Luo Jianming
The main symptom of lumbar disc herniation is low back and leg pain, which can cause pain and difficulty in patients' life and work in mild cases, and loss of ability to live and work in severe cases. The United States every year due to low back and leg pain and the loss of labor to pay the medical expenses and compensation costs amounted to 50 billion U.S. dollars. Obviously the disease has become a social problem, but also an important element in our therapeutics.
"Nucleus pulposus removal", is a major means of surgical treatment of lumbar disc herniation. Undeniably, in the 60's and 70's, no less, it was a treatment that surgeons were proud of. Decades have passed, but surgeons still regard this (nucleus pulposus removal) as a family heirloom, believing that the main cause of lumbar and leg pain is the mechanical compression caused by the herniated nucleus pulposus on the dural sac and the nerve root, and therefore strive to get rid of all the evils in order to show the effect of the surgery. However, the clinical efficacy is unsatisfactory, poor surgical efficacy, sequelae, high recurrence rate, and even more unsuccessful surgery, and then the second time finally cause patients lifelong pain.
Data shows that after surgical removal of the nucleus pulposus, about 30% of patients do not have the slightest reduction in symptoms, and the condition of individual patients has worsened. If the low back pain is due to mechanical compression of the protruding nucleus pulposus, the symptoms will disappear immediately after surgical removal of the nucleus pulposus, but this is not the case, and worse, many low back pain is not due to the protruding disk compression caused by the misdiagnosis of the surgical treatment, which results in the worsening of the symptoms instead of alleviating them. A large number of facts such as these have triggered many scholars to question the pathogenesis of lumbar disc herniation causing low back pain and the theory of surgical removal of medulla oblongata to relieve low back pain. According to the American Journal of Orthopaedic Surgery, 2000 patients were followed up for 1 year, 3 years and 5 years, and the recurrence rate was 33% in 1 year after surgery; 56.5% in 3 years; and up to 76.6% in 5 years. The protruding intervertebral disk has been removed, but the symptoms recurred, which is enough to show that the nucleus pulposus removal can not lift the lumbar back and leg pain in lumbar herniation, indicating that there are other reasons for triggering the symptoms of lumbar and leg pain. Is mechanical compression of a herniated lumbar disc the underlying cause of low back and leg pain? Can surgical removal of the herniated nucleus pulposus solve the symptoms of low back and leg pain? On the clinical treatment of the relevant issues and treatment mechanism of the controversial views, to explain my views and colleagues for a discussion.
1. Is mechanical compression and irritation of the herniated intervertebral disc the main cause of low back and leg pain?
The author analyzed the treatment results of 500 patients with lumbar disc herniation diagnosed by CT and MRI treated with needle knife from 1990 to 2001, and concluded that compression and irritation of the protruding intervertebral discs are not the root cause of low back and leg pain.
1.1 Needle and knife treatment for lumbar disc herniation is not about the ability of the needle and knife to enter the spinal canal to remove or strip away the protruding intervertebral discs, but rather about loosening the soft tissues outside the spinal canal and then combining them with manipulation to restore the balance of forces in the lumbar spine. The Yellow Emperor's Classic of Internal Medicine (Su Wen) states that the human body has yin and yang and qi, and that a balance of yin and yang assists the vital qi in traveling through the fourteen meridians. If there is obstruction or overflow where the qi travels, there is an imbalance of yin and yang, resulting in disease and pain. Chinese medicine uses acupuncture and moxibustion to clear the meridians and correct the imbalance of yin and yang in order to treat disease and pain. The use of needles and knives to loosen the soft tissues outside the spinal canal and acupuncture and moxibustion to unblock the meridians can achieve the purpose of curing diseases and removing pain. This means that the main cause of low back pain is not due to mechanical compression of the protruding discs.
1.2, imaging shows: in 25 ~ 50 years of age normal male manual laborers L4 ~ 5, L5 ~ S1 interspace CT scan results, found that 45% of the people show that the lumbar disc protrusion, part of the display of the dural sac and the nerve root of the phenomenon of varying degrees of compression, but there is no clinical symptoms of lumbar and leg pain. On the other hand, some patients with lumbar herniation have CT scans showing that the herniated intervertebral discs have no compression on the dural sacs and nerve roots, but the symptoms of low back and leg pain are very obvious, which suggests that there is another reason for the low back and leg pain other than compression by the herniated intervertebral discs.
