Purpose This review was made to identify the risk factors for knee osteoarthritis (KOA) in middle-older aged (= 40 years), and to provide the newest evidence for the prevention of KOA.Method Cohort study and case-control study of the risk factors of KOA was included from Pubmed, Web of Science, Ovid Technologies, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Database, SinoMed from their inceptions to July 2023. Two authors independently screened the literature and extracted data. Assessment of quality was implemented according to Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Quality Assessment Scale. Meta-analysis was performed using RevMan 5.3 software.Results 3597 papers were identified from the seven databases and 29 papers containing 60,354 participants were included in this review. Meta-analysis was performed for 14 risk factors, and 7 of these were statistical significance (P < 0.05). The risk factors which were analyzed in this review included trauma history in knee (1.37 [95% CI 1.03-1.82], P = 0.030), body mass index (BMI) = 24 kg/m(2) (1.30 [95% CI 1.09-1.56], P = 0.004), gender (female) (1.04 [95% CI 1.00-1.09], P = 0.030), age = 40 (1.02 [95% CI 1.01-1.03], P = 0.007), more exercise (0.75 [95% CI 0.62-0.91], P = 0.003), a high school education background (0.49 [95% CI 0.30-0.79], P = 0.003) and an university education background (0.22 [95% CI 0.06-0.86], P = 0.030).Conclusion The risk factors analyzed in this review included trauma history in knee, overweight or obesity, gender (female), age = 40 and the protective factors included more exercise and a high school or an university education background.

Identification of exosome-related genes (ERGs) and competing endogenous RNAs (ceRNAs) associated with intervertebral disc degeneration (IDD) may improve its diagnosis and reveal its underlying mechanisms. We downloaded 49 samples from Gene Expression Omnibus and identified candidate ERGs using differentially expressed ERGs (De-ERGs), exosome-related gene pairs (ERGPs), and machine learning algorithms [least absolute shrinkage and selection operator (LASSO) and support vector machine (SVM)]. Immune cell-related ERGs were selected via immune-infiltration analysis, and clinical values were assessed using receiver operating characteristic curves. Based on the De-ERGs, a ceRNA network comprising 1,512 links and 330 nodes was constructed and primarily related to signal transduction pathways, apoptosis-related biological processes, and multiple kinase-related molecular functions. In total, two crucial De-ERGs [angio-associated migratory cell protein (AAMP) and 4-aminobutyrate aminotransferase (ABAT)] were screened from results in De-ERGs, ERGPs, LASSO, and SVM. Increased AAMP expression and decreased ABAT expression were positively and negatively correlated with CD8+ T cell infiltration, respectively. AAMP/ABAT was the only pair differentially expressed in IDD and correlated with CD8+ T cell infiltration. Furthermore, AAMP/ABAT displayed higher accuracy in predicting IDD than individual genes. These results demonstrated the ERGP AAMP/ABAT as a robust signature for identifying IDD and associated with increased CD8+ T cell infiltration, suggesting it as a promising IDD biomarker.

BackgroundOssified spinal meningioma (OSM) is a rare form of a spinal tumor. The surgical strategies and pathologic findings related to OSM have been investigated in recent years. However, multiple OSMs are rarely reported. Here, we intend to present a rare case of multiple OSMs and review the relevant published literature.Case PresentationA 76-year-old woman experienced a progressive sensorimotor disturbance in her bilateral lower limbs for the past 2 years. She complained of inability to walk, urinary incontinence, and chronic constipation when referred to our hospital. A neurological examination revealed a diminished sensation below the bilateral T7, and her neurological status was Nurick Grade 6. Magnetic resonance imaging (MRI) revealed multiple intradural-extramedullary neoplasms at the T7–T11 level. Computed tomography (CT) scans showed five high-density masses of varying sizes in the spinal canal at the T7–T12 level. The patient underwent tumor resection through T7–T11 laminectomy. A histopathological examination revealed multiple OSMs.ConclusionWe reported a rare case of multiple OSMs in an elderly patient. After one-stage complete resection, the patient recovered with satisfactory curative effect. Although elderly patients will face various postoperative complications due to their poor physical condition, we still recommend one-stage complete resection of multiple OSMs to reduce recurrence.

