椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景：椎体成形和椎体后凸成形的应用越来越多,但两者的对比研究较少,而且大部分都是回顾性病例分析,缺乏系统性评价。目的：对比椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的效果。方法：全面收集椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的对照研究,两个研究者独立评价文献,并采集数据,在严格文献质量评价的基础上,进行系统评价。结果与结论：共纳入13篇文献,总计728例患者。在疼痛及功能评分方面,两种方法差异无显著性意义（P=0.69,0.35）;在改善后凸角度及减少骨水泥渗漏方面,椎体后凸成形优于椎体成形（P〈0.00001,0.0001）。在新发邻椎骨折方面,两种方法差异无显著性意义（P=0.41）。提示椎体成形和椎体后凸成形均能明显减轻疼痛、改善功能,但二者间无差异;椎体后凸成形可更好地改善后凸角度,并减少骨水泥渗漏;关于新发邻椎骨折,还不能得出确切结论,尚需更多设计严谨的随机对照研究加以证实。     

椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景:椎体成形和椎体后凸成形的应用越来越多,但两者的对比研究较少,而且大部分都是回顾性病例分析,缺乏系统性评价。目的:对比椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的效果。方法:全面收集椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的对照研究,两个研究者独立评价文献,并采集数据,在严格文献质量评价的基础上,进行系统评价。结果与结论:共纳入13篇文献,总计728例患者。在疼痛及功能评分方面,两种方法差异无显著性意义(P=0.69,0.35);在改善后凸角度及减少骨水泥渗漏方面,椎体后凸成形优于椎体成形(P<0.00001,0.0001)。在新发邻椎骨折方面,两种方法差异无显著性意义(P=0.41)。提示椎体成形和椎体后凸成形均能明显减轻疼痛、改善功能,但二者间无差异;椎体后凸成形可更好地改善后凸角度,并减少骨水泥渗漏;关于新发邻椎骨折,还不能得出确切结论,尚需更多设计严谨的随机对照研究加以证实。     

Minimally invasive non-surgical management of plantar fasciitis: A systematic review

Background

Minimally invasive non-surgical techniques have been widely used worldwide to treat musculoskeletal injuries. Of these techniques, injectable pharmaceutical agents are the most commonly employed treatments, with corticosteroids being the most widely used drugs. The aim of this article is to review current scientific evidence as well as the effectiveness of minimally invasive non-surgical techniques, either alone or combined, for the treatment of plantar fasciitis.

单双侧椎体后凸成形骨水泥注入修复骨质疏松性椎体压缩性骨折的荟萃分析

背景：球囊椎体后凸成形可有效治疗骨质疏松引起的椎体压缩性骨折,但对于采用单侧还是双侧入路哪种入路疗效更佳、并发症更少,目前尚无定论。目的：系统评价单侧与双侧穿刺入路椎体后凸成形治疗骨质疏松性椎体压缩性骨折的疗效和安全性。方法：应用计算机检索PubMed、EMBASE、Cochrane Library、ISI Web of Knowledge、CBM等数据库1963年1月至2014年3月文献,收集单侧对比双侧入路椎体后凸成形治疗骨质疏松性椎体压缩性骨折的随机对照试验,由2名评价者独立评价纳入研究的质量并提取资料,并用RevMan 5.2软件进行统计分析。结果与结论：共纳入14个随机对照试验,共876例患者,其中单侧入路组442例,双侧入路组434例。Meta分析结果显示,单侧入路组手术时间、单个椎体平均注射骨水泥及骨水泥渗漏率少于双侧入路组[均数差MD=-19.33,95%可信区间（-24.42,-14.24）;均数差MD=-2.07,95%可信区间（-2.42,-1.71）;OR=0.47,95%可信区间（-24.42,-14.24）];两组目测类比评分、椎体高度变化及 Cobb 角变化方面的差异无显著性意义。结果说明在椎体后凸成形治疗中,单侧入路可减少骨水泥渗漏率。     

Benefits and harms of normal saline instillation before endotracheal suctioning in mechanically ventilated adult patients in intensive care units: A systematic literature review and meta-analysis

ObjectivesThis systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator.Research MethodologyThis review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses.ResultsIn total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning.ConclusionThis systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits.Implications for Clinical PracticeAs recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning.     

