Minimally Invasive Medicine Learning Materials

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Minimally invasive medicine learning materials

( Minimally invasive soft tissue limb section )

Foreword

Chronic pain caused by soft tissue injury is well known but difficult to cure symptoms. Its pathogenesis early in the twe

century, there are two different people understanding that soft tissue adhesions degeneration and bone changes

(osteoarthritis) doctrine of two kinds. The former, because of its pathogenesis is not yet sufficient knowledge nor have

reliable means of inspection and treatment, non-surgical therapy can not be treated radically. The surgical treatment o

neck, waist, buttocks and other parts in a wide range of tingling, pain alone is a prominent lesion surgery release, backpain caused by neglect of other lesser extent, risk factors, and only after can reduce the symptoms. Therefore, the rele

conduct from the soft tissue neck angle, low back pain research at a standstill. Since the latter can make use of imagin

studies to prove that the degeneration of bone tissue in the objective disc exists to make people more attention to bo

changes. Combined efforts of many scholars, so that surgery achieved a certain effect , so the " bone theory" This nerv

compression caused by the mechanical theory of soft tissue pain caused widespread international attention , and in th

clinical occupy a major position.

With the continuous development of medicine, there have been many and "bone oppression theory" does not match

phenomenon, such as clinical: Symptoms and hyperplasia site separation; asymptomatic lumbar disc, etc.; had so peop

look again doctrine came into the soft tissue. Early sixties declared sting proposed pathogenesis of pain and soft tissue

damage, "aseptic inflammatory lesions " Through extensive clinical practice . After years of clinical practice, has basicabecome the theoretical basis of the doctrine of degeneration of soft tissue adhesions. The emergence of minimally inv

therapy of traditional Chinese medicine has brought a new starting point for the treatment of soft tissue injury. It fills t

gaps in chronic soft tissue injury and surgical therapy in the treatment of African -surgical therapy between the soft tis

damage in the clinical treatment of pain has made great development.

TCM minimally invasive soft tissue is soft tissue injury in many basic treatment, according to previous experience, the

method of treatment of soft tissue injuries summed up the combination of different characteristics of Western medici

traditional Chinese medicine. Which has a representative, such as release of sharp knife , blade needles, beryllium nee

water knife , loosen the needle to release represented dial blunt needle , pine needle bars , round bladeless release p

flat blade release pin head no and another has developed a sharp release of both functional release another blunt nee

cannula release. Since the exact efficacy of minimally invasive medicine, medical workers and patients deeply loved. Bworth noting that the essence of traditional Chinese medicine minimally invasive therapy has evolved into a closed lys

However, currently engaged in the minimally invasive treatment of traditional Chinese medicine doctors are engaged

most of the previous acupuncture, massage, physical therapy and other non- surgical therapy anesthesia medical work

which requires knowledge of the structure and minimally invasive work there are some differences. When the diagnos

doctors who still own the original theoretical knowledge to guide, doctors who treat the majority of its local anatomy

physiology , pathology and surgery methods applied are not clear purpose , the negative impact on the clinical brough

very serious . Therefore, the system of the present study is to improve the professional knowledge of the efficacy and

priority levels.

Minimally invasive techniques

Minimally invasive surgery is a new treatment techniques developed in the past 20 years, since the restrictions anatom

structures and technical conditions, mainly used in the cervical and lumbar spine. With the maturing of the passage of

the accumulation of experience and clinical technology, its use will be more extensive. Commonly used techniques are

frequency technology, intradiscal radiofrequency thermocoagulation by radiofrequency make the disc becomes tough

collagen fibers shrink, thus contributing to a tear or rupture of the intervertebral disc repair. Into the annulus intradisc

electrothermal annuloplasty (IDET) and disc nucleus gasification angioplasty. Laser technology percutaneous laser disc

decompression (PLDD) was first proposed by the United States Choy (1984 ), the physical effects of nucleus pulposus t


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laser vaporization , cutting , freezing , so prominent intradiscal pressure drops, the annulus back reduced , thereby red

the spinal cord and nerve root irritation. This approach is most scholars agree that, because of trauma, maximize the

retention of the stability of the spine, the disadvantage is narrower indications, whether vaporization laser radiation h

damage has been caused more concern. Ozone technology, surgery may produce ozone nucleus dissolution mechanis

therapeutic action by the following: 1 oxidation proteoglycan, 2 destroy the nucleus pulposus, three anti-inflammatory

analgesic . Ozone can seriously damage the structure of the nucleus pulposus and cartilage endplate but the spinal cor

nerve roots and the smaller muscles affected. Although advantageous in that it has a strong oxidation no permanent

residue. Knife technique, knife technology is developed in the traditional Chinese medicine on the basis of a nine -pin

minimally invasive therapy, the use of special needles in the treatment area for cutting, separating, reduce tension,decompression. For high stress points around the spine have a good effect, because it is through the method of skin cl

release, it requires the operator to grasp a good knowledge of anatomy and structural level, and the intensity of the

practices, stability, precision, there are very strict requirements.

A minimally invasive lysis: for superficial soft tissue scar adhesions diseases, such as scar formation after traumatic

hemorrhage, wound partial adhesions after surgery. Commonly used needle with knife, water, knife, blade needle.

Depending on the size of scar formation , high stress levels using a simple cut fiber , "Z" shaped cut sneak peeling ;

2 of minimally invasive surgery to reduce tension : pain point for soft tissue local high tension diseases, such as fascial

compartment pressure, high- stress stimulation of local fascia caused by long-term high- tension formed cord , nodule

mass. Commonly used needle with beryllium needles, blades needles, crochet and so on. Usually without anesthesia ,

fascia prick from 1 to 3 points can be achieved to reduce tension decompression therapy;3 minimally invasive orthopedic surgery: For a number of conditions to allow the deformity correction, mainly through

dynamic balance and static balance in two ways;

4 minimally invasive dissection: for blocking deep soft tissue disease;

5 minimally invasive stimulation: for the system to adjust the treatment of diseases , such as bladder full sun by stimul

acupoints back treatment of cervical vertigo, ridge -derived indigestion, irritable bowel syndrome and other endogeno

spinal visceral surface correlation disease;

6 minimally invasive suturing: Some percutaneous arthroscopic suture techniques and suture technique carried out

gradually in recent years to promote the application. Such as percutaneous suture acromioclavicular joint dislocation,

arthroscopic suture cruciate ligament injury.

Directory

The first chapter Basics

A soft tissue injury .......................................... ( 5 )

2 pathological basis of soft tissue injury .......................................................... ( 6 )

3 clinical application of minimally invasive soft tissue ............................................................ ( 7 )

4 soft tissue minimally invasive surgery ........................................................................ ( 7 )

5 minimally invasive soft tissue and relieve the high stress fibers ..................................................................... ( 10 )

6 minimally invasive soft tissue and bone fiber tube high-pressure ..................................................................... ( 11 )

The second chapter in the monograph

1 , supraspinatus tendinitis ........................................................................ ( 14 )

2 , subacromial bursitis ........................................................................ ( 15 )

3 , biceps tenosynovitis ............................................................... ( 17 )

4 , supinator syndrome ........................................................................ ( 18 )

5 , total humeral epicondyle extensor tendinitis .............................................................................. ( 20 )

6 , pronator teres release ( volar forearm interosseous nerve entrapment syndrome ) ................................................ ( 2

7 , narrow radial styloid tenosynovitis .............................................................................. ( 23 )

8 , transverse carpal ligament contracture ........................................................................ ( 25 )


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9 , stenosing flexor tendon sheath ............................................................... ( 27 )

10 , ischial tuberosity bursitis ............................................................... ( 28 )

11 , gluteus greater trochanter bursitis ........................................................................... ( 29 )

12 , popliteal muscle strain .......................................... ( 31 )

13 , knee medial collateral ligament release ............................................................... ( 32 )

14 , knee ligament release ............................................................... ( 34 )

15 , knee synovitis ............................................................... ( 35 )

16 , the common peroneal nerve fiber tubes release .............................................................................. ( 37 )

17 , the first release from the ligament ( ankle sprain ) ..................................................................... ( 38 )18 , tarsal tunnel syndrome ........................................................................ ( 39 )

19 , under the Achilles tendon bursitis ........................................................................ ( 41 )

20 , foot pain ........................................................................ ( 42 )

Appendix

Common limbs tenderness ........................................................................ ( 44 )


A soft tissue injury

In addition to the human bones, organs and other tissues outside the sensory organs are soft tissue. Soft tissue injury

disease refers to the skin, muscles, tendons, tendon sheaths, ligaments, fascia, synovium, synovial, spinal cord, periphnerves, blood vessels and other diseases due to the injury or chronic strain occurred. Pain caused by soft tissue injury

well known worldwide, but is difficult to cure diseases. In ancient Greece, people have a soft tissue injury awareness, h

Socrates once said, "to treat pain as geniuses ." Ancient Western visible damage to soft tissue pain caused by attention

recognizing the complex and difficult treatment.