2. Is low back pain caused by mechanical compression or by sterile inflammation or chemicals?
Traditionally, the mechanism of sciatica caused by lumbar disc herniation is that the nucleus pulposus protrusion simply mechanically compresses the lumbosacral spinal nerve roots. But the clinical facts are not so.
Crarfin (1991), who raised the issue of mechanical compression of radicular pain, believed that mechanical compression is not the only factor causing pain, and reported that in four cases of radicular pain, no changes were found in the structures related to the nerve roots, and the radicular pain was gradually relieved. Xuan Hiking (1976) confirmed that compression of the nerve root by a nucleus pulposus protrusion caused neurological dysfunction by spinal canal exploration surgery without secondary, aseptic inflammatory lesions of the epidural connective tissue, depending on the degree of compression and numbness or paralysis of the lower extremities, and clinically there was no phenomenon of low back or leg pain. Only aseptic inflammatory lesions of the adipose tissue outside the nerve root sheaths can cause low back pain. In other words, the inflammatory response is an important factor in the production of severe pain directly.
How, however, is the inflammatory reaction of the nerve sheath membrane and epidural in the lumbar spinal canal generated? And how is it causally related to the herniated nucleus pulposus of the intervertebral disc? The intervertebral disc has dual innervation, its lateral part and anterior longitudinal ligament receive sympathetic gray traffic branch innervation, the posterior lateral branch and posterior longitudinal ligament receive gray traffic branch and sinus nerve dual innervation, was unevenly distributed, most of the distribution of the lateral and posterior, the region is also the intervertebral disc is vulnerable to injury sites. Histological observation of the disc's microdamage is not easy to cause inflammation and healing, as well as the disc's non-hematogenous properties also limit the inflammatory and healing response, the original poor healing leads to decreased tissue strength, repeated injury, and ultimately lead to persistent inflammation.Seal (1990) found that surgically resected intervertebral disc tissues contain increased phosphatidic acid A (PLA) content, which suggests that it is involved in the inflammatory process. This scholar further injected PLA extracted from the mesentery tissue into the hind paws of rats and induced a marked inflammatory response. It also indicated that the increased PLA in the mesentery tissue was involved in the inflammatory response. Wu Wenwen et al. (1996) measured PLA activity in medullary tissues surgically obtained from 20 patients with lumbar synostosis, and the results of the study showed that PLA activity in the medullary tissues of the patients was significantly higher than the level of PLA activity in their own blood and in the medulla of the discs of the healthy human body, and that the degree of lumbar and leg pain of the patients was significantly correlated with the PLA activity in the medulla.
The nucleus pulposus of the intervertebral disc is the largest closed structure in the body without blood transport. After the intervertebral disc herniation, the fibrous annulus ruptured, and the enzyme protein β-nerve root sheath membrane in the nucleus pulposus stroma has a strong chemical irritation, which leads to inflammatory reaction of the connective tissue in the vertebral canal and the destruction of the local tissues, so that the endogenous pain mediators are released (e.g., bradykinin, serotonin, histamine, acetylcholine, prostaglandin E1E2, and triene B4). etc.). This produces a stronger aseptic inflammatory response before mechanical compression of the nerve roots in the spinal canal impairs dysfunction, in which both non-neurogenic pain mediators and neurogenic pain substances play an important role in mediating low back pain.
Mechanical stressors can lead to neurally mediated dysfunction, which manifests clinically as sensory and motor deficits. The nerve root has no nerve periphery and is tightly wrapped in connective tissue and covered by a peripheral sheath. It has been demonstrated that nerve roots are supplied with nutrients (1) from the internal blood supply system and (2) from the cerebrospinal fluid. Nerve root capillary plasma proteins to the nerve running less than the spinal ganglion and peripheral nerves, prone to edema, especially severe lumbar disc herniation patients, compression leads to venous stasis in the spinal canal, arterial and venous short-circuits open, capillary permeability increases, nerve root edema is more pronounced, 6.7Kpa (52mmHg) compression for 2 minutes, is enough to cause edema, and then block the capillary reflux
The nerve root dystrophy and dysfunction eventually appeared, clinically manifested as paresthesia or paralysis.
According to relevant reports, it has been confirmed that patients with lumbar disc herniation have an increased content of phosphatidic acid A in the deep muscles of the lower lumbar region (spinal muscles).PLA is an inflammatory chemical analgesic substance, and in addition to the inflammatory response within the spinal canal that is involved in the formation of neurogenic pain in lumbar disc herniation, the damaging inflammatory response of the extra-vertebral soft tissues is likely to be an important factor in the initiation of lumbar and leg pain. This inflammation can lead to two secondary pathogenetic factors, low back pain and myalgias.
