebral plate space. ③A few severe cases of this disease may have a positive branch leg elevation test, but the strengthening test must be negative. [Basic treatment] a. Manipulation 1. oblique trigger maneuver: the patient lies on his side, the lower limb immediately adjacent to the bed is in the extended position, the upper side of the lower limb to take the flexed hip and knee position, the operator placed one elbow on the upper side of the front of the shoulder, the other elbow on the upper side of the patient’s pelvis, both elbows wrenching in the opposite direction, can hear the lumbar “creaking” sound, then stop the maneuver The same method to the opposite side of the manipulation treatment 1 time, then the end of the manipulation. 2. massage techniques: ① first with the palm of the hand in the waist gently massage for a moment to eliminate the patient’s tension, and then thumb push, pop, pluck, press, pressure L3 transverse process end and lumbar muscle parts. And with rolling method, rubbing method, palm root pushing and other techniques, once a day for 20 minutes each time. Acupuncture point massage method: first use the rolling method to treat along the Governor’s vein and the foot solar bladder meridian for 5-7 minutes, then use the thumb to press the Kidney Yu, Huanjiao, Fengshi, Yinmen, Zhizhong, Chengshan, Kunlun and other points for 1 to 2 minutes each, then next to the L3 transverse process and the strip-like hard object, use the thumb to flick along the direction perpendicular to the muscle fiber for 3-5 minutes, and finally use the rubbing method to rub the small fissure from the Governor’s vein to the foot solar bladder meridian on both sides for 6-8 minutes, once a day. ③Pointer massage method: first, use the thumb to press deeply on the painful points or strips and nodes on the inner edge of the psoas major muscle for 1 to 3 minutes, then use the tip of the thumb to press heavily for half a minute, then use the thumb at the tip of the transverse process, pushing up and down, back and forth, separating and gyrating and kneading the strips or nodes for 1 to 3 minutes, then use the fingers to press directly, gyrate and sedate on the acupuncture points, sedate bilateral kidney points for chronic or severe conditions, and sedate the ring jump for those with In chronic or severe cases, the acupuncture points should be calmed for half a minute, and in cases with low back pain, the acupuncture points should be calmed for half a minute. Local injection therapy (closed therapy) 1. Injection site: the pressure point at the tip of the L3 transverse process, or at the striae and nodes. 2. Injection drug: prednisolone acetate 3ml + lidocaine hydrochloride 3ml; prednisolone 2ml + lidocaine 2ml + summer no injection 2ml; prednisolone 2ml + lidocaine 2ml + vitamin B1100mg + vitamin B12500ug. 3. Injection method and precautions: local routine disinfection, according to different parts and different locations to choose the length of Acupuncture point selection: according to the doctrine of acupuncture and moxibustion meridians, generally choose the end of the L3 transverse process or under the transverse process, and match the points with Manzhong, Zhizhong, Lumbar Yangguan, Kidney Yu, Life Gate, Taixi, etc. 2. 2. Technique: lifting and twisting, even stagnant needling, also tonic, diarrhea or flat tonic and flat diarrhea. After acupuncture can be added moxibustion, fire pot, etc., once / day, ten times for a course of treatment. 