Objective To manage the preoperative, intraoperative and postoperative pain of percutaneous kyphoplasty (PKP) under the concept of enhanced recovery after surgery (ERAS) and explore the role of pain management under the ERAS concept in enhancing postoperative rehabilitation of PKP. Methods From January to December 2016, 136 patients with osteoporotic compression fractures treated with PKP of local anesthesia were selected, among which 71 patients in the ERAS group were treated between July and December 2016, who were treated with celecoxib capsule for analgesia before the operation and such local anesthetics as lidocaine and ropivacaine combined with intravenous injection of dexmedetomidine hydrochloride for multi-mode analgesia during the operation; after the operation, celecoxib capsules and tizanidine hydrochloride tablets were orally administered by the routine for analgesia; if the pain was increased, 40 mg parecoxib would be added for analgesia by intramuscular injection. While 65 patients in the conventional group were treated between January and June 2016, who were given intraoperative local anesthesia with lidocaine; if the patients suffered from severe pain after the operation, they would be given 40 mg parecoxib by intramuscular injection. The Visual Analogue Scale (VAS), mean arterial pressure (MAP), the complications after surgery, postoperative infections, bed rest time, length of hospital stay and patient satisfaction were compared between the two groups. Results There was no statistical difference in age, gender or fracture vertebral number between the two groups (P>0.05). The preoperative, intraoperative and postoperative VAS scores (4.0±1.5, 4.8±1.8, 1.6±1.1), MAP change [(22.0±4.7) mm Hg (1 mm Hg=0.133 kPa)], bed rest time [(1.5±0.7) days], and length of hospital stay [(3.8±0.8) days] in the ERAS group were significantly less than those in the conventional group [4.7±1.7, 5.7±1.5, 2.4±1.1, (31.3±6.1) mm Hg, (2.1±0.8) days, and (5.0±1.6) days, respectively] (P<0.05). The incidence of intraoperative complication of bone cement leakage (4.2%, 3/71) in the ERAS group was lower than that in the conventional group (13.8%, 9/65) (P<0.05); there was no statistical difference in postoperative pulmonary infection between the two groups (P>0.05). Patients’ satisfaction was significantly improved from 86.2% (the conventional group) to 95.8% (the ERAS group) (P<0.05). There was no incision infection, urinary tract infection or venous thrombosis in the two groups. Conclusion With the concept of ERAS, taking a management of pain can effectively alleviate the dis-comfortable pain feeling, improve the patients’ satisfaction, and enhance the recovery for the patients after PKP surgery.
ObjectivesTo evaluate the clinical efficacy of massage in the treatment of primary dysmenorrhea (PD).MethodsCNKI, VIP, WanFang Data, CBM, The Cochrane Library, PubMed and EMbase databases were searched to collect randomized controlled trials (RCTs) on the treatment of primary dysmenorrhea from inception to January 6th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. RevMan 5.3 software was used for meta-analysis.ResultsA total of 10 RCTs were included, including 758 patients with PD. Meta-analysis results showed that the total effective rate (RR=1.14, 95% CI 1.03 to 1.26, P<0.000 01; RR=1.24, 95% CI 1.15 to 1.34, P<0.000 01) and the dysmenorrhea symptom score (MD=–2.59, 95% CI –3.08 to –2.29, P<0.000 1) in massage group were superior to the control group.ConclusionCurrent evidence suggests that massage for PD has certain advantages. However, due to the limited quality of the included studies, high-quality clinical trials are required to further verify the clinical efficacy of massage in the treatment of primary dysmenorrhea.
Objective To investigate the incidence of full-term prelabor rupture of membranes (FPROM) and risk factors for FPROM. Methods A prospective nested case-control study was performed on pregnant women in early pregnancy and their spouses, who underwent prenatal examination for the first time in Zhuhai Center for Maternal and Child Health Care from May 2021 to December 2022. Pregnant women with a clear diagnosis of FPROM were included in the case group, and pregnant women without FPROM were randomly selected at a 1∶3 ratio for inclusion in the control group. A questionnaire survey was performed to collect exposure information possibly related to FPROM. The hospital's medical record system was used for information verification and to record the pregnancy outcomes. A multivariate logistic regression analysis was used to investigate the risk factors for FPROM. Results The incidence of FPROM in this study was 24.27%. The multivariate logistic regression analysis showed that obesity pregnant women, smoking, drinking, unbalanced diet, high-intensity physical activity during pregnancy, eating areca nut before pregnancy, using glucocorticoids during pregnancy, older at the time of first pregnancy, a history of adverse pregnancy outcomes, a history of pregnancy complications, a history of diabetes, a history of scar uterus, no folate supplementation during pregnancy, repeated intrauterine operations, polyembryony, polyhydramnios, transverse fetus and fetal cephalopelvic disproportion as the way of conception were risk factors for FPROM (P<0.05). Additionally, the pregnant women whose spouses were obese or smoked or drinking had an increased risk of FPROM (P<0.05). Lower gravidity and lower parity were protective factors against FPROM (P<0.05). Conclusion There are many risk factors for FPROM. Special attention should be given to the life behaviors of pregnant women during pregnancy, and health education should be strengthened for pregnant women and their spouses to help them develop good living habits and reduce the incidence of FPROM.
