Percutaneous foraminal endoscopy for the treatment of lumbar lateral recess stenosis in elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

Treatment of upper lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of percutaneous endoscopic lumbar discectomy through two different approaches in treating upper lumbar disc herniation.@*METHODS@#From March 2015 to August 2019, 32 patients with upper lumbar disc herniation treated by percutaneous endoscopic lumbar dicecromy(PELD) were analyzed retrospectively and divided into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) group according to different methods. There were 19 patients in PETD group, including 10 males and 9 females aged from 30 to 65 years old with an average of (44.70±12.08) years old;5 patients on L, 6 patients on L, 8 patients on L;6 patients were central herniation, 8 patients were paracentric herniation, and 5 patients were migration of herniation. There were 13 patients in PEID group, including 4 males and 9 females aged from 25 to 55 years old with an average of (42.23±12.09) years old;the courses of disease ranged from 1 to 7 months with an average of (2.90±3.02) months;3 patients on L, 4 patients on L, 6 patients on L;2 patients were central herniation, 4 patients were paracentric herniation, 3 patients were migration of herniation, 4 patients were prolapse free type protrusion. VAS and ODI score before operation, postoperative at 3 days, 3 and 6 months were compared between two groups, advanced MacNab standard at 1 year after operation were applied to evaluate clinical effects.@*RESULTS@#Operation were successful operated in 32 patients and obtained following up without nerve injury and infection of intervertebral space. One patient in PETD groups occurred dural sac tear in operation, but no adverse reaction afteroperation. PETD group was followed up from 12 to 24 months with an average of (15.80±3.48) months, while PEID group was followed up from 12 to 30 months with an average of (16.70±4.66) months, while there was no statistical difference between two groups (>0.05). VAS and ODI score at different time points after operation were higher than that of before operation (<0.05). According to advanced MacNab standard at 1 year after operation, 11 patients obtained excellent results, 6 good, 1 moderate and 1 poor in PETD group;while 7 patients got excellent results, 4 good, 2 moderate in PEID group.@*CONCLUSION@#Both of two surgical approach could achieve satisfactory efficacy in treating upper lumbar disc herniation, PETD is more suitable for central herniation, paracentric herniation and patients with mild displacement, PEID has advantage on prolapse free type protrusion.

Preliminary analysis on X-ray in youth neck type of cervical spondylosis with upper crossed syndrome / 中国骨伤

OBJECTIVE@#To analyze the X-ray characteristics in youth neck type of cervical spondylosis with upper crossed syndrome(UCS).@*METHODS@#The patients who had a neck type of cervical spondylosis with or without UCS were selected from January to October 2017, 20 cases in each group, and 10 normal volunteers were chosen in the study. X-ray examination of lateral and hyperextension-hyperflexion of cervical spine were performed to observe cervical spine angle, angular displacement and adjacent vertebral body slip.@*RESULTS@#The cervical spine angle was (-0.40±9.64)° in the UCS group, significantly less than (14.35±9.01)° in the normal group and (12.34±5.65)° in the non-UCS group(0.05).@*CONCLUSIONS@#In young patients who has a neck type of cervical spondylosis with UCS, the cervical curvature prone to straighten or reverse, the upper cervical flexion and extension are limited, while the lower cervical is in a flexion.