3. auricular acupuncture: milli-needle acupuncture affected lumbosacral vertebrae mainly, can also be taken Shen Men, kidney area, etc., can be slightly twisted, acupuncture after the patient is asked to move the waist, but also both ears with the acupuncture, stay acupuncture for ten minutes, once every other day, can be made 2 to 3 times. Fourth, small needle knife therapy small needle knife therapy for a more positive effect of a treatment method, needle knife can directly release the adhesions, peel off the scar, so that the scar tissue “stuck” neurovascular “liberation” out, and needle knife has a similar acupuncture method, can unblock the meridians, accelerate The acupuncture knife is similar to acupuncture, which can unblock the meridians, accelerate the circulation of blood and Qi, and promote the absorption of soft tissue inflammation, thus eliminating the stimulation or compression of peripheral nerves by various pathological factors. The patient is in prone position, and the pressure point is found at the tip of the L3 transverse process, marked with gentian violet, routinely disinfected and operated aseptically, the left thumb presses the marked point, the right hand holds the needle knife, so that the blade is parallel to the longitudinal axis of the body and close to the edge of the left thumb, and the needle is rapidly inserted vertically to reach the surface of the transverse process, then the blade is moved to the inner side of the tip of the transverse process, and 2 to 3 cuts are made longitudinally first, then peeling is performed, and the tissue under the knife is felt to be loosened and the needle can be removed. can be repeated 1 time. In the application of this method, first of all, the patient should do a good job of thinking, release tension, to prevent dizziness needle shock, careful inspection of the needle tool before surgery, gentle operation, to prevent broken needles, if the pain, numbness, electric sensation to stop the operation. In addition, for the sake of safety, you can also choose the trigeminal needle instead of a small needle knife, the use of trigeminal needle stripping is not easy to damage the neurovascular, and stripping direction is not restricted. The Chinese herbal medicine is often used to add flavor: Angelica sinensis, Chuanxiong rhizome, Ge Gen, Qiangwu, Safflower, Angelica dahurica, Radix et Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Wujianpi, Wailingxian, Papaya, Danshen, Gui Zhi, Bai Shao, Haitongpi, Boswellia, Myrrh 100g each, Chuan Cao Wu 50g each, Scorpion 20g, Radix et Rhizoma 50g, Strychnine 50g. The above medicines are crushed into fine powder and mixed well, take 50~100g each time and apply to the affected area. Apply the mixture with vinegar on the affected area, and irradiate with infrared lamp or divine lamp for 30 minutes, once a day. Or take regular amount of the above medicine, put the medicine into cloth bag and seal it, add water 1500ml. boil it for 15~20 minutes, wash and hot compress the affected area while it is hot, once a day. Other therapies 1. physical therapy Excitation electricity, computerized medium frequency (heart, blood pressure normal) microwave, nano wave, computerized multi-power fumigation, ultra-short wave electrotherapy machine, ultrasonic therapy, ultra-laser, etc. 2. 2. drugs Apply anti-inflammatory and pain-relieving drugs such as fentanyl, fotarine, etc., and apply drugs that activate blood circulation and remove blood stasis such as panax notoginseng tablets, etc. 3. Chinese medicine ion introduction Select 12g of Angelica sinensis, 10g of Chuanxiong rhizome, 15g of Pueraria lobata, 10g of Safflower, 15g of Salvia miltiorrhizae, 15g of Eucommiae, 15g of Radix Rehmanniae, 15g of Niubiziae, 10g of Cao Wu, 15g of Wailingia, 15g of Papaya, 10g of Yuan Hu, 15g of Radix Rehmanniae, 15g of Radix Rehmanniae, 20g of Angelicae dahuricae, and 6g of Sinensis. add 1500ml of water, soak for 3 hours and then Boil for 20 minutes, filter out the medicine night with 4 layers of gauze, put it in a bottle in the refrigerator and set aside. When treatment, take 20ml of last night, add a small amount of vinegar and warm it to 40℃, take 2 pieces of 6 layers of 10cm×12cm gauze, soak through pharmaceutical, 1 piece on the lesion site, another piece on the opposite side of the lesion site, take ion introduction treatment machine, put the lead plate of the anode end on the gauze of the lesion site, put the end of the cathode on the other piece of gauze, turn on the power, turn on the timer, treat for 20 minutes each time. 1 time per day. Surgical indications: If the above non-surgical treatment is not effective or ineffective, surgical treatment can be used. 2. 