During running, the cutaneous nerve is chronically compressed for some reasons, which leads to nerve dysfunction, which is manifested as a series of sensory dysfunction, autonomic dysfunction, nutritional dysfunction and even motor dysfunction of different degrees of nerve distribution, collectively known as cutaneous nerve compression syndrome.
The main clinical manifestations of cutaneous nerve entrapment syndrome are pain, tenderness, muscle tension, abnormal sensation and other common symptoms, such as hypersensitivity, hypoesthesia, sensory loss, hypersensitivity and so on. In traditional Chinese medicine, it belongs to the category of arthralgia. Traditional medical knowledge of arthralgia syndrome is nothing more than wind, cold, dampness, heat and pathological products of phlegm and blood stasis, and its pathogenesis is deficiency of vital qi and exogenous wind and cold.
Modern medicine believes that the cutaneous nerve, especially the nerve trunk of the limb, runs for a long time when it passes through some anatomical parts such as bone foramen, bone descent and fascia. Tendon muscle margin and fibrous bone canal are easily subjected to repeated friction stimulation or compression to produce lesions, and this kind of chronic disease-stimulated skin spirit, in the final analysis, is to compress nerves. This disease is common in clinic and occupies an important position in mononeuropathy. However, because it often has no obvious inducement, the onset is slow, and it is easy to be ignored and evolved into a chronic disease, even resulting in an incurable disease.
Diagnostic basis of cutaneous nerve entrapment syndrome
The diagnosis of cutaneous nerve entrapment syndrome is based on: ① long-term chronic local pain or abnormal sensation; (2) define local tenderness points; Palpation can touch subcutaneous nodules or cord-like masses; ③ Local muscle tension does not affect body movement; ④ Except for other nervous system diseases.
Principles of treatment of percutaneous compression syndrome
Decompression is the key to treat cutaneous nerve entrapment syndrome. Tracing back to ancient folk traditional methods for treating pain, such as scraping and cupping, physical decompression is also an important mechanism.
Because the etiology of cutaneous nerve entrapment syndrome is complex, and the local lesions are not single J, it is impossible to treat it effectively in one way, so the basic principle of treating cutaneous nerve entrapment syndrome is to find out the etiology and treat it according to syndrome differentiation. In the choice of methods, we advocate that those who can be treated with physical therapy should not be treated with drugs, those who can be treated with non-invasive therapy should not be treated with invasive therapy, and those who can be treated with limited invasive therapy should not be treated with surgical incision.
Beryllium needle instrument and its operation method
"Nine Needles of Lingshu" contains the name of "nine needles, each with different shapes ..."; The three-day journey is a needle, three and a half inches long; ..... Five Beryllium Zhao, four inches long and two and a half inches wide; ..... Cheng is the needle, sharp as millet, and the main pulse can't sink, so it will be angry ..... Beryllium needle is as sharp as a sword, so as to get a big pus. "Combining the advantages and disadvantages of previous therapies, the combination of traditional Chinese and western medicine adopts non-invasive surgery and selects new titanium alloy materials to develop modern Beryllium needle. The application of modern beryllium needle in the treatment of cutaneous nerve entrapment syndrome has good curative effect, less trauma, less injury and no pain.
1, beryllium needle specification
The diameter is 0.50 ~ 0.75mm, the total length is 5 ~ 8cm, the needle length is 1cm, and 0.50 ~ 0.75 mm. There are two kinds of needle handles, one is a common needle handle wound with steel wire, which is about 3-5 cm long. The other is to install the beryllium needle on a handle with a length of 10 cm and a diameter of 075 cm. During treatment, the knife-edge line and the plane of the handle should be marked on the same plane to identify the direction of the knife-edge line in the body.
