Objective
To evaluate the clinical effects of surgical treatment for 30 patients with discogenic low back pain.
Methods
A total of 30 patients with 36 intervertebral discs were treated with posterior approach lumbar discectomy and interbody fusion with internal fixation by strict criteria. All patients were followed up for one year. The low back pain before and one year after surgery was evaluated by Japanese Orthopaedic Association (JOA) score and Visual Analogue Scale (VAS) score.
Results
The patients’ JOA score increased from 14.6±2.3 (before operation) to 27.1±0.9 (one year after operation) (t=–26.936, P<0.001), while the patients’ VAS score decreased from 6.2±1.6 (before operation) to 1.4±0.9 (one year after operation) (t=16.335, P<0.001), and the differences were significant.
Conclusion
When the conservative treatment is invalid, the operation of posterior lumbar intervertebral fusion is an effective method for the patinets with discogenic low back pain.
Objective To evaluate whether minimally invasive (MI) cardiac surgery has advantages over conventional median sternotomy (MS), so as to provide evidence for clinical diagnosis and therapy. Methods We searched CBM, VIP, CNKI, PubMed, and Elsevier databases from 1995 through 2008. The literature about the therapeutic effect of minimally invasive cardiac surgery and conventional median sternotomy was identified. The data was extracted, and the methodological quality was evaluated by two reviewers independently. The Meta-analyses were performed using RevMan 4.2 software. Results A total of 8 studies involving 492 MI patients and 712 MS patients met the inclusion criteria. Of these eight studies, two studies were randomized trials and the other six studies were retrospective cohort studies. The results of meta-analyses showed that the MI group had a better postoperative effect, and the cardiopulmonary bypass time (WMD=16.45, 95%CI 2.56 to 30.35, P=0.02), chest-tube drainage (WMD= –132.63, 95%CI –208.53 to –56.72, P=0.0006) and hospitalization stay (WMD= –1.22, 95%CI –2.14 to –0.30, P=0.009) of MI group were less than those of MS group, but the aorta clamping time (WMD=0.47, 95%CI –1.35 to 2.29, P=0.61) and operating time (WMD=26.67, 95%CI –8.91 to 62.25, P=0.14) were not significantly different between the two groups. Conclusion The minimally invasive cardiac surgery has a better postoperative therapeutic effect than conventional median sternotomy cardiac surgery.
Objective To investigate the treatment methods and the cl inical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy. Methods A retrospective analysis was performed in 18 patients (10 males and 8 females, aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008. The disease duration was 10-26 months (mean, 15.6 months). All patients had single vertebral hemangioma, including 2 cases at C3, 3 cases at C4, 5 cases at C5, 5 cases at C6, and 3 cases at C7. The X-ray films showed a typical “pal isade” change. According to the cl inical and imaging features, there were 13 cases of type II and 5 cases of type IV of cervical hemangioma. The standard anterior cervical decompression and fusion with internal fixation were performed and then percutaneous vertebroplasty (PVP) was used. The cervical X-ray films were taken to observe bone cement distribution and the internal fixation after operation. The recovery of neurological function and the neck pain rel ief were measured by Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Results All operations were successful with no spinal cord and nerves injury, and the incisions healed well. Anterior bone cement leakage occurred in 2 cases without any symptoms. All cases were followed up 24-28 months (mean, 26 months) and the symptoms were improved at different degrees without fracture and collapse of vertebra or recurrence of hemangioma. During the follow-up, there was no implant loosening, breakage and displacement, and the mean fusion time was 4 months (range, 3-4.5 months). The JOA score and VAS score had a significant recovery at 3 months and at last follow-up when compared with preoperative values (P lt; 0.05). Based on JOA score at last follow-up, the results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Conclusion The anterior cervical decompression and fusion with internalfixation combined with PVP treatment is one of the ideal ways to treat symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy, which could completely decompress the spinal cord and effectively alleviate the cl inical symptoms caused by vertebral hemangioma.
ObjectiveTo compare the clinical results of throacolumbar fractures treated through Wiltse paraspinal approach and conventional posterior approach.