目的 观察经皮椎体成形术(PVP)、经皮球囊扩张椎体后凸成形术(PKP)对胸腰椎椎体压缩性骨折患者脊柱-骨盆矢状位参数的影响.方法 回顾性分析2016 年5 月至2018 年5 月在中日友好医院接受PVP 或PKP 治疗的 120 例新鲜单节段胸腰椎椎体压缩性骨折患者临床资料,按术式分为PVP组(67 例)和PKP组(53 例),比较两组手术情况、脊柱-骨盆矢状位参数、术后椎体恢复情况及疼痛、功能障碍情况.结果 两组围手术期未见并发症发生,但PVP组手术时间、骨水泥注入量均显著少于PKP组,骨水泥渗漏率显著高于PKP组.术后两组腰椎前凸角(LL)、骶骨倾斜角(SS)较术前显著增加,骨盆倾斜角(PT)、C7～S1 矢状面轴向距离(SVA)较术前显著减少,但PVP组与PKP组间差异无统计学意义(P＞0.05 ).末次随访时,两组椎体压缩程度差异无统计学意义(P＞0.05),但PVP 组椎体高度恢复率显著低于PKP 组,椎体高度丢失率显著高于PKP组(P＜0.05).术后两组疼痛视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)均较术前显著下降,但 PVP 组VAS、ODI评分显著高于PKP组(P＜0.05).结论 PVP与PKP 治疗胸腰椎椎体压缩性骨折均能在一定程度上恢复脊柱-骨盆矢状位整体平衡,但PKP骨水泥渗漏率较低,术后椎体高度恢复及功能障碍改善也较为显著.

OBJECTIVE:This meta-analysis aimed to compare the efficacy and safety of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) local corticosteroid injection for carpal tunnel syndrome (CTS). METHODS:Database including Pubmed, Embase, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs). The outcomes mainly included Boston Carpal Tunnel Questionnaire (BCTQ): Symptom Severity Scale (BCTQs), Functional Status Scale (BCTQf); and electrophysiological indexes: distal motor latency (DML), sensory distal latency (SDL), compound muscle action potential (CAMP), sensory nerve action potential amplitude (SNAP), and sensory nerve conduction velocity (SNCV). Adverse events were also recorded. RESULTS:Overall, nine RCTs were finally screened out with 469 patients (596 injected hands). Pooled analysis showed that US-guided injection was more effective in BCTQs (SMD, -0.69; 95% CI, -1.08 to -0.31; P = 0.0005), BCTQf (SMD, -0.23; 95% CI, -0.39 to -0.07; P = 0.005), CAMP (MD, 0.64; 95% CI, 0.35-0.94; P < 0.0001) improvement, and a lower rate of adverse events (RR, 0.34; 95% CI, 0.22-0.52; P < 0.00001). Subgroup analysis revealed that the US-guided injection had significantly better CMAP than the LM-guided for the in-plane approach (MD, 0.69; 95% CI, 0.36-1.01; P < 0.0001) but not for the out-plane approach (MD, 0.39; 95% CI, -0.39 to 1.17; P = 0.33). CONCLUSIONS:US-guided injection was superior to LM-guided injection in symptom severity, functional status, electrodiagnostic, and adverse events improvement for CTS. To some extent, the in-plane approach yields better results compared with the out-plane process under US guidance.

背景:椎体成形术与后路融合内固定术用于治疗脊柱椎体继发性转移瘤,然而鲜有涉及上颈椎区域转移瘤的研究报告.目的:观察后路枕颈部融合固定术联合椎体成形术治疗枢椎转移瘤病理性骨折的疗效和安全性.方法:回顾性分析2004年3月至2018年8月收治的12例枢椎转移瘤病理性骨折患者的临床资料.所有患者均出现枕颈部疼痛,其中8例出现明显脊髓压迫症状.采用Tokuhashi评分系统预测患者的生存期,采用脊柱肿瘤不稳定性评分(SINS)用于评估脊柱稳定性,采用JOA评分、NDI指数和VAS评分分别评估神经功能和疼痛症状.所有患者手术前后均行X线片、三维CT及MRI评估枢椎复位情况,并测量脊髓有效空间(SAC).结果:所有患者均获得随访,随访时间3～30个月,平均(17.7±9.1)个月.所有患者均行后路枕颈部融合内固定联合椎体成形术.患者平均年龄(68.9±12.1)岁,平均手术时间为(167±30)min,平均失血量为(293±73)ml,注入的平均骨水泥量为(2.8±0.2)ml.术前VAS评分为(7.8±0.9)分,JOA评分为(7.3±2.5)分,NDI评分为(80.0±11.4)分,术后1个月及末次随访VAS评分分别为(5.4±1.2)分和(4.1±1.2)分,JOA评分为(9.6±2.1)分和(10.9±1.6)分,NDI评分为(63.2±15.6)分和(59.7±15.5)分,均较术前有明显改善,差异有统计学意义(P<0.05).SAC由术前(7.7±1.6)mm增至末次随访的(11.9±1.6)mm,差异有统计学意义(P<0.05).随访期间可见枢椎不同程度复位,1例患者出现深部伤口感染,采用清创治疗后好转,1例患者出现无症状骨水泥渗漏,1例患者病情恶化,术后3个月死亡.结论:采用后路枕颈部融合内固定联合椎体成形术治疗枢椎转移瘤病理性骨折可迅速缓解疼痛,有一定复位效果,提供良好的脊柱稳定性,且并发症较少,提高了癌症晚期患者的生存质量,是一种安全、有价值的姑息性治疗方法.