The first is Hegmar.Freibeg.ober.Steindier.GrateCopemar, Strong and Japan as the representative of the mountains in

sea of soft tissue : For chronic soft tissue injury caused pain pathogenesis , early in the twentieth century on the existe

two different points of view adhesions degeneration is the cause of pain. ( Which in 1843 Fororiep that " rheumatism

patients with muscle pain induration in 1951 , Lewellym and Jones co-wrote " fibrositis " (Fibrositis) a book that fibrom

is pain in the muscles and bones of the most common causes . ) the second is the thirties Williem.Mixter, Verbiert fifti

considered as the representative of bone changes ( osteoarthritis ) is causing the pathogenesis of pain. Since then theformer course of the pathogenesis of soft tissue injury and did not have enough knowledge , reliable screening metho

treatments have not mastered ; non-surgical acute phase heat, physical therapy , massage therapy , such as the partia

closure of up to a certain therapeutic purposes, but the pathological after changing the development of tissue fibrosis

scar contracture formation to the above treatment can not be treated fundamentally recurrent symptoms . The surge

the waist, hip pain part in a wide range of hair , pain alone a prominent lesion surgery release , ignoring the other caus

low back pain to a lesser extent risk factors, can only alleviate the symptoms of postoperative and no cure , and the re

rate is high , so after that, on making back pain or low back pain from the perspective of the treatment of soft tissue

coverage less and less. Research increasingly stagnant , "soft tissue Doctrine" close to being abandoned. Since the latt

make use of X -ray, myelography , especially seven , eighty years later , the universal application of CT and MRI scans ,

objectively prove bone tissue degeneration , disc herniation exist , so that people are more more attention to bone ch

combined with many scholars in anatomy and physiology , diagnostic techniques and other aspects of the surgical pro

done a lot of research , so that surgery achieved a certain effect , so the " bone theory" this nerve root compression ca

by mechanical theory of pain caused widespread international attention . From the mid-twentieth century has been in

clinical occupy a major position.

With the continuous development of medicine, there have been many and " bone theory" does not match the phenom

such as clinical : Symptoms and hyperplasia site separation ; asymptomatic lumbar disc ; many spinal stenosis test resu

from objective indicators radiological point of view, has been more severe spinal cord compression, but the lack of any


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clinical manifestations of patients ; portion of objective indicators show the spinal cord, nerve roots oppressed patient

non-surgical treatment , the symptoms under control, but the spinal cord , nerve root compression phenomenon still e

many cases still postoperative pain, pain reoperation also found no reason , even if the implementation of spinal fusio

surgery , but also can not relieve persistent pain . Therefore , non-surgical therapy in the last ten years more and more

attention by people . Such as: anesthetic nerve block therapy to treat soft tissue pain ; to Feng -day treatment method

represent promising . Clinically have achieved a certain effect . Early sixties declared sting proposed pathogenesis of so

tissue damage through a lot of pain in clinical practice known as " aseptic inflammatory lesions ." After years of clinica

practice , has become one of the basic theoretical foundation of non -surgical treatment of soft tissue injury .

2 aseptic inflammation is the pathological basis of soft tissue injuryWhen the body is compromised , the ability to maintain its survival with two , one for self-defense capability , one for

capacity . Inflammation is the most basic form of self-defense , which, blood vessels, nerves reaction has a close relatio

. Inflammation and repair often simultaneously.

Inflammation is a nonspecific defense reaction of the body to the damage occurring factors , which aims to eliminate t

limitations or exclusion of foreign pathogenic factor and lethal cell injury when the body is compromised. Inflammatio

the blood vessel during the reaction is most sensitive , the body is stimulated, venules and capillaries change the

permeability of the wall , so that some of the components within the plasma extravasation , the dilution factor of

inflammation , to reduce or eliminate its destructive power . While pumping blood antibodies , inflammatory mediato

conditioning factors, such as resistance against Lysozyme matter .

Aseptic inflammatory mediators occupies a very important position in the inflammatory response . Although a variety media , from its source can be divided into plasma , such as hormone bradykinin , complement and coagulation - solub

fiber system ; derived cells such as histamine , 5 - hydroxytryptamine, allergic reactions and chronic substance , allergi

eosinophilic leukocyte chemotactic factors , prostaglandins, lysosomes, lymphokines like.

According to current knowledge , almost all of these inflammatory mediators under normal conditions or in the form o

precursor , or in the inactive form. When the body is damaged or compromised, they can be quickly transformed into

strong medium vigor , its main role is to influence vasodilator prostaglandins , increased vascular permeability mainly

histamine , 5 - hydroxytryptamine, complement C3a and bradykinin ; there leukocyte chemotaxis mainly complement

fragments , C3a, C5a , etc. ; cause fever and heat source for endogenous prostaglandins ; cause pain mainly bradykinin

prostaglandins ; major cause tissue damage is derived from the neutrophils and macrophages lysosomal enzymes. Alth

they played a very strong effect , but the body and quickly generate controlled substances , and timely process to limitmedia or excessive reaction , avoid excessive damage.

Pathogenesis of soft tissue injury is damage to the body by some kind of stimulation , resulting in barriers to their

surrounding tissue blood circulation , increased capillary permeability , inflammation, pain caused by substances leakin

stimulating the surrounding tissue to produce symptoms , the body appeared protective tension, more heavy blood

circulation disorder that metabolites and inflammatory mediators can not be excreted as soon as possible , over time,

formation of adhesions between organizations , degeneration, fibrosis, and eventually replaced by scar tissue .

3 Clinical application of minimally invasive soft tissue

Minimally invasive soft tissue using some means or methods of organization will loosen stuck together , to restore the

original function . This therapy in many of our subjects had reflected. As in cardiothoracic surgery, chronic constrictive

pericarditis , the pathological changes are visceral and parietal pericardium thickening due to chronic inflammatory ch

, fibrous scar tissue to form a hard , parietal and visceral pericardium sticking to each other , the pericardial cavity disa

, cardiac scar tissue to be bound by the long-term , resulting in a series of symptoms. Treatment is surgical excision of

pericardial thickening of fibrous tissue , so that the heart is bound to restore the original function ; obstruction of adhe

in abdominal surgery is the most common complication of abdominal surgery , surgery is required when necessary loo

adhesions between organizations ; bone surgery because of lower extremity fractures long brake , knee injury or

inflammation of the knee sliding device adhesions, contracture , fibrosis caused by stiff knee adhesive shall adopt the


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loose adhesions solution treatment ; tendon adhesions and scar tissue trauma caused by lumbar disc herniation with n

root surrounding tissue lysis of adhesions , etc. are required to use different forms of methods to achieve relieve symp

caused by the purpose ; gluteal muscle contracture is a large rotor upper gluteus medius only point cut part of the mu

and tendon tension is too high fiber and achieve their goals. As can be seen above , minimally invasive surgical techniq

disciplines has occupied a certain position . Another clinical physiotherapy, acupuncture, massage , partial closure , ne

blocks and other non -surgical therapy treatment mechanism is relaxing its local tissue and reach the goal .

4 soft tissue minimally invasive surgery

Minimally invasive surgery is the use of soft tissue along the edge ( or no edge ) of the needle directly to the lesion, its

organization mechanical release, improving its pathological changes, a treatment to restore the original function of theorganization . Soft tissue is minimally invasive modern medicine, human anatomy , physiology , pathology , biomechan

and minimally invasive surgical techniques based on sets of traditional medicine acupuncture techniques featured in o

the modern medical technology. Use direct lesion of the needle blade , the treatments alter the pathological changes

muscles, tendons, fascia , ligaments, and other soft tissue synovial restore the normal function of the implicated parts

reach therapeutic purposes.

First, a lifting mechanism of the high stress fiber: normal development of muscles pulling the bone is important, the siz

direction of the existing bone morphology and its components are related to stress . Due to continuous repeated stati

force, muscle or tendon fibers to make long-term state of tension , acting on the bone surface stress generated by the

ending of " osteoarthritis ." Minimally invasive soft tissue can be cut beyond the bone surface or mitigate these high- s

fibers , change the direction and size of its force in parallel to achieve the purpose of lifting the cause . 2 fiber tube higpressure to reduce bone : bone fiber tubes , pipes from the bone tissue and the fibers on the rampage , said fibrous tu

Their bone structure can be divided into fiber tubes , joints and muscle fiber tube ( or tendon ) vascular three. It may h

associated with blood vessels and nerves and tendons and other tissues through . Mainly from the protection and the

tube tissue. For some reason caused by increased pressure within the tube when the tube is irritation or compression

contents produce symptoms . Minimally invasive soft tissue contractures can release tension by fibrous tissue tube , in

tube to relieve pressure, to achieve the purpose relieve symptoms .

