颈腰痛杂志2008年第29卷第6期TheJournalofCervicodyniaandLumbodynia2008,Vol.29No.6···腰椎间盘突出症(Lumbardischerniation,LDH)是骨科临床常见病和多发病,而腰腿痛是LDH患者寻求医学治疗的最主要的原因,也是脊柱疾病中研究最多的课题,其分型方法颇多,本文就其各类分型进行分析,并探讨其临床意义,以期提高临床诊疗水平,为临床工作者提供参考。1中医辨证分型腰椎间盘突出症属中医“腰腿(脚)痛”、“偏痹”范畴。历代医家根据自己的临床经验对其分型,论述不一。《诸病源候论·腰脚疼痛候》指出:“肾气不足,受风邪之所为也,劳伤则肾虚,虚则受于风冷,风冷与正气交争,故腰脚痛。”《普济方·身体门》亦曰:“夫足少阴肾之经也,属于腰脚而主于骨,足厥阴肝经也,内血而主于筋。若二脏俱虚,为风邪所乘,搏于经络,流于筋骨,故令腰脚疼痛,筋脉挛急,不得屈伸也。”说明腰椎间盘突出症与肝肾亏虚、劳损及风寒侵袭等有关,可以看出众多医家已经针对上述原因分型治之。张崇辉[1]将腰椎间盘突出症分为血瘀型、湿热型、风寒型、肾虚型四型辨证论治。陈虹[2]则将其分为血瘀型、寒湿型、虚损型三证辨证治疗。黄锦芳等[3]将LDH分为三型六亚型辨证治疗,即气滞血瘀(瘀阻偏重、血瘀生热)、虚损劳伤(元气偏虚、肝肾偏虚)、寒凝湿滞(寒凝偏重、湿滞偏重)。《中医病证诊断疗效标准》[4]将腰椎间盘突出症规范为血瘀型、寒湿型、湿热型、肝肾亏虚型。而《中药新药临床研究指导原则》第三辑[5]约定的证型有血瘀证、寒湿证、湿热证和肾虚证。Cateninsignalsregulatecellgrowthandthebalancebetweenprogenitorcellexpansionanddifferentiationinthenervoussystem[J].DevBiol,2003,258(2):406-418.[8]ChennA,WalshCA.Regulationofcerebralcorticalsizebycontrolofcellcycleexitinneuralprecursors[J].Science,2002,297(5580):365-369.[9]WexlerEM,GeschwindDH,PalmerTD,Lithi-umregulatesadulthippocampalprogenitordevelopmentthroughcanonicalWntpathwayactivation[J].MolPsychiatry,2007,13(3):285-292.[10]邢雪松,吕威力.wnt-1在大鼠缺血再灌注海马组织内源性神经干细胞早期增殖分化中的作用[J].中国组织工程研究与临床康复,2007,3(11):412-414.[11]WangXL,YangYJ,XieM,etal.Prolifera-tionofneuralstemcellscorrelateswithWnt-3proteininhypoxic-ischemicneonateratsafterhyperbaricoxygentherapy[J].Neu-roreport,2007,18(16):1753-1756.[12]MuroyamaY,KondohH,TakadaS,Wntpro-teinspromoteneuronaldifferentiationinneu-ralstemcellculture[J].BiochemBiophysResCommun,2004,313(4):915-921.[13]YinZS,ZhangH,HuaXY,etal.Wnt-3aproteinpromoteneuronaldifferentiationofneuralstemcellsderivedfromadultmousespinalcord[J].NeurolRes,2007,245(4):653-655.[14]HaydenMA,AkongK,PeiferM,NovelrolesforAPCfamilymembersandWingless/WntsignalingduringDrosophilabraindevelop-ment[J].DevBiol,2007,305(1):358-376.[15]HirschC,CampanoLM,WohrleS,CanonicalWntsignalingtransientlystimulatesprolifera-tionandenhancesneurogenesisinneonatalneuralprogenitorcultures[J].ExpcellRes,2007,313(3):572-587.[16]YuJM,KimJH,SongGS,JungJS.IncreaseinproliferationanddifferentiationofneuralprogenitorcellsisolatedfrompostnatalandadultmicebrainbyWnt-3aandWnt-5a[J].MolCellBiochem,2006,288(1-2):17-28.[17]KempCR,WillemsE,WawrzadM,etal.Ex-pressionofFrizzled5,Frizzled7,andFriz-zled10duringearlymousedevelopmentandinteractionswithcanonicalWntsignaling[J].DevDyn,2007,236(7):2011-2019.[18]LangeC,MixE,RateischakK,RolfsA.Wntsignalpathwaysandneuralstemcelldiffer-entiation[J].NeurodegenerDis,2006,3(1-2):76-86.[19]KatohM,KatohM.Notchligand,JAG1,isevolutionarilyconserved...