ABSTRACT
BACKGROUND:At present, a large number of studies have proved that the discectomy and interbody fusion are effective in treatment of lumbar disc herniation. But for the treatment of lumbar disc herniation with Modic change, the advantages and disadvantages of above two kinds of surgical methods are stil inconclusive. OBJECTIVE: To systematicaly review the effectiveness of discectomy versus interbody fusion in treatment of lumbar disc herniation with Modic change. METHODS: We searched PubMed, Embase, The Cochrane Library (Issue 2, 2015), CBM, CNKI, VIP and WanFang database for randomized controled trials on discectomyversus interbody fusion for lumbar disc herniation with Modic change from inception to May 1st, 2015. Clinical outcomes were back pain Visual Analog Scale, leg pain Visual Analog Scale, Oswestry Disability Index, lumbar Japanese Orthopaedic Association score, the number of cases affecting complications, and MacNab criteria. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:Nine randomized controled trials were included, involving 945 patients. The results of meta-analysis showed that compared with discectomy group, back pain Visual Analog Scale was lower [MD=0.81, 95%CI (0.69, 0.92),P < 0.000 01]; Oswestry Disability Index was lower [MD=2.07, 95%CI (1.62, 2.52),P< 0.000 01]; lumbar Japanese Orthopaedic Association score was higher [MD=-2.32, 95%CI(-4.32,-0.32),P=0.02] in the interbody fusion group. No significant difference in leg pain Visual Analog Scale and MacNab criteria outcomes was detected between both groups. These findings verified that interbody fusion was safer and more effective for lumbar disc herniation with Modic change, compared with discectomy.
ABSTRACT
BACKGROUND:Many studies concern the comparison of micro-titanium plate fixation and suture suspension fixation during cervical posterior expansive open-door laminoplasty, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of micro-titanium plate. OBJECTIVE:To systemicaly evaluate the efficacy and safety of micro-titanium plate fixationversus suture suspension fixation in cervical posterior expansive open-door laminoplasty. METHODS: English and Chinese randomized controled trials were searched by two reviewers. They retrieved the Cochrane Central Register of Controled Trials (CENTRAL), PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CMB, VIP and Wanfang database for randomized controled trials addressing micro-titanium plate fixationversus suture suspension fixation in cervical posterior expansive open-door laminoplasty published from database foundation to March 1, 2015. The references were also searched by hand. Meta-analyses were performed by using the Rev-Man 5.3 software, provided by the Cochrane Colaboration. RESULTS AND CONCLUSION: A total of 9 studies involving 642 patients were included. The results of meta-analyses showed that: (1) safety: There were no significant differences between the two groups in operation time [SMD=-0.02, 95%CI (-0.57, 0.54),P=0.95 > 0.05], and intraoperative blood loss [SMD=0.07, 95%CI (-0.26, 0.40),P=0.69 > 0.05]. (2) Efficacy: compared with suture suspension fixation, Japanese Orthopaedic Association Scores were higher [SMD=0.26, 95%CI (0.10, 0.42),P=0.001 < 0.05], the angle of the opened laminae was bigger [SMD=0.25, 95%CI (0.02, 0.48),P=0.04 < 0.05], cervical curvature was better [SMD=0.46, 95%CI (0.27, 0.65),P < 0.000 01], and incidence of axial symptoms was lower [RR=0.40, 95%CI(0.29, 0.56),P< 0.000 01] after micro-titanium plate fixation. These findings suggest that during expansive open-door laminoplasty for treatment of cervical spondylosis, micro-titanium plate fixation and suture suspension fixation can obtain good clinical outcomes. However, Japanese Orthopaedic Association Scores were higher and the angle of the opened laminae was better in micro-titanium plate fixation than in suture suspension fixation. Micro-titanium plate fixation could effectively prevent loss of cervical curvature and reduce the incidence of axial symptoms. For the poor quality of the original studies and smal sample size, a prudent choice is suggested. More high-quality large-sample studies are needed for further verification.
ABSTRACT
BACKGROUND:Supination maneuver is mainly used for reduction of radial head subluxation in children, but recently, pronation maneuver has also achieved good results in the treatment of radial head subluxation. OBJECTIVE:To objectively evaluate the efficacy of pronationversus supination maneuvers for the reduction of radial head subluxation by using Meta-analysis. METHODS:PubMed, Cochrane Central Register of Controled Trials (CENTRAL), EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang were searched from database establishment to December 2014 for colecting the randomized controled trials (RCTs) about pronationversus supination maneuvers for the reduction of radial head subluxation, and the references of those RCTs were also searched by hand. After study selection, assessment and data extraction were conducted by two reviewers independently. Meta-analyses were performed by using the RevMan 5.2 software. RESULTS AND CONCLUSION:Five studies involving 436 patients were included. The results of Meta-analyses showed that: compared with the supination maneuvers group the pronation maneuvers group had a higher rate of successful reduction at the first attempt [RR=1.17, 95%CI (1.08, 1.28),P=0.000 3] and lower rate of failed reduction [RR=0.25, 95%CI(0.09, 0.65),P=0.005]. There was no significant difference in the rate of successful reduction at the second attempt [RR=1.39, 95%CI (0.75, 2.58),P=0.30]. Based on the results of systemic assessment, the level of evidence assessed by the GRADE system showed that the outcome indicators of the rate of successful reduction at the first attempt and rate of failed reduction were graded as intermediate level; the outcome indicator of the rate of successful reduction at the second attempt was graded as low level. For the poor quality of the original studies, a prudent choice is suggested; and more highly-quality, large-sample studies are needed.
ABSTRACT
BACKGROUND:At present, a large number of studies have proved that the expandable intramedul ary nail and interlocking intramedul ary nail are effective in treatment of limb fractures. However, for the treatment of tibial fractures, the advantages and disadvantages of the two kinds of fixation methods are stil inconclusive. OBJECTIVE:To systematical y review the effectiveness and safety of expandable intramedul ary nail and interlocking intramedul ary nail for treatment of tibia fracture. METHODS:We searched PubMed, Embase, The Cochrane Library (Issue 1, 2015), CBM, CNKI, VIP and WanFang Data for articles concerning randomized control ed trials on expandable intramedul ary nail versus interlocking intramedul ary nail published from inception to January 1, 2015. The key words were“tibia, fracture, tibia fracture, tibia fractures, expandable intramedul ary nail, expandable nail, intramedul ary nail, interlocking intramedul ary nail”. Meta-analysis was performed using RevMan 5.2 software. RESULTS AND CONCLUSION:Ten randomized control ed trials involving 574 patients were included. The results of meta-analysis showed that, compared with interlocking intramedul ary nail, expandable intramedul ary nail was shorter in operation time [MD=-23.42, 95%CI (-26.94,-19.90), P<0.000 01], less in intraoperative hemorrhage [MD=-47.64, 95%CI (-52.21,-43.09), P<0.000 01], less in fluoroscopy times [MD=-1.40, 95%CI (-1.49,-1.30), P<0.000 01], shorter in union time [MD=-30.84, 95%CI (-35.27,-26.41), P<0.000 01], and less in incidence of complications [OR=0.20, 95%CI (0.10, 0.40), P<0.000 01]. The Johner-Wruh scores showed on significant difference. These findings suggest that expandable intramedul ary nail for tibia fracture has more advantages than interlocking intramedul ary nail. That is to say, the expandable intramedul ary nail is an improved nail of interlocking intramedul ary nail, but a large sample of high quality randomized control ed trials are stil needed to confirm the conclusion.