Treatment of displacement-type lumbar intervertebral disc protrusion on L2-L5 with percutaneous endoscopic interlaminar discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the operative characteristic, safety, clinical effect of percutaneous endoscopic interlaminar discectomy (PEID) in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅.</p><p><b>METHODS</b>Form November 2015 to October 2016, 15 patients with displacement-type lumbar intervertebral disc protrusion were treated with percutaneous endoscopic interlaminar discectomy. There were 9 males and 6 females, aged from 19 to 63 years old with an average of 42 years. All the patients with single-segment displacement-type lumbar intervertebral disc protrusion were diagnosed by clinical and iconography data, and complicated with low back pain and single lower limbs radioactivity pain. Lesion occurred in L₄,₅ of 8 cases, L₃,₄ of 4 cases, L₂,₃ of 3 cases. The patients were divided into 4 regions according to Lee standard (displaced nucleus pulposus location on spinal canal), I region was 2 cases, II region was 3 cases, III region was 5 cases, IV region was 5 cases.Preoperative, postoperative 3 months, final follow-up, lumbago-leg pain and lumbar function were assessed by VAS, JOA scores;at final follow-up, MacNab was used to evaluate the clinical effect;postoperative 3 months, rechecked lumbar MRI to observe discectomy condition.</p><p><b>RESULTS</b>All the operations were successfully complete under local anesthesia, and no complications such as injuries of nerve root and dural sac, postoperative hemorrhage, local infection were found. Operative time was 45 to 90 min with an average of 54.8 min;and hospitalization time was 3 to 4 days with an average of 3 days. All 15 cases were followed up for 12 to 13 months with an average of 12.2 months, no recurrence was found. Preoperation, postoperative 3, 12 months, VAS scores were 8.2±1.4, 3.0±0.6, 1.7±0.5, JOA scores were 8.76±3.32, 23.61±2.14, 24.82±3.43, respectively. Postoperative VAS, JOA scores were obviously improved(<0.05). According to MacNab standard to evaluate the clinical effect, 9 cases obtained excellent results, 5 good, 1 fair.</p><p><b>CONCLUSIONS</b>PEID is a micro-trauma surgical method and has advantage of safe and effective in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅, but requires laminoplasty during operation, and under local anesthesia to operation maybe can induce neurostimulation.</p>

Application of broad easy immediate surgery in percutaneous transforaminal endoscopic technology for lumbar lateral recess stenosis in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.</p><p><b>METHODS</b>From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.</p><p><b>RESULTS</b>All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found.</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.</p>

Effect of post pyloric feeding on hospital-acquired pneumonia and mortality in patients with critical respiratory disease / 肠外与肠内营养

Objective:To investigate the effect of post pyloric feeding on hospital-acquired pneumonia and mortality in patients with critical respiratory disease.Methods:A retrospective survey of 41 cases of post pylorus feeding (post pylorus feeding group,n =41) in respiratory intensive care unit (RICU) was carried out,and 41 patients who received nasogastric feeding (nasogastric feeding group,n =41) were investigated in the same RICU.The incidence of ventilator-associated pneumonia (VAP),the incidence of hospital-acquired pneumonia (HAP,excluding VAP) and the in-hospital mortality of RICU were observed and compared between the two groups.Vomiting,aspiration,gastric retention,diarrhea,and the times of stopping enteral feeding were observed and compared as well.Results:The incidence of HAP in the post pylorus feeding group was 2.4％,which was significantly lower than that in the nasogastric feeding group (22％,P ＜ 0.05).The incidences of VAP in the post pylorus feeding group and nasogastric tube feeding group were 16.7％ and 8.7％ individually,which was no significant difference between the two groups (P ＞ 0.05).The mortality in RICU in the post pyloric feeding group was 36.6％,which was similar to that in the nasogastric feeding group (41.5％) (P ＞ 0.05).There was no difference in terms of vomiting,aspiration,gastric retention,diarrhea,and the times of stopping enteral nutrition.Conclusion:Compared with nasogastric feeding,post pyloric feeding reduces the incidence of HAP in critical respiratory patients.Nevertheless,post pyloric feeding fails to affect the incidence of VAP and in-hospital mortality in RICU.

Ki-67 expression affects the clinical therapeutic effect on advanced lung adenocarcinoma / 医学研究生学报

Objective The expression level of the Ki-67 protein is a marker of the poor prognosis in non-small-cell lung cancer. This study explored the correlation of the Ki-67 expression level with the clinical efficacy in the treatment of advanced lung adenocarcinoma.Methods From January 2015 to December 2015, 92 patients with stage Ⅳ lung adenocarcinoma were treated in the Department of Respiratory and Critical Care Medicine of Nanjing General Hospital, 65 with oral gefitinib for EGFR mutation-positive or crizotinib for ALK positive (the targeted therapy \[TT\] group) and the other 27 with pemetrexed + cisplatin or nedaplatin (the chemotherapy \[CT\] group). The expression of Ki-67 was determined by immunohistochemistry, its relationship with the clinicopathological features and therapeutic effects was analyzed, and the progression-free survival (PFS) was calculated.Results Ki-67 was expressed lowly in 43 (46.7%) and highly in 49 (53.3%) of the cases. The median PFS after treatment was significantly longer in the patients with a low than in those with a high Ki-67 expression in the TT group (10 vs 7 mo, P<0.05) and in the CT group as well (8 vs 7 mo, P<0.05). Ki-67 (HR=1.011, 95% CI: 1.000-1.023) and ALK (HR=0.325, 95% CI: 0.112-0.942) were shown to be predictive factors of poor PFS.Conclusion The expression level of Ki-67 affects the effect of clinical treatment, especially that of the first-line targeted therapy, on advanced lung adenocarcinoma.