3 . Less pressure within the organization : from trauma or chronic fatigue so that local tissue metabolism disorder caus

compartment syndrome bone tendons , joint capsule , bursa , or increased pressure within the bone appeared a series

clinical manifestations, can cut through local tissue lysis needle If the joint capsule , bursa , myofascial 's wall to relieve

pressure within the organization , improve blood circulation local organizations to restore local tissue metabolic imbalphenomenon , to reduce or relieve symptoms purposes. 4 lifting adhesions between organizations : due to trauma , ch

fatigue or surgery, did not receive timely treatment, the local adhesion of muscle fiber and its surrounding tissue occu

such as: between the muscles and the muscles between the muscle and bone , skin and tissue adhesion between the

symptoms affect normal tissue function appears. By loosening reduce tissue adhesion between , to restore normal

physiological state.

5. Improve local organizations aseptic inflammation : the long-term due to trauma or chronic strain , causing local tissu

blood circulation is blocked, increased capillary permeability , inflammatory pain caused by substances accumulate , fo

a partial aseptic inflammation and pain symptoms. Minimally invasive soft tissue can improve local tissue metabolism

blood circulation , reduce pain caused by substances produced to promote the absorption of aseptic inflammation . Se

the indications

Adapt to any part of the body due to the soft tissue injury or chronic strain, and local organizations have organic chang

ie, the formation of adhesions between the soft tissue , fibrous contracture, the pressure increased, wall thickening an

other pathological changes , invalid or symptoms of repeated non-surgical therapy attack ) clinical symptoms caused .

soft tissue injury caused by back pain, nerve root of some neck muscles tense as cervical dislocation caused by the

emergence of the vertebral artery and clinical manifestations of sympathetic cervical spondylosis , back of the neck by

loosening tight muscles contracture , coupled with the appropriate traction bonesetting treatment.

2 . Third lumbar transverse process syndrome, heel spurs , knee eminence between hyperplasia and other diseases.


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3 elbows, ankles pipe, tube feet , carpal tunnel and other entrapment caused by clinical syndrome, migraine headache

tenosynovitis , shoulder and neck, lumbar nerve root entrapment in different parts of the surrounding tissue or being

squeezed due to related illness.

4 ganglion cyst , joint caused by increased pressure within the joint pain, synovitis, bursitis, muscle fasciitis caused by v

parts of the body , such as the ischial tuberosity bursitis , calcaneal tuberosity bursitis and so on. 5 by trauma , strain, l

tissue caused by post-operative adhesions , scar . Such as tennis elbow, levator scapula injuries, and medical sequelae

bone and joint diseases ( arthritis, ankylosing spondylitis, gout , osteoarthritis avascular necrosis, fibrous joints stiff lim

etc.) .

Third, contraindicationsA fever, infection patients.

2 hemophilia and bleeding tendencies or clotting mechanism .

3 exacerbation of severe visceral lesions , diabetes, mental illness .

4 physical weakness, substandard authors .

5 treatments site infection or redness, swelling, heat, pain, abscess . 6 diagnosis is not clear, cross-sectional anatomica

structures ( congenital deformity or after surgery ) were the treatments of complex parts , pathological changes and th

Board . 7 treatments have important parts of neighboring organs and can not be protector.

IV Treatment

Classification of soft tissue : spinal ( 10% ) ( discectomy surgery , interventional , RF ) ? ? ?

A ) the manner and needle treatmentsA sharp separation : release pin flat blade , helical blade release pin ( blade , scissors, periosteal stripping )

Needle acupuncture knife , beryllium needles, pine needles, needle blade , long circular needle , needle spatula , new

pin , water knife , loosen the needle , pick needle , giant crochet , Xiaokuan needle teeth crochet , needle mirror , lily S

barrier , improved knife

2 blunt dissection : Round release pin , flat head release pin ( knife, forceps and fingers separated ) dial needles, pine n

bars , floating -pin, flat head release pin , round needles release

3 needle cannula release : You can select the needle core be sharp or blunt treatments according to different needs

Second ) surgery in patients with orthostatic Step 1 : Depending on the way the lesion and the treatments can take a

different position to operate. 2 needle positions : lesion treatments and techniques to choose the right part based on

must be an important part of the organization in favor clued as the needle point .Needle 3 : Using both fast and slow method, namely the needle into the skin and quickly to relieve pain, when the

subcutaneous needle blade , you need to slow the needle tip can shake around when necessary to stimulate more sen

tissue ( nerves, blood vessels, etc. ) to generate avoidance reflex action to reduce the unnecessary tissue damage.

4-pin edge direction : The different levels of the various parts , in order to avoid important organization in accordance

the principle of the needle blade and tissue to the direction parallel to the order of the spinal cord, nerve roots, nerve

artery, vein , muscle fiber.

Three ) a longitudinal surgical dredge method : pin edge treatments and tissue fibers parallel to the direction , the adh

between the organization and the organization 's release , mainly adapted to adhesions organizations. 2 rampant lysis

method: vertical pin edge treatments and tissue fiber parts , cut tight muscle or tendon fibers. Mainly adapted to relie

high pressure and high fiber tube bone stress fibrous tissue .

3 cutting method : pin edge of the lesion, selected according to the size of the scar tissue adhesions in different direct

and depth of the line cutting practices in order to reduce the size and extent of tissue adhesion , and promote local les

suction change . 4 transparent stripping method : needle up between the organization and the organization , the use o

needle separation of adhesions between the two organizations . This method is mainly suitable for a larger degree of

adhesion area but not severe tissue adhesions ( also known as blunt dissection ) .

5 perforation decompression method: the needle edge of the lesion, the lesion can be punctured or myofascial wall , t


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wall can be expanded if necessary, incision , accelerate metabolism and absorption of organizations. This method is us

intracapsular pressure and aseptic inflammation . D) Notes 1 . Soft tissue minimally invasive surgery with the continuo

development of its basic theory and technology research , the role of acupuncture almost to lose their function , and w

replaced by closed surgical technique . Everything so the treatment room should have required the operating room an

surgeon must master strict surgical aseptic technique .

2 soft tissue from acupuncture , although minimally invasive surgery , but already have a functional surgery , patients w

have skills in addition to acupuncture practices , but also must be familiar with modern medical knowledge of local hu

anatomy , physiology, pathology and histology , must have a certain surgical techniques and imaging foundation , espe

orthopedic surgery basic knowledge and techniques.3 For soft tissue invasive , the treatments in , the doctor in addition to their own have the medical knowledge and surg

experience , patient treatments parts feel a doctor treatments ways a very important indicator , if required to success

complete the surgery , doctors between the patients with essential .

4 . Precise soft tissue biggest feature of minimally invasive surgery , treatments that doctors must confirm the diagnos

clear the site , a clear pathological changes, specifically the treatments , explicit avoidance method and the adjacent k

organizations to achieve the purpose of the treatments , except otherwise affect its therapeutic effect, will cause

unnecessary damage , worse postoperative complications.

5 minimally invasive soft tissue and reduce the high stress fibers

Muscles pulling on the normal development of bones is important. 1892 Julius Wolf (Julius wolff 1836 - 1902 year) ma

classic formulation , forming the famous Wolf 's Law: "Every change in bone morphology and function , or just each fuis a variation on them, inevitably followed to determine the cause of the external morphology of secondary bone chan

these changes are carried out in accordance with the law of the digital . " Bosite (Basset) Wolff 's law in modern langua

will change as follows : " the existing bone morphology and composition occur automatically Fangxiang settle or

replacement work pressure along their quality based work pressure. the size of the increase or decrease in reflex . "

On the occurrence of lumbar transverse process is highlighted by the pedicle and lamina juncture outward , can be see

from the transverse abdominal muscle ossification made on the fascia, as the ribbon , thin , round and abdominal wall

First to observe differences in children and adults lumbar transverse lumbar transverse process between the five child

lumbar transverse process is basically the same , but adult lumbar transverse process , waist three longest , followed b

two, four , waist a five shortest . Well, from the physiological and anatomical point of view, the third lumbar transvers

process , unlike the first and second lumbar transverse ribs protection , but also from the fourth and fifth lumbar transprocess has ilium protection. In the tip of the third lumbar transverse process of adhering closely with many activities

trunk muscles and fascia , especially the middle of the back fascia fibers gradually gathered outside to inside cross into

bundles attached to the tip of the third lumbar transverse . It was palpable in patients using finger -touch fascia and m

fibers attached to the tip of the transverse process , feel fibers such as taut bowstring . So according to the law of

development of lumbar transverse process , anatomy and physiology Woiff law, should be considered adult third lumb

transverse process is too long because of the fascia and muscle attached to the role of high stress fiber tip formed .

