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Needle-knife therapy
Small needle knife is an acupuncture instrument made of metal material, which looks like a needle and a knife. It is developed on the basis of the needle and the front needle in the ancient nine needles, combined with the scalpel used in modern medical surgery, and is the product of organic combination with soft tissue release surgery. It has a history of more than ten years, and has a trend of further development in recent years, which has been valued by the world.

Small needle knife therapy is a closed release between surgical and non-surgical methods. It is formed on the basis of open surgery combined with acupuncture. The operation characteristic of small needle knife therapy is to easily cut, peel and other different starting stimuli in the deep part of the treatment site to achieve the purpose of relieving pain and getting rid of the disease. The indications are mainly soft tissue injury and osteoarthrosis.

The advantage of small needle knife therapy is that the treatment process is simple and is not limited by any environment and conditions. In the treatment process, the incision is small, no suture is needed, the damage to human tissues is small, infection is not easy to cause, no adverse reaction is caused, the patient has no obvious pain and fear, there is no need to rest after operation, the treatment time is short, the course of treatment is short, and the patient is easy to accept. 1, needle

Small needle knives are mostly made by themselves, with slightly different shapes and lengths, generally about 10- 15 cm, with diameters ranging from 0.4- 1.2 mm, and are divided into three parts: handle, needle body and needle knife. The width of the needle knife is generally equal to the diameter of the needle body, and the cutting edge is sharp. Some are modified with small surgical blades, and some are modified with dental probes.

Small needle knife must be autoclaved or soaked in alcohol before use.

2, the operation method

1), the choice of body position is based on the principle that doctors are convenient to operate and patients feel comfortable when receiving treatment. If the neck is treated, sitting position is often used; The head can be raised or lowered according to the position of the disease;

(2), choose a good location, choose a good treatment point, local aseptic disinfection, namely, first with alcohol disinfection, then with iodine disinfection, then with alcohol to smell.

The doctor puts on the sterile gloves, and finally confirms the injection site and marks it. Sterile hole towel can be applied to the body joints or complicated parts to prevent pollution during operation.

In order to alleviate the pain caused by local surgery, local anesthesia can be used to block nerve pain conduction. Commonly used injection drugs are:

A, 1% novocaine 2-5ml/ each injection point.

B, about 5 ml of 2% lidocaine per injection point.

C, 5ml of 2% lidocaine and 0 ml of triamcinolone acetonide A 1, mixed and injected into 2-3 treatment points respectively.

(3), commonly used demoulding methods are:

A, along the distribution direction of muscle fibers or tendons, that is, the tip of the needle knife clings to the tissue to be peeled and moves forward and backward (it is not allowed to pull up and down for insertion), so that the laterally adhered tissue fibers are broken and loosened.

B swing the tip of the horizontal or fan-shaped needle knife to break and loosen the vertically adhered tissue fibers.

C, do oblique or non-directional needle knife tip stroke swing action, make irregular adhesion tissue fiber fracture, loose.

Stripping measures should be taken according to whether there is adhesion or not. Pay attention to all kinds of peeling actions, and the amplitude must not be too large to avoid scratching important tissues such as blood vessels and nerves.

(4) Each acupoint can be removed by cutting and peeling for 2-5 times each time, and it can be cured after general treatment of 1-5 times, and the interval between two times can vary from 5-7 days as the case may be.

(5), small needle knife application indications:

First, the patient consciously has pain symptoms somewhere.

B, the doctor can touch the sensitive tenderness in the lesion.

C, palpation can touch the subcutaneous cord-like or flaky or spherical hard objects and nodules.

D, there is a noise when dialing the lesion with your finger. 1, cervical spondylosis

Acupoint selection: pain points are the main ones. Yangming meridian headache combined with valley and Neiting points; Headache in shaoyang meridian with foot near weeping and Fengchi point; Taiyang meridian headache with Kunlun and Houxi points.

Methods: Straight needling method was used. Gently peel 1-2 times, which can be combined with local massage to enhance the curative effect.

2. Inflammation of lateral humerus and upper ankle (tennis elbow)

Acupoint selection: Find the most obvious tenderness.

Methods: the knife edge line of the small needle knife was parallel to the extensor carpi and penetrated into the subcutaneous layer of the lateral epicondyle of humerus. First, use the longitudinal dredging and peeling method, then use the incision and peeling method to go backwards, and feel that the sharp edge has been scraped flat. Then use the transverse scraping method to dredge the extensor carpi extensor carpi communis and supinator tendon, and then take out the needle knife for dressing. Bend the elbow joint 2-4 times, with an interval of 5 days each time.

