ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
【Abstract】 Objective The effects and the complications of anhydrous alcohol intra-abdominal coeliac plexus block were studied for treating unresectable pancreatic cancer pain. Methods From Jan.2001 to Sep.2005, 61 patients with severe pancreatic cancer pain and accompanied gastrointestinal tract obstruction were treated by anhydrous alcohol intra-abdominal coeliac plexus block and palliative surgical therapy. Pain-relief, KPS and complications in 3 months after operation were observed. Results The cancer pain in all patients was controlled in one week after the block (P＜0.05). KPS was improved (P＜0.05). Three months after operation, 45(86.5%) patients were without pain or with only light pain. There were no severe complications. Conclusion Anhydrous alcohol intra-abdominal coeliac plexus block is a method with safe and good effective and less complications for the treatment of pancreatic carcinomatous pain.
By reviewing the current status of chronic pain and combining with the new definition of pain revised by the International Association for the Study of Pain in 2020, firstly a prevention-based approach, self-management of pain, and multidisciplinary collaboration based on the integration of bio-psycho-social-environmental factors is proposed. The medical mode will greatly improve the treatment effect of chronic pain and the quality of life of patients. Secondly, the importance of strengthening humanistic care and paying attention to health education, as well as improving medical staff’s awareness of chronic pain and the level of diagnosis and treatment are pointed out. Finally, it is clarified that innovative non-drug treatments and the establishment of digital pain management platforms are the future of chronic pain.
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 summarize the application progress of surface electromyography (sEMG) and surface electromygraphic biofeedback (sEMGBF) in low back pain (LBP).
Methods
The related literature about the application of sEMG and sEMGBF in diagnosis and therapy of LBP was summarized and analyzed.
Results
As a auxiliary diagnostic technique, lumbar muscle fatigue, lumbar muscle activity disorder, flexion-relaxation phenomenon, and asymmetry of the paravertebral muscle electromygraphic activity were found in patients with LBP by sEMG. For treatment, sEMG combined with sEMGBF technology to form sEMGBF training. sEMGBF training include sEMGBF training and sEMGBF stretching exercise. sEMGBF training can improve lumbar muscle activity disorder, recover muscle function, and relieve back pain.
Conclusion
sEMG can monitor the electromyographic signal and sEMGBF biofeedback information can relax or strengthen the muscle. It is very meaningful for diagnosis and therapy of LBP.
ObjectivesTo systematically review the epidemiological characteristics of post-stroke shoulder pain (PSSP).MethodsPubMed, WanFang Data, CNKI, EMbase, The Cochrane Library and SinoMed databases were electronically searched to collect studies on the morbidity of PSSP from inception to November 30th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software.ResultsA total of 13 studies were included. The total sample size was 3 514, including 1 357 patients with PSSP. The results of meta-analysis showed that the total morbidity of PSSP was 45.0% with 95%CI 32.0% to 58.0%. The results of subgroup analysis showed that the morbidity of PSSP was 55.5% (95%CI 48.1% to 63.0%) prior to 2010 and 40.6% (95%CI 28.3% to 52.9%) after 2010, respectively. The morbidity of PSSP in Asia was 61.2% (95%CI 51.3% to 71.1%), and in Europe and America was 18.4% (95%CI 9.9% to 26.9%), respectively.ConclusionsCurrent evidence suggests that PSSP has high morbidity, and it may be affected by regional factors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo discuss clinical manifestation, laboratory examination, imaging and pathological features of intrahepatic cholangiocellular carcinoma(ICC) patients with fever as initial symptom accompanied with liver area pain, in order to improve the clinicians' acquaintance for ICC under similar circumstances.
MethodThe case informations including medical history, clinical manifestation, laboratory examination, imaging finding, pathological examination, and treatment of 4 patients diagnosed with ICC by pathological biopsy from july 2013 to October 2014 in the First hospital of Lanzhou University were analyzed retrospectively.
ResultsAll of four cases showed the fever as the initial symptom accompanied with the liver area pain. All of them had got chronic HBV infection. The WBC, neutrophil percentage, and procalcitonin were increased on admission in 3 cases. the levels of serum ALP and GGT were elevated in 3 patients. The AFP was obviously increased in 1 patient. The serum CA19-9 had moderately elevated in 2 patients. the ferroprotein was obviously increased in 2 patients. All the patients were confirmed under the abdominal CT scans and the liver pathological biopsy.
ConclusionPatients with fever and liver area pain as intial symptoms, and with chronic hepatitis B and space-occupying lesions, who should be alert for ICC.
Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.
In post-coronavirus disease 2019 era, people’s style of work and life have undergone major changes. The sedentary style of work and life, such as long-time office work, online meetings, home eating, online social interactions, and reduced range of activities, affect people’s physical and mental health. Neck and shoulder pain is one of the common symptoms. By combining the clinical practice experience of orthopedic medical experts in West China Hospital of Sichuan University, and reviewing a large number of literatures, this article summarized the definition, incidence, hazards, causes, evaluation and prevention of neck and shoulder pain in post-coronavirus disease 2019 era. It aimed to provide experience for the prevention and treatment of neck and shoulder pain in post-coronavirus disease 2019 era.
Objective To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). MethodsA prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups (n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups (P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. Results In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels (P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group (P>0.05), there were significant differences at other time points of two groups compared to preoperative score (P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours (P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points (P<0.05). No significant difference was found in Bromage motor block scores between the groups (P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference (P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups (P>0.05). ConclusionUltrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
