Systematic Reviews Published in the April 2013 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The April 2013 issue (2nd DVD for 2013) contains 5484 complete reviews, 2341 protocols for reviews in production, and 22,600 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 692,000 randomized controlled trials, and 15,700 cited papers in the Cochrane methodology register. The health technology assessment database contains some 12,000 citations. Ninety-four new reviews have been published in the previous 3 months, of which four have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided.     

LEVOMEPROMAZINE FOR NAUSEA AND VOMITING IN PALLIATIVE CARE

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The April 2013 issue (2nd DVD for 2013) contains 5484 complete reviews, 2341 protocols for reviews in production, and 22,600 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 692,000 randomized controlled trials, and 15,700 cited papers in the Cochrane methodology register. The health technology assessment database contains some 12,000 citations. Ninety-four new reviews have been published in the previous 3 months, of which four have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided.     

基于“筋骨并重”探讨针药并用、理筋整复手法治疗神经根型颈椎病(气滞血瘀证)的效果及机制

目的:观察针药并用、理筋整复手法治疗神经根型颈椎病(气滞血瘀证)的临床效果,初步对可能的起效机制进行探究。方法:将就诊于我院的118例神经根型颈椎病患者,按照随机数字表法分为对照组(n=59)和观察组(n=59)。对照组患者给予理筋整复手法;观察组患者在对照组基础上加用针灸、中药汤剂进行内外合治。比较两组有效率,测定颈椎活动度,评估颈肩疼痛程度、强度、分级指数,监测血清中肿瘤坏死因子-α(TNF-α)、降钙素基因相关肽(CGRP)、内皮素-1(ET-1)、一氧化氮(NO)水平变化。结果:观察组的有效率高达93.22%(55/59),明显高于对照组的77.97%(46/59),差异有统计学意义(χ~2=0.018,P0.05);与对照组相比,观察组患者治疗后的颈椎活动度改善更明显,颈椎活动相关的右旋、左旋、后伸、前屈、左屈、右屈度明显高于对照组(P0.05);观察组患者治疗后的颈椎疼痛减轻更明显,VAS、PPI、PRI评分显著降低(P0.05);观察组患者炎症状态、血管内皮功能改善优于对照组,血清中TNF-α、CGRP、ET-1水平低于对照组,NO水平高于对照组(P0.05)。结论:针药并用、理筋整复手法利于提高神经根型颈椎病患者的颈椎活动度,缓解颈椎痛感,其机制可能与干预血清中TNF-α、CGRP、ET-1、NO水平以减轻炎症反应、改善血管内皮功能有关,值得进行临床推广。     

通络饮联合针刺疗法治疗神经根型颈椎病49例疗效观察

目的观察通络饮联合针刺疗法治疗神经根型颈椎病的临床疗效。方法将97例神经根型颈椎病患者随机分为治疗组(49例)和对照组(48例),对照组予常规针刺治疗,治疗组在对照组治疗基础上加用通络饮。两组疗程均为21天,随访3个月,观察临床疗效,比较治疗前后疼痛程度、NDI指数及血液流变学相关指标的情况。结果 1治疗组总有效率为95.92%,而对照组总有效率为81.25%;组间临床疗效比较,差异有统计学意义(P0.05)。2治疗前后组内比较,两组疼痛VAS积分、NDI积分差异均有统计学意义(P0.05);组间治疗后比较,疼痛VAS积分、NDI积分差异,治疗组优于对照组(P0.05)。3治疗前后组内比较,治疗组全血黏度(高切、低切)、血浆比黏度差异有统计学意义(P0.05);组间治疗后比较,全血比黏度(高切、低切)、血浆黏度差异有统计学意义,治疗组优于对照组(P0.05)。结论通络饮联合针刺疗法治疗神经根型颈椎病的疗效满意,可显著改善患者的颈部疼痛及功能障碍。     

理筋整复推拿法治疗神经根型颈椎病30例临床观察

目的 观测理筋整复推拿法治疗神经根型颈椎病的临床疗效.方法 搜集门诊神经根型颈椎病确诊患者共60例随机分为治疗组与对照组各30例,治疗组采用理筋整复推拿法进行治疗,对照组采用常规针刺进行治疗.每日治疗1次,5次为1个疗程,治疗2个疗程后观察疗效.结果 总有效率93.34％,对患者症状、体征改善明显.结论 理筋整复推拿法治疗神经根型颈椎病疗效确切,安全可靠,值得推广.     

