目的:探讨肝癌术后患者卡尔森式疼痛管理理念运用方法及其对患者生存质量的影响.方法:选取行手术治疗的肝癌患者108例,按照随机数字表法,分为对照组(n=54)与观察组(n=54),对照组患者采用传统疼痛控制,观察组患者采用卡尔森式疼痛管理理念,对两组术后疼痛程度,以及康复过程差异进行比较.结果:观察组的模拟视觉评价法(VAS)评分、状态焦虑量表(SAI)评分和特质焦虑量表(T AI)评分均优于对照组(P<0.05);且观察组术后康复情况和疼痛控制满意度优于对照组(P<0.05).结论:肝癌患者术后采取卡尔森式疼痛管理理念,可使患者的疼痛感,以及焦虑程度得以明显减轻,促进患者病情康复,提高患者的生存质量.

OBJECTIVE:To compare the efficacy and safety of autologous blood products (ABPs) and corticosteroid injections (CSIs) in the treatment of lateral epicondylitis. TYPE OF STUDY:Meta-analysis. LITERATURE SURVEY:We systematically searched EMBASE, PubMed, the Cochrane Library, and Web of Science to identify randomized controlled trials (RCTs) that compared ABPs with CSIs for the treatment of lateral epicondylitis without language and publication date restriction through April 2015. METHODOLOGY:Two investigators independently included and assessed the quality of each eligible study according to the method recommended by the Cochrane Collaboration. Available data about the main outcomes were extracted from each study and heterogeneity was assessed using the Q statistic and the inconsistency index (I(2)). We also evaluated the publication bias and conducted a subgroup analysis. Review Manager 5.2 software was used for data syntheses and analyses, and the standardized mean difference (SMD) or mean difference (MD) was estimated by using random effects models with a 95% confidence interval (CI). To investigate the efficacy among different trial durations, the follow-up times were divided into short periods (2-4 weeks), intermediate periods (6-24 weeks) and long-term periods (≥24 weeks). SYNTHESIS:Ten RCTs (n = 509) were included in this meta-analysis. The pooled analysis showed that CSIs were more effective than ABPs for pain relief in the short term (SMD = 0.88; 95% CI = 0.31-1.46%; P = .003). However, in the intermediate term, ABPs exhibited a better therapeutic effect for pain relief (SMD = -0.38; 95% CI = -0.70 to -0.07%; P = .02), function (SMD = -0.60; 95% CI = -1.13 to -0.08%; P = .03), disabilities of the arm, shoulder, and hand (MD = -11.04; 95% CI = -21.72 to -0.36%; P = .04), and Nirschl stage (MD = -0.81; 95% CI = -1.11 to -0.51%; P < .0001). In the long term, ABPs were superior to CSIs for pain relief (SMD = -0.94; 95% CI = -1.32 to -0.57%; P < .0001) and Nirschl stage (MD = -1.04; 95% CI = -1.66 to -0.42%; P = .001). Moreover, for grip strength recovery, no significant difference was found between the 2 therapies (P > .05). CONCLUSIONS:Limited evidence supports the conclusion that CSIs are superior to ABPs for pain relief in the short term; however, this result was reversed in the intermediate and long term. ABPs seemed to be more effective at restoring function in the intermediate term. Because of the small sample size and the limited number of high-quality RCTs, more high-quality RCTs with large sample sizes are required to validate this result.

OBJECTIVE:The aim of this study was to review all systematic reviews and meta-analyses and provide an overview of the evidence of efficacy of interventions for clavicle fractures. METHODS:The Cochrane Library, PubMed, MEDLINE, Chinese Biomedicine database, China Academic Journals Full-text Database, VIP Chinese Science and Technology Periodicals Database and Wanfang Database were searched for eligible studies using keywords related to clavicle fractures. The methodological quality of included studies was assessed using the AMSTAR assessment tool. Direct evidence was analyzed narratively. Randomized controlled trials were pooled again for meta-analysis. The GRADE approach was used in summary conclusions. RESULTS:The result of pooled data showed that while operative treatment had lower nonunion and malunion rates and higher patient satisfaction than non-operative treatment modalities [RR=6.57, 95% CI (3.01, 14.35), RR=6.93, 95% CI (2.99, 16.09); RR=0.68, 95% CI (0.51, 0.90)], these 3 outcomes were based on low-quality evidence. There was no difference between dissimilar operative and dissimilar non-operative treatments. CONCLUSION:Operative treatment is more effective than non-operative treatment in terms of nonunion and malunion rates and patient satisfaction. As the quality of evidence comparing efficacy between intervention methods is generally low, further original studies are needed.