Kyphoplasty. A treatment for osteoporotic vertebral compression fractures

Patients experience more than 700,000 osteoporotic vertebral compression fractures each year in the United States, primarily because of bone brittleness and the inability of the vertebrae to resist increased forces applied to them. Patients diagnosed with this type of fracture are given the option of conservative or operative treatment approaches. Although a typical compression fracture generally heals in 6 to 12 weeks, patients may be offered the kyphoplasty procedure, which reduces the fracture and stabilizes it with cement. Although this procedure is not without risk, it is deemed a safe and effective treatment option. This article reviews the indications, implications, and care provided to patients pursuing kyphoplasty after osteoporotic vertebral compression fracture.     

Benefits of ozone on mortality in patients with COVID-19: A systematic review and meta-analysis

BackgroundThe Coronavirus disease-2019 (COVID-19) pandemic continues, and the death toll continues to surge. Ozone therapy has long been used in the treatment of a variety of infectious diseases, probably through its antioxidant properties and the supply of oxygen to hypoxic tissues. This systematic review and meta-analysis aimed to determine the efficacy of ozone on mortality in patients with COVID-19.MethodsA systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Prospective controlled trials on treatment of COVID-19 with ozone, compared with placebo or blank, were reviewed. Studies were pooled to risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (CIs).ResultsEight trials (enrolling 371 participants) met the inclusion criteria. Ozone therapy showed significant effects on mortality (RR 0.38, 95% CI 0.17–0.85; P = 0.02), length of hospital stay (WMD −1.63 days, 95% CI −3.05 to −0.22 days; P = 0.02), and polymerase chain reaction (PCR) positivity (RR 0.07, 95% CI 0.01–0.34; P = 0.001).ConclusionsOzone therapy significantly reduced mortality, PCR positivity, and length of stay in hospitalized patients with COVID-19. Ozone therapy should be considered for COVID-19 patients.     

单侧与双侧入路脊柱行后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景:椎体后凸成形明显改善了骨质疏松性椎体压缩骨折的治疗过程,但临床上对于单侧入路还是双侧入路还存在一定争议.目的:对比单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的疗效.方法:全面收集椎体单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的随机对照研究,由两个研究者独立评价文献,并采集数据,在严格文献质量评价的基础上,进行Meta系统评价.结果与结论:共纳入5篇文献,241例患者.在止痛及骨水泥渗漏方面,两种脊柱入路差异无显著性意义(P=0.99,P=0.56);在改善后凸角度方面,双侧入路优于单侧入路(P=-0.05);在手术时间方面,单侧入路优于双侧入路(P＜0.000 01).表明单侧入路与双侧入路均能明显减轻疼痛,二者差异无显著性意义;二者骨水泥渗漏率差异无显著性意义;双侧入路可更好地改善脊柱后凸角度,但手术时间较长:鉴于纳入的文献质量不高,结论尚需更多设计严谨的随机对照研究加以证实.     

骨质疏松椎体压缩性骨折治疗进展

骨折是老年性骨质疏松患者最常见 ,同时也是最严重的一种并发症。在美国 ,每年有 15 0万人发生此类骨折 ,其中脊柱骨折占 3 0 %。对于骨质疏松椎体压缩性骨折 (osteoporoticver tebralcompressionfracturesVCFs) ,传统采用保守治疗 ,强调卧床休息。但这些方法都不能迅速有效地缓解患者持续、严重的疼痛 ,而且在患者下床活动后由于伤椎的进一步压缩 ,疼痛及后凸畸形加重 ,导致胸腔容积缩小 ,通气障碍 ,慢性缺氧 ,心肺功能障碍 ,死亡率明显升高。近年来 ,新出现的经皮椎体成形术 (percutaneousvertebroplasty ,PVP)及在此基础上发展起来的…     

Complex management of osteoporotic vertebral fracture

Background. Compression fractures of the thoraco-lumbar spine are the most common form of damage to the skeletal system caused by osteoporosis. These fractures are stable and do not produce neurological deficits. The intensity of the clinical symptoms depends on the degree of kyphotic distortion of the spine and the number of fractured vertebrae. Among the most serious consequences of such injuries are chronic pain, habituated poor body posture (deeper thoracic kyphosis with compensatory hyperlordosis in the lumbar spine), motor and functional limitations, reduced quality of life, and heightened risk of subsequent spinal fractures.
Material and methods. We analyzed a group of 26 patients treated for spinal fractures associated with osteoporosis, in order to evaluate the effectiveness of the treatment methods applied.
Conclusions. Our results indicate that the best outcomes are obtained when the period of immobility is reduced to a minimum and rehabilitation is commenced as early as possible.     

Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis

ObjectiveUltrasound has an excellent diagnostic accuracy for fractures that is reportedly comparable to plain radiographs. We aim to summarize the diagnostic accuracy of ultrasound for upper extremity fractures in children.MethodsDatabases were searched from inception through November 2019 using pre-defined index terms, including “ultrasound,” “fractures of upper extremities” and “children”. The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for fractures was conducted using the random-effects bivariate model. Subgroup analysis of fracture site (elbow vs non-elbow fractures) was also performed. Meta-regression was performed to determine if the site of fracture affected the diagnostic accuracy.ResultsThirty-two studies were identified in the meta-analysis. Ultrasound for fractures of the upper extremities has a sensitivity: 0.95 (95% CI: 0.93–0.97), specificity: 0.95 (95% CI: 0.91–0.98), positive likelihood ratio: 21.1 (95% CI: 10.8–41.5) and negative likelihood ratio: 0.05 (95% CI: 0.03–0.07), with an area under ROC (AUROC) curve of 0.98 (95% CI: 0.97–0.99). Subgroup analysis for elbow fracture showed ultrasound has a sensitivity: 0.95 (95% CI: 0.86–0.98), specificity: 0.87 (95% CI: 0.76–0.94), positive likelihood ratio: 7.3 (95% CI: 3.7–14.4) and negative likelihood ratio: 0.06 (95% CI: 0.02–0.16), with an AUROC of 0.96 (95% CI: 0.94–0.97). Meta-regression suggested the fracture sites would affect diagnostic accuracy of ultrasound (elbow vs non-elbow, p < 0.01).ConclusionsCurrent evidence suggests ultrasound has excellent diagnostic accuracy for non-elbow upper extremity fractures in children, serving as an alternative diagnostic modality to plain radiographs.     

PVP治疗骨质疏松性椎体骨折

目的探讨PVP技术治疗骨质疏松性椎体骨折止痛效果。方法18例（21个椎体）骨质疏松性骨折进行PVP治疗。术前、术后3d、1个月、3个月应用VAS对患者疼痛进行评价并测量椎体高度变化。结果术前VAS为7．944±0．938;术后3d为2．778±1．003;术后1个月为2．667±0．767;术后3个月为2．611±0．850。术前与术后3个时间段差异有显著性,P〈0．05;术后3个时间段之间差异均无显著性,P〉0．05,且在椎体高度变化方面,术前、术后差异无显著性。结论PVP治疗骨质疏松性骨折止痛作用迅速、有效。     

骨质疏松性椎体骨折模型的建立

目的:建立大鼠的骨质疏松性椎体骨折模型,探讨骨折愈合程度与X射线、骨结构和力学性能的相互关系,以期能为临床治疗提供科学的指导和理论依据。方法:实验于2005-07/2006-07在解放军兰州军区总医院骨研所完成。实验动物:选择雌性SPF级8个月龄SD大鼠54只。实验分组:采用随机数字法将大鼠分为2组:骨质疏松组和对照组,每组27只。实验干预:骨质疏松组经双背侧手术切除卵巢,对照组行伪手术。术后3个月,所有动物麻醉下,采用L5椎体手术开窗刮除术区内松质骨方法建立人工椎体骨折模型。实验评估:于术后1,2,4,6,8,12周观察两组大鼠腰椎影像学、骨组织切片组织学与受累椎体力学性能。结果:54只SD大鼠全部进入结果分析。①影像学观察:术后两组X射线片示L5椎体有一骨折缺损透光区。对照组在术后6周时原透光区与周围骨质无明显差别,而骨质疏松组原透光区仍清晰可见,于8周时无明显差别。②组织学观察:两组软骨细胞在骨愈合1周时出现,形成软骨岛,但骨质疏松组软骨细胞每高倍视野数量明显少于对照组,另外,软骨细胞改建成成熟骨细胞,骨小梁形成数量,胶原纤维排列与对照组比较有显著性差异。③力学性能:在骨质愈合6～12周,L5椎体的最大载荷、弹性模量、最大应力明显低于同期对照组,差异有显著性意义(P<0.05)。结论:骨质疏松性椎体骨折SD大鼠模型,符合动物模型标准,可用于研究新骨形成与正常骨质结构关系,观察骨质疏松性椎体骨折愈合机制,并证明骨质疏松性松质骨骨折修复过程中,骨折愈合质量降低。     

Intranasal ketamine for acute pain management in children: A systematic review and meta-analysis

