Objective To provide evidence-based therapeutic schedule for an adult patient with Lumber Isthmic Spondylolisthesis grading II. Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to April 2011), DARE (April 2011), CENTRAL (April 2011), MEDLINE (April 2011), EMbase and CBM were searched to collect high quality clinical evidence, and then we told a patient information about treatment plans. The plan was chosen by the patient for she knew her conditions and the plans. Results We included 1 meta-analysis, 3 randomized controlled trials, 5 systematic reviews and 1 prospective study on the natural course of isthmic spondylolisthesis were included. Literature evidence indicated that the prognosis of isthmic spondylolisthesis was good. Surgery should be selected when there was neither no remission of symptom, nor progression of lumber olisthy with conservative treatment. The long-term effect of surgery may be good, but it cannot change the natural course of the disease. Based on literature evidence, the patient chose the conservative treatment. After one year’s treatment the patient recovered, her sciatica relieved, and CT showed no progression of lumber olisthy. Conclusion Patient with low grand isthmic spondylolisthesis chose conservative treatment may achieves good effects, whereas on the process of the treatment, regular follow-up to monitor the progression of lumber olisthy should be conducted.
ObjectiveTo introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design. MethodsBetween March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI). ResultsNo complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2±10.5)° and (33.7±9.7)° respectively, showing no significant difference (t=0.84, P=0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). At last follow-up, no failures of internal fixation was found, and bony fusion was obtained. ConclusionThe preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.
ObjectiveTo compare the effectiveness of treatment of isthmic spondylolisthesis between two different fusion surgeries combined with pedicle screw fixation system. MethodsA retrospectively analysis was made on the clinical data of 98 patients with lumbar isthmic spondylolisthesis treated between February 2009 and May 2012. Of 98 cases, 53 underwent posterior lumbar interbody fusion (PLIF) combined with internal fixation (group A), and 45 underwent posterolateral fusion (PLF) with internal fixation (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and degree of spondylolisthesis between 2 groups (P>0.05). The operation time, intraoperative blood loss, reduction rate of spondylolisthesis, reduction loss rate, fusion rate, intervertebral space height, Japanese Orthopedic Association (JOA) score, and the recovery rate of JOA score were compared between 2 groups. ResultsThe operation time and intraoperative blood loss of group A were significantly higher than those of group B (P<0.05). Dural tear occured in 4 cases of group A and 1 case of group B during operation; 6 cases had radicular symptoms after operation in group A; incision infection was found in 1 case of 2 groups respectively. The follow-up time was 24-36 months in group A and was 26-40 months in group B. No significant difference was found in the JOA score at preoperation and 2 weeks after operation between 2 groups (P>0.05). The JOA score and the recovery rate of JOA score of group A were significantly better than those of group B at 2 years after operation (P<0.05). X-ray film showed that the reduction rate of group A was significantly higher than that of group B after 2 weeks of operation (P<0.05); the reduction loss rate of group A was significantly lower than that of group B after 2 years after operation (P<0.05). The intervertebral space height of group A was significantly higher than that of group B at 2 weeks and 2 years after operation (P<0.05). The fusion rate of group A was significantly better than that of group B at 2 years after operation (P<0.05). ConclusionPLIF can achieve a greater degree of reduction, better restore disc height, and lumbar curvature than PLF. PLIF is superior to PLF in maintaining intervertebral height after operation. And PLIF has higher fusion rate, restores the stability of the spine in a greater extent, and it also can achieve a better long-term outcome.
ObjectiveTo compare the fixation strength of optimum placed pedicle screw (OS) with re-directionally correctly placed pedicle screw (RS) following a violation of lateral pedicle. MethodsThirty fresh lumbar vertebrae (L1-5) were obtained from 6 pigs weighing 95-105 kg, male or female. Each vertebra was instrumented with a monoaxial pedicle screw into each pedicle using two different techniques. On one side, a perfect screw path was created using direct visualization and fluoroscopy. A pedicle screw of 5 mm in diameter and 35 mm in length was placed with a digital torque driver (OS). On the other side, a lateral pedicle wall violation was created at the pedicle-vertebral body junction with a guide wire, a cannulated tap, and a pedicle probe. This path was then redirected into a correct position, developed, and instrumented with a 5-mm-diameter by 35-mm-long pedicle screw (RS). For each pedicle screw, the maximal torque, seating torque, screw loosening force, and post-loosening axial pullout were measured. Screw loosening and axial pullout were assessed using an MTS machine. ResultsMaximal insertion torque was (111.4±8.2) N·cm and (78.9±6.4) N·cm for OS and RS respectively, showing significant difference (Z=3.038, P=0.002). The seating torque was (86.3±7.7) N·cm and (59.7±5.3) N·cm for OS and RS respectively, showing significant difference (Z=2.802, P=0.005). The screw loosening force was (76.3±6.2) N and (53.0±5.8) N for OS and RS respectively, showing significant difference (Z=2.861, P=0.004). The post-loosening axial pullout force was (343.0±12.6) N and (287.0±10.5) N for OS and RS respectively, showing significant difference (Z=2.964, P=0.003). ConclusionCompared with OS, RS placement after a lateral wall violation shows significantly decreased maximal insertion torque, seating torque, screw loosening force, and post-loosening axial pullout. On this occasion, RS augmentation is a probable option for remediation.
