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*The professional part involved in this article is only for medical professionals to read and refer to the 29th article related to the prevention and treatment of osteoporosis published by Professor Bian Pingda of Zhejiang Provincial People's Hospital in the medical field.
Sister Zhang is 54 years old this year.
Five years ago (49 years old), her menstrual cycle changed and she developed lower back pain.
She had worsened lower back pain after menopause at the age of 50.
She denied any obvious trauma or a history of falls.
Low back pain often appears after standing for a long time and walking for a long time, and it gets worse after weight-bearing.
It can be relieved after lying down and resting.
For example, it’s no problem to cook seven or eight dishes in a row when you’re young, but now that you cook one or two dishes, your waist is so sore that you don’t dare to go to a vegetable market two miles away to buy groceries, even if you carry two or three catties in your hand.
When Cai walks, her waist hurts so much that she can't go home.
.
.
Either for injections, or on the way to get the injections, Sister Zhang first came to the local township health center for medical treatment, and the doctor gave her acupuncture and moxibustion.
After acupuncture and moxibustion, the back pain was relieved, but after 2 to 3 days, the back pain started to come up again.
After repeating this for 3 months, switch to "small needle knife" treatment, do it once a week for 10 times in a row.
The result was the same.
The pain was relieved in the first three days after the treatment, but the pain remained the same by the fourth day.
Hearing that an old Chinese medical envoy from Jiangxi had a good "blade needle" in the county seat, Sister Zhang went here admiringly.
The blade needle is shaped like an acupuncture needle, but the front end is flat with a blade.
It is said that it integrates the advantages of acupuncture needles and minimally invasive surgical instruments, and can treat various stubborn diseases that are difficult to cure by conventional methods.
But receiving "blade acupuncture" treatment is very painful.
Before the treatment, a local anesthetic is given.
Sister Zhang is particularly afraid of pain.
If someone else gets one, she has to get two.
I went there once a week for 80 yuan each time.
It lasted for two years before and after, but there was no obvious effect.
It seems that I can only come to the provincial capital.
It is the famous doctor number of the pain department of a university hospital, and the registration fee is 200.
The shock wave treatment took about 20 minutes each time, and it was very painful.
After finishing the treatment, the whole body was relaxed, but after three to five days, the pain recurred.
Going to the orthopedics department again, the magnetic resonance examination of the lumbar spine showed: "Lumbar 5/sacral 1 intervertebral disc degeneration and bulging.
"
The director of the orthopedics department said that there is no obvious symptoms of nerve root compression and no surgery is required.
Let's go home! In the past six months, he has been receiving "acupoint closure" treatment at the "Chinese Medical Center" of the local Chinese Medicine Hospital.
The doctor gave her hormones (triamcinolone acetonide injection) and other drugs (Figure 1), once every two weeks, but the back pain seemed to be aggravated.
Figure 1 Sister Zhang's recent treatment at the local county hospital of traditional Chinese medicine.
The "culprit" of Sister Zhang's lower back pain.
Sister Zhang's lower back pain is actually due to the rapid decline in estrogen levels and osteoclast activity after entering the perimenopausal period.
Significant increase, resulting in rapid loss of vertebral bone [1].
There are two reasons for this: First, Sister Zhang's back pain occurred after entering the perimenopausal period, and there was no obvious history of trauma or falls before the onset.
There were no obvious vertebral fractures and disc herniation after repeated lumbar MRI examinations.
Nerve root or dural sac; secondly, the pain in the back and back of Sister Zhang is wide, and it appears after standing for a long time and walking for a long time, and it aggravates after bearing weight, and relieves after lying down and resting.
After admission, the physical examination revealed that the patient had no obvious tenderness in the back and back.
Dual-energy X-ray absorptiometry showed osteoporosis (see Figure 2).
Figure 2 Sister Zhang’s dual-energy X-ray absorption method bone mineral density report.
The patient’s blood routine, blood tumor markers, rheumatoid rheumatoid factor and other tests were not abnormal, but the blood reproductive hormone test showed estradiol <10pg/ml, blood biochemistry The examination showed that the blood calcium was 2.
63 (normal value 2.
11～2.
52) mmol/L, and the examination of bone turnover markers showed that the type I collagen carboxy-terminal peptide β special sequence (CTX) was 1043 pg/ml [2] (see Figure 3), suggesting sister Zhang The bone is losing rapidly.
Figure 3 Sister Zhang's report on serum bone turnover markers.
Zhang Sister's treatment and reflection on low back pain.
Chinese medicine believes that if it is unreasonable, it will hurt, and if it is not good, it will hurt. Acupuncture has the effects of dredging the meridians, and is often used clinically to treat neck and shoulder pain, lumbosacral pain, joint pain, hemiplegia, facial paralysis and other diseases.