Percataneous endoscopic lumbar discectomy for the treatment of lumbar intervertebral disc protrusion / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of percataneous endoscopic lumbar discectomy for lumbar intervertebral disc protrusion.</p><p><b>METHODS</b>The clinical data of 46 patients with lumbar intervertebral disc protrusion underwent percataneous endoscopic lumbar discectomy were retrospectively analyzed. There were 21 males and 25 females, aged from 23 to 65 years old with an average of 42 years. The course of disease was from 5 to 87 months with an average of 13.4 months. Protrusion located in L₂,₃ of 2 cases, L₃,₄ of 3 cases, L₄,₅ of 28 cases, L₅S₁ of 13 cases. There were 5 patients with central type, 34 with para-side type, 7 with extreme lateral type. VAS, ODI and JOA scores were used to analyze the condition of pain releasing and lumbar functional improvement. According to MacNab standard to evaluate the clinical effect at final follow-up.</p><p><b>RESULTS</b>All the operations were successful, operative time was 125 to 210 min with a mean of 153.6 min; and all the patients were follow-up for 6 to 12 months with an average of 8 months; no injuries of nerve and blood vessel, infection were found. Postoperative 3 days and final follow-up, VAS score was 3.1±0.7, 2.2±0.6 respectively, and was obviously lower than preoperative 7.3±1.2(<0.05). At final follow-up, JOA and ODI were (23.5±2.4) points, and (22.10±9.26)%, respectively, and was obviously improved compared with preoperative (13.2±2.8) points and (69.12±13.15)% (<0.05). According to modified MacNab standard to evaluate the clinical outcome, 30 cases got excellent results, 14 good, 2 fair, no recurred and overhauling were found.</p><p><b>CONCLUSIONS</b>Percataneous endoscopic lumbar discectomy is a minimally invasive technique, with advantage of safety and effectiveness, and apply to treatment of lumbar intervertebral disc protrusion.</p>

Application analysis of patient reported outcome scale for low back and leg pain / 中国骨伤

<p><b>OBJECTIVE</b>To explore the reliability ,validity and reaction degree of patient reported outcome scale for low back and leg pain.</p><p><b>METHODS</b>Two hundreds inpatients were analyzed between August 2010 and January 2012, including 93 males and 107 females with an average age of 50.3 years old ranging from 22 to 65 years. There were 144 cases of lumbar disc herniation and 56 of lumber spinal stenosis. All patients were tested by the patient reported outcome scale for low back and leg pain, and then analyzed the reliability,validity and reaction degree of the scale.</p><p><b>RESULTS</b>There was no statistical significence difference (P>0.05) and significant correlation (r>0.9) in scores of two times in patients with no change in illness. Measurement result of the scale had significant correlation (r>0.9) with Oswestry disability index (ODI). The total Cronbach's Alpha of the instrument was 0.931, the total split-half reliability was 0.912. The KMO value was 0.919, Bartlett test value was 1882.975 (P<0.001), factor analysis resulted in 3 factors with eigenvalue >1 which contributed to 64.364%. Scores of two times of 43 cases who felt better were 34.80+/-9.00 and 28.77+/-8.73, respectively,with stasitical significance (P<0.01).</p><p><b>CONCLUSION</b>The scale has a good reliability, validity and reaction degree,which can be applied for the therapeutic evaluation of low back and leg pain.</p>