3. Stenosing tenosynovitis of flexor tendon (snapping fingers)

Acupoint selection: local pain points.

Methods: longitudinal shovel stripping method was used

4, heel pain (heel spur)

Acupoint selection: the tip of bone spur (tenderness is the most obvious).

Methods: The patient lay on his back on the treatment bed, put his feet firmly, and found out the most obvious tenderness point. After routine disinfection, the needle edge line is perpendicular to the longitudinal axis, and the needle body forms a 60-degree angle with the heel, and the depth reaches the tip of the bone spur. After 3-4 times, the needle knife can be taken out. If 1 time does not heal, you can do it again after 5-7 days.

5, the third lumbar transverse process syndrome

Acupoint selection: where tenderness is obvious.

Methods: the knife edge line of small needle knife was parallel to the longitudinal axis of human body. When the knife edge touches the bone surface and there is a sense of looseness between the muscle and the bone surface, the needle can be taken out by horizontal stripping method. Generally 1 time, you will be cured, and you will be cured again after 5 days.

6. Chronic lumbar muscle strain

Acupoint selection: waist tenderness point (Shenshu point).

Methods: Same as before. Can be combined with cupping to enhance stimulation.

7. Lumbar disc herniation

Acupoints: the tender point of intervertebral space (at the intervertebral joint), the midpoint of numbness area of calf or Chengshan point.

Methods: Insert the needle knife into the waist at the center of the pain point. When the needle tip reaches the tissue around the intervertebral facet ligament, dredge and peel it for 3-4 times, and then take out the needle knife. The calf part can be peeled off vertically by a straight needle. 1, because the small needle knife therapy is operated under non-direct vision, it is easy to cause injury if you are unfamiliar with human anatomy, especially local anatomy, and the technique is improper. Therefore, doctors must be familiar with the anatomical knowledge of deep acupoint stimulation, so as to improve the accuracy of the operation and improve the curative effect.

2. Acupoint selection must be accurate, that is, when Ashi point is selected as the treatment point, the needle must be inserted in the center of the pain point and kept vertical when inserting the needle (the needle insertion method can be flexibly selected for non-pain point selection). For example, if the needle is deviated, it will easily dislocate from the deep lesion and damage the non-pathological tissue.

3. Pay attention to aseptic operation, especially for deep treatment, especially for deep cutting of important joints such as knee, hip, elbow and neck. If necessary, it can be covered locally with sterile hole towel or carried out in sterile operating room. Other parts of the body, pay attention to aseptic operation.

4. The needle insertion method of small needle knife should be quick and agile, which can reduce the pain caused by needle insertion. Deep stripping, such as shovel stripping, horizontal stripping and vertical stripping, should be done lightly, otherwise it will aggravate the pain and even damage the surrounding tissues. When cutting joints longitudinally, be careful not to damage or cut ligaments, tendons, etc.

5. After operation, local massage can be given to some treatment points with less trauma to promote blood circulation and prevent postoperative bleeding and adhesion.

6. For some cases, the short-term curative effect is very good. 1-2 months or more later, the pain recurred and the original disease state was restored, especially in the heavily loaded parts such as knee joint, shoulder elbow joint and waist. Attention should be paid to the following factors: the patient's habitual life, walking posture, working posture and so on lead to recurrence; The local adhesion was relieved by surgery, but the local activity was insufficient after operation and the wound was adhered. It is also caused by cold and dampness. Therefore, special attention should be paid to daily life. No therapy can cure all diseases, and closing the needle knife is no exception. Every therapy has to go through clinical tests, and the needle-knife blocking operation is no exception. Needle-knife closure surgery has experienced many years of hardships. After absorbing both positive and negative experiences and lessons, a more standardized needle-knife closure operation was gradually formed. Its indications and contraindications are gradually becoming clear.

Indications for closed needle knife surgery:

The scope of indications of needle-knife closed plough operation is relatively narrow, which can not cover doctors. Needle knife can never replace surgery, let alone all medicine. "The time when a needle ... a pinch of grass can cure all diseases is long gone. No matter which therapy is used to treat diseases, the key is to choose good indications in order to achieve good curative effect. Imagine that the kind of therapy you apply is simply that nr can treat that kind of disease, how can it achieve curative effect! Therefore, the selection of indications is the premise of successful closed surgery.

The indications for closed needle knife surgery are as follows:

1, soft tissue injuries such as muscles of trunk and limbs, tendons (ligaments) and structures around tendons.