Study objectiveTo assess the efficacy and safety of intranasal analgesic-dose ketamine as compared to intranasal fentanyl for pediatric acute pain.MethodsA systematic review and meta-analysis was performed following the PRISMA guidelines. We searched PubMed, Embase, and Scopus databases for randomized controlled trials from inception to December 2019. We conducted meta-analysis with random-effects models to evaluate pain reduction, rescue analgesia, adverse events and sedation between intranasal ketamine and intranasal fentanyl. Random-effects models were used to estimate weighted mean differences (WMD) and pooled relative risks (RR).ResultsA total of 546 studies were screened and 4 trials were included. In the meta-analysis of 4 studies including 276 patients, ketamine had similar reductions in pain scores from baseline to all post-intervention times (10 to 15 min: WMD -1.42, 95% CI -9.95 to 7.10; 30 min: WMD 0.40, 95% CI -6.29 to 7.10; 60 min: WMD -0.64, 95% CI -6.76 to 5.47). Ketamine was associated with similar rates of rescue analgesia (RR 0.74, 95% CI 0.44 to 1.25). Ketamine had a higher risk of non-serious adverse events (RR 2.00, 95% CI 1.43 to 2.79), and no patients receiving ketamine had a serious adverse event. There was one serious adverse event (hypotension) with fentanyl that self-resolved. No patients receiving either IN fentanyl or ketamine had significant sedation.ConclusionIntranasal analgesic-dose ketamine may be considered as an alternative to opioids for acute pain management in children. Its accepted use will depend on the tolerability of non-serious adverse events and the desire to avoid opioids.     

Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis

Objectives

To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during out-of-hospital cardiac arrest (OHCA).

Police AED programs: A systematic review and meta-analysis

Background

Approximately 359,400 out-of-hospital cardiac arrests occur in the United States every year, and around 60% of them are treated by emergency medical services (EMS) personnel. In order to alleviate the impact of this public health burden, some communities have trained police officers as first responders so that they can provide cardiopulmonary resuscitation and defibrillation to cardiac arrest patients. This paper is a review of the current literature on the impact of police automated external defibrillators (AEDs) programs in these communities.

Methods and results

A literature search of electronic journal databases was conducted to identify articles that evaluated police AED programs and quantified survival rates. The 10 articles that met the inclusion criteria were very heterogeneous in terms of study design, controlling for confounders, outcome definitions, and comparison groups. Two communities found a statistically significant difference in survival and 6 studies reported a statistically significant difference in time to defibrillation after the implementation of these programs. The weighted mean survival rate of the study groups was higher than that of the control groups (p < 0.001), as was the weighted mean survival rate of the group first shocked by police compared to those first shocked by EMS (39.4% vs. 28.6%, p < 0.001). The pooled relative risk of survival was 1.4 (95% CI: 1.3–1.6).

Conclusions

Though there are many challenges in initiating these programs, this literature review shows that time to defibrillation decreased and survival from out-of-hospital cardiac arrests increased with the implementation of police AED programs.     

Esmolol in the management of pre-hospital refractory ventricular fibrillation: A systematic review and meta-analysis

BackgroundEsmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).ObjectivesWe performed a systematic review and meta-analysis to assess the effectiveness of esmolol on pre-hospital refractory VF/pVT, compared with standard of care.MethodsMEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible studies. Two investigators independently extracted relevant data and assessed the methodological quality of each included study using the ROBINS-I tool. The quality of evidence for summary estimates was assessed according to GRADE guidelines. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome of interest were calculated.ResultsThe search yielded 3253 unique records, of which two studies were found to be in accordance with the research purpose, totaling 66 patients, of whom 33.3% (n = 22) received esmolol. Additional evidence was provided in the paper but was not relevant to the analysis and was therefore not included. Esmolol was likely associated with an increased rate of survival to discharge (RR 2.82, 95% CI 1.01–7.93, p = 0.05) (GRADE: Very low) and survival with favorable neurological outcome (RR 3.44, 95% CI 1.11–10.67, p = 0.03) (GRADE: Very low). Similar results were found for return of spontaneous circulation (ROSC) (RR 2.63, 95% CI 1.37–5.07, p = 0.004) (GRADE: Very low) and survival to intensive care unit (ICU)/hospital admission (RR 2.63, 95% CI 1.37–5.07, p = 0.004) (GRADE: Very low).ConclusionThe effectiveness of esmolol for refractory VF/pVT remains unclear. Trial sequential analysis (TSA) indicates that the evidence is inconclusive and that further trials are required in order to reach a conclusion. Therefore, it is imperative to continue to accumulate evidence in order to obtain a higher level of scientific evidence.