2. Beryllium needle therapy has four common techniques.
Disease acupuncture: mainly used to acupuncture the cutaneous nerve compression points of trunk, abdomen, back and limbs. The thumb of the doctor's left hand is pressed next to the definitely diagnosed cutaneous nerve compression point, and the beryllium needle vertically penetrates the compression point with the wrist force of the right hand according to the predetermined scale T, and the needle can be pulled out quickly without twisting. The depth of needle insertion depends on the patient's fat and thin position, as well as the different tender points of light, medium and heavy, which vary according to the condition and can be applied flexibly. Generally, the depth of needle penetration is about 3-5 cm.
Puncture: mainly used for the head and limbs with thin muscle tissue. A method in which the thumb of the doctor's left hand is pressed next to the definitely diagnosed cutaneous nerve entrapment point, and the needle tip of the doctor's right hand is pricked vertically on the entrapment point with a beryllium needle, and the needle is quickly pulled out after being lightly pressed. Generally, the needle is shallow, not more than 0.5 cm.
Puncture method: it is mainly suitable for cutaneous nerve entrapment syndrome formed after spinal cord compression. The doctor holds a needle and sticks it into the pre-selected part (the part must be selected correctly) to a certain depth, and then cuts it back and forth with the needle blade. The general stroke range is about 1 cm, so as to cut off the rope, and the action should be light and flexible, not rough.
Compound manipulation: it is mainly suitable for the situation that a rope is formed after compression and the compression part is deep. This needle insertion method is divided into three steps. (1) Step 1 is to use the rapid needling method, and quickly insert the needle into the diagnosed compression site with the right hand and put it in place at one time.
(2) The second auxiliary technique, that is, pressing the left thumb to prick, and then changing the methods of pinching, shrinking and pulling, makes the local tissue relax and reduces the resistance, and the beryllium needle makes initial contact with the jammed cord to ensure the accuracy of beryllium needle puncture.
(3) The third step, that is, on the basis of the first two steps, the stabbing method is adopted, as above.
When releasing cutaneous nerve compression, local release of compression point or decompression of plate needle can obviously improve symptoms. When releasing beryllium needle, attention should be paid to protecting the blood vessels of nerve and nerve bundle, which is helpful to the rehabilitation of nerve function. Therefore, compared with other therapies, it has the advantages of no anesthesia, less trauma, no pain, less damage to peripheral nerve tissue during operation, less scar formation around nerve after operation and obvious improvement of symptoms. Compared with other metal materials, beryllium needle has four remarkable advantages: high hardness, good medium temperature performance, long-term corrosion resistance and durability. The application of beryllium needle in cutaneous nerve entrapment syndrome combines the advantages of other therapies, especially the small needle knife therapy, which is not only suitable for popularization and application in domestic primary medical units, but also reduces many unnecessary troubles as acupuncture therapy abroad.
Operating steps of beryllium needle therapy
The clinical application of beryllium needle therapy includes the following procedures: positioning, disinfection, needle insertion, needle loosening and needle removal.
Positioning: after finding the tenderness point on the body surface by palpation, draw a cross indentation vertically downward with your fingertips, and pay attention to the intersection point of the cross indentation aiming at the center of the tenderness point.
Disinfection: routinely disinfect the skin with iodophor or alcohol-iodine-alcohol, and its range is slightly larger than the operating range of treatment by 2 times.
Acupuncture: There are two kinds: point needling and spring needling. ① Puncture method: The operator holds the needle handle with one thumb and forefinger, and holds the needle body with sterile dry cotton ball or sterile gauze piece with the other thumb and forefinger. The needle tip is aimed at the center of the cross indentation of the skin, and the hands suddenly downward, and the beryllium needle can quickly penetrate the skin. When the beryllium needle passes through the skin, the resistance of the needle tip is small, and the staff who enter the needle have a sense of emptiness. When the needle tip penetrates deep fascia, it will encounter great resistance, and the staff holding the needle will feel resistant. According to different situations, the needle placement method is adopted. (2) Puncture method: The surgeon holds the needle with plastic trocar in one hand, with the needle tip aligned with the midpoint of the cross indentation, and presses the cannula vertically downward, while the thumb and middle finger end of the other hand are opposite, and the middle finger nail is aligned with the needle tail, so that the needle tail exposed outside the cannula can instantly penetrate the skin, and then the cannula is pulled out and the needle is inserted layer by layer.