Objective To evaluate the effectiveness and safety of different injection sites for collagenase chemonucleolysis for lumbar intervertebral disc protrusion (LIDP). Methods We searched for randomized controlled trials (RCTs) and quasi-RCTs in the following electronic databases: Pubmed (1966 to May 2006), EMBASE(1966 to May 2006), The Cochrane library (Issue 2, 2006), CRD(Center for Reviews and Dissemination),York University, CBM (1978 to May 2006 ), CNKI(1994-2006)and VIP(1989-2006). Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. Results Eight studies involving a total of 1035 participants met the inclusion criteria. Meta-analysis was not carried out because of apparent heterogeneity. Four studies made comparisons among intradisc, extradisc, and combined intra- and extra-disc injection. One study (62 participants) showed that intradisc injection was superior to extradisc injection (RR 3.71, 95% CI 1.19 to 11.58, Plt;0.05). Another study (240 participants) showed that intradisc injection was superior to combined intra- and extra-disc injection after 3 months and 6 months of follow-up (RR 0.88, 95% CI 0.80 to 0.98, Plt;0.05). The other two studies showed no significant difference among intradisc, extradisc, and combined intra- and extra-disc injection. Four studies (436 participants in total) showed that amongst three extradisc injections, both anterior epidural space injection and lateral epidural space injection were superior to posterior epidural space injection (Plt;0.05). Although one study indicated that anterior epidural space injection was superior to lateral epidural space injection (RR 1.24, 95% CI 1.03 to 1.51, Plt;0.05), no statistical significance was found between anterior epidural space injection and lateral epidural space injection in two other studies (Pgt;0.05). Conclusions There is insufficient evidence to identify which injection site for collagenase is the most effective for lumbar intervertebral disc protrusion. The included studies showed that both anterior and lateral epidural space injection were superior to posterior epidural space injection. However, these studies are too small and poor quality, and have different diagnostic criteria, follow-up time points, outcome measures and efficacy parameters. Thus, more high quality and large-scale RCTs are needed.
目的 分析腰椎间盘突出症手术后复发的原因，探索有效的手术治疗方法。 方法 对2004年8月－2011年7月收治的32例腰椎间盘突出症术后复发再手术的患者，根据其病因采用3种不同手术方法治疗，其中椎间盘摘除术14例，椎间盘摘除联合腰椎后外侧融合内固定术7例，椎间盘摘除联合腰椎后路椎体间融合内固定术11例，术后应用改良Macnab疗效评定标准、Oswestry功能障碍指数（ODI）和影像学检查对手术治疗的临床疗效进行评价。 结果 3种手术治疗方法均取得了满意的优良率；术后3个月及末次随访ODI评分术后较术前明显降低，差异有统计学意义（P＜0.05）。 结论 腰椎间盘突出症术后复发与多种原因有关；根据复发患者的情况合理选择手术治疗方法均能取得较好的临床疗效。
目的 观察盐酸氨基葡萄糖治疗腰椎小关节骨关节炎的临床疗效。 方法 2010年9月－2012年5月门诊就诊的160例腰椎小关节骨关节炎患者随机分为两组进行治疗，对照组80例，口服非甾体抗炎药物尼美舒利；试验组80例，在服用尼美舒利的基础上加服盐酸氨基葡萄糖，治疗周期为2周。对两组患者治疗前及治疗后1、2周后日常生活能力、视觉疼痛模拟、心理测评（采用症状自评量表检测）3项指标进行检测，比较两组的临床疗效，并对患者进行3个月随访。 结果 两组患者各指标检测结果显示，治疗后较治疗前均明显改善，试验组明显优于对照组；总有效率试验组为97.3%，对照组为86.1%，试验组明显优于对照组，组间比较差异有统计学意义（P＜0.05）。 结论 盐酸氨基葡萄糖联合尼美舒利治疗腰椎小关节骨关节炎具有较好的临床疗效。
