八段锦治疗神经根型颈椎病的系统评价与Meta分析

[目的] 系统评价八段锦治疗神经根型颈椎病的临床疗效。[方法] 计算机检索中国知网数据库（CNKI）、维普资讯中文科技期刊数据库（VIP）、万方数据库（Wan-fang）、中国生物医学文献数据库（SinoMed）、Web of science、Clinical Trials gov、Pubmed、EMBASE、CENTRAL、Cochrane Library，查找出八段锦治疗神经根型颈椎病的随机对照试验（RCT），检索时限均从建库至2019年7月1日。两名研究者按照纳入与排除标准独立进行文献筛选、资料提取和偏倚风险评估，应用RevMan 5.3软件对最后纳入的研究进行Meta分析。[结果] 最终纳入10个RCT，共843例患者。Meta分析结果显示：八段锦+常规治疗与常规治疗比较，其临床疗效的总有效率差异具有统计学意义[OR=4.19，95% CI（2.42，7.26），P<0.000 01]；八段锦+常规治疗与常规治疗+颈部“米”字操比较，其临床疗效的总有效率差异具有统计学意义[OR=3.41，95% CI（1.56，7.46），P=0.002]；八段锦+常规治疗与常规治疗比较，其疼痛视觉模拟评分法（VAS）评分差异具有统计学意义[MD=-1.90，95% CI（-1.97，-1.83），P<0.000 01]。[结论] 基于现有的研究，该系统评价显示，与常规治疗相比，八段锦+常规治疗在临床疗效总有效率、VAS评分方面有一定的治疗优势。与常规治疗+颈部“米”字操比较，八段锦+常规治疗在临床疗效的总有效率方面有一定的治疗优势。但由于纳入研究的质量不高，仍需要大样本、多中心、随机、双盲试验及试验参照CONSORT标准和STRICTA声明进行RCT研究。     

单开门椎板成形术联合椎间孔切开术治疗脊髓型合并神经根型颈椎病疗效分析

目的评价颈后路单开门椎管成形术联合椎间孔切开术在治疗颈椎管狭窄症合并单侧神经根型颈椎病中的作用。方法回顾性研究2006年7月至2009年1月44例颈椎管狭窄症合并单侧神经根压迫症状患者,行颈后路单开门椎管成形术联合椎间孔切开术治疗的23例患者为A组,单纯行颈后路单开门椎管成形术治疗的21例患者为B组。引起椎间孔狭窄的原因:椎间盘突出、钩椎关节骨赘形成、关节突增生。神经根症状主要表现为单侧上肢疼痛、感觉减退、肌力下降和反射减弱。A组手术为颈后路单开门椎管成形术联合椎间孔切开术,关节突内侧缘切除范围均小于等于50%;B组仅行颈后路单开门椎管成形术。结果术后随访20～36个月,平均28个月。采用日本骨科协会评分法计算两组髓性症状术后改善率,差异无统计学意义;根性症状术后临床效果评价:A组优18例,良3例,一般2例;B组优7例,良3例,一般9例,差2例。结论对合并有单侧神经根型的颈椎管狭窄症患者,采用颈后路单开门椎管成形术联合椎间孔切开术可取得良好的手术效果。     

Maitland手法结合牵引推拿TDP治疗神经根型颈椎病的临床研究

目的观察Maitland手法结合牵引、推拿、特定电磁波辐射仪(TDP)治疗神经根型颈椎病(cervical spondylotic radicu-lopathy,CSR)的临床疗效和安全性。方法采用随机对照临床试验的方法,将146例CSR患者分为治疗组、对照A组和对照B组进行3个疗程(30 d)的治疗观察。治疗组采用Maitland手法、牵引、推拿、TDP疗法治疗,对照A组采用推拿、牵引、TDP疗法治疗,对照B组采用牵引、TDP疗法治疗。比较3组临床疗效及疼痛评分、颈椎功能评分改善情况。结果治疗结束时,治疗组、对照A组和对照B组的总有效率分别为97.9%、85.7%和65.3%;1个月后随访,3组的总有效率分别为93.7%,77.6%和57.1%;治疗组的总有效率优于对照A组和对照B组(均P0.01)。治疗组疼痛评分差值和颈椎评分差值分别为4.5±1.5和10.4±3.5,对照A组的分别为3.2±1.9和7.6±2.9,对照B组的分别为2.4±1.5和5.2±2.9,治疗组的疼痛评分差值和颈椎评分差值优于对照A组和对照B组(均P0.01)。结论 Maitland手法结合牵引、推拿和TDP治疗CSR具有一定临床时效性、科学性,值得推广。     

马勇教授治疗神经根型颈椎病经验

马勇教授治疗神经根型颈椎病,注重审因辨证,或治肾,或治脾,或治肝,或治从风寒湿。常用经验方项痹康,常用药对有：附子-干姜-桂枝;桂枝-葛根-芍药;黄芪-桂枝;黄芪-当归-鸡血藤;附子-淫羊藿。     

Posterior endoscopic discectomy: Results in 300 patients

Background:

Posterior endoscopic discectomy is an established method for treatment of lumbar disc herniation. Many studies have not been reported in literature for lumbar discectomy by Destandau Endospine System. We report a series of 300 patients operated for lumbar dissectomy by Destandau Endospine system.

Materials and Methods:

A total of 300 patients suffering from lumbar disc herniations were operated between January 2002 and December 2008. All patients were operated as day care procedure. Technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision. Endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route. The results were evaluated by Macnab''s criteria after a minimum followup of 12 months and maximum up to 24 months.

Results:

Based on modified Macnab''s criteria, 90% patients had excellent to good, 8% had fair, and 2% had poor results. The complications observed were discitis and dural tear in five patients each and nerve root injury in two patients. 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months.

Conclusion:

Edoscopic discectomy provides a safe and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return to work.     

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.     

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,     

The efficacy of interlaminar epidural steroid administration in multilevel intervertebral disc disease with chronic low back pain: a randomized,blinded, prospective study

Background Context

Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of a local anesthetic (LA) and steroid using the interlaminar (IL), transforaminal, and caudal techniques is a preferred approach.