显微内窥镜下腰椎间盘摘除和传统开放手术治疗腰椎间盘突出症的

背景：显微内窥镜手术系统将传统开放手术和显微内镜技术相结合,将传统的髓核摘除内镜化、微创化。与传统开放手术相比,显微内窥镜腰椎间盘摘除可放大手术野、有良好的照明系统,术者视野更清晰,操作更为精细,对周围组织的损伤也较小。 目的：对显微内窥镜下腰椎间盘摘除和传统开放手术治疗腰椎间盘突出症的疗效及临床价值进行评价。 方法：按照Cochrane系统评价的方法,计算机检索Medline(1990-01/2010-03)、Embase(1990-01/2010-03)、Cochrane图书馆及中国生物医学数据库(1990-01/2010-03),并采用手工检索等方法收集会议文献。文献检索无语种限制。收集所有相关随机对照试验,采用Cochrane协作网提供的软件Revman 5.0进行Meta分析,以获得显微内窥镜下腰椎间盘摘除和开放手术治疗腰椎间盘突出症的疗效是否有差异的相关证据。 结果与结论：共纳入12个研究,包括1 748例腰椎间盘突出症患者。进行Meta分析结果显示,显微内窥镜手术的操作时间与传统开放手术无明显差异,但在术中出血量、术后卧床时间和住院时间上优于传统开放手术。提示显微内窥镜手术是一种治疗腰椎间盘突出症理想的微创手术方式。     

椎板间入路治疗腰椎间盘突出症

目的 研究椎板间入路显微椎间盘切除术治疗腰椎间盘突出症的手术效果. 方法对36例病人行显微椎间盘切除术,术中对椎间盘碎片及纤维环缺损情况进行评估,分析术前资料和术后随访情况.结果 椎板间入路在28例(78%)病人中可充分暴露椎间隙,部分椎间孔扩大术在17例(47%)病人中使用.碎片-裂隙型及碎片-包含型病人手术效果最好,复发率低.结论 椎板间入路是治疗腰椎间盘突出症的一种安全、有效的手术技术,椎间盘突出类型及椎间盘切除术后纤维环的完整性对预测腰腿痛复发有价值.     

METRx系统辅助下显微外科手术治疗腰椎间盘突出症

目的探讨METRx系统辅助下腰椎间盘突出症显微外科手术的技术特点和临床疗效。方法于METRx系统辅助下显微外科手术治疗51例腰椎间盘突出症患者(L4-5椎间盘突出24例、L5-S1椎间盘突出27例),记录手术时间、术中出血量和住院时间,并于术前和术后1周、3个月、末次随访时采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价手术前后疼痛改善情况,复查腰椎MRI评价椎管减压程度。结果 51例患者手术成功率为98.04%(50/51),平均手术时间为125 min、术中出血量为50 ml、住院时间5 d、术后随访24个月。与术前相比,术后1周(P=0.036,0.029)、3个月(P=0.018,0.023)和末次随访时(P=0.007,0.013)VAS和ODI评分均减少;至末次随访时,ODI改善率为35.37%。无手术相关感染、术后脑脊液漏和神经功能缺损加重、手术切口感染病例。术后1例出现附件炎,1例神经根刺激症状明显,均经对症治疗后痊愈。结论 METRx系统辅助下显微外科手术治疗腰椎间盘突出症,可以有效解除神经根压迫、保护硬脊膜囊和神经根、减少手术并发症的发生。     

腰椎间盘突出症的显微手术治疗

目的总结腰椎间盘突出症的显微外科治疗经验.方法回顾性分析48例腰椎间盘突出症病人的临床资料,所有病人行显微镜下腰椎间盘切除术,观察分析手术疗效.结果术后Nakai分级:优42例,良4例,中2例,优良率95.8％.术前腰痛视觉模拟评分法(VAS)评分平均2.46分,放射痛VAS评分平均7.25分;出院时腰痛VAS评分平均0.71分,放射痛VAS评分0.44分;手术前后腰痛和放射痛VAS评分差异均有统计学意义(P＜0.05).结论显微镜下椎间盘切除术是治疗腰椎间盘突出症的一种安全、有效的方法.     