Small needle knife therapy can quickly relieve muscle spasm, loosen fascia and tissue adhesions, and is often used clinically to treat cervical spondylosis, lumbar disc herniation, tenosynovitis, plantar fasciitis, and frozen shoulder.
In addition to treating chronic soft tissue injuries, blade needle therapy is also suitable for treating traumatic bursitis, tenosynovitis, myofasciitis and other diseases.
Since the back pain of Sister Zhang was mainly caused by the rapid loss of her bones, there was no obvious soft tissue damage, so after receiving the above-mentioned treatment measures, the results had little effect.
Long-term acupoint injection of hormones not only does not help the treatment of low back pain, but also induces the formation of osteoporosis and fibrotic scars, and aggravates the symptoms of chronic low back pain [3].
Sister Zhang received an intravenous infusion of the anti-bone resorption drug zoledronic acid injection (5mg).
She felt that her back pain was significantly relieved on the 2nd day, and it was basically relieved on the 3rd day.
On the 4th day, the blood calcium returned to normal (2.
47mmol).
/L), the rapid decrease of blood CTX (444.
7pg/ml), suggesting that the rate of bone loss has been significantly reduced by Sister Zhang [4].
Therefore, after being discharged from the hospital, Sister Zhang should not receive "small acupuncture" and "blade acupuncture" treatments, and no more "closed" treatments, but she must persist in the sun, drink milk, participate in outdoor activities, and pay attention to strengthening Exercise for the waist.
References: [1]Bijelic R,Milicevic S,Balaban J.
Risk factors for osteoporosis in postmenopausal women[J].
Med Arch,2017,71(1):25-28.
[2]Bian Pingda, Shou Zhangxuan , Li Xiuyang, et al.
The predictive value of bone turnover markers in the changes of bone mineral density in elderly men[J].
Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2018, 11(2): 155-159.
[3] Chronic Expert consensus on the medical treatment of musculoskeletal pain.
Expert consensus on the medical treatment of chronic musculoskeletal pain (2018)[J].
Chinese Journal of Pain Medicine, 2018, 24(12): 881-886.
[4] Qian Sufeng, Wang Jue, Bian Pingda, et al.
The value of bone turnover markers in the prediction of bone mineral density changes after intravenous infusion of zoledronic acid in elderly women with osteoporosis[J].
Chinese Journal of New Drugs and Clinics, 2019, 38 (5) ): 295-298.
Sister Zhang is 54 years old this year.
Five years ago (49 years old), her menstrual cycle changed and she developed lower back pain.
She had worsened lower back pain after menopause at the age of 50.
She denied any obvious trauma or a history of falls.
Low back pain often appears after standing for a long time and walking for a long time, and it gets worse after weight-bearing.
It can be relieved after lying down and resting.
For example, it’s no problem to cook seven or eight dishes in a row when you’re young, but now that you cook one or two dishes, your waist is so sore that you don’t dare to go to a vegetable market two miles away to buy groceries, even if you carry two or three catties in your hand.
When Cai walks, her waist hurts so much that she can't go home.
.
.
Either for injections, or on the way to get the injections, Sister Zhang first came to the local township health center for medical treatment, and the doctor gave her acupuncture and moxibustion.
After acupuncture and moxibustion, the back pain was relieved, but after 2 to 3 days, the back pain started to come up again.
After repeating this for 3 months, switch to "small needle knife" treatment, do it once a week for 10 times in a row.
The result was the same.
The pain was relieved in the first three days after the treatment, but the pain remained the same by the fourth day.
Hearing that an old Chinese medical envoy from Jiangxi had a good "blade needle" in the county seat, Sister Zhang went here admiringly.
The blade needle is shaped like an acupuncture needle, but the front end is flat with a blade.
It is said that it integrates the advantages of acupuncture needles and minimally invasive surgical instruments, and can treat various stubborn diseases that are difficult to cure by conventional methods.
But receiving "blade acupuncture" treatment is very painful.
Before the treatment, a local anesthetic is given.
Sister Zhang is particularly afraid of pain.
If someone else gets one, she has to get two.
I went there once a week for 80 yuan each time.
It lasted for two years before and after, but there was no obvious effect.
It seems that I can only come to the provincial capital.
It is the famous doctor number of the pain department of a university hospital, and the registration fee is 200.
The shock wave treatment took about 20 minutes each time, and it was very painful.
After finishing the treatment, the whole body was relaxed, but after three to five days, the pain recurred.
Going to the orthopedics department again, the magnetic resonance examination of the lumbar spine showed: "Lumbar 5/sacral 1 intervertebral disc degeneration and bulging.
