Low-dose amitriptyline for treatment of persistent arm pain due to repetitive use

Amitriptyline is sometimes used to treat arm pain related to repetitive use, but rigorous evidence of its benefit is lacking. This randomized controlled trial investigated whether amitriptyline provided greater pain relief or improved arm function than a placebo pill in adults with arm pain associated with repetitive use that had persisted for at least 3 months. Participants (N = 118) were randomly assigned to receive 25 mg of amitriptyline or a placebo pill for 6 weeks. The primary outcome was intensity of pain (10-point numerical rating scale) and secondary outcomes were arm symptoms, arm function, grip strength, mood, and sleep. Assessments were done at baseline, 3 and 6 weeks of treatment, and 1 month after the treatment ended. Changes in arm pain were not statistically significant. However, the amitriptyline group improved more than the placebo group in arm function (p = 0.023) and sense of well being (p = 0.034). In a longitudinal analysis, the amitriptyline group’s arm function score improved 0.45 points per week faster than placebo after adjusting for subject characteristics (p = 0.015). At the treatment’s midpoint, the amitriptyline group reported more “troublesome side-effects” than the placebo group (52.5% vs. 27.1%, p = 0.005), but this difference decreased by the end of the treatment (30.5% vs. 22.0%, p = 0.30). The most frequent side effect was drowsiness. In conclusion, this study found that low-dose amitriptyline did not significantly decrease arm pain among these participants but did significantly improve arm function and well being. Future research is needed to explore the effects of higher doses and longer duration of treatment.     

一种用于腰椎负荷CT检查的自动形态分析模型

目的 提出一种用于腰椎负荷检查的自动形态分析模型,并评估该模型在腰椎退行性疾病诊断中的临床应用价值.方法 采用腰大肌放松体位(PRP)和腰椎伸位轴向负荷(ACE)两种体位进行CT检查,利用建立的分析模型评价加压前、后L2～S1各椎间盘中心层面的椎管腔最大横径、纵径及硬膜囊面积的变化.结果 ACE体位检查后椎管横径、纵径变小,横截面积变小,模型分析结果与专家测量具有极高的一致性.结论 自动形态分析模型对腰椎退行性疾病具有重要的辅助诊断价值.ACE体位CT检查可获得更多的放射学诊断信息,可以作为临床诊断椎管狭窄的重要依据.     

The influence of static axial torque in combined loading on intervertebral joint failure mechanics using a porcine model

Background. The spine is routinely subjected to repetitive combined loading, including axial torque. Repetitive flexion–extension motions with low magnitude compressive forces have been shown to be an effective mechanism for causing disc herniations. The addition of axial torque to the efficacy of failure mechanisms, such as disc herniation, need to be quantified. The purpose of this study was to determine the role of static axial torque on the failure mechanics of the intervertebral joint under repetitive combined loading.

Methods. Repetitive flexion–extension motions combined with 1472 N of compression were applied to two groups of nine porcine motion segments. Five N m of axial torque was applied to one group. Load–displacement behaviour was quantified, and planar radiography was used to document tracking of the nucleus pulposus and to identify fractures.

Findings. The occurrence of facet fractures was found to be higher (P = 0.028) in the axial torque group (7/9), compared to the no axial torque group (2/9). More hysteresis energy was lost up to 3000 cycles of loading in the axial torque group (P < 0.014). The flexion–extension cycle stiffness was not different between the two groups until 4000 cycles of loading, after which the axial torque group stiffness increased (P = 0.016). The percentage of specimens that herniated after 3000 cycles of loading was significantly larger (P = 0.049) for the axial torque group (71%) compared to the no axial torque group (29%).

Interpretation. Small magnitudes of static axial torque alter the failure mechanics of the intervertebral disc and vertebrae in combined loading situations. Axial torque appears to accelerate the susceptibility for injury to the intervertebral joint complex. This suggests tasks involving axial torque with other types of loading, apart from axial twist motion, should be monitored to assess exposure and injury risk.     

二孔法电视胸腔镜下结合OB胶治疗肺大疱破裂后气胸

目的探讨二孔法电视胸腔镜下结合OB胶治疗肺大疱破裂后气胸的可行性。方法患侧腋前线第5或第6肋间1cm切口作观察孔,锁骨中线第2肋间1cm切口作操作孔,伸入小号卵圆钳探查定位后,夹住并固定肺大疱下的正常肺组织,在离胸壁距离最近点用长针尖穿刺肺大疱,抽吸肺大疱内气体后,注入OB胶粘闭肺大疱。直径1cm肺大疱注入0．5mL胶水。结果8例患者均痊愈出院,手术时间一侧平均为30min,术中出血量一侧平均约为20mL,术后疼痛程度均为轻度（VAS分级）,随访最长时间19个月,无复发及其他并发症。结论二孔法电视胸腔镜下结合OB胶治疗肺大疱破裂后气胸具有操作简便、减少手术创伤及术后疼痛、费用低、复发低等优点,但需严格掌握适应证。