Since plantar fascia calcaneal tuberosity , before the line is divided into five beams arrived at the plantar pad. Plantar p

proximal phalanx firmly fixed on the bottom , and continue with the department periosteum. In normal walking , the b

forward, toe dorsiflexion , plantar proximal phalanx plantar fascia stretch across the metatarsal heads , because this ac

plantar fascia easy to make in the beginning part of the stretch excessive stress , then the tendon the beginning part o

film caused by osteoarthritis , the formation of bone spurs .

How-ever, for such clinical symptoms caused due to high stress fibers , often surgical resection , such as the third lumb

transverse process syndrome after repeated non- surgical treatment of poor persons , the use of a surgical removal of

third lumbar transverse process -2cm, in order to reduce high stress fibers and reach the goal . Now release the needl

through the release beyond the tip of the transverse process of high stress fibers , changing the tensile stress beyond

size and location of the bone surface , reaching the same purpose and effect of surgery .

6 minimally invasive soft tissue and bone fiber tube high-pressure


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With the continuous development of soft tissue science, " fibrous tubes " More and more appear in various profession

magazines , people have recognized the " bone fiber tubes " This particular anatomical structure of the human soft tis

injury there is a very close relationships. Thus structural changes caused by entrapment syndrome is also not uncomm

Fibrous tunnel tube is composed of bone tissue and was hung on the fiber. It can be through the nerves , blood vessels

tendons and other tissues. Exists in many parts of the body . Its main function is to fix or change a direction of moveme

the tube contents , so that they take the trajectory at a fixed or moving lines , some fibrous tube also has the role of th

pulley .

First, the organizational structure of fibrous tubes

From the organizational structure of the bone fiber tubes can be divided into the bone fiber tubes , fiber tube joints , m( or tendon ) fiber tube categories.

A bone fiber tubes : the bone tissue and the crossing of the fibers. If located in the lumbar facet after the outer portio

the bone , the upper wall of the mastoid , deputy sudden inferior wall , medial wall of the former vice conflict betwee

ditch outside wall of the mastoid collateral ligament milk vice ditch fiber tube there lumbar medial branch nerve branc

through ; under the line of the sternocleidomastoid and trapezius muscle tendon and tendon in the posterior occipita

composition , there is a large pillow , the small nerves, blood vessels and the posterior occipital occipital lymph throug

tendon bow bone fiber tube ; the thoracic spine side ditch cross fiber to its previous configuration, there thoracic spin

nerve after thoracic spinal nerve medial branch through the medial branch bone fiber tubes ; the greater sciatic foram

and sacrospinous ligaments , sciatic nerve , hips moving , veins, bone piriformis and sciatic foramen obturator muscle f

through the tube and so on.Two fiber tube joint : the joint and fiber ( ligaments ) consisting pipe. Such as carpal tunnel : the carpal bones and the

transverse carpal ligament on both sides composed of fibrous bone tunnel deep flexor tendon , flexor hallucis longus t

and the median nerve , which refers to the superficial flexor tendon by means ; ankle tube: Located below the medial

malleolus of the tibia by the flexor retinaculum , the medial malleolus , talus , calcaneus , triangular ligament and tend

surrounded organize the order in which they are arranged from front to back through the tendon , flexor digitorum lon

tendon , posterior tibial artery, posterior tibial vein and the posterior tibial tibial nerve , flexor hallucis longus tendon ;

lumbar nerve branch bone fiber tube : Located between the lumbar spinal canal after outward , toward the front to th

, and the direction perpendicular to the intervertebral tube , the inner sidewall of the lower lumbar facet bone surface

the outer edge of the transverse process between the upper bound for the transverse ligament between sickle edge ,

upper edge of the lower bound of the transverse process of the lower vertebra , lateral border of the medial borderbetween transverse ligament , there dorsal branch and with line blood vessels through .

3 muscle or tendon fiber tube ( hole ) : the muscle or tendon fibers fiber tube . Supinator tube: at the top of the back o

forearm , the supinator shallow depth of two enclosed rear wall of muscle fibers deep near the ending point of the

composition, the anterior wall of muscle fibers shallow or and tendon fibers , within which there is radial nerve throug

deep branch ; lateral cutaneous nerve of arm piercing hole : arm lateral cutaneous nerve from the bottom of the radia

nerve in the deltoid point ended flat , wear triceps lateral head to the outside of the arm muscles and triceps brachiali

interval between , on the outside of the arm from the lower third of the septum piercing the deep fascia distributed in

outer side of the lower arm ; peroneal nerve behind the knee walking through the lateral sulcus , peroneus longus and

peroneus longus muscle fibers from the fibular head and neck starting formed arch ; atlantooccipital after piercing the

hole occipital nerve atlantooccipital film is like.

Two bone fiber tube contents

Most of the bone through the nerve fiber tube and accompanying vessels: such as foot tube , the dorsal branch fibrou

tubes , elbows , etc. The contents of a single organizer mostly tendon , tendon sheath , such as the palm side of the fin

and phalangeal joint board consisting of palm fiber tube flexor tendon bone through ; humeral segment large , small n

on the transverse ligament ditch its composition , there fibrous long head of biceps tendon through the tube ; content

the more complex , such as carpal bone fiber tube , in addition to nine tendons and a nerve by outside , in some cases

lumbrical tube ; nerve within the tarsal tunnel , tendons , blood vessels through ; occipital bone fiber tubes have nerve


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blood vessels and lymph nodes.

Three special structure of fibrous tube - fibrous septa

In addition to the main tube of fibrous structure composed of fiber tube part also has a memory in the fiber compartm

its purpose is to isolate the tube within the tissue . If the tube is emitted from the ankle to the deep flexor support sur

with three fibrous septa that form four fascia sheath ankle , pipe contents from different fascia sheath through ; withi

intervertebral canal , not only through the nerve root , intervertebral arterial and venous blood vessels and connective

protection , there is also the presence of fibrous septa . In the lower part of the intervertebral canal mouth with a fibro

septa , even in the intervertebral disc and facet joint capsule, the intervertebral canal mouth into the upper and lower

the tube through the nerve roots, branches and lumbar intervertebral spinal artery vein the branch , under the down tthrough the intervertebral vein branch , otherwise the upper mouth of the intervertebral canal outside a fibrous septu

between the intervertebral disc and connected to the transverse and transverse ligament , the mouth is divided into u

and lower two holes , lumbar nerve through the hole from under the root .

Fourth, clinical research

Through clinical observation, fibrous activities of high frequency content of the tube , pipe joints and bone fiber conte

lead to complicated by entrapment syndrome. If the palm side of the knuckles by the phalanx volar plate and tough

connective tissue ( finger flexor tendon sheath ) jointly surrounded by bony fibers pipes, through the flexor tendon , a

function is to protect and support the flexor tendon role in preventing muscle contraction when , a " bow hand" tendo

the finger joints . From the viewpoint of biomechanical point of view, the tendon sheath to provide a mechanical slidin

fulcrum , changing the direction of the force , which will help play a tendon sliding effect. Under normal circumstanceswall is smooth , the inner tube sliding in the tendons without any resistance. But when local damage , or systemic dise

such as : When endocrine disorders, fibrous stenosis , so that the movement of the tendon is limited clinical symptom

activity limitation . Common trigger finger , biceps tendinitis and carpal tunnel syndrome, etc, this physiological and

pathological changes in the relevant structures . Fiber tube joints : the human anatomy in many and more common cli

People have also had an earlier understanding. Such as carpal tunnel syndrome, cubital tunnel syndrome , tarsal tunne

syndrome. Reasons other than fiber tube joint fracture more easily wound injury , the anatomical structure of great

significance . On the one hand bone fiber tube is composed of joints , joint surrounding tissue, increased pressure with

pipe joints and increased contents, ganglion cyst , etc. , can lead to increased pressure within the fiber tube . On the o

hand , if uncoordinated movement in the joints , the shape and volume of the affected bone fiber tube , and secondly,

tendon fiber tube joints mostly passed . Tendon movement also provides an important factor for the pathological damthe pipe. The contents of the tube as the posterior complex fibrous tendinous arch tube , except the occipital inner lar

small nerve and occipital artery , the fiber tube within 2-3 tablets are also present lymph nodes in the normal case, pre

without any effect , occurs when the body's inner tube systemic diseases , such as influenza, female menstrual and oth

reactive lymph nodes can lead to disease , posterior bone fiber tubes due to enlarged lymph nodes , so that increased

pressure within the tube , there occipital small nerve compression clinical manifestations, some patients also appear

occipital artery compression performance , such as the occipital tenderness and so on.

Fifth, the treatment of bone fibrous tunnel syndrome

In the past to use more heat, physical therapy and other methods to partial closure in clinical achieved a certain effect

for thickening or fibrous contracture patients with pathological changes , due to ineffective therapy more often requir

use of surgical resection of fibrous tissue contractures thickening of purpose. Because of the many problems of surger

most patients is not easy to accept. By loosening the needle with a blade , needle blade through direct skin tight fibrou

tissue contracture , closed -type fibrous tissue contracture its mechanical release , in reducing bone fiber tube high-pr

, they also will not lead to a result of openness scar after surgery brings , to the physiological recovery .