目的 观察比较盐酸氨基葡萄糖单独使用及与硫酸软骨素联合使用治疗腰椎小关节骨关节炎（LFOA） 的临床疗效。 方法 2009年1月－2011年1月，将80例LFOA患者随机分成两组，A组口服盐酸氨基葡萄糖，B组口服盐酸氨基葡萄糖和硫酸软骨素两种药物，6周为1个疗程，间断治疗4个疗程。分别比较用药前与用药后3、6周及5、8、11个月时的日本骨科协会（JOA）评分、晨僵和压痛程度变化。 结果 治疗后，两组的JOA评分在各观察时点均增加，与治疗前比较差异有统计学意义（P＜0.05）。组间行JOA评分治疗改善率的比较，在各观察时点差异均有统计学意义（P＜0.05），B组JOA评分改善率优于A组。治疗3周后，两组晨僵和压痛评分均降低，与本组治疗前比较差异有统计学意义（P＜0.05）；组间比较，差异亦有统计学意义（P＜0.05），B组晨僵和压痛程度均低于A组。第6周，第5、8、11个月，两组组间比较晨僵和压痛程度差异均无统计学意义（P＞0.05），但各疗程结束后两组晨僵和压痛程度均呈持续降低趋势。 结论 单独应用盐酸氨基葡萄糖及盐酸氨基葡萄糖与硫酸软骨素的联合应用治疗LFOA疗效确切，联合用药优于单独应用盐酸氨基葡萄糖。
【摘要】 目的 观察盐酸氨基葡萄糖治疗腰椎关节突关节骨性关节炎（lumbar zygapophyseal joint osteoarthritis，LZOA）的临床疗效及安全性。 方法 2009年1月-2010年1月，对90例LZOA患者随机分成治疗组和对照组，各45例。治疗组口服盐酸氨基葡萄糖，6周为1个疗程，治疗3个疗程，前2周均加用洛索洛芬钠；对照组患者仅给予洛索洛芬钠口服12周。比较两组治疗后2、6周及3、6、12个月的疗效及安全性。 结果 治疗后6周、3个月，治疗组与对照组症状均明显改善，对照组改善更明显。治疗6个月后，治疗组评分持续下降，到12个月时与治疗前比较差异有统计学意义（Plt;0.01）；而对照组评分则逐渐增高，到12个月时与其治疗前比较差异无统计学意义（Pgt;0.05）。两组的不良反应率分别为6.67%、15.56%，差异有统计学意义（Plt;0.01）。 结论 盐酸氨基葡萄糖治疗LZOA疗效确切，且安全性良好。【Abstract】 Objective To observe the clinical efficacy and safety of glucosamine hydrochloride on lumbar zygapophyseal joint osteoarthritis (LZOA). Methods From January 2009 to January 2010, 90 patients with LZOA were randomly divided into therapeutic group and comparative group, with 45 patients in each group. Patients in therapeutic group were treated with oral administration of glucosamine hydrochloride for 3 courses (6 weeks for one course; adding loxoprofen for the early 2 weeks). Patients in comparative group were treated with oral administration of loxoprofen for 12 weeks. The efficacy and safety between the two groups was compared. Results Symptoms in both group were relieved after 6-week and 3-month treatment. More obvious relief was observed in the comparative group. The scoring of therapeutic group kept decreasing after 6-month treatment. The efficacy showed significant improvement after 12-month treatment compared with which before the treatment was significant（Plt;0.01）. The scoring in comparative group kept increasing, which showed no significant difference after 12-month treatment（Pgt;0.05）. The adverse effect rate was 6.67% and 15.56% respectively in two groups, which was significant different（Plt;0.01）. Conclusions Glucosamine hydrochloride provides good efficacy and safety for patients with LZOA.
目的:探讨使用Moss Miami系统经骶棘肌肌间隙入路在APERTURE工具的引导下微创治疗腰椎滑脱症的疗效。方法:20例腰椎滑脱症患者(男11例,女9例),年龄30～65岁(平均40岁)。其中退变性14例、峡部裂5例、腰椎间盘突出合并钙化1例;Ⅰ度滑脱15例,Ⅱ度滑脱5例。滑脱部位:L4滑脱14例,L5滑脱6例,采用全麻俯卧位下经下腰部正中小切口(5cm),经双侧骶棘肌肌间隙入路在APERTURE工具的引导下放置Moss Miami系统进行复位固定和椎体间及后外侧植骨融合。结果:本组患者术中在C臂X光机监视,经骶棘间隙放置Moss Miami固定系统简单易行,切口较小、显露好、出血少,对骶棘肌等软组织造成的损伤轻,复位固定效果满意。术后经6月随访表明:本组患者腰腿痛等临床症状缓解,X线片显示滑脱复位无丢失、植骨融合良好、内固定器械无松动及断裂。结论:在C臂X光机监视下,采用Moss Miami经骶棘肌肌间隙入路在APERTURE工具的引导下治疗腰椎滑脱症具有切口小、肌肉软组织损伤轻、出血少、固定器械放置简单易行等优点,有利于患者术后康复。