显微外科治疗椎间盘突出症围手术期的护理

1对象与方法我院2002年5月~2008年6月行显微椎间盘切除术41例,其中男20例,女21例;年龄28~65岁。颈椎间盘突出症12例,胸椎间盘突出症3例,腰椎间盘突出症26例。均采用显微手术治疗。     

亚洲人群动脉瘤性蛛网膜下腔出血高压氧辅助治疗疗效的Meta分析

目的综合评价亚洲人群动脉瘤性蛛网膜下腔出血(aSAH)高压氧(HBO)辅助治疗的临床疗效。方法计算机检索Ovid、Pub Med、MEDLINE、EBSCO及EMBASE等外文数据库,以及中国生物医学文献数据库、中国知网、万方数据库、维普数据库等中文数据库,检索从建库开始至2017年2月发表的HBO辅助治疗aSAH的随机对照研究。采用Rev Man 5.3进行统计分析。结果纳入符合标准文献10篇,共856例a SAH。Meta分析结果显示:和对照组相比,HBO辅助治疗组GOS评分明显增高(RR=1.19,95%CI:1.04~1.36,P=0.010)、ADL评分明显增高(MD=-11.99,95%CI:-13.95~-10.3,P=0.00001)、Barthel指数明显增高(MD=12.42,95%CI:5.82~19.03,P=0.0002)、症状性血管痉挛发生率明显降低(RR=0.56,95%CI:0.41~0.78,P=0.00060.05)、治疗结束时大脑中动脉平均血流速度明显降低(MD=-10.07,95%CI:-16.33~-3.80,P=0.002)。结论亚洲人群a SAH术后进行HBO辅助治疗可以改善病人预后。     

计算机导航技术辅助全髋关节置换的系统分析

背景：传统手术方法依赖术者的经验和目测解剖标志来安置髋臼假体往往会产生偏差,而在术中应用计算机导航技术可以很好地提高髋臼假体位置的精确度。 目的：研究全髋关节置换应用计算机导航系统对髋臼假体植入位置精度的影响及临床意义。 方法：计算机检索Cochrane Library、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库,手工检索相关的中文杂志,纳入符合要求的临床试验,用RevMan5.0.18软件进行统计分析。 结果与结论：共纳入9篇临床试验合计695例。Meta分析结果显示：与传统手术相比,计算机导航技术在全髋关节置换后髋臼假体位置放置更精准超[RR=0.22,95%CI(0.14~0.34),P < 0.000 01]、双下肢不等长较传统手术轻[RR=-4.61,95%CI(-7.74~-1.48),P=0.004];而外展角度[RR=-1.76,95%CI(-5.02~1.50),P=0.29]、前倾角度[RR=-1.28,95%CI(-5.68~3.12),P=0.57]、术后脱位率[RR=1.25,95%CI(0.05~31.66),P=0.89]差异均无显著性意义。提示导航技术与传统手术在髋臼位置的精确度方面差异并无显著性意义。     

内镜手术与显微手术治疗垂体腺瘤疗效的Meta分析

目的比较内镜手术与显微手术治疗垂体腺瘤的安全性和有效性。方法计算机检索Pubmed、EMbase、CBM、CNKI、万方及VIP等数据库,查找所有比较内镜手术与显微手术治疗垂体瘤的随机对照试验或病例对照研究,检索时限均为建库至2014年5月31日。按纳入排除标准由两人独立进行研究的筛选、资料提取和质量评价后,采用Rev Man5.2软件进行Meta分析。结果共纳入8个研究、712例患者,结果显示,与显微手术相比,内镜手术肿瘤全切率[优势比(OR)=1.23;95%可信区间(CI)(0.62~2.46);P=0.56]、手术时间(P0.05)、术后激素水平改善率[OR=1.21;95%CI(0.58~2.55);P=0.61]、术后脑脊液漏发生率[OR=1.44;95%CI(0.80~2.58);P=0.23]、脑/脑膜炎发生率明显减少[OR=1.15;95%CI(0.38~3.48);P=0.81]、尿崩发生率[OR=1.17;95%CI(0.71~1.94);P=0.53]均无明显改善,而术后鼻出血发生率[OR=0.24;95%CI(0.07~0.78);P=0.02]和术后住院天数明显缩短(P0.05)。结论内镜手术与显微手术相比其术后鼻出血患者较少,术后住院天数短。     

