Objective To assess the effectiveness and safety of collagenase for intervertebral disk hernia, to facilitate the rational selection of the most appropriate therapy. Methods We searched the following electronic databases: Medline (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 to 2006), and VIP (1989 to 2006). RCTs or quasi-RCTs were included. RevMan 4.2 was used for statistical analysis. Results Six RCTs and one quasi-RCT involving 829 participants were included. One study showed that the short-term effective rate was similar between chemonucleolysis (CNL) and percutaneous laser dise decompression (PLDD), but the long-term effective rate of PLDD was superior to that of CNL (RR 0.35, 95%CI 0.13 to 0.96). One study revealed that the short- and long-term effective rate of CNL were higher than those of placebo (Plt;0.05). Two studies comparing collagenase vs chymopaain were heterogeneous: one indicated that chymopapain was superior to collagenase according to ITT analysis (Plt;0.05); but the other revealed no significant difference among the high- and low-dose collagenase groups and chymopapain group (Pgt;0.05). One trial showed that the effective rate between collagenase and automated percutaneous lumbar discectomy (APLD) was not significantly different (Pgt;0.05). The overall results of CNL vs Triamcinolone Acetonide showed no significant difference, but significant difference was found among patients with different types of intervertebral disk hernia. One study showed that CNL was superior to Prednisolone. Three studies reported adverse effects, mainly involving pain, neurologic deficit, cauda equina syndrome and allergic reaction amongst others. Conclusions No adequate evidence shows which therapy is more effective for intervertebral disk hernia. More high-quality trials are required.
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.
Objective To find the difference between the collagenase activity and tissue inhibitor of metalloproteinase-1 (TIMP-1) expression level in normal urethral tissue and in urethral scar tissue, and to study the effect of collagenase activity and TIMP-1 expression level on the degradation of urethral scar. Methods The urethral tissues were derived from 10 human surgical specimens of urethral stricture scar and 10 human normal urethral specimens from patients with brain death. The collagenase activity was detected by ELISA assay, and the TIMP-1 mRNA level by RT-PCR. Results The collagenase activity of urethral scar tissue was (15.32±2.29) U and lower than that of normal urethral tissue (24.67±6.78) U, there was significant difference between them (P lt; 0.01). The TIMP-1 expression level of urethral scar tissue was higher than that of normal urethral tissue, there was significant difference between them (P lt; 0.05). Conclusion The high level of TIMP-1 expression and the low collagenase activity in urethral scar tissue may inhibit the degradation of urethral scar, and may be one of important causes of the scar tissue hyperplasia.
Collagenase can promote wound healing, and its effect depends on the degradation of necrotic tissue and the collagen degradation products produced by collagenase. The possible mechanisms include accelerating re-epithelialization, promoting the formation of granulation tissue and blood vessels, and regulating inflammatory response. At present, clinical studies have shown that collagenase combined with sharp debridement or negative pressure wound therapy can significantly promote the healing of diabetic foot ulcers, and its efficacy is similar to that of hydrocolloid occlusive dressing and silver-containing wound dressings. Collagenase can promote the repair of diabetic foot ulcers, but its effect is affected by many factors, and large-sample, good design, high quality and multi-center randomized controlled trials are still needed to explore its efficacy and appropriate use conditions. This paper expounds that collagenase is one of the options in the treatment of diabetic foot ulcers from mechanism and clinical effect.