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>

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>