Taken together, these observations suggest that (1) simple mechanical compression of normal nerve roots does not cause pain but produces numbness or paralysis. (2) Chemical irritation from aseptic inflammatory lesions of the nerve root's extrasynovial and epidural adipose tissue is the cause of pain. (3) Nucleus pulposus removal does not relieve low back pain caused by lumbar synostosis. (4) The lumbar spine is the central axis of the body's lumbar activity, the support point for the lumbar forces, and plays the role of a lever as a means of maintaining the dynamic balance of the lumbar region. Medullary nucleus pulposus removal, destroying the normal structure of the lumbar spine, the small joints are destroyed, causing the force balance of the lumbar spine to be out of balance, so it is not difficult to imagine the sequelae and complications after the surgery. (5) Surgical treatment of patients with pain, medical costs are expensive, patients are not easy to accept.
To this end, the clinical treatment of lumbar synostosis should not only eliminate the inflammatory irritation of the epidural and nerve root sheath membrane of the fat tissue in the spinal canal, but also eliminate the damaging inflammatory reaction of the soft tissue outside the spinal canal, which is an important part of lifting the pain, and it must be combined with the manipulation of correcting the balance of vertebral forces, adjusting the problem of the dynamic balance of the soft tissues out of balance with the needle knife and lifting the compression on the dural sacs and the nerve roots. World Journal of Traditional Chinese Medicine and Orthopaedics, 2005, Issue 1
Luo Jianming
Atlantoaxial subluxation subluxation syndrome refers to the offset or anterior tilt of the dentate process of the central vertebrae, which results in the atlantoaxial vertebrae and the cervical vertebrae being out of alignment with the central axis of force, and straightening of the upper cervical vertebrae with the hooked vertebral joints being wrongly sewn and vertebral body rotated. Dissonance; cervical 1, 2, 3 nerve stimulation and headache, even tinnitus, blurred vision, facial paralysis; cervical sympathetic ganglion stimulation and throat discomfort, chest tightness, nausea, or insomnia, amnesia, a series of symptoms and signs.
The recognition of this disease is still a recent thing, in the past, most of the above symptoms will be categorized as vertebral artery-type cervical spondylosis. Because it is believed that atlantoaxial joints are asymmetric and can have anatomical variations, most radiographs of the cervical spine ignore the open position and fail to observe the atlantoaxial joints.
China's famous chiropractic expert Wei Yizong first in his edited "Chinese Dictionary of Orthopedics and Traumatology", will be included in this disease ①; and in the book "Modern Chinese Orthopedics", the diagnostic basis of this disease and diagnostic typing ②. The diagnostic basis is as follows:
Diagnostic basis: the patient has cephalic and facial symptoms such as posterior occipital discomfort, dizziness and headache, or migraine, and azimuthal vertigo, and the X-ray film shows that the open-mouth position of the dentate process is skewed or tilted anteriorly; lateral positions C1, 2, and 3 are angularly rotated, and there is a change in the neck curvature, and localized pressure and pain in the atlantoaxial point of the lateral deviation (i.e., the two Wind Pool points are asymmetrical) can be felt by palpation.
Subtypes:
1) Lateral deviation type: X-ray open-mouth position of the odontoid process offset, atlantoaxial rotation; lateral film C2, 3 after the angular, cervical curvature change is not big, the neck movement is normal.
2) Anterior tilt type: X-ray of the dentate process in the open mouth position is anteriorly tilted, atlantoaxial pivot is posteriorly tilted, and bilateral signs are seen; the neck curvature is increased in the lateral position, and the C2 and 3 are in the form of a step, with limited flexion and extension of the neck, and rotation is still possible.
3) Mixed: This refers to the coexistence of anterior tilt and lateral deviation.
Therapies:
Pan Donghua et al. (3) reported that according to the atlantoaxial typing and dialectic treatment of atlantoaxial stitches, according to the changes in the cervical spine Zhangkou position X-ray film, the atlantoaxial stitches are divided into lateral deviation and anterior tilt type, the treatment method: first of all, the tendon management techniques, atlantoaxial stitches should not be for the cloth bib traction, the first cream (medicine ironing), the bone empty needle pressure to the tendon management and relaxation of the tendons, after 3-5 days of osteopathic method. Osteopathic method: it is appropriate to dialectic treatment, lateral deviation type: the operator with the left elbow to lift the patient's jaw (light lifting), the right thumb, index finger two fingers were placed on both sides of the atlantoaxial (equivalent to the Fengchi point), the line wants to close the first away from the manipulation of the rotary reset, anterior tilt type: the operation is the same as the above, but the thumb pressure on the second cervical vertebral spinous processes, repeated 2~3 times. Treatment results of this group of 67 cases, are clinically cured, the shortest duration of 5 days, the longest one month, an average of 2 weeks, the effect is remarkable. The authors emphasize that the diagnosis of atlantoaxial subluxation with the Weiss radial artery test has an accuracy rate of 100%.