① Muscle injury can include nodules, cords, tenderness, muscle spacer tissue injury and transverse process syndrome of the third lumbar vertebra, such as tennis elbow, soft tissue adhesion, scar, contracture and lump.

② Tendon injury includes tendon end, the junction of ligament attachment and detachment, and the junction of ligament and joint capsule.

(3) The damage of peritendinous structure is loose connective tissue, synovitis, fat pad injury, tenosynovitis, etc. Needle-knife closure can improve the blood circulation and joint function of the lesion. 2, facial spasm, mandibular joint dysfunction, chondromalacia patellae and other difficult diseases.

3, hyperosteogeny, osteoarthritis, such as calcaneus hyperosteogeny, hyperosteogeny (bone spur or osteophyte) at the attachment of tendons, ligaments and joint capsules, including hyperplasia in joint cavities, such as intercondylar crest of tibial plateau.

4, myositis ossificans is better in the early stage, which can improve blood circulation and joint function.

5. Nerve entrapment syndrome includes some nerve entrapment syndromes of the anterior and posterior branches of spinal nerves.

Compression syndrome of posterior branch of spinal nerve includes: compression syndrome of greater occipital nerve, compression syndrome of medial branch and lateral branch of posterior branch of thoracolumbar nerve, compression syndrome of medial branch and lateral branch of posterior branch of thoracolumbar nerve (including acute lumbar sprain, chronic low back pain, low back pain after spinal comminuted fracture, etc.). ), lower lumbar nerve posterior branch compression syndrome, gluteal epithelial nerve compression syndrome.

Compression syndrome of anterior branch of spinal nerve includes carpal tunnel syndrome, piriformis syndrome, lateral femoral cutaneous nerve compression syndrome, fibular canal and metatarsal bone.

Tube syndrome, etc.

6. Osteosarcoma and intraosseous hypertension, such as tarsal sinus syndrome, calcaneal hypertension, costal chondritis, avascular necrosis of femoral head and increased intraosseous pressure in osteoarthritis.

7. Cervical spondylosis can be treated by acupotomy except for patients with severe paralysis of cervical spondylotic myelopathy, especially for nerve root type, vertebral artery type and sympathetic type (including cervical coronary heart disease-angina pectoris). Some patients with cervical spondylotic myelopathy, such as monoplegia, have also achieved good results with acupotomy.

8, lumbar disc herniation in addition to acute cauda equina compression requires emergency surgical treatment, other mild and severe patients (including postoperative unhealed, recurrence and sequelae) can be treated with needle knife closure surgery. Including acupotomy to release the external orifice of nerve root, ligamentum flavum between laminae and lateral recess.

9. Cervical and lumbar spinal stenosis can be treated by closed needle knife except paralysis. Not only extraspinal decompression can be done, but also intraspinal decompression can be done.

10, Mandibular joint dysfunction and hemifacial spasm are two kinds of diseases that are difficult to deal with at present, and acupotomy is a new breakthrough in this field with good curative effect.

1 1. Osteonecrosis diseases such as avascular necrosis of femoral head can not only eliminate pain, but also improve function. After closing the operation with needle knife, the development of the lesion can be controlled first, and then the slightly collapsed lesion can be restored to normal state. The curative effect of treating epiphyseal necrosis of femoral head in children is quite good, as are other osteonecrosis and epiphyseal rickets. For patients with increased intraosseous pressure such as avascular necrosis of femoral head, not only the joint capsule can be loosened, but also the intraosseous decompression of femoral head and neck can be performed. 12. Rheumatoid arthritis and ankylosing spondylitis can improve symptoms in the acute stage, and can correct deformities and improve joint function in the post-illness stage, such as joint mobility disorder, joint stiffness, humpback and other deformities. As long as the joints have mobility, the function can be improved.

13, joint dysfunction (rigidity) Due to trauma, improper operation or fixation, all joints of shoulder, elbow, wrist, hip, knee and ankle have mobility disorders and rigidity. As long as the trabecular bone of the joint is not connected (there is no bone fusion), there is still a certain degree of mobility. It is possible to improve or restore the function through needle knife closure surgery. The earlier the treatment opportunity, the better the curative effect.

14, deformity correction

Needle-knife closure surgery can correct bone and joint deformities, such as clubfoot, valgus foot, high arch foot and toe-up foot, or the healing of some limb fractures and deformities.