MethodsSeventy-six cases of single segmental thoracolumbar fractures (Type A) were treated by posterior reduction and pedicle screw instrumentation from January 2011 to January 2013. Thirty-five cases were treated through Wiltse paraspinal approach (group A), including 27 males and 8 females with an average age of 39.7 years. Forty-one cases were treated through conventional posterior approach (group B), including 30 males and 11 females with an average age of 41.6 years. The data including incision length, operation time, intraoperative blood loss, postoperative volume of drainage, the anterior vertebral height, Cobb angle and complications were compared between the two groups.
ResultsAll operations were finished successfully. The incision length, operation time, intraoperative blood loss and postoperative volume of drainage were (8.3±1.9) cm, (74.0±21.9) min, (125.0 ±46.7) mL, and (51.0±42.6) mL respectively in group A, and (10.7±2.8) cm, (97.0±18.2) min, (245.0±56.1) mL, and (190.0±72.3) mL in group B respectively. There was significant difference between the two groups (P<0.05). The restoration of anterior vertebral height and the correction of Cobb angle were well maintained in both groups. The difference was statistically significant before and after treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no difference in the complication rate between the two groups (P>0.05).
ConclusionCompared with conventional posterior approach, Wiltse paraspinal approach has the advantage of shorter operation time, less trauma and blood loss. It is a better option for the treatment of throacolumbar fractures.
Objective To evaluate the preliminary the therapeutic effect of the aortic proximal anastomosis device applied in coronary artery bypass grafting (CABG), and further to assess its safety and feasibility. Methods From January 2006 to May 2007， 50 patients underwent CABG were received the aortic proximal anastomosis device ［Novare Enclose Ⅱ device (Novare Surgical System, Cupertino, CA)］, in which 16 were underwent in onpump CABG and 34 in offpump CABG(OPCAB). The age was 56.2±18.7years(from 55 to 80 years), and there were 38 males and 12 females. Preoperative complications included hypertension in 28 cases, diabetes in 17 cases, old myocardial infarction 18 cases and old cerebral infarction in 15 cases. A total of 175 proximal anastomoses were performed (3.2±1.3), among which there were 152 vein, 12 free left internal mammary artery (LIMA) and 11 radial artery anastomoses. Results Intraoperative transient graft flow meter revealed a satisfactory blood flow. There were no device related complications, and there was no hospital death. 2 cases needed chest re-exploration for hemostasis, 2 cases needed tracheostomy for respiratory insufficiency, and 1 case needed hematodialysis for renal inadequacy caused by diabetic nephropathy. All this 5 patients got recovered and discharged after active treatment. There were no cerebra related complications and no severe cardiac accidents. Follow-up 1 to 3 months after surgery via telephone or letter revealed a 100% survival rate and a 100% exemption rate of cardiac accident. Conclusion Preliminary clinical application of the Novare Enclose Ⅱ device is safe and efficient, but its middle and longterm effect remains to be further observed.
Objective To study the indications, methods, and therapeutic effect of absorbable rib-connecting-pins fixation in the treatment of multi ple rib fractures. Methods Between March 2007 and September 2009, 40 patients with multiple rib fractures received internal fixation with absorbable rib-connecting-pins, including 8 one-side flail chest and 1 twoside flail chest. There were 32 males and 8 females with an average age of 39.8 years (range, 25-72 years). The injury was caused by traffic accident in 32 cases, fall ing from height in 6 cases, and blunt hitting in 2 cases. Preoperatively, imaging data of the chest X-ray or spiral CT three-dimensional (3D) examination showed that all patients had multiple ribs fractures and displacement. The number of fractured ribs was 4-10 (median, 6), and the fracture location ranged from the 2nd to the10th ribs. Of them, 28 cases were accompanied by hemathorax, pneumathorax or hemopneumothorax; 5 cases by thoracic organ injury; and 10 cases byother part trauma. The time from injury to hospital ization was less than 1 day in 26 cases, 1-3 days in 12 cases, and 3-6 days in 2 cases, and the time from hospital ization to operation was 3 hours to 3 days (mean, 1.2 days). Results The median fixation rib number was 5 (range, 3-8). The mean operative time, the time in bed, and hospital ization days were 32 minutes (range, 15-50 minutes), 4.5 days (range, 2-7 days), and 11.2 days (range, 5-18 days), respectively. All incisions healed by first intention. No pulmonary infection, pulmonary atelectasis, intrathoracic infection or other compl ications occurred. All cases were followedup 6-12 months (mean, 8 months). PaO2 [(86.6 ± 2.2) mmHg (1 mm Hg=0.133 kPa)] and SpO2 (97.2% ± 0.6%) at 2 hours after operation were obviously improved when compared with preoperative ones [PaO2 (53.6 ± 4.7) mm Hg and SpO2 (86.2% ± 1.8%)], showing significant differences (t=2.971, P=0.005; t=2.426, P=0.020). The chest X-ray films or spiral CT 3D indicated that fracture of rib healed within 3-6 months (mean, 4.5 months) after operation. Conclusion Severe collapsed chest wall orflail chest caused by fracture of multiple ribs should be treated by absorbable rib-connecting-pins, which is a simple, firm, and effective method.
