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.
Objective To investigate the effectiveness of kyphoplasty in treating osteoporotic vertebral fracture according to comparative study. Methods Between March 2006 and August 2007, 60 patients with osteoporotic vertebral fractures were treated. Kyphoplasty was performed in 40 patients (test group) and conservative treatment was performed in 20patients as control (control group). In test group, there were 6 males and 34 females with an average age of 68.7 years (range, 56-78 years). The disease duration was 10-18 months (mean, 12 months). A total of 73 vertebral bodies fractured. In control group, there were 5 males and 15 females with an average age of 70.1 years (range, 57-80 years). The disease duration was 9-16 months (mean, 13 months). A total of 41 vertebral bodies fractured. There was no significant difference in the general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention in test group, and no leakage of bone cement occurred. The patients of 2 groups were followed up 36-38 months. The visual analogue scale (VAS) scores, European Vertebral Osteoporosis Study (EVOS) questionnaire scores, anterior and middle vertebral column heights, and Cobb angles of test group at 1-3 days, 12 and 36 months after treatment were significantly improved when compared with those before operation (P lt; 0.05); but there was no significant difference between before treatment and after treatment in control group (P gt; 0.05). After 12 and 36 months, the VAS scores, EVOS scores, anterior and middle vertebral column heights, and Cobb angles of test group were better than those of control group (P lt; 0.05). The incidence of vertebral re-fractures was higher in control group than in test group after 36 months (χ2=16.347, P=0.015). Conclusion Kyphoplasty can effectively rel ieve pain and restore the function after the procedure. The risk of vertebral re-fractures after kyphoplasty can be reduced in comparison with conservative treatment.
Objective To investigate the treatment method of senile patients with femoral intertrochanteric fractures and its cl inical outcomes. Methods From January 2005 to December 2007, 192 senile patients with femoral intertrochanteric fractures were treated, including 85 males and 107 females aged 65-92 years old (average 75 years old). The injury was causedby fall on walking in 106 cases, fall when riding a bicycle in 55 cases, and traffic accidents in 31 cases. According to Evans classification, there were 12 cases of type I A, 43 cases of type I B, 29 cases of type II, 24 cases of type III A, 23 cases of type III B, 26 cases of type IV, and 35 cases of type V. One hundred and fifty patients were associated with cardio-cerebrovascular diseases, 120 patients were compl icated with chronicle hypertension, 90 cases were associated with bronchitis, and 75 cases were compl icated with diabetes. The time from injury to hospital admission was 1 hour to 14 days. Among those patients, 108 were treated with conservative treatment, 68 received dynamic hip screw (DHS) fixation, and 16 underwent proximal femoral Gamma nail fixation. Results All the patients were followed up for 12-36 months (average 18 months). The fracture all reached bone union without occurrence of nonunion and delayed union. Patients could take care of themselves, and there were no occurrences of serious pains and dysfunctions. The therapeutic effect was satisfactory. The conservative treatment group: the average hospital stay length was 48 days; the average bone heal ing time was 14 weeks; 23 cases had different degrees of coxa adducta; Harris score system was adopted to evaluate hip joint function, 45 cases were graded as excellent, 31 as good, 10 as fair, and 22 as poor, and the excellent and good rate was 70.4%. DHS internal fixation group: the average operation time was 60 minutes; the average bleeding volume during operation was 200 mL, the average hospital stay length was 24 days; the average bone heal ing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function, 38 cases were graded as excellent, 21 as good, 8 as fair, and 1 as poor, and the excellent and good rate was 86.8%. Gamma nailfixation group: the average operation time was 70 minutes; the average bleeding volume during operation was 200 mL, the average hospital stay length was 14 days; the average bone heal ing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function, 11 cases were graded as excellent, 4 as good, 1 as fair, and the excellent and good rate was 93.8%. Conclusion For geriatric femoral intertrochanteric fractures, operative treatment should be performed, the preoperative preparation should be sufficient, and individual-oriented treatment method should be selected on the basis of physical conditions of patients and the types of fractures.
In order to find out the causes, diagnosis, and the prevention and treatment of vascular crisis following anastomosis of small vessels, 314 cases vascular crisis from 1985 to 1997, were analyzed, in which 152 cases, suffered from tissue necrosis either total or partial, making up 48.4%. One hundred and forty-four cases underwent conservative treatment occupying 45.8% and 104 cases had tissue necrosis, occupying 68.4%. Operative exploration was done on 170 cases, occupying 54.1% and 48 cases of them suffered from necrosis, which made up 31.6% of all necrotic cases. Eighty-six cases were followed up by regular visits, ranging from 40 days to 7 years, with the finding that those who had regained normal circulation after vascular crisis recovered as well as those without crisis, and among those who did not regain normal circulation but survived with the help of collateral circulation after vascular crisis, they were usually cases of bad union, healing of wound, persistent swelling, different degree of tissue atrophy, poor recovery of sensation. It was concluded that proper use of vascular anastomosis technique and prophylactic measures preventing postoperative vascular spasm were extremely important, in the prevention of development of vascular crisis following anastomosis of small vessels. If vascular crisis did not respond well to conservative treatment, prompt surgical exploration should be undertaken.