[目的]比较脊柱肿瘤后路全脊椎整块切除(total en-blocspondylectomy,TES)后,双棒联合卫星棒与常规双棒固定的临床效果.[方法]回顾性分析本院2013年6月-2018年9月脊柱肿瘤行TES术的33例患者,依据术前医患沟通结果,15例采用联合棒固定,18例采用常规棒固定.比较两组围手术期、随访与影像资料.[结果]两组患者均顺利完成手术,术中无严重并发症.两组在手术时间、出血量、引流量、住院时间、早期并发症的差异无统计学意义(P＞0.05).联合棒组恢复下地行走和完全负重时间显著早于常规棒组(P＜0.05).随时间推移,两组患者VAS评分、ODI指数和ASIA分级均显著改善(P＜0.05);相应时间点两组间差异均无统计学意义(P＞0.05).断棒率联合棒组为2/58(3.45％),常规棒组为6/30(20.00％),差异有统计学意义(P＜0.05).影像方面,与术前相比,术后即刻两组患者LKA显著减少(P＜0.05),AVH和PVH均显著增加(P＜0.05).与术后即刻相比,末次随访时两组患者LKA、AVH和PVH矫正均有丢失;联合棒组LKA和AVH显著小于常规棒组(P＜0.05).至末次随访时,节段融合率联合棒组为93.33％;常规棒组为88.89％,差异无统计学意义(P＞0.05).[结论]后路TES联合卫星棒技术能够提供坚强三维固定,分散固定棒的应力,从而降低术后断棒发生.

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.

a t i o n s y s t e m C : p e r c u t a n e o u s vertebroplasty, percutaneous kyphoplasty O: VAS, ODI, cement leakage, adjacent fractures, vertebral height, local kyphotic angle, Cobb angle S: Interventional studies (RCTs) and observational studies (cohort or case-control studies).Condition being studied: PKP and PVP without stenting are two minimally invasive vertebral augmentation (VA) proc edu res reco mmen ded as o p tions f o r t re a t i n g osteoporotic VCFs only in people who have severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management.Recent studies comparing both procedures demonstrate the advantages of BKP over VP in terms of sagittal balance improvement, cement leakage, improved mortality rates, and cost savings.Thus, PKP appears to be the current standard of care for VCFs, even if recovery of vertebral body (VB) height may be only temporary as there is often a total or partial VB collapse after balloon deflation, prior to cement injection.The third-generation percutaneous VA system has been shown in biomechanical studies to be superior to BKP in terms of sagittal height restoration and height maintenance.

Purpose: Revision surgery for adjacent segment degeneration (ASD) commonly requires exposing and removing the original fixation. To minimize trauma and to reduce the operation time and blood loss, we introduced a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional (3D)-printed navigation templates. Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All surgical data, including the operation time, blood loss, and incision length, were recorded. We evaluated the clinical efficacy using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and computed tomo-graphy (CT) scans were used to evaluate the stability of CBT screw fixation, the accuracy of screws, and the fusion rate. Results: The mean follow-up was 22.4±4.7 months (12–31 months). The VAS, ODI, and JOA scores were analyzed by SPSS 21.0 and showed significant improvement at 2 weeks and the last follow-up compared with preoperative data (P<0.05). Seventy-six CBT screws were inserted with navigation templates; 2 screws were Grade B, and the other screws were Grade 0 or A. Changes in intervertebral height showed good stability of CBT screw fixation (P>0.05). All the patients exhibited satisfactory fusion results. Conclusion: Revision surgery for ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with the advantages of a short operation time, a small incision, and less blood loss.