"
The director of the orthopedics department said that there is no obvious symptoms of nerve root compression and no surgery is required.
Let's go home! In the past six months, he has been receiving "acupoint closure" treatment at the "Chinese Medical Center" of the local Chinese Medicine Hospital.
The doctor gave her hormones (triamcinolone acetonide injection) and other drugs (Figure 1), once every two weeks, but the back pain seemed to be aggravated.
Figure 1 Sister Zhang's recent treatment at the local county hospital of traditional Chinese medicine.
The "culprit" of Sister Zhang's lower back pain.
Sister Zhang's lower back pain is actually due to the rapid decline in estrogen levels and osteoclast activity after entering the perimenopausal period.
Significant increase, resulting in rapid loss of vertebral bone [1].
There are two reasons for this: First, Sister Zhang's back pain occurred after entering the perimenopausal period, and there was no obvious history of trauma or falls before the onset.
There were no obvious vertebral fractures and disc herniation after repeated lumbar MRI examinations.
Nerve root or dural sac; secondly, the pain in the back and back of Sister Zhang is wide, and it appears after standing for a long time and walking for a long time, and it aggravates after bearing weight, and relieves after lying down and resting.
After admission, the physical examination revealed that the patient had no obvious tenderness in the back and back.
Dual-energy X-ray absorptiometry showed osteoporosis (see Figure 2).
Figure 2 Sister Zhang’s dual-energy X-ray absorption method bone mineral density report.
The patient’s blood routine, blood tumor markers, rheumatoid rheumatoid factor and other tests were not abnormal, but the blood reproductive hormone test showed estradiol <10pg/ml, blood biochemistry The examination showed that the blood calcium was 2.
63 (normal value 2.
11～2.
52) mmol/L, and the examination of bone turnover markers showed that the type I collagen carboxy-terminal peptide β special sequence (CTX) was 1043 pg/ml [2] (see Figure 3), suggesting sister Zhang The bone is losing rapidly.
Figure 3 Sister Zhang's report on serum bone turnover markers.
Zhang Sister's treatment and reflection on low back pain.
Chinese medicine believes that if it is unreasonable, it will hurt, and if it is not good, it will hurt. Acupuncture has the effects of dredging the meridians, and is often used clinically to treat neck and shoulder pain, lumbosacral pain, joint pain, hemiplegia, facial paralysis and other diseases.
Small needle knife therapy can quickly relieve muscle spasm, loosen fascia and tissue adhesions, and is often used clinically to treat cervical spondylosis, lumbar disc herniation, tenosynovitis, plantar fasciitis, and frozen shoulder.
In addition to treating chronic soft tissue injuries, blade needle therapy is also suitable for treating traumatic bursitis, tenosynovitis, myofasciitis and other diseases.
Since the back pain of Sister Zhang was mainly caused by the rapid loss of her bones, there was no obvious soft tissue damage, so after receiving the above-mentioned treatment measures, the results had little effect.
Long-term acupoint injection of hormones not only does not help the treatment of low back pain, but also induces the formation of osteoporosis and fibrotic scars, and aggravates the symptoms of chronic low back pain [3].
Sister Zhang received an intravenous infusion of the anti-bone resorption drug zoledronic acid injection (5mg).
She felt that her back pain was significantly relieved on the 2nd day, and it was basically relieved on the 3rd day.
On the 4th day, the blood calcium returned to normal (2.
47mmol).
/L), the rapid decrease of blood CTX (444.
7pg/ml), suggesting that the rate of bone loss has been significantly reduced by Sister Zhang [4].
Therefore, after being discharged from the hospital, Sister Zhang should not receive "small acupuncture" and "blade acupuncture" treatments, and no more "closed" treatments, but she must persist in the sun, drink milk, participate in outdoor activities, and pay attention to strengthening Exercise for the waist.
References: [1]Bijelic R,Milicevic S,Balaban J.
Risk factors for osteoporosis in postmenopausal women[J].
Med Arch,2017,71(1):25-28.
[2]Bian Pingda, Shou Zhangxuan , Li Xiuyang, et al.
The predictive value of bone turnover markers in the changes of bone mineral density in elderly men[J].
Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2018, 11(2): 155-159.
[3] Chronic Expert consensus on the medical treatment of musculoskeletal pain.
Expert consensus on the medical treatment of chronic musculoskeletal pain (2018)[J].
Chinese Journal of Pain Medicine, 2018, 24(12): 881-886.
[4] Qian Sufeng, Wang Jue, Bian Pingda, et al.
The value of bone turnover markers in the prediction of bone mineral density changes after intravenous infusion of zoledronic acid in elderly women with osteoporosis[J].
Chinese Journal of New Drugs and Clinics, 2019, 38 (5) ): 295-298.