Ge Bing et al. ④ reported on the comparison of the efficacy of different osteopathic manipulative techniques in the treatment of atlantoaxial joint disorders. Methods: 52 cases of atlantoaxial joint disorders were randomly divided into two groups, and were treated with the Zhengfu manipulative technique under traction (27 cases) and the traditional cervical spine rotational localization wrenching method (25 cases), and the efficacy of the two groups was observed. The results suggested that the therapeutic effect of the Zhengfu manipulation under traction was better than that of the cervical spine rotation and positioning wrench (P<0.05).
Locke Dafu et al. ⑤ reported the use of supine dialing and stretching rotation method for the treatment of atlantoaxial vertebral subluxation, method: the patient lies on his back with a thin pillow on his neck, and firstly, he performs the pressing, kneading, and pointing maneuvers on his neck, focusing on the acupoints of fengchi, tianzhu, dummy door, xuanming, and shanjing, so as to make the muscles of the neck fully relaxed, and then he goes to the pillow, and then the medical practitioner fixes one hand's thumb on the patient's crooked transverse process, and one hand holds down the mandible, and then pulls and pulls and rotates the patient in a direction of the longitudinal axis. Extension traction side rotation, so that the patient's shoulders and the bed edge is basically flush, head and neck level slightly below the level of the bed 30 degrees, and then gradually increase the angle of rotation, the first healthy side of the spin to the extreme, slightly increase the strength of the staccato, followed by the affected side of the spin to the extreme, but also slightly force staccato, if you feel under the hands of the sense of movement or thumping sound, and the patient's self-awareness of the symptoms to reduce the head and neck rotation, that is, said to be the success of the reset. 1 ~ 2 days 1 time, with 5 ~ 8 times. 1~2 times a day, with 5~8 times. Results: 120 cases in this group, 88 cases were cured, 22 cases were effective, 7 cases were improved, 2 cases were ineffective, 1 case was deteriorated, and the total effective rate was 97.5%.
Yao Xinmiao et al. (6) used manipulation with traditional Chinese medicine to treat atlantoaxial misalignment, method: manipulation: the patient takes a low seat, the neck is naturally relaxed, the doctor stands behind the patient, first presses, kneads, pushes, rolls the method of the neck to make the muscles around the neck fully relaxed, and then presses the Fengchi points on both sides. Atlantoaxial dislocation to the right, the operator to the left forearm around the patient's jaw, the right hand to support its needle, along the cervical spine physiological bending arc of the direction of the lifting and traction for 1 to 3 minutes, in order not to exacerbate the degree of the original symptoms, and then the right hand thumb thumb pressed on the patient's cardinal vertebrae spinous process, hands cross force, often can be heard clicking sound, according to the cardinal vertebrae spinous process of the thumb often feel a sense of misalignment of the falling space. Then the operator changed to use the right hand to embrace the patient's jaw, with the left thumb to press the patient's atlantoaxial transverse process on the right side of the atlantoaxial vertebrae, in the same way to the right to rotate, after the operation, the neck around the line of myofascial manipulation, to alleviate the spasm of the soft tissues, adhesions. Then X-ray radiographs were taken to check the reset situation, and if it was not ideal, it was done once every other day. And use the basic formula, drug composition: raw astragalus 30g, angelica 12g, Pueraria lobata 20g, chuanxiong rhizome 30g, xuanhu 10g, tianma 15g, hook vine 12g, dilong 30g, zejia 20g, licorice 6g. add and subtract according to the symptom: at the beginning of the disease, there is a clear history of trauma, plus safflower, wulingzhu; recurrent episodes, the disease for a long time in-depth, depletion of qi and blood, liver and kidney deficiency, plus Codonopsis pilosulae, chickweed vines, duchenne, cornelian cherry blossom. Results: 87 cases in this group, 38 cases were cured, 28 cases were effective, 14 cases were effective, and 7 cases were ineffective.