Release: release is the key step of the whole treatment. The purpose of loosening is to reduce the tension of the surrounding fascia and the pressure of the fascia chamber through which the cutaneous nerve passes. Therefore, the depth of acupuncture can be the depth of beryllium needle penetrating fascia, not the depth of muscle layer, which can avoid bleeding and reduce postoperative reaction. According to the needs of treatment, the fascial layer can be released in the following ways: ① a little release: suitable for cases with limited pain points and accurate positioning. The tip of beryllium needle can pass through deep fascia, and the local pain of patients often disappears. ② Multi-point release: It is suitable for cases with limited pain points but vague positioning. When the needle tip of beryllium needle passes through the deep fascia, gently lift it, withdraw the needle from the fascia to the subcutaneous area, slightly change the angle of the needle tip, and then pass through the fascia layer. This can be repeated 3 ~ 5 times. ③ Linear release: It is suitable for cases with large pain range, long course of disease, thick fascia and high muscle tension. Linear release is actually repeated and continuous acupuncture in one direction, forming a fascia crack of 0.5 ~ 0.7 cm.
Needle removal: after needle removal, press the needle insertion point with a cotton ball or gauze piece, quickly pull out the needle and press the needle insertion point 1 ~ 2 minutes, and ask the patient about the local feeling. The original pain of general patients is relieved or disappeared. Sterile dressing should be applied to the needle entry point and kept dry and clean within 24 hours.
Indications of beryllium needle therapy:
(1) 1 ~ 2 cases of ineffective conservative treatment;
② Cases of adhesion and compression again after surgical treatment;
③ The first diagnosis of cutaneous nerve entrapment syndrome was clear.
Taboo of Beryllium Needle Therapy: Taboo
① Local soft tissue inflammation;
② those with bleeding tendency;
③ Diabetes patients are prone to limb ischemia or soft tissue infection;
(4) unconscious, unable to cooperate or the patient does not accept this treatment plan.
Needle sensation of beryllium needle release
Because beryllium needle is a closed operation, in order to carry out the operation safely and accurately, besides mastering the operation, it is also extremely important to master the needle feeling of the operation for its accuracy and safety.
After the beryllium needle enters the beryllium needle four times, the lesion is in the superficial part and can reach the deep part. If the lesion is in a deeper part or muscle hypertrophy. The depth can't be reached after the needle is inserted, so it needs to be deepened. At this time, it is necessary to grope for the needle and judge it by the sense of the needle. If the tissue touched by the knife is in the tissue gap, the patient can complain that he has no feeling. If you touch a blood vessel and stab a normal muscle, the patient will complain of pain. If you encounter a nerve patient and complain of numbness or electric shock, you should lift the blade gently in time, move the blade slightly by L ~ 2mm, and continue to inject the needle until you reach the required depth, that is, the lesion. At present, various surgical methods of beryllium needle are used for treatment. When they arrived at the injured site, all patients complained of pain, and there was no pain or numbness or electric shock. In the process of treatment, if there is pain or numbness, electric shock, etc., the direction of the knife edge should be changed immediately. That is to say, the feeling of acid swelling is the normal feeling of beryllium needle. Pain, numbness and electric shock are all abnormal feelings.
If you feel abnormal, the needle can't be inserted and the operation can't be done. No sensation means that the beryllium needle is in the tissue space and does not reach the lesion. Generally speaking, it is not appropriate to do operations such as loosening, peeling and incision. However, many pathological tissues have been seriously degenerated, and they have lost consciousness, and they have no feeling during needle insertion and operation. However, this universal effect is not ideal.