Analysis of curative effect of the intervertebral space lavaging for the treatment of incisions deep infections at early stage after posterior lumber internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the reason,diagnose outline,therapeutic tool of the incisions deep infections at early stage after lumber internal fixation.</p><p><b>METHODS</b>From January 2001 to December 2011, 10 patients with incisions deep infections at the early stage after the posterior lumber internal fixation were treated with intervertebral space lavaging. There were 1 male and 9 females with an average age of 63 years, and an average infection started at the 6th day after operation. The main clinical features including backleg pain aggravating, fervescence, fresh seepage from the wound, and blood inflammatory index increased, etc. According to whether the wound could heal at the first treatment stage as a evaluation standard of curative effect.</p><p><b>RESULTS</b>Ten cases were followed up with an average period of 17 months. The wounds of 9 cases healed at the first stage and no recurrence and complications were found. One case underwent debridgement of many times with the therapic period of 7 months,at last,after taking out the vertebral pedicle bolt,the wound healed,and no recurrence after follow-up of 18 months.</p><p><b>CONCLUSION</b>The deep wound infections after the lumber internal fixation should receive intervertebral space lavaging as soon as possible. The method can finally remain internal fixations and obtain satisfactory effects, but avoiding too much tissue cutting and tube setting in the deep intervertebral space are the keys to the successful fixation.</p>

Case-control study on manipulation combined with Chinese herbs for the treatment of lumbar disc herniation within chronic stage / 中国骨伤

<p><b>OBJECTIVE</b>To observe and compare the therapeutic effects of two methods to lumbar disc herniation treated by manipulation combined with Chinese herbs and traction with Western medicine.</p><p><b>METHODS</b>A multi-center with a central district unit was used to study the patients with lumbar disc herniation from November 28th, 2008 to May 7th, 2010. All the patients were divided into treatment group and control group. The treatment group had 100 cases, including 45 males and 55 females, averaged (43.43 +/- 9.18) years. The treatment group was treated by manipulation combined with Chinese herbs; Control group had 100 cases (5 cases were fall off), including 38 males and 57 females, averaged (42.29 +/- 9.78) years. The control group was treated by traction with Western medicine. The course of treatment was 3 weeks. VAS, M-JOA, LMS (lower limb muscle strength) and classification efficacy was used to evaluate outcome and therapeutic effects before and after treatment.</p><p><b>RESULTS</b>VAS and M-JOA were improved after the treatment both in treatment group and control group; there was no significant difference in LMS before and after treatment in both groups. VAS and M-JOA in treatment group was superior to those of control group after treatment. There was no significant difference in LMS. According to classification efficacy, 41 cases got excellent result, 34 good, 13 fair and 12 poor in treatment group; in control group, 35 cases obtained excellent results, 16 good, 19 fair and 25 poor. The effect of treatment group was better than that of control group.</p><p><b>CONCLUSION</b>Both of two methods can improve the score of VAS, M-JOA, and treatment group is better than that of control group. While for the improvement of LMS, both of two methods have no obvious effects.</p>

Randomized controlled study on traditional Chinese medicine in improving joint function of moderate osteofluorosis / 中国地方病学杂志

Objective To observe the improving effect in joint function of moderate skeletal fluorosis treated by traditional Chinese medication(main ingredient was Strychnine).MethodsFrom December 2007 to July 2009,120 moderate skeletal fluorosis patients met the inclusion criteria were divided into the treatment group(60 cases)and the control group(60 cases)in the skeletal fluorosis hospital of Xinzhou,the treatment group was given basic treatment and traditional Chinese medication,the control group wa8 given basic treatment and placebo.The treatment lasted 12 weeks,follow up 24 weeks.Before treatment,after treatment 4 weeks,8 weeks,12 weeks,36 weeks,a third party evaluate comprehensive function of both upper and lower limb and joint dysfunction.Results The main effect of both drugs was statistically significance in the scores of the upper forearm in the finger by touching the posterior contralateral ear, upper arm touched by the finger back in the opposite corner subscapularis function, lower limb function and single-joint dysfunction(F values were 4.08,14.32,35.81,13.02, all P<0.05), the main effect of time also was significant (F values were 82.63,72.82,277.33,328.16, all P<0.05),①the upper forearm in the finger by touching the posterior contralateral ear functions:At the time of 8,12 weeks,scores of the treatment group were lower than those of before treatment and control group (all P<0.05);At the time of 36 weeks,scores of the treatment group were lower than that 12 weeks(all P<0.05);At the time of 8,12,36 weeks, scores of the control group were lower than those of before treatment(all P < 0.05);②upper arm function, namely fingers touching the opposite corner subscapularis:At the time of 4,8,12 weeks, scores of the treatment group were lower than those of before treatment(all P<0.05); At the time of 36 weeks, scores of the treatment group were lower than that 12 weeks(all P<0.05); At the time of 8,12,36 weeks, scores of the treatment group were lower than those of the control group (all P<0.05);③Lower extremity functions: At the time of 8,12 weeks,scores of the treatment group were lower than those of before treatment and control group (all P<0.05);At the time of 36 weeks, scores of the treatment group were lower than that 12 weeks(all P<0.05) ; At the time of 8,12,36 weeks, scores of the control group were lower than those of before treatment (all P<0.05);④single joint functions:At the time of 4,8,12 weeks,scores of the treatment group were lower than those of before treatment(all P<0.05); At the time of 36 weeks,scores of the treatment group were lower than that 12 weeks(all P<0.05) ; At the time of 8,12,36 weeks, scores of the control group were lower than those of before treatment(all P<0.05);At the time of 4,8,12,36 weeks, scores of the treatment group were lower than those of control group(all P<0.05);⑤At the end of treatment and follow-up,the improvement rate in joint functions in the treatment group were 88.33% (53/60),93.33% (56/60); the control group were 28.07%(16/57),40.35%(23/57), (Fisher test, P<0.01,X2=56.21, P<0.01). ConclusionTraditional Chinese medication(its main ingredient is Strychnine), an effective drug for improving joint dysfunction in patients suffering from moderate skeletal fluorosis, is simple and effective.