Through the bone fiber tube structure, contents and function analysis, summed prone parts of clinical symptoms , help

physicians in clinical diagnosis , more accurate diagnosis of the site of the disease, improve diagnosis and treatment ef


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A soft tissue injury

In addition to the human bones, organs and other tissues outside the sensory organs are soft tissue. Soft tissue injury

disease refers to the skin, muscles, tendons, tendon sheaths, ligaments, fascia, synovium, synovial, spinal cord, periph

nerves, blood vessels and other diseases due to the injury or chronic strain occurred. Pain caused by soft tissue injury

well known worldwide, but is difficult to cure diseases. In ancient Greece, people have a soft tissue injury awareness,

Socrates once said, "to treat pain as geniuses." Ancient Western visible damage to soft tissue pain caused by attention

recognizing the complex and difficult treatment.

The first is Hegmar.Freibeg.ober.Steindier.GrateCopemar, Strong and Japan as the representative of the mountains insea of soft tissue: For chronic soft tissue injury caused pain pathogenesis, early in the twentieth century on the existen

two different points of view adhesions degeneration is the cause of pain. (Which in 1843 Fororiep that "rheumatism"

patients with muscle pain induration in 1951, Lewellym and Jones co-wrote "fibrositis" (Fibrositis) a book that fibromy

pain in the muscles and bones of the most common causes .) The second is the thirties Williem.Mixter, Verbiert fifties

considered as the representative of bone changes (osteoarthritis) is causing the pathogenesis of pain. Since then the f

course of the pathogenesis of soft tissue injury and did not have enough knowledge, reliable screening methods and

treatments have not mastered; non-surgical acute phase heat, physical therapy, massage therapy, such as the partial c

of up to a certain therapeutic purposes, but the pathological After changing the development of tissue fibrosis and sca

contracture formation to the above treatment can not be treated fundamentally recurrent symptoms. The surgery at t

waist, hip pain part in a wide range of hair, pain alone a prominent lesion surgery release, ignoring the other causes ofback pain to a lesser extent risk factors, can only alleviate the symptoms of postoperative And no cure, and the relapse

is high, so after that, on making back pain or low back pain from the perspective of the treatment of soft tissue covera

and less. Research increasingly stagnant, "soft tissue Doctrine" close to being abandoned. Since the latter can make us

ray, myelography, especially seven, eighty years later, the universal application of CT and MRI scans, objectively prove

tissue degeneration, disc herniation exist, so that people are more more attention to bone changes, combined with m

scholars in anatomy and physiology, diagnostic techniques and other aspects of the surgical procedure done a lot of

research, so that surgery achieved a certain effect, so the "bone theory" This nerve root compression caused by mech

theory of pain caused widespread international attention. From the mid-twentieth century has been in clinical occupy

major position.

With the continuous development of medicine, there have been many and "bone theory" does not match the phenomsuch as clinical: Symptoms and hyperplasia site separation; asymptomatic lumbar disc; many spinal stenosis test result

from objective indicators radiological point of view, has been more severe spinal cord compression, but the lack of any

clinical manifestations of patients; portion of objective indicators show the spinal cord, nerve roots oppressed patient

non-surgical treatment, the symptoms under control, but the spinal cord , nerve root compression phenomenon still e

many cases still postoperative pain, pain reoperation also found no reason, even if the implementation of spinal fusion

surgery, but also can not relieve persistent pain. Therefore, non-surgical therapy in the last ten years more and more

attention by people. Such as: anesthetic nerve block therapy to treat soft tissue pain; to Feng-day treatment methods

represent promising. Clinically have achieved a certain effect. Early sixties declared sting proposed pathogenesis of sof

tissue damage through a lot of pain in clinical practice known as "aseptic inflammatory lesions." After years of clinical

practice, has become one of the basic theoretical foundation of non-surgical treatment of soft tissue injury.

2 aseptic inflammation is the pathological basis of soft tissue injury

When the body is compromised, the ability to maintain its survival with two, one for self-defense capability, one for re

capacity. Inflammation is the most basic form of self-defense, which, blood vessels, nerves reaction has a close relatio

Inflammation and repair often simultaneously.

Inflammation is a nonspecific defense reaction of the body to the damage occurring factors, which aims to eliminate t

limitations or exclusion of foreign pathogenic factor and lethal cell injury when the body is compromised. Inflammatio

the blood vessel during the reaction is most sensitive, the body is stimulated, venules and capillaries change the


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permeability of the wall, so that some of the components within the plasma extravasation, the dilution factor of

inflammation, to reduce or eliminate its destructive power. While pumping blood antibodies, inflammatory mediators

conditioning factors, such as resistance against Lysozyme matter.

Aseptic inflammatory mediators occupies a very important position in the inflammatory response. Although a variety o

media, from its source can be divided into plasma, such as hormone bradykinin, complement and coagulation - soluble

system; derived cells such as histamine, 5 - hydroxytryptamine, allergic reactions and chronic substance, allergic eosin

leukocyte chemotactic factors, prostaglandins, lysosomes, lymphokines like.

According to current knowledge, almost all of these inflammatory mediators under normal conditions or in the form o

precursor, or in the inactive form. When the body is damaged or compromised, they can be quickly transformed into astrong medium vigor, its main role is to influence vasodilator prostaglandins, increased vascular permeability mainly

histamine, 5 - hydroxytryptamine, complement C3a and bradykinin; There leukocyte chemotaxis mainly complement

fragments, C3a, C5a, etc.; cause fever and heat source for endogenous prostaglandins; cause pain mainly bradykinin a

prostaglandins; major cause tissue damage is derived from the neutrophils and macrophages lysosomal enzymes. Alth

they played a very strong effect, but the body and quickly generate controlled substances, and timely process to limit

or excessive reaction, avoid excessive damage.

Pathogenesis of soft tissue injury is damage to the body by some kind of stimulation, resulting in barriers to their

surrounding tissue blood circulation, increased capillary permeability, inflammation, pain caused by substances leakin

stimulating the surrounding tissue to produce symptoms, the body appeared protective tension, more heavy blood

circulation disorder that metabolites and inflammatory mediators can not be excreted as soon as possible, over time, tformation of adhesions between organizations, degeneration, fibrosis, and eventually replaced by scar tissue.

3 Clinical application of minimally invasive soft tissue

Minimally invasive soft tissue using some means or methods of organization will loosen stuck together, to restore the

original function. This therapy in many of our subjects had reflected. As in cardiothoracic surgery, chronic constrictive

pericarditis, the pathological changes are visceral and parietal pericardium thickening due to chronic inflammatory cha

fibrous scar tissue to form a hard, parietal and visceral pericardium sticking to each other, the pericardial cavity disapp

cardiac scar tissue to be bound by the long-term, resulting in a series of symptoms. Treatment is surgical excision of

pericardial thickening of fibrous tissue, so that the heart is bound to restore the original function; obstruction of adhes

in abdominal surgery is the most common complication of abdominal surgery, surgery is required when necessary loosadhesions between organizations; bone surgery because of lower extremity fractures long brake, knee injury or

inflammation of the knee sliding device adhesions, contracture, fibrosis caused by stiff knee adhesive shall adopt the k

loose adhesions solution treatment; tendon adhesions and scar tissue trauma caused by lumbar disc herniation with n

root surrounding tissue lysis of adhesions, etc. are required to use different forms of methods to achieve relieve symp

caused by the purpose; gluteal muscle contracture is a large rotor upper gluteus medius only point cut part of the mus

and tendon tension is too high fiber and achieve their goals. As can be seen above, minimally invasive surgical techniq

disciplines has occupied a certain position. Another clinical physiotherapy, acupuncture, massage, partial closure, nerv

blocks and other non-surgical therapy treatment mechanism is relaxing its local tissue and reach the goal.

4 soft tissue minimally invasive surgery

Minimally invasive surgery is the use of soft tissue along the edge (or no edge) of the needle directly to the lesion, its

organization mechanical release, improving its pathological changes, a treatment to restore the original function of the

organization. Soft tissue is minimally invasive modern medicine, human anatomy, physiology, pathology, biomechanic

minimally invasive surgical techniques based on sets of traditional medicine acupuncture techniques featured in one o

modern medical technology. Use direct lesion of the needle blade, the treatments alter the pathological changes in th

muscles, tendons, fascia, ligaments, and other soft tissue synovial restore the normal function of the implicated parts

reach therapeutic purposes.