抗血小板药物治疗腔隙性梗死效果的Meta分析

目的评价抗血小板药物对腔隙性梗死患者二级预防的治疗效果。方法以stroke,lacunar infarction,platelet aggregation inhibitors,antiplatelet,randomized controlled trial等英文词汇计算机检索1980年1月1日-2016年11月20日美国国立医学图书馆生物医学信息检索系统、荷兰医学文摘、Cochrane在线图书馆等数据库收录的关于腔隙性梗死患者抗血小板治疗的随机对照临床试验,采用Jadad量表、Cochrane系统评价手册和Rev Man 5.3统计软件进行文献质量评价和Meta分析,R软件Gemtc程序包和JAGS软件进行网状Meta分析。结果共获得4068篇英文文献,经剔除重复和不符合纳入标准者,最终纳入12项质量较高(Jadad评分≥4分)的临床试验共24 969例腔隙性梗死患者。Meta分析显示:与安慰剂相比,抗血小板药物单抗治疗可以显著降低缺血性卒中复发率(RR=0.480,95%CI:0.300~0.780;P=0.003)和所有脑卒中复发率(RR=0.780,95%CI:0.630~0.970;P=0.030);而抗血小板药物单抗与双抗治疗效果差异无统计学意义(缺血性卒中复发率:RR=0.900,95%CI:0.760~1.050,P=0.170;所有脑卒中复发率:RR=0.910,95%CI:0.820~1.010,P=0.070)。网状Meta分析(包括阿司匹林、安慰剂、西洛他唑和噻氯匹定4种干预措施)显示:仅西洛他唑治疗后所有脑卒中复发率低于阿司匹林(OR=0.341,95%Cr I:0.011~0.673)和安慰剂(OR=0.615,95%Cr I:0.191~1.042)。结论抗血小板药物单抗治疗可以显著降低腔隙性梗死患者缺血性卒中和所有脑卒中复发风险,且与双抗治疗效果无明显差异;西洛他唑较阿司匹林能够更显著降低腔隙性梗死患者所有脑卒中复发风险。     

转化生长因子β1基因509C/T多态性与腰椎间盘突出症血瘀证及椎间盘退变程度的关联研究

背景：腰椎间盘突出症在中医临床以血瘀证多见,但目前仍缺少理想的防治手段。既往研究已报道了转化生长因子β1基因509C/T多态性可能与椎间盘退变的发生和发展相关。 目的：探讨广西地区汉族人腰椎间盘突出症血瘀证及椎间盘退变与转化生长因子β1基因509C/T多态性的关联性。 方法：纳入2008-01/2009-12在广西中医学院第一附属医院骨科临床确诊为腰椎间盘突出症患者,其中中医辨证为血瘀证的共60例,同期相匹配的非血瘀证患者60例,均进行转化生长因子β1基因509C/T多态性检测,并观测患者的椎间盘退变等指标。采用非条件Logistic回归Forward(LR)法分析椎间盘退变和转化生长因子β1基因509C/T多态性的交互作用与腰椎间盘突出症中医证型的关联性。腰椎椎间盘退行性变的程度根据磁共振成像检测结果分为轻度、中度及重度。 结果与结论：腰椎间盘突出症转化生长因子β1基因509C/T基因型者的腰椎间盘的退变程度较CC和TT基因型高,血瘀证组患者椎间盘退变程度比非血瘀证患者更严重 (P < 0.05)。重度椎间盘退变者患腰椎间盘突出症血瘀证的风险是轻中度椎间盘退变者的1.818倍(OR =1.818,95%CI:1.275~2.931,P < 0.05)。转化生长因子β1基因509C/T多态性与重度椎间盘退变的累积暴露发生腰椎间盘突出症血瘀证的风险是其中某单一因素的2.038倍(OR=2.038,95%CI:1.379~3.423,P < 0.05)。实验结果提示重度椎间盘退变很可能是广西壮族自治区汉族人腰椎间盘突出症血瘀证的潜在危险因素之一,携带转化生长因子β1基因CT基因型的患者在引发椎间盘退变加重相关因素的作用下,患血瘀型腰椎间盘突出症的可能性更大。     

