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Objective:To investigate the clinical efficacy of thunder-fire moxibustion combined with external application of Chinese herbal ointment at the trigger point on lumbodorsal myofascial pain syndrome of cold-damp stagnation type.Methods:A total of 90 patients with lumbodorsal myofascial pain syndrome of cold-damp stagnation type admitted to Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from September 2021 to April 2022 were included in this study. They were randomly divided into three groups ( n = 30/group) using the random number table method. Patients in the Chinese herbal ointment group were treated by external application of Chinese herbal ointment at the trigger point. Patients in the thunder-fire moxibustion group were treated with thunder-fire moxibustion. Patients in the combined therapy group were treated with thunder-fire moxibustion combined with external application of Chinese herbal ointment at the trigger point. All patients were treated for 28 consecutive days. Clinical efficacy was compared among the three groups. Before and after treatment, the Visual Analogue Scale score, local tenderness score, Oswestry Disability Index score and Pittsburgh Sleep Quality Index score were compared among the three groups. Results:Total response rate (96.67%) in the combined therapy group was significantly higher than 73.33% in the thunder-fire moxibustion group and 66.67% in the Chinese herbal ointment group ( χ2 = 9.01, 4.70, both P < 0.05). Visual Analogue Scale score and local tenderness score in the combined therapy group were (1.96 ± 0.93) points and (1.00 ± 0.69) points, respectively, which were significantly lower than (2.43 ± 0.87) points and (1.37 ± 0.56) points in the thunder-fire moxibustion group and (2.77 ± 0.86) points and (1.50 ± 0.57) points in the Chinese herbal ointment group ( F = 6.22, 5.38, both P < 0.05). The Oswestry Disability Index score in the combined therapy group was (19.80 ± 3.80) points, which was significantly lower than (22.30 ± 2.82) points in the thunder-fire moxibustion group and (23.60 ± 3.71) points in the Chinese herbal ointment group ( F = 9.07, both P < 0.05). After treatment, the Pittsburgh Sleep Quality Index score in the combined therapy group was (5.30 ± 1.12) points, which was significantly lower than (6.50 ± 1.33) points in the thunder-fire moxibustion group and (6.73 ± 1.41) points in the Chinese herbal ointment group ( F = 10.59, both P < 0.05). Conclusion:Thunder-fire moxibustion combined with external application of Chinese herbal ointment at the trigger point is highly effective on lumbodorsal myofascial pain syndrome of cold-damp stagnation type than monotherapy. The combined therapy can markedly reduce pain and greatly improve lumbodorsal function and sleep quality.
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Objective:To introduce a new operative technique of mini-invasive plating of midshaft clavicle fractures with lateral clavicle anatomic locking plate and evaluate its clinical outcomes.Methods:From August 2017 to March 2019, 30 midshaft clavicular fracture patients were included in this study and retrospectively analyzed. There were 22 males and eight females with an average of 44.63±13.22 years (range 14-65 years). According to Robinson classification nine patients were classified as Type 2A2, 17 patients were classified as Type 2B1 and four patients were classified as Type 2B2. Before operation no symptoms of neurovascular injury was observed in this group. Operations were performed on an average of 2.33±1.75 d (range 0-7 d) after the injury. By comparing the injured clavicle lengths with the opposite healthy side pre and postoperatively on anteroposterior chest x-ray to evaluate the effect of indirect reduction. Shoulder function was evaluated using the Constant-Murley score at 6th month after the operation. Meanwhile, 32 patients with midshaft clavicular fracture treated with open reduction and internal fixation using clavicle reconstruction locking plate treated by the same group surgerons were compared in incision length, surgical duration, intraoperative fluoroscopy times, blood loss, fracture reduction, fracture healing time, Constant-Murley score and other complications. There were 25 males and seven females with an average of 42.63±14.18 years (range 16-70 years). According to Robinson classification six patients were classified as Type 2A2, 19 patients were classified as Type 2B1 and seven patients were classified as Type 2B2.Results:In mini-invasive group all patients were treated successfully with minimally invasive percutaneous osteosynthesis (MIPO) technique using lateral clavicle anatomic locking plate. The mean surgical duration was 63.40±7.82 minutes (range 48-92 min), The mean intraoperative fluoroscopy was 4.83±1.58 times (range 3-8 times). The mean blood lose was 15.67±4.13ml (range 10-30 ml). In open reduction group the mean surgical duration was 56.22±10.11 min (range 42-80 min), the mean intraoperative fluoroscopy was 3.91±1.49 times (range 2-5 times). The mean blood lose was 56.88±13.93 ml (range 40-100 ml). There was a significant difference in statistic by comparing surgical duration, intraoperative fluoroscopy times, blood loss ( P<0.05). In mini-invasive group the average proportional difference of the clavicular length was 12.15%±2.69% (range 5.2%-15.1%) preoperative and 0.45%±0.44% (range -0.2%-1.6%) postoperative comparing with the opposite healthy side, in open reduction group the average proportional difference of the clavicular