First, a lifting mechanism of the high stress fiber: normal development of muscles pulling the bone is important, the siz


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direction of the existing bone morphology and its components are related to stress. Due to continuous repeated static

muscle or tendon fibers to make long-term state of tension, acting on the bone surface stress generated by the ending

"osteoarthritis." Minimally invasive soft tissue can be cut beyond the bone surface or mitigate these high-stress fibers

change the direction and size of its force in parallel to achieve the purpose of lifting the cause. 2 fiber tube high pressu

reduce bone: bone fiber tubes, pipes from the bone tissue and the fibers on the rampage, said fibrous tubes. Their bo

structure can be divided into fiber tubes, joints and muscle fiber tube (or tendon) vascular three. It may have associate

blood vessels and nerves and tendons and other tissues through. Mainly from the protection and the fixed tube tissue

some reason caused by increased pressure within the tube when the tube is irritation or compression of the contents

produce symptoms. Minimally invasive soft tissue contractures can release tension by fibrous tissue tube, inner tube trelieve pressure, to achieve the purpose relieve symptoms.

3. Less pressure within the organization: from trauma or chronic fatigue so that local tissue metabolism disorder cause

compartment syndrome bone tendons, joint capsule, bursa, or increased pressure within the bone appeared a series o

clinical manifestations, can cut through local tissue lysis needle If the joint capsule, bursa, myofascial's wall to relieve

pressure within the organization, improve blood circulation local organizations to restore local tissue metabolic imbala

phenomenon, to reduce or relieve symptoms purposes. 4 lifting adhesions between organizations: due to trauma, chr

fatigue or surgery, did not receive timely treatment, the local adhesion of muscle fiber and its surrounding tissue occu

such as: between the muscles and the muscles between the muscle and bone, skin and tissue adhesion between the c

symptoms affect normal tissue function appears. By loosening reduce tissue adhesion between, to restore normal

physiological state.5. Improve local organizations aseptic inflammation: the long-term due to trauma or chronic strain, causing local tissue

blood circulation is blocked, increased capillary permeability, inflammatory pain caused by substances accumulate, for

a partial aseptic inflammation and pain symptoms. Minimally invasive soft tissue can improve local tissue metabolism

blood circulation, reduce pain caused by substances produced to promote the absorption of aseptic inflammation. Sec

the indications

Adapt to any part of the body due to the soft tissue injury or chronic strain, and local organizations have organic chang

the formation of adhesions between the soft tissue, fibrous contracture, the pressure increased, wall thickening and o

pathological changes, invalid or symptoms of repeated non-surgical therapy attack) clinical symptoms caused. 1 neck s

tissue injury caused by back pain, nerve root of some neck muscles tense as cervical dislocation caused by the emerge

the vertebral artery and clinical manifestations of sympathetic cervical spondylosis, back of the neck by loosening tightmuscles contracture , coupled with the appropriate traction bonesetting treatment.

2. Third lumbar transverse process syndrome, heel spurs, knee eminence between hyperplasia and other diseases.

3 elbows, ankles pipe, tube feet, carpal tunnel and other entrapment caused by clinical syndrome, migraine headache

tenosynovitis, shoulder and neck, lumbar nerve root entrapment in different parts of the surrounding tissue or being

squeezed due to related illness.

4 ganglion cyst, joint caused by increased pressure within the joint pain, synovitis, bursitis, muscle fasciitis caused by v

parts of the body, such as the ischial tuberosity bursitis, calcaneal tuberosity bursitis and so on. 5 by trauma, strain, loc

tissue caused by post-operative adhesions, scar. Such as tennis elbow, levator scapula injuries, and medical sequelae o

and joint diseases (arthritis, ankylosing spondylitis, gout, osteoarthritis avascular necrosis, fibrous joints stiff limbs, etc

Third, contraindications

A fever, infection patients.

2 hemophilia and bleeding tendencies or clotting mechanism.

3 exacerbation of severe visceral lesions, diabetes, mental illness.

4 physical weakness, substandard authors.

5 treatments site infection or redness, swelling, heat, pain, abscess. 6 diagnosis is not clear, cross-sectional anatomica

structures (congenital deformity or after surgery) were the treatments of complex parts, pathological changes and the


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Board. 7 treatments have important parts of neighboring organs and can not be protector.

IV Treatment

Classification of soft tissue: spinal (10%) (discectomy surgery, interventional, RF)? ? ?

A) the manner and needle treatments

A sharp separation: release pin flat blade, helical blade release pin (blade, scissors, periosteal stripping)

Needle acupuncture knife, beryllium needles, pine needles, needle blade, long circular needle, needle spatula, new ni

water knife, loosen the needle, pick needle, giant crochet, Xiaokuan needle teeth crochet, needle mirror, lily Stubbs b

improved knife

2 blunt dissection: Round release pin, flat head release pin (knife, forceps and fingers separated) dial needles, pine neebars, floating-pin, flat head release pin, round needles release

3 needle cannula release: You can select the needle core be sharp or blunt treatments according to different needs

Second) surgery in patients with orthostatic Step 1: Depending on the way the lesion and the treatments can take a di

position to operate. 2 needle positions: lesion treatments and techniques to choose the right part based on, there mu

an important part of the organization in favor clued as the needle point.

Needle 3: Using both fast and slow method, namely the needle into the skin and quickly to relieve pain, when the

subcutaneous needle blade, you need to slow the needle tip can shake around when necessary to stimulate more sen

tissue (nerves, blood vessels, etc.) to generate avoidance reflex action to reduce the unnecessary tissue damage.

4-pin edge direction: The different levels of the various parts, in order to avoid important organization in accordance w

the principle of the needle blade and tissue to the direction parallel to the order of the spinal cord, nerve roots, nerveartery, vein, muscle fiber.

Three) a longitudinal surgical dredge method: pin edge treatments and tissue fibers parallel to the direction, the adhe

between the organization and the organization's release, mainly adapted to adhesions organizations. 2 rampant lysis

method: vertical pin edge treatments and tissue fiber parts, cut tight muscle or tendon fibers. Mainly adapted to reliev

high pressure and high fiber tube bone stress fibrous tissue.

3 cutting method: pin edge of the lesion, selected according to the size of the scar tissue adhesions in different directi

and depth of the line cutting practices in order to reduce the size and extent of tissue adhesion, and promote local les

suction change. 4 transparent stripping method: needle up between the organization and the organization, the use of

needle separation of adhesions between the two organizations. This method is mainly suitable for a larger degree of

adhesion area but not severe tissue adhesions (also known as blunt dissection).

5 perforation decompression method: the needle edge of the lesion, the lesion can be punctured or myofascial wall, t

can be expanded if necessary, incision, accelerate metabolism and absorption of organizations. This method is used fo

intracapsular pressure and aseptic inflammation. D) Notes 1. Soft tissue minimally invasive surgery with the continuou

development of its basic theory and technology research, the role of acupuncture almost to lose their function, and w

replaced by closed surgical technique. Everything so the treatment room should have required the operating room an

surgeon must master strict surgical aseptic technique.

2 soft tissue from acupuncture, although minimally invasive surgery, but already have a functional surgery, patients w

have skills in addition to acupuncture practices, but also must be familiar with modern medical knowledge of local hum

anatomy, physiology, pathology and histology , must have a certain surgical techniques and imaging foundation, espec

orthopedic surgery basic knowledge and techniques.

3 For soft tissue invasive, the treatments in, the doctor in addition to their own have the medical knowledge and surgi

experience, patient treatments parts feel a doctor treatments ways a very important indicator, if required to successfu

complete the surgery, doctors between the patients with essential.

4. Precise soft tissue biggest feature of minimally invasive surgery, treatments that doctors must confirm the diagnosis

the site, a clear pathological changes, specifically the treatments, explicit avoidance method and the adjacent key

organizations to achieve the purpose of the treatments, except otherwise affect its therapeutic effect, will cause


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unnecessary damage, worse postoperative complications.

5 minimally invasive soft tissue and reduce the high stress fibers

Muscles pulling on the normal development of bones is important. 1892 Julius Wolf (Julius wolff 1836 - 1902 year) ma

classic formulation, forming the famous Wolf's Law: "Every change in bone morphology and function, or just Each func

a variation on them, inevitably followed to determine the cause of the external morphology of secondary bone change

these changes are carried out in accordance with the law of the digital. " Bosite (Basset) Wolff's law in modern languag

change as follows: "the existing bone morphology and composition occur automatically Fangxiang settle or replaceme

work pressure along their quality based work pressure. The size of the increase or decrease in reflex. "

On the occurrence of lumbar transverse process is highlighted by the pedicle and lamina juncture outward, can be seethe transverse abdominal muscle ossification made on the fascia, as the ribbon, thin, round and abdominal wall fit. Fir

observe differences in children and adults lumbar transverse lumbar transverse process between the five children of l

transverse process is basically the same, but adult lumbar transverse process, waist three longest, followed by back tw

four, waist a five shortest. Well, from the physiological and anatomical point of view, the third lumbar transverse proc

unlike the first and second lumbar transverse ribs protection, but also from the fourth and fifth lumbar transverse pro

has ilium protection. In the tip of the third lumbar transverse process of adhering closely with many activities and trun

muscles and fascia, especially the middle of the back fascia fibers gradually gathered outside to inside cross into bund

attached to the tip of the third lumbar transverse . It was palpable in patients using finger-touch fascia and muscle fibe

attached to the tip of the transverse process, feel fibers such as taut bowstring. So according to the law of developme

lumbar transverse process, anatomy and physiology Woiff law, should be considered adult third lumbar transverse protoo long because of the fascia and muscle attached to the role of high stress fiber tip formed.