Objective To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. Methods The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups (P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients’ lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients’ lumbar and back function improvement before operation and at 6 months after operation. Results The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B (P<0.05). There was no nerve root injury, dural tear, cerebrospinal fluid leakage, and hematoma formation during and after operation in the two groups. All patients were followed up after operation, the follow-up time in group A was 6-18 months (mean, 10.5 months) and in group B was 6-20 months (mean, 9.3 months). There was no complication such as internal fixation fracture, loosening and nail pulling occurred during the follow-up period of the two groups. There was no significant difference in VAS scores between the two groups at 3 days after operation (t=1.448, P=0.154); the VAS score of group A was significantly lower than that of group B at 3 and 6 months after operation (P<0.05). The ODI scores of the two groups were significantly improved at 6 months after operation (P<0.05), and there was no significant difference in ODI scores between the two groups before operation and at 6 months after operation (P>0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups (Z=–0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference (χ2=0.001, P=0.979 ). Conclusion The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.
ObjectiveTo analyze and compare the clinical efficacy and safety between one-stage operation and staged operation in the treatment of tandem spinal stenosis (TSS).MethodsThe data of 39 patients with TSS were retrospectively analyzed, who were definitely diagnosed and treated surgically between February 2011 and March 2016 in the Affiliated Hospital of Southwest Medical University. According to whether one-stage decompression was performed, the patients were divided into group A (cervical and lumbar vertebral canal decompression procedures were performed in one stage, n=21) and group B (cervical and lumbar spinal canal decompression procedures were performed in two stages with a time interval of 3-6 months, n=18). Both one-stage and staged operations were performed by the same surgical team. The Nurick scores, Japanese Orthopedic Association (JOA) scores of cervical spine and lumbar spine, and Oswestry Disability Index (ODI) before operation and in postoperative follow-up, postoperative JOA improvement rate, and perioperative indicators were recorded and compared.ResultsAll patients completed the operations successfully, and the lengths of follow-up were all longer than 12 months. There was no significant difference in gender, age, body mass index, preoperative duration of symptoms, preoperative Kang grade, preoperative Schizas grade, preoperative underlying diseases, preoperative cervical or lumbar spine JOA score, preoperative ODI, preoperative Nurick score, decompression segment or distribution, or length of follow-up between the two groups (P>0.05). The Nurick score, JOA score of cervical and lumbar spine, and ODI at one year after operation and the last follow-up were significantly improved compared with those before operation. The one-year after operation improvement rates of JOA of cervical and lumbar spine in group A were significantly higher than those in group B [cervical spine: (70.55±9.28)% vs. (55.29±7.82)%, P<0.05; lumbar spine: (69.50±4.95)% vs. (51.58±7.62)%, P<0.05], but there was no significant difference in the improvement rate of JOA between the two groups at the last follow-up (P>0.05). There was no significant difference in Nurick score or ODI between the two groups at one year after operation or the last follow-up (P>0.05). There was no significant difference in the average length of hospital stay between the two groups [(15.67±3.40) vs. (15.72±1.57) d, P>0.05]. The operation time [(293.10±43.83) vs. (244.44±22.29) min] and intraoperative bleeding [(533.33±180.51) vs. (380.56±38.88) mL] in group A were significantly higher than those in group B (P<0.05). The incidence of postoperative complications of group A was higher than that of group B (57.1% vs. 16.7%, P<0.05).ConclusionsCompared with staged surgery, one-stage operation in the treatment of TSS has a significant improvement in neurological function and clinical efficacy in short-term follow-up, but there is no significant difference in long-term follow-up. Staged surgery has the advantages of shorter operation time, less intraoperative blood loss, lower postoperative complication rate, and higher safety.