X-ray analysis on 114 patients with moderate endemic skeletal fluorosis by treatment of Guo's Chinese herbal / 中国骨伤

<p><b>OBJECTIVE</b>To observe the X-ray features of bone damage in patients with moderate endemic skeletal fluorosis and the changes of X-ray after treatment with herbal therapy.</p><p><b>METHODS</b>From 2007.12 to 2009.8,114 patients with moderate endemic skeletal fluorosis were randomly divided into treatment group and control group by central randomization system. There were 60 patients in treatment group including 26 males and 34 females,aged from 39 to 60 years with an average of (51.68 +/- 4.98) years; There were 54 patients in control group included 30 males and 24 females, aged from 39 to 60 years with an average of (52.15 +/- 4.86) years. Both treatment and control groups were treated with basic treatment including calcium supplementation and preparation stage with herb decoction. Patients were orally given 600 mg Caltrate everyday for calcium suptrointestinal function and promoting the digestion and absorption of herb decoction for 3 days. Patients in treatment group were rally given Guo's Maqian decoction(200 ml,twice daily) for 8 weeks. Eight weeks later,Guo 's Maqian decoction was replaced y Guokangning capsule (0.44 g per cansule,2 capsules,three times daily) for 4 weeks. The treatment course lasted 12 weeks. The time for followed-up after treatment was 24 weeks. When the treatment finished, 7 experts on orthopaedics and radiology evaluated and statistically analyzed the X-ray features pre and post treatment,using expert evaluation scale (including the appearance and changes of osteosclerosis,osteoporosis softening,joint changes close to the bone and mixed changes) designed referring endemic skeletal fluorosis X-ray findings and sub-degree standard(WS192-2008).</p><p><b>RESULTS</b>All X-ray features of endemic skeletal fluorosis appeared in the X-ray of the 114 patients with moderate endemic skeletal fluorosis. Osteosclerosis: 4 cases in forearm, 7 in calf,4 in pelvis,4 in lumbar vertebrae ;Osteoporosis and bone softening: 23 cases in forearm patients, 23 in calf, 5 in pelvis, 8 in lumbar vertebrae; Mixed changes: 6 cases in forearm, 9 in calf, 10 in pelvis, 1 in lumbar vertebrae patients; oint changes: 107 cases in forearm, 47 in calf, 28 in pelvis, 19 in lumbar vertebrae. There were X-ray no changes before and after the treatment in all of parts in control group. In treatment group, there were only 2 patients showed extraperiostealin and joint changes after the treatment, in which one showed better ossification of interosseous membrane of leg and another one showed disappearance of the lateral hyperplasia of the left pelvic acetabulum. There were no changes between before and after treatment in X-ray of all parts in the rest patiens of the treatment group. There was no significant difference between before and after treatment in both groups (P > 0.05).</p><p><b>CONCLUSION</b>There is no obvious improvement in radiology of patients with skeletal fluorosis treated by Guo's therapy.</p>