Objective To evaluate the effect and safety of the conservative treatment for the protrusion of cervical vertebra intervertebral disc. Methods We searched CBM disk (1978~2007), CNKI (1979~2007), VIP (1989~2007). Telephone interviewed the original authors of claimed randomized controlled trials(RCTs) to identify whether they are truly RCTs. Only true RCTs and quasi-randomized controlled trials were included and the quality of them was critically assessed. Results Five RCTs and eleven quasi-randomized controlled trials were identified and included. It showed that lifting-massage, massage combining with traction or acupuncture, articulus mobilization combining with traction and electrotherapy, traction combining with computer intermediate frequency therapeusis and injectio ad acumen combining with massage have marked improvement. But it could hardly draw a conclusion that all the combining therapies had better curative effect. Conclusions Weak evidence shows that combining conservative treatment can improve the curative effect of the protrusion of cervical vertebra intervertebral disc. The results need to be supported by well designed and high quality trials.
ObjectiveTo assess the effect of surgical treatment or conservative treatment on the clinical outcomes for displaced 3-part or 4-part proximal humeral fractures in elderly patients. MethodsWe searched CNKI (between January 1979 and April 2014), Wanfang Data (between January 1982 and April 2014), Medline (between January 1946 and April 2014), PubMed (between January 1966 and April 2014), Embase (between January 1974 and April 2014) and Cochrane Database of Systematic Reviews (between January 2005 and April 2014) for randomized controlled trials comparing surgical treatment and conservative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients. The data were extracted and a Meta-analysis was made using RevMan 5.2. ResultsFive randomized controlled trials with a total of 226 patients were accepted in this Meta-analysis. The differences of Constant scores[WMD=0.48, 95%CI (-4.39, 5.35), P=0.85], incidences of avascular necrosisr of the humeral head[RR=0.66, 95%CI (0.37, 1.16), P=0.15], incidences of nonunion[RR=0.56, 95%CI (0.20, 1.58), P=0.27], incidences of osteoarthritis[RR=0.35, 95%CI (0.10, 1.22), P=0.10] between the two groups were not statistically different. The difference of incidences of additional surgery after primary treatment was statistically significant[RR=3.52, 95%CI (1.18, 10.45), P=0.02]. ConclusionThe results does not support the surgical treatment to improve the shoulder function when compared with conservative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures. But surgical treatment increases the incidence of additional surgery after primary treatment. Considering surgery can increase the trauma and economic burden of patients, so the conservative treatment is suggested.
ObjectiveTo investigate etiology of granulomatous mastitis and it,s conservative treatment method. MethodThe clinical data of 120 patients with granulomatous mastitis given drugs for closed treatment plus massage dredge and ductal lavage from January 2011 to December 2012 in this hospital were analyzed retrospectively. ResultsOne hundred and one cases were cured following conservative treatment for 2 to 8 weeks,19 cases were underwent surgical treatment because of poor outcome.Nine of 101(8.9%) cured patients were relapsed for following-up of 30 to 42 months. ConclusionClosed treatment with drugs,which is effective,could keep patient with granulomatous mastitis from having mastectomy and reduce recurrence.
ObjectiveTo evaluate effect and safety of a novel conservative therapy for post-lobectomy bronchopleural fistula. MethodsWe retrospectively analyzed the clinical data of 20 patients with post-lobectomy bronchopleural fistula in our hospital between 2000 and 2013 year. There were 12 males and 8 females at average age of 67.7±8.7 years. Endobronchial naso-bronchial lavage (ENBL) was used for 10 patients (an ENBL group). Traditional method-thoracostomy drainage tube (TDT) was used for the other 10 patients (a TDT group). ResultsCompared with the TDT group, shorter hospital day was found in the ENBL group (49.7±9.6 d versus 68.3±9.8 d, P < 0.001). Fistula healing time was also shorter in the ENBL group than that in the TDT group (43.7±9.7 d versus 62.6±8.8 d, P < 0.001). There were lower complication rate, less inflammatory reaction, and better recovery in the ENBL group than those in the TDT group. ConclusionENBL may be a promising procedure for post-lobectomy bronchopleural fistula.
Osteoporotic vertebral compression fractures (OVCFs) are common in elderly patients with reduced bone density. Pain and loss of function after fractures have a serious impact on the patient's activities of daily living and quality of life. Management of patients with early OVCFs who choose non-surgical treatment is necessary to prevent complications, relieve pain, and improve functional status. This paper focuses on the development of OVCFs non-surgical management in many aspects, which may provide reference for the rapid recovery of OVCFs patients in the process of non-surgical management.