单侧双通道内镜手术治疗腰椎管狭窄症安全性的Meta分析

目的 系统分析单侧双通道内镜手术（UBE）与显微镜下椎管减压术（MED）治疗腰椎管狭窄症的安全性。方法 计算机检索Pubmed、Cochrane library、MEDLINE、Web of Science、Embase等英文数据库,以及中国知网和万方中文数据库。纳入UBE和MED治疗腰椎管狭窄症的临床随机对照试验（RCT）及队列研究。观察指标包括总并发症发生率,以及硬膜外血肿、神经根损伤、硬膜囊损伤、减压不彻底、因相关并发症再次手术发生率。采用Revman 5.3软件进行Meta分析。结果 最终纳入7篇相关研究,包括2篇RCT、5篇队列研究;共纳入475例病人,其中UBE有248例,MED有227例。Meta分析显示两种手术方法的总并发症发生率以及硬膜外血肿、神经根损伤、硬膜囊损伤、减压不彻底、因相关并发症再次手术等并发症发生率均无统计学差异（P>0.05）。结论 UBE与MED治疗腰椎管狭窄症在安全性方面基本一致。     

Microendoscopic discectomy for prolapsed lumbar intervertebral disc

BACKGROUND: Lumbar disc prolapse is a common problem and the current surgical standard for its treatment is a microsurgical discectomy. Microendoscopic discectomy (MED) is a minimally invasive spinal procedure being done successfully for prolapsed intervertebral disc disease. AIMS: We report the technique, outcome and complications seen in 107 cases of prolapsed lumbar intervertebral disc who underwent MED. SETTING AND DESIGN: The study was carried out at the Department of Neurosurgery, at a tertiary hospital in South India and the data was collected prospectively. MATERIALS AND METHODS: 107 patients with prolapsed lumbar intervertebral disc who were seen at our institution between November 2002 and January 2006 were included in the study. Data was collected prospectively. The METRx system (Medtronic Sofamor Danek, Memphis,TN) was used to perform MED. Outcome assessment was done by the modified Macnab criteria. RESULTS: 107 patients (67 males, 40 females) underwent MED for prolapsed lumbar intervertebral disc. Follow up ranged from 2 to 40 months with a mean follow up 12.9 months. Seventy six patients had an excellent outcome, 22 patients had a good outcome, 5 patients had a fair outcome and 3 patients had a poor outcome. One patient with a long dural tear required conversion to a standard microdiscectomy and was excluded from outcome assessment. Complications included dural puncture with K-wire (1), dural tear (2), superficial wound infection (1), discitis (1) and recurrent disc prolapse (2). CONCLUSIONS: Microendoscopic Discectomy (MED) is a safe and effective procedure for the treatment of prolapsed lumbar intervertebral disc.     

Results of Destandau microendoscopic lumbar discectomy

BACKGROUND AND PURPOSE: Endoscopic methods are increasingly used in spine surgery, including the operative treatment of lumbar disc herniation. In this study we present a clinical series of 45 patients with lumbar disc prolapse who were operated on endoscopically with ENDOSPINE instrumentation (Karl STORZ GmbH and Co. KG), using the Destandau technique. MATERIAL AND METHODS: Between 2005 and 2006 endoscopy was used in 76 operations of lumbar disc prolapse and in 45 patients the entire procedure was performed endoscopically. All procedures were carried out from a posterior approach using a 4 mm Hopkins 0 degrees -telescope placed in the working insert equipped with channels for suction tube, operative instruments and nerve root retractor. The outcome was assessed using modified McNab criteria both directly and three months (in 35 patients) postoperatively. RESULTS: Good to excellent outcome was achieved in 89% of patients, which is consistent with results reported by experienced authors and comparable with results of "classic" microdiscectomy. Five patients reported no improvement and 3 of them were subsequently reoperated using the open surgical approach. In 3 patients the dural sac was lacerated but none of the tears exceed a few millimetres in length and they were not associated with neural injury. They were easily repaired endoscopically with a patch of "Tachocomb" tissue sealant. CONCLUSIONS: Destandau microendoscopic discectomy (MED) is a novel, safe and effective method that minimizes invasiveness of the surgical approach. Results achieved with this method are comparable to those achieved with "classic" microdiscectomy.     