It should be noted that in the past, "needle knife" was always literally explained: needle knife has two functions: needle and knife. Therefore, the indications of acupotomy include acupuncture indications and surgical indications. This statement is extremely inaccurate and may be harmful. Because the indications of acupuncture and moxibustion can never be used as indications for needle knife closure surgery; Acupuncture needles can never be replaced by acupuncture knives. This is a matter of principle and there is no room for ambiguity. Needle knife is a miniature surgical instrument, which is a kind of scalpel, just like scalpels, such as peeling knife, triangle knife, tonsil knife, corneal knife, meniscus knife or amputation knife, but they are all scalpels! Its function is cutting, so it can't be used as an acupuncture needle! It should also be noted that some people think that acupotomy is suitable for all surgical operations, which is unrealistic. The actual situation is that the needle knife sealing operation can never replace the operation, and the operation can't eliminate the needle knife. Both of them have their own advantages, so they should complement each other, support each other, learn from each other's strengths and develop together, just like all kinds of scalpels exist at the same time.

No matter which medical method is adopted, its indications may change with the passage of time, the deepening of research and the exploration of clinical practice. Some diseases treated by closed needle knife surgery are effective and can be absorbed; Some diseases are not effective and should be given up. Survival of the fittest is the law of nature. Therefore, we should continue to explore and let the needle knife closure surgery serve the majority of patients and benefit the people.

Contraindications for closed needle knife surgery;

Contraindications can be divided into absolute contraindications and relative contraindications. This concept of absolute and relative can be changed at different stages and under different conditions, which needs to be explored continuously in clinical practice. While mastering the indications of needle knife closure surgery, we should pay more attention to strictly mastering the contraindications, taking safety first as the principle and not taking it lightly.

L, systemic contraindications

① Hemophilia, thrombocytopenia and abnormal bleeding and coagulation time are absolute contraindications. Someone asked about the history of bleeding when doing the closed needle knife operation for the third lumbar transverse process syndrome, but the patient concealed the history of hematoma after operation. Hematoma after closed needle knife surgery is estimated to be about 1500ml. After treatment, the patient did not raise any objection (the patient failed to inform the doctor about the history of hematoma in the past operation), but as a doctor, he should do a comprehensive examination. According to the equipment conditions of the hospital, he should

② Patients with psychosis, severe neurosis or hysteria should use it with caution. We should find such patients from their performance clues.

③ For patients with fever, the body has been damaged by acute diseases, while chronic soft tissue injuries and other diseases have taken the second place, and will be considered after rehabilitation.

④ During the onset of all internal diseases, such as coronary heart disease, myocardial infarction, heart failure, lung, liver, gallbladder, pancreas, kidney, etc. Closed needle knife surgery is not allowed.

⑤ Patients with leukopenia, high erythrocyte sedimentation rate and anemia should wait until their condition improves before performing needle knife closure surgery.

⑥ Patients with uncontrolled symptoms of hypertension and diabetes will be suspended from operation until their blood pressure is relatively stable and diabetes is well controlled and close to normal.

⑦ Don't make needle knives for women during menstruation. Patients with menorrhagia and long menstrual flow should undergo closed needle knife surgery after their condition improves.

⑧ Patients with osteoporosis should be treated selectively. Use with caution in the elderly, patients with hyperparathyroidism and the elderly and infirm.

Pet-name ruby for patients with osteoporosis caused by fracture, postoperative and long-term fixation, special attention should be paid when doing acupotomy or manipulation in undergraduate department. If necessary, preoperative and intraoperative exploration should be done well to avoid collateral damage. 2. Local contraindications

① Patients with skin inflammation at the surgical site, such as fistula, skin inflammation, folliculitis, etc., are prohibited from performing needle knife sealing surgery.

② There is inflammation and abscess in the deep part of the operation site, which is characterized by local redness, swelling, heat, pain and dysfunction.

③ There are important organs, great vessels and nerve trunks in the operation site that cannot be avoided, which may cause bleeding, nerve trunk injury, pneumothorax, infection and other injuries.

There is no strict age limit for contraindications. Age is not an absolute factor. As long as you are healthy and have stable life indicators, age is not the biggest obstacle. Of course, when performing needle knife closure surgery, we should also fully estimate the endurance of the elderly and the size of the stimulation and interference to the body. Some of them are indications for needle knife closure surgery, and diseases that can only be alleviated after needle knife treatment. It is estimated that patients can tolerate it, so they should be treated with good explanation in order to eliminate the pain at an early stage.

In short, we should consider the following points before the needle knife closing operation:

First, is it an adaptation symptom of acupotomy?

Secondly, does the surgeon have the skills to do this kind of needle knife surgery, and can the patient bear the interference of this treatment?

Third, firmly establish the idea of patient first and safety first, and never take chances.