The needle feeling of beryllium needle is the feeling of the patient after the beryllium needle is inserted into the human body, and the needle feeling of beryllium needle is the feeling of the doctor's own hand after the beryllium needle is inserted into the human body. This feeling is extremely important for us to correctly judge the position and structure of beryllium needle. If it is pricked on a muscle, it is a soft feeling. Beryllium needles will have a soft feeling if they are pricked on fascia and nerves. If beryllium is pricked on the diseased nodule, it will feel hard and soft. If beryllium needles are stuck in blood vessels, there will be a feeling of great resistance at first, and then suddenly disappear. If the beryllium needle is on the tissue gap, there will be a sense of emptiness without resistance. If the beryllium needle sticks to the bone, it will have a hard feeling. According to these different handfeel, we can judge whether the beryllium needle reaches the site we need treatment or not according to the hierarchical anatomy and the handfeel of the beryllium needle.
Beryllium needle in traditional Chinese medicine: cutaneous nerve decompression
Clinically, a considerable number of patients who are often diagnosed as "chronic soft tissue injury", "myofascitis" or "rheumatic disease" belong to neurological dysfunction. Some of these chronic diseases can't be cured by many methods for a long time, and beryllium needles can solve them once or twice.
Why is this? Chen Xiuhua, director of the Traditional Therapy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine, said that beryllium needle, as a suitable technology promotion project in state administration of traditional chinese medicine, has the characteristics of strong pertinence, simple operation, safety, little trauma, no side effects and remarkable clinical effect. Her explanation revealed the reason.
Beryllium needle is a kind of neurolysis.
Chen Xiuhua introduced that during the operation of cutaneous nerve, nerve dysfunction caused by chronic entrapment occurred for some reasons, which showed a series of sensory dysfunction, vegetative dysfunction, nutritional dysfunction and even motor dysfunction in different degrees in the nerve distribution area, collectively known as cutaneous nerve entrapment syndrome.
This disease is one of the common clinical diseases, characterized by local pain and abnormal sensation. Muscle tension, tenderness, painful nodules, cord-like masses and radiation pain were found in the examination.
According to the data, beryllium needle originated from Lingshu Nine Needles. The book records that "nine needles have different shapes ... five beryllium needles are four inches long and two and a half inches wide; ..... Beryllium needle, blade end, to take big pus ". It can be seen that beryllium needle is a kind of instrument slightly thicker than acupuncture needle, with flat end and blade. Beryllium needle is only in the fascia layer, with little trauma and basically no bleeding. Generally, it can effectively release a large number of tiny compressed cutaneous nerves distributed in the skin and fascia within one or two minutes, which is equivalent to a minimally invasive neurolysis.
Modern beryllium needle is made of titanium alloy and is designed according to the characteristics of high tension of soft tissue caused by compression of cutaneous nerve. Generally, the knife edge is inclined, the knife edge line is 0.5 ~ 0.75 mm, and the needle handle is an ordinary steel wire wound needle handle, which is about 3 ~ 5 cm long. During treatment, the knife-edge line and the plane of the handle should be marked on the same plane to identify the direction of the knife-edge line in the body.
For example, for cervical spondylosis, cutting the subcutaneous tissue and fascia of the patient's neck with beryllium can dredge meridians, regulate qi and blood, improve local microcirculation, promote the regression of local congestion and edema and the absorption of aseptic inflammation, and effectively release a large number of tiny compressed cutaneous nerves widely distributed in the skin and fascia.
Beryllium needle therapy has strong clinical practical value, which is mainly suitable for cutaneous nerve entrapment syndrome in all parts of the body. Including the first diagnosis of cutaneous nerve entrapment syndrome; Conservative treatment 1 ~ 2 cases of ineffective treatment; There were 2 cases of adhesion and compression again after surgical treatment.
Five steps to complete clinical operation
The elderly suffering from the entrapment syndrome of medial branch of saphenous nerve knee joint have persistent pain in medial knee and anterior medial leg, and the pain is aggravated when walking and strenuous activity. So, he came to the traditional therapy center of Guangdong Provincial Hospital of Traditional Chinese Medicine for medical treatment.