He Zongbao (7) use of cervical spine positioning oblique trigger treatment of atlantoaxial spine syndrome, method: in the occipital part of the line of one-finger Zen push method, kneading and pressing the wind pool, Fengfu, day, dialing the pressure and pain points to the side of the main disease. Diagonal wrench technique: the doctor stands behind the patient, with the left thumb on the top of the right spinous process, the right hand holding the jaw, so that the patient's head and neck to maintain a slightly forward position, the two hands relative to the slow force to the right upward rotation, at this time, more than the feeling of the thumb joints under the thumb to move, and can be heard to ringing sound. Postoperative has not been corrected can be repeated 1 time head row five fingers to take, please knock method. Once a day, 6 times for 1 course of treatment. Combined with acupuncture silk bamboo air through rate valley, wind pool, external customs. Results: observation of 150 cases in 120 cases cured, effective 30 cases.
Liao Shanjun (8) used acupuncture as the main treatment of atlantoaxial joint disorders 184 cases, another 181 cases of Western medicine control group. Results: 98.4% of the total clinical effectiveness of the treatment group, the control group was 30.9%, the treatment group efficacy is significantly better than the western medicine group (P & lt; 0.01)
Xu Shunpei et al. reported that acupuncture and treatment of atlantoaxial misalignment of the atlantoaxial joints, 19 patients with acupuncture Fengchi (double), Fengfu, mute door, Tianzhu (double), after the Creek (double) combined with occipitomandibular distraction side wrenching method of reset treatment. Results: 13 cases were cured, accounting for 68.4%; 6 cases were effective, accounting for 31.6%; the total effective rate was 100%. It is believed that acupuncture with massage techniques for the treatment of this disease can activate blood circulation and eliminate blood stasis, relieve spasm and pain, rectify the wrong shift, the therapeutic effect is remarkable; also emphasized that after healing the disease should be maintained in the correct position of the sitting and lying posture, in order to consolidate the efficacy of the treatment and prevent recurrence.
Yang Yougang et al12 synthesized domestic and international literature on atlantoaxial dislocation caused by congenital, traumatic and pathologic atlantoaxial joints, and concluded that atlantoaxial instability and dislocation are more common in the clinic, which can easily lead to upper cervical spinal cord compression, whose clinical manifestations include occipitocervical symptoms (such as occipitocervical pain and limited cervical rotational activities); and some of the patients have spinal cord compression manifestations (such as weakness of the limbs, unstable walking, numbness, pain, and sensory hypersensitivity, pain, and pain, and the ability to feel the pain). Some patients have spinal cord compression (e.g. limb weakness, walking instability, limb numbness, pain, and sensory hypersensitivity, hand fine motor disorder, etc.) and vertebral artery-type cervical spondylosis (e.g. vertigo, visual blurring, sudden collapse). Open radiographs can clarify the shape of the odontoid process and whether the odontoid process is symmetrical with the atlantoaxial quickspacing. Lateral cervical radiographs mainly measure the atlantoaxial distance (ADI), which is 3 mm in normal adults, and if it is greater than this value, atlantoaxial instability or subluxation can be diagnosed. Surgical methods for atlantoaxial instability and dislocation include atlantoaxial implant fusion, wire fixation, internal fixation with wrench clamps, internal fixation with articular screws and atlantoaxial pedicle screw fixation, simple atlantoaxial implant fusion, internal fixation with odontoid screws, screw fixation with transaxial atlantoaxial lateral block, and internal fixation with atlantoaxial steel plate via oropharyngeal anterior approach.
Yang also pointed out that the various surgical approaches have drawbacks and have not achieved fully ideal physiologic requirements. That is, simple decompression and repositioning cannot correct atlantoaxial instability, and although internal fixation can stabilize the atlantoaxial joint, it loses the motion function of the atlantoaxial joint, which leads to obvious limitation of head and neck activities, especially rotational activities, and thus secondary degeneration and instability of the upper and lower joints. Moreover, the atlantoaxial spinal decomposition has a special structure, the adjacent structures are complex, and there are important nerves and blood vessels in the surrounding area, so the surgery is difficult and high risk.