Since plantar fascia calcaneal tuberosity, before the line is divided into five beams arrived at the plantar pad. Plantar p

proximal phalanx firmly fixed on the bottom, and continue with the department periosteum. In normal walking, the bo

forward, toe dorsiflexion, plantar proximal phalanx plantar fascia stretch across the metatarsal heads, because this act

plantar fascia easy to make in the beginning part of the stretch excessive stress, then the tendon the beginning part of

film caused by osteoarthritis, the formation of bone spurs.

How-ever, for such clinical symptoms caused due to high stress fibers, often surgical resection, such as the third lumba

transverse process syndrome after repeated non-surgical treatment of poor persons, the use of a surgical removal of t

third lumbar transverse process -2cm, in order to reduce high stress fibers and reach the goal. Now release the needle

through the release beyond the tip of the transverse process of high stress fibers, changing the tensile stress beyond tand location of the bone surface, reaching the same purpose and effect of surgery.

6 minimally invasive soft tissue and bone fiber tube high-pressure

With the continuous development of soft tissue science, "fibrous tubes" More and more appear in various professiona

magazines, people have recognized the "bone fiber tubes" This particular anatomical structure of the human soft tissu

injury there is a very close relationships. Thus structural changes caused by entrapment syndrome is also not uncomm

Fibrous tunnel tube is composed of bone tissue and was hung on the fiber. It can be through the nerves, blood vessels

tendons and other tissues. Exists in many parts of the body. Its main function is to fix or change a direction of moveme

the tube contents, so that they take the trajectory at a fixed or moving lines, some fibrous tube also has the role of the

pulley.

First, the organizational structure of fibrous tubes

From the organizational structure of the bone fiber tubes can be divided into the bone fiber tubes, fiber tube joints, m

(or tendon) fiber tube categories.

A bone fiber tubes: the bone tissue and the crossing of the fibers. If located in the lumbar facet after the outer portion

bone, the upper wall of the mastoid, deputy sudden inferior wall, medial wall of the former vice conflict between milk

outside wall of the mastoid collateral ligament milk vice ditch fiber tube there lumbar medial branch nerve branch thr

under the line of the sternocleidomastoid and trapezius muscle tendon and tendon in the posterior occipital bone

composition, there is a large pillow, the small nerves, blood vessels and the posterior occipital occipital lymph through


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tendon Bow bone fiber tube; the thoracic spine side ditch cross fiber to its previous configuration, there thoracic spina

nerve after thoracic spinal nerve medial branch through the medial branch bone fiber tubes; the greater sciatic forame

sacrospinous ligaments, sciatic nerve, hips moving , veins, bone piriformis and sciatic foramen obturator muscle fibers

through the tube and so on.

Two fiber tube joint: the joint and fiber (ligaments) consisting pipe. Such as carpal tunnel: the carpal bones and the

transverse carpal ligament on both sides composed of fibrous bone tunnel deep flexor tendon, flexor hallucis longus te

and the median nerve, which refers to the superficial flexor tendon by means; ankle tube: Located below the medial

malleolus of the tibia by the flexor retinaculum, the medial malleolus, talus, calcaneus, triangular ligament and tendon

surrounded organize the order in which they are arranged from front to back through the tendon, flexor digitorum lontendon, posterior tibial artery, posterior tibial vein and the posterior tibial tibial nerve, flexor hallucis longus tendon; lu

nerve branch bone fiber tube: Located between the lumbar spinal canal after outward, toward the front to the rear, a

direction perpendicular to the intervertebral tube, the inner sidewall of the lower lumbar facet bone surface and the o

edge of the transverse process between the upper bound for the transverse ligament between sickle edge, the upper

of the lower bound of the transverse process of the lower vertebra, lateral border of the medial border between trans

ligament, there dorsal branch and with line blood vessels through.

3 muscle or tendon fiber tube (hole): the muscle or tendon fibers fiber tube. Supinator tube: at the top of the back of

forearm, the supinator shallow depth of two enclosed rear wall of muscle fibers deep near the ending point of the

composition, the anterior wall of muscle fibers shallow or and tendon fibers, within which there is radial nerve Throug

deep branch; lateral cutaneous nerve of arm piercing hole: arm lateral cutaneous nerve from the bottom of the radial in the deltoid point ended flat, wear triceps lateral head to the outside of the arm muscles and triceps brachialis interv

between , on the outside of the arm from the lower third of the septum piercing the deep fascia distributed in the out

of the lower arm; peroneal nerve behind the knee walking through the lateral sulcus, peroneus longus and peroneus l

muscle fibers from the fibular head and neck starting formed arch; atlantooccipital after piercing the fascia hole occipi

nerve atlantooccipital film is like.

Two bone fiber tube contents

Most of the bone through the nerve fiber tube and accompanying vessels: such as foot tube, the dorsal branch fibrous

tubes, elbows, etc. The contents of a single organizer mostly tendon, tendon sheath, such as the palm side of the finge

phalangeal joint board consisting of palm fiber tube flexor tendon bone through; humeral segment large, small nodule

the transverse ligament ditch its composition, there Fibrous long head of biceps tendon through the tube; contents of more complex, such as carpal bone fiber tube, in addition to nine tendons and a nerve by outside, in some cases, also

lumbrical tube; nerve within the tarsal tunnel , tendons, blood vessels through; occipital bone fiber tubes have nerves

vessels and lymph nodes.

Three special structure of fibrous tube - fibrous septa

In addition to the main tube of fibrous structure composed of fiber tube part also has a memory in the fiber compartm

its purpose is to isolate the tube within the tissue. If the tube is emitted from the ankle to the deep flexor support surf

with three fibrous septa that form four fascia sheath ankle, pipe contents from different fascia sheath through; within

intervertebral canal, not only through the nerve root, intervertebral arterial and venous blood vessels and connective

protection, there is also the presence of fibrous septa. In the lower part of the intervertebral canal mouth with a fibro

septa, even in the intervertebral disc and facet joint capsule, the intervertebral canal mouth into the upper and lower

the tube through the nerve roots, branches and lumbar intervertebral spinal artery vein the branch, under the down t

through the intervertebral vein branch, otherwise the upper mouth of the intervertebral canal outside a fibrous septu

between the intervertebral disc and connected to the transverse and transverse ligament, the mouth is divided into u

and lower two holes, lumbar nerve through the hole from under the root.

Fourth, clinical research

Through clinical observation, fibrous activities of high frequency content of the tube, pipe joints and bone fiber conten

lead to complicated by entrapment syndrome. If the palm side of the knuckles by the phalanx volar plate and tough


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connective tissue (finger flexor tendon sheath) jointly surrounded by bony fibers pipes, through the flexor tendon, and

function is to protect and support the flexor tendon role in preventing muscle contraction when , a "bow hand" tendo

the finger joints. From the viewpoint of biomechanical point of view, the tendon sheath to provide a mechanical slidin

fulcrum, changing the direction of the force, which will help play a tendon sliding effect. Under normal circumstances,

wall is smooth, the inner tube sliding in the tendons without any resistance. But when local damage, or systemic disea

such as: When endocrine disorders, fibrous stenosis, so that the movement of the tendon is limited clinical symptoms,

activity limitation. Common trigger finger, biceps tendinitis and carpal tunnel syndrome, etc, this physiological and

pathological changes in the relevant structures. Fiber tube joints: the human anatomy in many and more common clin

People have also had an earlier understanding. Such as carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnesyndrome. Reasons other than fiber tube joint fracture more easily wound injury, the anatomical structure of great

significance. On the one hand bone fiber tube is composed of joints, joint surrounding tissue, increased pressure withi

pipe joints and increased contents, ganglion cyst, etc., can lead to increased pressure within the fiber tube. On the oth

hand, if uncoordinated movement in the joints, the shape and volume of the affected bone fiber tube, and secondly, t

tendon fiber tube joints mostly passed. Tendon movement also provides an important factor for the pathological dam

the pipe. The contents of the tube as the posterior complex fibrous tendinous arch tube, except the occipital inner larg

small nerve and occipital artery, the fiber tube within 2-3 tablets are also present lymph nodes in the normal case, pre

without any effect, occurs when the body's inner tube systemic diseases, such as influenza, female menstrual and othe

reactive lymph nodes can lead to disease, posterior bone fiber tubes due to enlarged lymph nodes, so that increased

pressure within the tube, there occipital small nerve compression clinical manifestations, some patients also appear oartery compression performance, such as the occipital tenderness and so on.