BACKGROUND: Minimal y invasive transforaminal lumbar interbody fusion can be performed through a tiny incision using a expandable channel. Compared with open transforaminal lumbar interbody fusion, minimal y invasive transforaminal lumbar interbody fusion has smal er surgical field, more elaborate operation and less injury to the surrounding tissue which is conductive to accelerate overal recovery. OBJECTIVE: To evaluate the surgical outcome and clinicaI value between minimal y invasive and open transforaminal lumbar interbody fusion in treatment of single segment degenerative lumbar disease. METHODS: The Cochrane library, PubMed database, Embase database, SCI database, CNKI database, Wanfang database and Chinese Biomedical database were searched for control ed trials, prospective cohort study and retrospective cohort study on the comparison between minimal y invasive and open transforaminal lumbar interbody fusion in treatment of degenerative lumbar disease. Furthermore, we also manual y searched the relevant references and four Chinese orthopedic journals. Methodology quality of the trials was critical y assessed and the relative data were extracted. Cochrane Col aboration provided Revman 5.1 software was used for Meta-analysis. RESULTS AND CONCLUSION: Seven studies involving 856 cases were included. Al the studies observed the surgical time, and the results of Meta-analysis showed that there was no statistical y significant difference in the surgical time between minimal y invasive and open transforaminal lumbar interbody fusion (P=0.11); six studies observed the intraoperative blood loss, and the results showed that the intraoperative blood loss of minimal y invasive transforaminal lumbar interbody fusion was significantly less than that of the open transforaminal lumbar interbody fusion (P < 0.000 01); two studies observed the weight bearing time, and the results showed that the weight bearing time after minimal y invasive transforaminal lumbar interbody fusion was shorter than that after open transforaminal lumbar interbody fusion (P < 0.000 01); six studies observed the intraoperative and postoperative complications, and the results showed that there were no significant differences between minimal y invasive and open transforaminal lumbar interbody fusion (P=0.75); three studies observed the fusion rate, and the results showed there was no significant difference between minimal y invasive and open transforaminal lumbar interbody fusion (P=1.00). The results showed that minimal y invasive transforaminal lumbar interbody fusion was the ideal method for the treatment of single segment degenerative lumbar disease.

BACKGROUND: It is relatively ideal to repair nerve defects using autologous nerve graft. But it has its drawbacks. A better treatment for repairing nerve defects should be found. OBJECTIVE: To investigate the influence of autogenous vein graft (AVG) under induction of exogenous nerve growth factor (NGF) on the peripheral nerve repair and regeneration after injury. METHODS: Wistar rats were used to prepare injured models of peripheral nerve and were divided randomly into three groups. The nerve defect was bridged with autogenous vein, and the neural regeneration room was formed and injected with NGF in the experimental group. The rats in the control group were injected with normal saline instead of NGF. In the standard group, autogenous nerve grafting was performed. The animal ethology observation, electrophysiological and morphological detection were performed at 1 and 3 months after operation. RESULTS AND CONCLUSION: All experimental animals had different regeneration and repair of nerve tissues. By contrast, there was a better manifestation in repairing the peripheral nerve defects in the experimental group, and neuroelecrophysiology detection showed that nerve concluctive velocity (NCV) was significantly faster than those in the other groups. Morphological observation showed that the quantity and quality of regenerative nerve fiber were superior to the control group obviously (P < 0.05), and they had not significant differences compared with the standard group (P > 0.05). The co-therapy of NGF and autogenous vein graft can promote repair and regeneration of peripheral nerve after injury. The treatment not only can increase quantity of regenerative nerve fiber, but also can significantly promote their quality.