Attention to manipulative treatment:
Atlantoaxial subluxation manipulation needs to be very careful. In particular, the rotary method or oblique trigger method, need to pay special attention to, otherwise easy to cause atlantoaxial or dentate fracture, dislocation, complicated medulla oblongata injury, the lesser paraplegia, the more serious can lead to death. It has been reported that the use of oblique wrenching method leads to atlantoaxial subluxation, resulting in paraplegia and death, and dentate fracture is reported in 5 cases.10 11 Therefore, in the "Chinese chiropractic treatment norms" formulated by the World Federation of Orthopedic Associations, it is clearly stated that rotational method should be used with caution for atlantoaxial subluxation, and the oblique wrenching method is prohibited for cervical spondylosis12 , which is a lesson learned in the process of diagnosis and management of the syndrome. Therefore, clinicians should pay attention to the standardization of treatment when applying manipulation in the treatment of this disease.
References:
1) Wei Yizong, Dictionary of Chinese Orthopedics and Traumatology, Beijing: China Traditional Chinese Medicine Publishing House, 2001: 576
2) Wei Yizong, Modern Orthopedic Medicine of Traditional Chinese Medicine, Background: China Traditional Chinese Medicine Publishing House, 2004: 806-809
3) Pan Donghua, Wei Chunde, et al. Diagnostic typing and dialectical treatment of atlantoaxial subluxation. diagnostic typing and dialectic treatment. World Journal of Orthopedics and Traumatology of Traditional Chinese Medicine, 2001,2(3) 77-78
4) Ge Bing, Jin Yi, Wang Yao, Pan Chonghai. Comparison of the efficacy of different osteopathic maneuvers in the treatment of atlantoaxial joint disorders. Shanghai Journal of Traditional Chinese Medicine, 2000,34(11)30-31
5) Luo Dafu, Wu Xiangguang. Observation on the efficacy of 120 cases of atlantoaxial subluxation treated by supine dial extension and rotation method. Massage and Guidance, 2000,16(6)39
6) Yao Xinmiao, Gao Hong. Clinical analysis of the treatment of atlantoaxial subluxation by manipulation with traditional Chinese medicine. Chinese Orthopedic Injury, 2002,15(5)309
7) He Zongbao. Cervical positioning oblique wrench for the treatment of atlantoaxial syndromes in 150 cases: a preliminary study. Acupuncture Research, 1998,23(3)208
8) Liao Shanjun. Observation on the efficacy of acupuncture-based treatment of 184 cases of atlantoaxial joint disorder. Chinese Acupuncture and Moxibustion, 2000,20(11)655-656
9) Xu Shunpei, Chai Tieqi. Clinical observation on 19 cases of atlantoaxial misalignment treated with acupuncture and push. Heart of Chinese medicine, 2001,33(5)42-43
10) Yuwu Aw, A case report of paraplegia caused by strong oblique pulling, Massage and guidance, 1992,1(43)
11) Daogui Wu et al. Four cases of dentate fracture caused by massage, Chinese orthopedics and injuries, 1994 Supplement
12) Yougang Yang, Zhengxue Quan. Progress in the diagnosis and treatment of atlantoaxial instability and dislocation[J]. Journal of Neck and Low Back Pain, 2005,26(3):230-232.
13) Chinese bone-setting method of chiropractic treatment diagnosis and treatment standard, China Traditional Chinese Medicine Newspaper, 2004,8,9 Engaged in pediatrics medical treatment, teaching, scientific research for 21 years, specializing in children's hematological system diseases and oncological diseases, scientific research direction: glucose-6-phosphate dehydrogenase deficiency detection and hemolytic mechanism, scientific research achievements: glucose-6-phosphate dehydrogenase deficiency detection and hemolytic mechanism. Scientific research achievements: development and application of glucose-6-phosphate dehydrogenase test paper, which has been popularized and used for more than 200,000 cases in more than 10 provinces, won the Second Prize of Guangxi Scientific and Technological Progress and the Second Prize of Guangxi Medical and Health Scientific and Technological Progress in 1997, and was awarded the honorary title of the First Guangxi Outstanding Youth Scientific and Technological Entrepreneurship Prize in 98 years. Main papers: "Clinical and experimental diagnosis of hemoglobin H disease and glucose-6-phosphate dehydrogenase deficiency Chinese Hematology 1991;12(11):578"; "Influence of the average hemoglobin concentration of red blood cells on the reduction test of methemoglobin Chinese Journal of Hematology 1992;13(10):547"; "Re-improvement of the methemoglobin reduction test Chinese Hematology Journal 1998;19(10):548''; ''Determination of maternal and neonatal G-6-PD activity by the test paper method Chinese Pediatric Blood 1996;(2):75''; ''Characteristics and application of G-6-PD test paper Chinese Pediatric Blood 1998;(3):134''.