OBJECTIVE: To evaluate the therapeutic effect of amniotic membrane transplantation(AMT) for ocular burn. METHODS: Twenty patients with ocular burn(28 eyes) were treated with amniotic membrane transplantation. Of them, there were 6 cases of severe alkali burn(10 eyes), 8 cases of severe acid burn(10 eyes), and 6 cases of thermal burn(8 eyes). RESULTS: In 28 eyes, ocular inflammation was controlled after 3-7 days of surgery; no continued dissolution, perforation and iris atrophy were found. There were corneal transparency in 16 eyes, keratoleukoma in 4 eyes, and total corneal opacity in 8 eyes. All eyeballs were saved and had stable ocular surface. There was no allograft immune rejection and secondary infection. CONCLUSION: Amnitic membrane transplantation can relieve the inflammatory reaction, reduce the growth of blood vessel and restrain the proliferation of fibrous tissue. It is an effect surgical method for ocular burn in reconstruction of ocular surface and salvage of eyeball.
Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
Objective
To observe the treatment efficacy and safety of glucosamine hydrochloride tablets on uremia patients with knee osteoarthritis (OA).
Methods
A total of 118 uremia patients with knee OA were selected and randomly divided into the glucosamine hydrochloride tablets treatment group (treatment group) and the coated aldehyde oxystarch capsules group (control group) with 59 cases in each group. The course was 8 weeks. The Lequesne Index was assessed for curative effect evaluation, and the change of blood indexes was observed to evaluate drug safety.
Results
The total effective rate of Lequesne Index in the treatment group was 72.9%, while that in the control group was 13.6%; the difference was statistically significant (χ2=42.303, P<0.001). There was no significant change in the two groups before and after treatment in terms of the patients’ dialysis adequacy, routine blood, blood electrolytes, liver and kidney function (P>0.05).
Conclusion
Glucosamine hydrochloride tablets is curative and safe in the treatment of uremia patients with OA.
ObjectiveTo investigate the efficacy of macrolide antibiotics on patients with lower respiratory tract infection.
MethodsA total of 146 patients with lower respiratory tract infections were selected from January 2011 to January 2014 in the Department of Respiratory Medicine of our hospital and divided into low risk and high risk group. Based on the clinical characteristics of the patients, low risk treatment plan was erythromycin capsule 0.25 g once, 3 times/day plus compound liquorice mixture, followed by clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture or clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture; high risk group treatment was macrolide antibiotics (erythromycin, clarithromycin) 0.25 g once, 3 times/day and second generation cephalosporins (cefaclor or cefuroxime) 0.25 g once, 3 times/day plus compound liquorice decoction.
ResultsThe clinical seven-day curing rate was 54.1%, and the total effective rate was 93.1%. For low risk treatment regimen, the sevenday curing rate was 63.6%, and the total effective rate was 94.9%; for high risk treatment regimen, the seven-day curing rate was 34.0%, and the total effective rate was 89.4%. Acute bronchitis had high curing rate which was 70.1%.
ConclusionMacrolide antibiotics (erythromycin, clarithromycin) oral administration in the treatment of lower respiratory tract infection is reliable and effective, which is worth promoting in clinical application.