Clinical success of transforaminal endoscopic discectomy with foraminotomy: A retrospective evaluation

Objective

Transforaminal endoscopic surgery has evolved from an intradiscal procedure to a true foraminal epidural procedure where both a targeted discectomy and foraminal decompression can be performed. The success of transforaminal decompression for radiculopathy using preoperative selective nerve root block as part of a treatment algorithm for single level and multilevel lumbar disc herniations is described here.

Methods

After Institutional Review Board Approval, charts from 195 patients with complaints of lower back and radicular pain who received one or more endoscopic discectomy procedures were reviewed. Visual Analog Scale was applied to each patient preoperatively and 6 months after the procedure.

Results

Patients with multi-level pathologies receiving one procedure have an average relief of 69.7% attributed to correct diagnosis of the inflicting level as opposed to 83.9% improvement in patients with a single level herniation.

Conclusion

Patients with single level lumbar herniations receiving one endoscopic discectomy have excellent outcomes, but with a good response to a selective nerve root block as a preoperative adjunct, patients with multilevel disc herniations also have significant benefit from single level endoscopic discectomy.     

Perioperative results following open and minimally invasive single-level lumbar discectomy

Lumbar discectomy is the most commonly performed spine surgery and in recent years, minimally invasive tubular discectomy has become increasingly popular among surgeons and patients. However, recent reports have raised the question of whether or not patients have shorter hospitalizations following minimally invasive discectomy. From 2005 to 2010, we analyzed 109 patients who underwent elective, single-level lumbar discectomy for central or paracentral disc herniations. A retrospective analysis of medical records was performed for perioperative complications. Tubular discectomy was not associated with increased rates of durotomy, nerve root injury, wound complications, or recurrent disc herniations requiring additional surgery. Minimally invasive tubular discectomy in the lumbar spine results in a small, but statistically significant, advantage in length of stay compared to conventional open microdiscectomy. While small on an individual basis, this difference may translate to substantial economic savings over time when one considers how many discectomies are performed in aggregate.     

艾司西酞普兰联合奥氮平治疗抑郁症的效果及安全性的Meta分析

目的 评价艾司西酞普兰联合奥氮平治疗抑郁症的效果及安全性,以期为抑郁症治疗方案的选择提供参考。 方法 计算机检索中国知网、万方、维普、超星读秀、中国生物医学文献数据库（CBM）、PubMed、Web Of Science、Cochrane Library数据库中相关文献,按纳入与排除标准筛选文献、提取资料并评价偏倚风险后,采用Revman 5.3进行Meta分析。 结果 共纳入16篇随机对照研究,包括1 300例患者。Meta分析结果显示,艾司西酞普兰联合奥氮平组与单用艾司西酞普兰组的终点总有效率（RR=1.16,95% CI：1.05~1.28,P=0.004）和终点痊愈率（RR=1.91,95% CI：1.58~2.31,P<0.01）均有统计学意义。治疗4周（SMD=-0.95,95% CI：-1.28~-0.62,P<0.01）和治疗8周后（SMD=-1.53,95% CI：-1.84~-1.22,P<0.01）,两组HAMD评分差异有统计学意义。艾司西酞普兰联合奥氮平组体质量增加（RR=6.21,95% CI：3.37~11.45,P<0.01）及嗜睡（RR=4.26,95% CI：2.17~8.36,P<0.01）发生率较单用艾司西酞普兰组高。 结论 艾司西酞普兰联合奥氮平治疗较单用艾司西酞普兰治疗对抑郁症的效果可能更好,但可能出现体质量增加及嗜睡的发生。     