2. Surgical method: Local soft tissue release is used. Surgical excision of part of the L3 transverse process and sensory branches of L2 and 3 nerve roots. Surgical excision of part of the L3 transverse process (generally 0.8-1 cm) and release of adhesions and excision of degenerative thickened tissues. Chinese medicine classification and prescription 1. Qi stagnation and blood stasis type: with obvious history of trauma, pain on both sides of the lumbar spine, and difficulty in bending straight up. Treatment: Promote blood circulation, resolve blood stasis, promote qi flow and relieve pain. Remedies: Shu Shu Shu and Blood circulation Tang with Di Long San plus or minus. Radix Angelicae Sinensis 15g, Radix et Rhizoma Sequoia 15g, Di Long 4, Radix Achyranthes Bidentatae 10g, Eucommia Ulmoides 15g, Safflower 6g, Green Peel 10g, Citrus Aurantium 10g, Rhizoma Ligustici Chuanxiong 10g, Boswellia Serrata 10g, Myrrh 10g, Sumac 10g, Dou Shuo 12g, Yuan Hu 10g, Radix Rehmanniae 15g, Radix Wei Ling Xian 15g, Glycyrrhiza Glabra 5g, Radix Qiang Wu 12g, Peach kernel 6. Decoction with water, 1 dose/day. 2. Cold and dampness blocking the ligament type: chronic pain, aggravated in the morning or when bending over, aggravated by wind and cold or climate change, and reduced by warmth and pain. The treatment is to disperse cold and promote paralysis, warm the meridians and open the ligaments. Radicals: Duluxiaosheng Tang plus or minus. Duluxiang 9g, Sang Sang Sang 15g, Du Zhong 12g, Niu Kne 12g, Hsiang Xin 6g, Gentiana Macrophylla 12g, Fu Ling 10g, Fang Feng 10g, Chuan Xiong 10g, Shu Di 15g, Dahurica dahurica 20g, Cao Wu 6g, Wei Ling Xian 15g, Papaya 15g, Seunghuang 12g, Licorice 3g, Paeonia lactiflora 10g. Decoction in water, 1 dose/day. 3. Kidney Yang deficiency with vague pain in the lumbar region, soreness and weakness, continuous, like massage, body fatigue, weakness of the waist and knees. In case of labor is even worse, lying down is alleviated, the face is characterized by the character Zhu Zhu Zhen Yao Ge F step swelling haggard shaking together “examining the malefactor does not tic real replacement material liver tiller Α Treatment: warming and tonifying kidney yang. Remedy: Tonifying the kidney and invigorating blood. Effects: The composition of the herbs: 15g of Radix Rehmanniae, 15g of Fructus Eucommiae, 12g of Fructus Lycii, 20g of Fructus Cuscutae, 10g of Semen Cuscutae, 15g of Radix Cuscutae, 10g of Myrrh, 12g of Cornu Cervi Pantotrichum, 10g of Safflower, 15g of Fructus Solanum, 15g of Herba Cistanches. Method: Decoction in water, 1 dose/day. 4. Kidney Yin deficiency: Heart trouble and insomnia, dry mouth and throat, flushing of cheeks, irritable heat in the five hearts, tinnitus and deafness, thin and weak pulse, red tongue, thin white fur. Treatment: Nourishing Yin and tonifying the kidney. Direction: Zhi Bai Di Huang Wan. Composition: Zhi Mu 40g, Huang Bai 40g, Shu Di Huang 160g, Cornu Cervi Pantotrichum 80g, Mudan Pi 60g, Yam 80g, Poria 60g, Zedekiah 60g. Usage: Add 80-110g of refined honey to make small honey pills or large honey pills, take 10g orally each time, 3 times/day. Prevention and care】 Rest and exercise: Take proper rest and avoid exertion on the back. Adhere to the rehabilitation gymnastics exercise, every morning and evening, the specific number of moderate and appropriate amount, slow movement, stay 3 to 5 seconds. Protect yourself from dampness, cold, strain, acute sprains, prolonged sitting and standing, and weight-bearing in exercise and daily life.