length was 11.58%±2.67% (range 4.5%-16.1%) preoperative and 0.62%±0.41% (range -0.2%-1.2%) postoperative comparing with the opposite healthy side. There was no difference in statistic by comparing the fracture reduction in these two groups ( P>0.05). The mean follow-up period was 11.3±2.8 months (range 10-18 months) in mini-invasive group. Radiographic healing of the fracture was achieved at a mean time of 3.57±0.90 months (range 3-5 months). In open reduction group the mean follow-up period was 11.8±2.2 months (range 10-18 months), fracture healing time was 4.27±1.12 months (range 3-6 months), and there was significant difference in fracture union ( P<0.05). In mini-invasive group the mean total incision length was 2.8±0.48 cm (range 2.5-4.0 cm), no patient complained of numbness or paresthesia on subclavicular region or anterior chest wall, and all patients were satisfied with the cosmesis of the wounds and showed excellent shoulder joint function with a mean Constant-Murley score of 94.83±2.55 (range 89-97) at sixth month after the operation. In open reduction group the mean incision length was 11.0±1.08 cm (range 10-14 cm), 9 patients complained of numbness or paresthesia on subclavicular region or anterior chest wall, and only 5 patients were satisfied with the cosmesis of the wounds with a mean Constant-Murley score of 90.59±4.23 (range 78-97). There was a significant difference in statistic by comparing incision length, satisfactory cosmesis results, Constant-Murley score and paresthesia on subclavicular region ( P<0.05). Conclusion:Mini-invasive percutaneous plating of midshaft clavicle fractures with lateral clavicle anatomic locking plate is a good option for the treatment of midshaft clavicle fractures with satisfactory cosmesis results and excellent return to function.
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Objective To introduce an indirect reduction technique using a modified tibial distraction support in minimally invasive percutaneous plate osteosynthesis (MIPPO) of distal femur fractures and investigate its clinical effect.Methods Between April 2014 and March 2016,26 distal femur fractures treated with MIPPO technique using a modified tibial distractionsupport were reviewed.There were 18 males and 8 females with an average age of (50±10.1) years (25-76 years).Among them,nineteen patients were type A and 7 patients were type C according to AO classification.Operations were performed on an average of (5.6±3.1) d (2-14 d) after the trauma.All the patients were performed indirect reduction with a modified tibial distraction support before using the MIPPO technique.Angular deformity was obtained from preoperative and postoperative for all subjects.In each case,intraoperative image intensification shots to confirm reduction and the operating time were recorded.Functional outcome was evaluated using the Schatzker-Lambert criteria 1 year postoperative.Results All the patients completed closed reduction using the modified tibia] distraction support.Preoperative anteroposterior radiographs revealed amean of 8.0°±3.1° (0-16°) angulation in the coronal plane.Lateral radiographs revealed a mean of 16.8°±8.4° (5°-8.6°) angulation in the sagittal plane.Postoperative anteroposterior and lateral radiographs showed a mean angulation of 1.8°±0.6° (0-3.2°) and 2.5°±0.6° (0-3.8°) of varus/valgus and apex posterior angulation,respectively.The mean operating time was (100±11.6) min (80-120 min).No intraoperative or postoperative complications were encountered.Twenty-five patients were followed up and the mean follow up time was (18±3.9) months (12-28 months).There were one delayed union and one non-union.The average time of radiographic evidence of bridging callous was present at (4±0.7) months (3-6 months) in the remained patients.There were 22 excellent patients and 3 good patients according to Schatzker-Lambert criteria one year postoperative.The excellent rate was 100％.Conclusion The modified tibial distraction support is simple and easy to manipulate which is a good option in MIPPO for distal femur fractures and has good clinical effects.
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<p><b>OBJECTIVE</b>To compare the related clinical outcomes of total disc replacement (TDR) versus fusion in management of lumbar degenerative disc disease (LDDD)and provide available basis for choice of surgical procedure.</p><p><b>METHODS</b>Computer systematically researched PubMed,EMBase, COCHRANE Library, CBMWin, CNKI, VIP databases for randomized controlled trials comparing TDR and fusion for LDDD. Data were searched until October 2013. The available statistical data was extracted after methodological assessment. The statistical soft RevMan 5.1 was used to analyze the results.</p><p><b>RESULTS</b>Total 1 658 cases of patients in 6 studies were conducted, including 543 cases of fusion and 1 115 cases of TDR. The results of Meta-analysis showed that TDR was superior to fusion in term of visual analogue scale (VAS) (OR = -3.33, 95%CI:-5.94--0.71, P = 0.01) , Oswestry disability index (ODI) (OR = -5.21, 95%CI:-7.51--2.92, P = 0.00) , complication (OR = 0.45, 95%CI:0.21-0.95, P = 0.04) . There were no statistically difference regarding operating time, blood loss and reoperation (P > 0.05). However, there was no difference in term of complication in two-year and five-year sub-analysis.</p><p><b>CONCLUSION</b>Regardless TDR may be more effective comparable to lumbar fusion at the immediate postoperative time, vigorous evidence is still requisite to certify the result in long-term follow-up.</p>