ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of different operation time for acute spinal cord injury(SCI) based on systematic review.</p><p><b>METHODS</b>PubMed database, EMBASE database, Cochrane Library, ISI Web of knowledge, CBM database, VIP database, CNKI database and Wanfang database were searched from their start year up to February 2017 for relevant randomized clinical trials on the treatment of acute spinal cord injury with different intervention times.</p><p><b>RESULTS</b>Four randomized clinical trials of total 156 cases were included. Early surgical intervention for the patients with incomplete spinal cord injury can improve the ASIA motor function score [MD=3.29, 95%CI(-7.90, 14.49), =0.56] and overall Frankel score[=7.65, 95%CI(2.69, 21.74), =0.000 1]. There was no significant difference in the improvement of the overall Frankel score[=4.88, 95%CI(0.74, 32.09), =0.10] for the patients with complete spinal cord injury between the early surgery and delayed surgery group. There was no significant difference in hospitalization time[MD=-3.4, 95%CI(-8.12, 1.32), =0.16], death rate [=1.07, 95%CI(0.21, 5.56), =0.93]and incidence of decubitus[=1.07, 95%CI(0.17, 6.69), =0.94] between the early surgery and delayed surgery group.</p><p><b>CONCLUSIONS</b>Early surgical intervention can promote the nerve function recovery after spinal cord injury, whithout further incidence of complications, but random control trails with higher quality are still required for this conclusion.</p>
Subject(s)
Humans , Randomized Controlled Trials as Topic , Recovery of Function , Spinal Cord Injuries , General Surgery , Time FactorsABSTRACT
Objective To compare characteristics of stress variations in 3D finite element models of normal and degenerative lumbar vertebrae and the dose-effect relationship, and analyze the mechanism of mechanical balance by traditional Chinese medicine (TCM) manipulation on degenerative lumbar vertebrae. Methods The 3D finite element model of intact, real human degenerative lumbar vertebrae (L4-5) was established to simulate the physiological activity of flexion and extension in lumbar vertebrae. The characteristics of stress variation in degenerative lumbar vertebrae under external loading, namely, the TCM manipulation was analyzed, and the stress variation in degenerative lumbar vertebrae under gradual increasing-external loading was analyzed as well, which was compared with the stress and strain variation in normal lumbar vertebrae under different motion status. Results Under different motion status, the stress distributions on lumbar disc as well as the elastic modulus of nucleus pulposus and fiber ring showed a gradually increasing tendency with lumbar degeneration increasing. TCM manipulation could change the stress distributions on lumbar disc, enlarge the space of spinal canal to a certain degree, and decrease the stress on nerve root. Stresses on small joints of the vertebral body and vertebral pedicle under posterior extension were larger than those under anterior flexion, while stresses on intervertebral disc under anterior flexion were greater than those under posterior extension, which showed a gradually increasing trend from top to bottom. Conclusions The mechanical environment of human lumbar vertebrae can be balanced by TCM manipulation, for the purpose of improving and treating lumbar disc diseases. The comparison with the 3D finite element model of normal human lumbar vertebrae and investigation on lumbar degeneration from perspective of changes in biomechanical environment and characteristics can provide scientific basis for clinic application of TCM manipulation in prevention and treatment of lumbar degenerative diseases, as well as new research idea for studying mechanical mechanism of TCM manipulation in effective prevention and treatment of lumbar lesions.
ABSTRACT
The spinal manipulation in traditional Chinese medicine (TCM) has a prominent clinical advantage in the treatment of chronic lumbar pain, such as low back pain, but the insufficient basic research on manipulation is a serious obstacle to its development. Using finite element analysis (FEA) can preferably simulate the mechanics under various kinds of spinal manipulation, analyze its action mechanism, test the hypothesis, standardize the operating practices, make quantitative, qualitative and optimal treatment plans, so as to provide an effective method for the basic research on manipulation therapy. This paper reviews the FEA studies of spinal manipulation in recent years, discusses the influence of different spinal manipulation on intervertebral disc, lumbar accessory structures, spinal loads and mechanical stability of the vertebral body. The results show that current FEA studies on spinal manipulation need to make the simulation method standardized and precise. Meanwhile, the research ideas of finite element method should be developed to guide the clinical application of spinal manipulation.
ABSTRACT
The spinal manipulation in traditional Chinese medicine (TCM) has a prominent clinical advantage in the treatment of chronic lumbar pain,such as low back pain,but the insufficient basic research on manipulation is a serious obstacle to its development.Using finite element analysis (FEA) can preferably simulate the mechanics under various kinds of spinal manipulation,analyze its action mechanism,test the hypothesis,standardize the operating practices,make quantitative,qualitative and optimal treatment plans,so as to provide an effective method for the basic research on manipulation therapy.This paper reviews the FEA studies of spinal manipulation in recent years,discusses the influence of different spinal manipulation on intervertebral disc,lumbar accessory structures,spinal loads and mechanical stability of the vertebral body.The results show that current FEA studies on spinal manipulation need to make the simulation method standardized and precise.Meanwhile,the research ideas of finite element method should be developed to guide the clinical application of spinal manipulation.
ABSTRACT
The spinal manipulation in traditional Chinese medicine (TCM) has a prominent clinical advantage in the treatment of chronic lumbar pain,such as low back pain,but the insufficient basic research on manipulation is a serious obstacle to its development.Using finite element analysis (FEA) can preferably simulate the mechanics under various kinds of spinal manipulation,analyze its action mechanism,test the hypothesis,standardize the operating practices,make quantitative,qualitative and optimal treatment plans,so as to provide an effective method for the basic research on manipulation therapy.This paper reviews the FEA studies of spinal manipulation in recent years,discusses the influence of different spinal manipulation on intervertebral disc,lumbar accessory structures,spinal loads and mechanical stability of the vertebral body.The results show that current FEA studies on spinal manipulation need to make the simulation method standardized and precise.Meanwhile,the research ideas of finite element method should be developed to guide the clinical application of spinal manipulation.