Chen Xiuhua first asked the patient to lie flat on the bed, and his posture remained unchanged. After she found the tenderness point on the body surface by palpation, she found the right needle to locate it.
Then disinfect the skin with the needle insertion point as the center, and routinely disinfect the skin with iodophor, which is slightly more than twice the treatment range.
I saw her holding a needle in her right hand and a sterile cotton ball in her left hand. She helped the needle into the skin, and her hands suddenly dropped, allowing the beryllium needle to quickly penetrate the skin and reach the fascia. When talking about the experience of needle application, Chen Xiuhua mentioned that when the beryllium needle passes under the skin, the resistance of the needle tip is small, and the male who enters the needle has a sense of emptiness. When the needle tip penetrates the deep fascia, they will encounter greater resistance, and the male holding the needle will feel rebellious.
Chen Xiuhua began to release acupuncture, that is, to reduce the tension of the cutaneous nerve passing through the surrounding fascia and the pressure in the compartment between fascia. She said that the depth of acupuncture can be as long as the beryllium needle penetrates the fascia, not as deep as the muscle layer, so as to avoid bleeding and reduce postoperative reaction.
After loosening, she pressed the needle entry point with a cotton ball or gauze piece, quickly pulled out the needle, and kept pressing the needle entry point 1 ~ 2 minutes, and the sterile dressing covered and bandaged it.
In just a minute or two, Chen Xiuhua completed the beryllium needle treatment. Walking in the old man's field, I felt that my leg pain was obviously relieved. Director Chen Xiuhua told him to treat/kloc-0 once a week, and three times is 1 course of treatment, so that he could stick to the treatment and consolidate the curative effect. The old man happily promised again and again.
Chen Xiuhua explained that the knee joint is the main load-bearing joint of the body. The subcutaneous fat is thin and the buffering capacity is poor, which is the most common part of saphenous nerve compression. Degeneration and hyperosteogeny of knee joint in the elderly are also important reasons for the compression of medial branch of saphenous nerve knee. Beryllium needle therapy can relieve the compression of soft tissue pressure on cutaneous nerve, reduce the surface tension and pressure of closed system and relieve pain.
The use of beryllium needles varies from person to person and from illness to illness.
Beryllium needle therapy for cutaneous nerve entrapment syndrome has the advantages of less trauma, less pain, no anesthesia, accurate location and full release, but it is not suitable for all people and diseases, and the indications and precautions must be strictly controlled, Chen Xiuhua stressed.
She said that subcutaneous infiltration anesthesia can be performed at the point of needle insertion according to the patient's condition before needle insertion. The depth of needle insertion is about 1 ~ 2 cm, and it should not go deep to avoid pneumothorax or neurovascular injury. The depth of acupuncture depends on the patient's fatness and the lesion site, and it varies according to the condition, so it should be applied flexibly.
For patients with aura of needle halo, first take out the beryllium needle to comfort the patient and let him lie flat. In light cases, give hot boiled water or sugar water and take a short rest to recover. In severe cases, on the basis of the above treatment, pinch or acupuncture points such as ditches with your fingers. She explained that the common causes of needle diseases are mental stress of patients, or physical weakness, hunger, fatigue, uncomfortable posture and excessive operation of doctors.
Hematoma will appear in clinic because of accidental injury to blood vessels and failure to press the needle in time. If it is a mild hematoma, it generally does not need to be treated and can subside on its own. If the local hematoma is serious, local compression can be continued to prevent further bleeding, and then oral and external drugs can be given to promote blood circulation and reduce swelling. The prevention method is to avoid blood vessels after the needle is taken out and press it properly.
She said that for postoperative patients, proper manipulation and functional exercise can not only restore the dynamic balance of the human body, relieve muscle spasm, but also further promote metabolism in the body.