颈牵态下磁场电脉冲疗法对神经根型颈椎病效果观察

目的：探讨颈牵态下磁场电脉冲疗法对神经根型颈椎病的疗效。方法：70例神经根型颈椎病患者分为治疗组与对照组各35例,治疗组采用颈牵态下磁场电脉冲疗法,对照组仅用颈牵引治疗及TDP照射,评价两组患者疗效、视觉模拟评分（VAS）及肌力。结果：治疗组总有效率97.14%,显著高于对照组的80.00%（P〈0.05）;治疗后两组患者VAS评分及最大握力均显著优于治疗前（P〈0.01）,且治疗组优于对照组（P〈0.01）。结论：颈牵态下磁场电脉冲疗法治疗神经根型颈椎病效果显著。     

下肢节段性神经根刺激H反射

探索理想的诊断腰骶神经根病的神经电生理技术。采用高压短脉冲电刺激技术直接刺激神经根，在比目鱼肌及半腱肌记录Ｈ反射，共检测正常人３０例，Ｓ１及Ｌ５神经根病２０例。（１）测定了比目鱼肌及半腱肌神经根刺激Ｈ反射正常值。（２）半腱肌和经目鱼肌ＮＲＳＨ在正常人可１００％记录到。９３）Ｌ５Ｓ１椎间隙及Ｓ１神经孔刺激，比目鱼肌及 半腱肌ＮＲＳＨ各参数相差均不显著。（４）单纯Ｓ１神经根病仅比目鱼肌ＮＲＳＨ异常，而     

Cervical posterolaterallaminoforaminotomy

Laminoforaminotomy is an effective treatment for cervical radiculopathy. We present our technique in conjunctionwith analysis of our long-term clinical results. The posterior approach in the surgical management of cervical radiculopathy is not only acceptable, but in certain cases is preferable to the anterior approach. When pathology is central, broad-based, and anterior, posterior procedures are unlikely to achieve decompression. However, with lateral or foraminal nerve root compression, the simpler posterior keyhole laminoforaminotomy is both safe and effective. Physicians advocating either the anterior or the posterior procedure exclusively are not providing, in our opinion, optimal care.     

侧卧位手法治疗神经根型颈椎病的疗效观察

神经根型颈椎病是临床上最为常见的颈椎病类型,多发于中老年人,是由于颈椎间盘退行性改变、颈椎骨质增生及颈部损伤等原因引起脊柱内、外平衡失调,刺激或压迫神经根而引起。推拿治疗时患者一般都采用坐位接受手法治疗。近年来,我院以侧卧体位下利用手法治疗神经根型颈椎病95例,     

Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniation

The aim of this clinical investigation was to determine whether the abnormal H-reflex complex present in patients with S 1 nerve root compression due to lumbosacral disc herniation is improved by single-session lumbar manipulation. Twenty-four patients with unilateral disc herniation at the L5-S1 level underwent spinal H-reflex electro-physiological evaluation. This was carried out before and after single-session lumbar manipulation in the side-lying position. Eligibility criteria for inclusion in the study were: predominant sciatica, no motor or sphincteric involvement, unilateral disc herniation at the L5-S1 level on CT or MR imaging, age between 20 and 50 years. H-reflex responses were recorded bilaterally from the gastrosoleous muscle following stimulation of tibial sensory fibers in the popliteal fossa. H-reflex amplitude in millivolts (HRA) and H-reflex latency in milliseconds (HR-L) were measured from the spinal reflex response. Pre- and post-manipulation measurements were compared between the affected side and the healthy side. Statistical evaluation was performed by the Wilcoxon matched-pairs test (SPSS). Thirteen patients displayed abnormal H-reflex parameters prior to lumbar manipulation, indicating an S1 nerve root lesion. The mean amplitude was found to be significantly lower on the side of disc herniation than on the normal, healthy side (P = 0.0037). Following manipulation, the abnormal HR-A increased significantly on the affected side while the normal HR-A on the healthy side remained unchanged (P = 0.0045). There was a significant difference between latencies on the affected side and those on the healthy side (P = 0.003). Following manipulation there was a trend toward decreased HR-L. However, this trend did not reach statistical significance (P = 0.3877). Eight patients displayed no H-reflex abnormalities before or after manipulation. Their respective HR-A and HR-L values did not change significantly following manipulation. Three additional patients were excluded due to technical difficulties in achieving manipulation or measuring spinal reflex. These observations may lend physiological support for the clinical effects of manipulative therapy in patients with degenerative disc disease.Presented in part at EURO SPINE, Zurich, 18 October 1996, the International Conference on Spinal Manipulation, Bournemouth, 19 October 1996, and the North American Spine Society Annual Meeting, Vancouver, 25 October 1996