BACKGROUND:"Tendon off-position"is a disease name included in the International Classification of Diseases 11th Revision,and also a clinical indication of manipulation,acupuncture and other treatments.However,its specific mechanism is still unclear.It is urgent to establish an animal model that can reflect the clinical and pathological characteristics of"tendon off-position,"so as to further study the mechanism of effective clinical treatments. OBJECTIVE:To establish an animal model of"tendon off-position"in rats based on isometric contraction of skeletal muscles,and to explore the changes of skeletal muscle function and morphological phenotype after"tendon off-position." METHODS:Sixty rats were randomly divided into control group,static-loading group and extra loading group,with twenty rats in each group.Rats in the control group were kept normally without treatment.In the latter two groups,the rats were fixed by the self-made static-loading modeling device and a static-loading(the body mass of each rats was applied as the static-loading)was applied to cause sustained isometric contraction of the upper limb muscles.Then,animal models of"tendon off-position"were successfully established.In the extra loading group,50%of the body mass was added to the ankle joint after modeling.The skeletal muscle samples were harvested at 2 and 4 weeks after modeling.The changes of limb grip strength,wet mass of skeletal muscle,and serum levels of creatine kinase-muscle and lactate dehydrogenase A were measured,and the changes of skeletal muscle histomorphology and ultrastructure were observed. RESULTS AND CONCLUSION:At 2 weeks after modeling,the rats in the static-loading group and extra loading group showed significantly decreased grip strength and wet muscle mass,significantly increased serum levels of creatine kinase-muscle and lactate dehydrogenase A,and abnormal muscle fiber morphology and structure accompanied by a large number of deposited collagen fibers.Electron microscopy results showed that the structure of myofibrils was disordered,the Z-line was distorted,and the light and dark boundaries were blurred.At 4 weeks after modeling,the grip strength of the model rats was increased compared with that at 2 weeks,the serum creatine kinase-muscle and lactate dehydrogenase A levels were decreased,and the changes of muscle fiber morphology and ultrastructure were recovered to varying degrees.It is suggested that the rat skeletal muscle injury model based on continuous isometric contraction of skeletal muscle can well reflect the pathological characteristics of"tendon off-position"at 2 weeks,and can be used to study the mechanism of acupuncture and manipulation in the treatment of"tendon off-position."

Objective To systematically review the efficacy and safety of different oral Chinese patent medicines combined with conventional western medicines in the therapy of lumbar disc herniation(LDH).Methods PubMed,Embase,Cochrane Library,Medline,CNKI,WanFang data,VIP and SinoMed databases were electronically searched to collect randomized clinical trials(RCTs)on oral Chinese patent medicines combined with conventional western medicines in the treatment of LDH from the inception to April 10,2023.Two reviewers independently screened the literature,extracted data,and evaluated the risk of bias of included studies.Network Meta-analysis was then performed by Stata 17.0 and RevMan 5.4 softwares.Results A total of 26 RCTs were included,involving 16 Chinese patent medicines with a total sample size of 2 448 cases.The network Meta-analysis results showed that 13 Chinese patent medicines combined with conventional western medicines had better effects than conventional western medicines alone.Among them,in terms of a better VAS score,the top three interventions were Jingyaokang capsules+conventional western medicine＞Yaobitong capsules+conventional western medicine＞Huoxue Zhitong capsules+conventional western medicine;in terms of a better Japanese Orthopaedic Associationl(JOA)score,the top three interventions were Qufeng Zhitong capsules+conventional western medicine＞Yaobitong capsules+conventional western medicine＞Luchuan Huoluo capsules+conventional western medicine;in terms of the clinical effective rate,the top three interventions were Luchuan Huoluo capsules+conventional western medicine＞Xianling Gubao capsules+conventional western medicine＞Tongzhi Surunjiang capsules+conventional western medicine;in terms of safety,no serious adverse drug reactions occurred in all studies,and the overall incidence of adverse drug reactions in the oral Chinese patent medicines combined with conventional western medicines group was lower than that in the conventional western medicines group.Conclusion The combination of oral Chinese patent medicines and conventional western medicines has been shown to improve the clinical efficacy of LDH.Among these,Yaobitong capsules stand out for its ability to reduce VAS score,improve JOA score ranking,and increase the effective rate.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusions.

Based on the pathogenesis of “tendon off-position and joint subluxation”， combined with modern ana-tomy and biomechanics， the characteristic manifestations of “tendon off-position” and “joint subluxation” of the knee and the intrinsic connection between them are clarified. Through sorting out the relationship between “tendon off-position and joint subluxation” and knee osteoarthritis （KOA） in modern research， it is believed that “tendon off-position and joint subluxation” is the key mechanism for the occurrence and development of KOA， and accordingly， it is proposed to take the diet as the guide， use bone manipulation for external diagnosis and treatment， use traditional Chinese medicine decoction for internal treatment， and use Daoyin exercise throughout the whole process as the strategy for KOA's comprehensive traditional Chinese medicine treatment to improve the clinical effectiveness.