经皮内窥镜下椎间盘切除术治疗腰4/5并腰5/骶1椎间盘突出症（附41例报告）

目的 探讨经皮内窥下镜椎间盘切除术治疗腰4/5并腰5/骶1椎间盘突出症的疗效及安全性。方法 选择2011年3月至2014年12月收治的41例腰4/5并腰5/骶1椎间盘突出症患者,运用局麻+监护在C臂机透视下分节段行靶向穿刺,经皮内窥镜椎间孔入路下行髓核摘除术。采用视觉模拟量表（VAS）评分和MacNab标准评估手术疗效。结果 41例均顺利完成手术,无术中更改术式,术后无神经根损伤、椎间隙感染等并发症发生。手术时间为72~106 min,平均（85±12.4） min。术中出血量为（30±5） ml。41例术后随访18~24个月,平均20.5个月;术后腰痛和腿痛VAS评分均明显下降（P<0.05）,而且随随访时间延长,vas评分下降越明显（>P<0.05）。按macnab标准评定疗效优良率95. 1%。本组41例均无复发。结论 经皮内窥下镜椎间盘切除术治疗腰4/5并腰5/骶1椎间盘突出症具有切口小、创伤小、并发症少、对脊柱稳定性影响小、术后恢复快、近期疗效可靠等优点。     

Microendoscopic discectomy (MED) for lumbar disc prolapse.

Microendoscopic discectomy (MED), which combines traditional lumbar microsurgical techniques with endoscopy, is being used as a minimally invasive procedure for lumbar disc herniation. We reviewed 30 patients who underwent MED at our institution and compared their outcome with that of patients subjected to the conventional method. Laboratory data suggested that MED was less invasive surgery. Moreover, MED allowed an early return to work. However, the difficulties of this endoscopic procedure were evident, because of the limited exposure and two-dimensional video display. The potential injury of the nerve root and prolonged surgical time remain as matters of serious concern. To overcome this problem, we used an operative magnifying glass during surgery and this helped us to accomplish the procedure comfortably. We recommend the use of an operative magnifying glass in the early stage of the introduction of MED, for it is quite useful to identify the three-dimensional relationships of the structures.     

Shuganjieyu capsule for major depressive disorder (MDD) in adults: a systematic review

Objectives: Shuganjieyu capsule is a pure herbal pharmaceutical product for depression. Our objective was to explore the effectiveness and safety of Shuganjieyu capsule for the treatment of major depressive disorder in adults.

Method: Eight computerized databases were searched. In addition, randomized controlled trials (RCTs) on Shuganjieyu capsule were hand-searched on seven key Chinese journals. Data were extracted and evaluated by two reviewers independently. Analysis was performed by intention-to-treat where possible. Prespecified subgroup analyses were different-dose regimens, patient spectrum, publication status, and treatment duration.

Results: Seven RCTs with 595 participants were included. Shuganjieyu capsule was superior than placebo in terms of response rate (RR = 2.42, 95% CI: 1.55–3.79; P = 0.0001), remission rate (RR = 4.29, 95% CI: 1.61–11.45; P = 0.004), the scores of the mean change from baseline of the HAM-D₁₇ (MD = ?4.17, 95% CI: ?5.61 to ?2.73; P < 0.00001) and from baseline of traditional Chinese medicine (TCM) syndrome score scale scores (MD = ?6.00, 95% CI: ?8.25 to ?3.75; P < 0.00001). In addition, Shuganjieyu plus venlafaxine had a significantly higher response rate (RR = 1.56, 95% CI: 1.29–1.88; P < 0.00001) and was superior in terms of the scores of the mean change from baseline of the treatment emergent symptoms scale scores (MD = ?0.74, 95% CI:?1.12 to ?0.35; P = 0.0002) than venlafaxine alone.

Conclusion: Shuganjieyu capsule is superior to placebo in terms of overall treatment effectiveness and safety. Both response rate and remission rate among patients treated with the combination of Shuganjieyu plus venlafaxine were significantly higher than those treated with venlafaxine alone. Due to the considerable risk of bias in majority of trials, recommendations for practice should be cautious, and additional, well-designed RCTs are needed in next step.