Fifth, the treatment of bone fibrous tunnel syndrome

In the past to use more heat, physical therapy and other methods to partial closure in clinical achieved a certain effect

for thickening or fibrous contracture patients with pathological changes, due to ineffective therapy more often require

use of surgical resection of fibrous tissue contractures thickening of purpose. Because of the many problems of surger

most patients is not easy to accept. By loosening the needle with a blade, needle blade through direct skin tight fibrou

tissue contracture, closed-type fibrous tissue contracture its mechanical release, in reducing bone fiber tube high-pres

they also will not lead to a result of openness scar after surgery brings, to the physiological recovery.

Through the bone fiber tube structure, contents and function analysis, summed prone parts of clinical symptoms, help

physicians in clinical diagnosis, more accurate diagnosis of the site of the disease, improve diagnosis and treatment eff

The second chapter in the monograph

Supraspinatus muscle sheath inflammation on a

Supraspinatus muscle is one of the most easily damaged shoulder muscles, acute exacerbation of symptoms more obv

so common in the elderly, more women than men.

Applied anatomy

Supraspinatus muscle is an integral part of the rotator cuff and deltoid has suspended the humerus and assistance out

functions, starting in the supraspinatus fossa of the scapula, through the greater tuberosity of the humerus subacromi

beyond the upper, which is closely linked tendon and joint capsule between the acromion and the supraspinatus musc

separated by the subacromial bursa, shoulder abduction is the supraspinatus tendon to the humeral head is pressed a

the glenoid fossa, the stability of the humerus, so can the deltoid rotating arm upward. When the abduction of 90 deg

below the shoulder bursa fell fully retracted. Nerve supply of the supraspinatus muscle is the scapular nerve, suprasca

nerve from the brachial plexus, 5-6 by cervical spinal nerves.

Etiology and pathology

Supraspinatus muscle is torn and degenerative rotator cuff muscles most likely to occur when the outreach arm, the

supraspinatus muscle needs to pass through the shoulder, under the narrow gap formed by the humeral head on to th

humeral head and the supraspinatus in a small muscle fiber tubes susceptible to bone squeezing or rubbing damage. O


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basis of the supraspinatus tendon strain variability, the result of minor trauma or excessive force, or local feel the wind

dampness evil, can cause tendonitis, and prone to calcification.

Clinical manifestations

Most showed a slow onset, progressive lateral shoulder pain, pain during exertion obvious shoulder abduction, humer

greater tuberosity or subacromial tenderness, when the left and right shoulder abduction to 60 degrees autonomy, du

pain and unable to continue outreach on the move, a "painful arc" phenomenon, when the supraspinatus tendon

calcification, X-ray visible locally calcification. "Pain Arc" is supraspinatus tendinitis peculiar kind of signs is the risk of

shoulder abduction yet reached 60 degrees less pain when passive abduction range to 60-120 degrees, severe pain wh

the move more than 120 degrees, but also reduce the pain and continue on the move autonomously, and thus the ran60-120 degrees this is called "painful arc."

Tendon rupture associated with acute injury affected the greater tuberosity of the humerus there was tenderness and

swelling associated with varying degrees of front joint, or bruising, pain abduction against resistance positive course fo

elderly, the supraspinatus fossa subsidence, and the emergence of a sense of subacromial snapping.

Chronic injury, slow onset, beginning only shoulder activities, especially outreach activities outside shoulder pain limite

after cold or trauma, pain can suddenly increased, severe impact on sleep and daily life, the pain may radiate to the ne

and arm. Long duration may occur disuse muscle atrophy.

Diagnosis and differential diagnosis

Under a subacromial bursitis: mainly for subacromial bursitis pain, tenderness subacromial, but shoulder abduction to

degrees, under the original shoulder tenderness obvious or disappear.2 biceps tenosynovitis: pain, tenderness to the main humeral sulcus, biceps against resistance when the elbow pain

increased.

3 periarthritis: more common in middle-aged about fifty years old, but the pain is not limited to the middle range of th

from the beginning to the entire range of motion activities both pain and local tenderness. Shoulder mobility.

4 nerve root type cervical spondylosis: Symptoms of radiation to the upper limbs, up forearms, fingers, etc., have a his

cervical disease.

Treatment Ideas

Acute phase or tendon rupture, should be fixed for the short brake and light the way with tendon topical and internal

medicine to relieve pain; For the duration of the long hair of acute or chronic strain, the choice of a closed-type releas

supraspinatus adhesions between the tendon and surrounding tissue and reduce local aseptic inflammatory stimuli; aftreatment with topical therapy and functional calcined practice.

Treatment

Position: 1) supine position, limb abduction of 60 degrees

2) patient sitting, slightly bent over, placed on the natural sagging upper thigh

Landmarks: 1cm at the subacromial

Therapeutic range: subacromial supraspinatus muscle sheath at

Tendon and Gang blade parallel to the needle, the needle body and skin subacromial vertical limb, the most obvious

tenderness at the needle, the needle edge of the capsule lesion, the patient may appear obvious soreness localized pa

stimulating needle blade and lysis of adhesions supraspinatus tendon and surrounding tissue, reducing the bursa press

promote metabolism exclusion, to be self-inductance of patients with subacromial pain relieve soreness or disappear

the needle, oppression pinhole moment, Band-Aid and topical .

Note: Note the direction of the needle blade to prevent cutting infraspinatus tendon.

Subacromial bursitis under 2

Subacromial bursitis usually caused by trauma or chronic fatigue caused by common people engaged in physical labor.

due to acute exacerbation of chronic fatigue, patients with more severe pain.

Applied anatomy

Subacromial bursa sac known as the deltoid muscle decline, can be divided into two parts under the acromion and the


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deltoid muscle, subacromial bursa located acromion, coracoacromial ligament between the supraspinatus muscle. Dec

the upper deltoid deltoid bursa located between the dead and the supraspinatus tendon, capsule after two adults is o

solution, subacromial bursa sac is the body's largest, with profits slip shoulder, reduce friction, easy strained effect. Th

bursa in the shoulder abduction can make greater tuberosity freedom of movement in the shoulder, so the activity is v

beneficial for the shoulder, called subacromial joint.

Etiology and pathology

Subacromial bursitis may be caused by direct or indirect trauma, but most of the disease secondary to soft tissue injur

degenerative changes around the shoulder joint, especially in the bursa at the bottom of the supraspinatus tendon inj

inflammation, calcium deposition common. Subacromial bursa tissue sandwiched between the acromion and the humhead, repeated friction can cause long-term damage, constantly stimulated, synovial hyperplasia, wall thickening, syno

fluid secretion, tissue adhesion, thus affecting the shoulder abduction, the lift and rotate activities.

Clinical manifestations

The main symptoms of subacromial bursitis shoulder pain, limited mobility and limitations of tenderness.

Pain can be gradually increased to at night particularly at night, can be painful wake up, when the shoulder joint pain

increased, especially abduction and external rotation of the pain were located deep in the shoulder and may involve d

outside the deltoid muscle, but also to the scapular neck, hands, etc. radiation, and when swollen bursa fluid, can caus

expansion of the shoulder profile, and the leading edge in the deltoid muscle mass to form a circular ridge, also availab

the deltoid region of the shoulder tenderness occur within range, to reduce pain, patients often make the shoulder ad

in the rotated position. With the proliferation of synovial thickening of the wall, the tissue adhesions, shoulder activitydecreased, late shows shoulder muscle atrophy.

Diagnosis

A shoulder strain or partial history of trauma often

The following two shoulder continuity dull, increased activity, when the most obvious shoulder abduction

3 tenderness in the shoulder, shoulder, large nodules, etc., often with the rotation of the humerus and displacement.

4 shoulder shape than the bulging, exists in the outer end of the shoulder tenderness, a sense of volatility

5 shoulder abduction test positive, subacromial pain is positive, active or passive abduction.

6 X-ray examination: no abnormal changes in general, and sometimes see the shadow round the shoulders of increase

density, swelling of the bursa of late calcification shadow of the supraspinatus muscle.

7 Early shoulder swelling, pain refused to press, especially night pain, local swelling palpable sense of volatility. Seen inlate shoulder soreness, pain worsened after exertion, chills thermophilic, lassitude, palpable mass of soft.

Differential Diagnosis

A shoulder joint tuberculosis: the latter local pain, often accompanied by fever, night sweats, weight loss, anemia, sho

muscle atrophy, multi-functional activity limitation, erythrocyte sedimentation rate, decreased hemoglobin, X-ray sho

bone destruction, joint space

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