[目的]观察后路长节段固定联合骨折断端间植骨融合术治疗强直性脊柱病合并过伸型胸腰椎骨折的疗效.[方法]回顾性分析2012.01～2016.12本院采用后路长节段固定联合骨折断端间植骨融合术治疗强直性脊柱病合并过伸型胸腰椎骨折28例患者.总结围手术期、随访与影像资料.[结果] 28例均顺利完成手术,无严重并发症.随时间推移,患者VAS和ODI评分显著减少(P＜0.05),而神经功能ASIA评级显著改善(P＜0.05).影像方面,28例患者术后影像显示骨折复位良好,内固定物位置良好.其中,20例患者于损伤前影像确诊为强直性脊柱病并脊柱后凸畸形;与损伤前相比,术后即刻局部后凸角(LKA)显著减少(P＜0.05),而椎体前缘高度(AVH)、椎体后缘高度(PVH)显著增加(P＜0.05);末次随访与术后即刻比较,LKA、AVH、PVH均无显著改变(P＞0.05).末次随访时,28例患者均达到Bridwell Ⅰ级融合,均未出现内固定松动、断钉断棒.[结论]采用后路长节段固定联合骨折端植骨融合术治疗强直性脊柱病合并过伸型胸腰椎骨折安全及可行,并可在一定程度上矫正后凸畸形.

BACKGROUND:Instrumentation failure (IF) is a common complication after total en bloc spondylectomy (TES) in spinal tumors. This study aims to evaluate the clinical outcomes of TES combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors. METHODS:The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with the satellite rod technique by a single posterior approach from June 2015 to September 2018 were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively, and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded. RESULTS:The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI, and ASIA scores significantly improved from before to after surgery (P < 0.05). The LKA, AVH, and PVH significantly improved from before to immediately after surgery and to the final follow-up (P < 0.05), and the postoperative and final follow-up values did not significantly differ (P > 0.05). CONCLUSIONS:TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.

PURPOSE:The current study aimed to compare the clinical and radiographic results of the 3D-printed artificial vertebral body (3DP-AVB) and titanium mesh cage (TMC) for the treatment of Kümmell's disease (KD) complicated by neurological deficits. PATIENTS AND METHODS:From January 2014 to July 2018, 28 consecutive patients diagnosed with KD and nerve injuries in our department were treated by posterior vertebral column resection and internal fixation. The patients were divided into two groups (3DP-AVB group and TMC group) based on the different anterior column reconstruction implants. Clinical and radiographic parameters were used to evaluate the outcomes. RESULTS:The two groups achieved excellent clinical and radiographic results 1 month after surgery with no significant difference (P>0.05), while 3DP-AVB group showed better outcomes compared with TMC group during the follow-up after 6 months (P<0.05). The risk of subsidence in 3DP-AVB group was lower than that in TMC group (41.6% vs 87.5%, P<0.05), and severe subsidence (≥5 mm) was correlated with the recurrence of back pain and bad daily life function. No significant difference was found in the improvement of neurological function between the two groups (P>0.05). The blood loss and operation time in 3DP-AVB group were significantly less than both in TMC group (P<0.05). CONCLUSION:The lower incidence of cage subsidence, with a better long-term efficacy in maintaining the height of the fused segment, relieving back pain, and improving daily life function indicates that the 3DP-AVB may be a superior alternative for KD with neurological deficits.

To compare transoral and endoscopic transnasal anterior release without odontoidectomy and posterior reduction and fixation to treat irreducible atlantoaxial dislocation (IAAD). From June 2006 to January 2017, 35 consecutive patients with IAAD underwent transoral (Tr-Oral group) or endoscopic transnasal (Tr-Nasal group) release and posterior fixation and fusion in our department. Clinical neurological recovery (Japanese Orthopedic Association (JOA) score) and radiological reduction parameters including atlantodontoid interval (ADI), space available for the cord (SAC) and cervicomedullary angle (CMA) were analyzed and compared. The operation duration, blood loss, length of intensive care unit (ICU)/hospital stay and complications were recorded. All 35 patients (18 and 17 patients in the Tr-Oral and Tr-Nasal groups, respectively) were followed up for a mean of 36.4 months (range, 21–60 months). All patients achieved excellent anatomical reduction and clinical neurological recovery, with no significant differences between the two groups. The JOA score, ADI, SAC and CMA were not significantly different between the two groups at various postoperative points. Although the Tr-Oral group had shorter operation time and less blood loss than the Tr-Nasal group, the Tr-Nasal group tended to have a significantly shorter hospital/ICU stay, earlier extubation and earlier oral intake than the Tr-Oral group. The transoral and endoscopic transnasal approaches can achieve equivalent release and reduction effects when treating IAAD. Compared to the transoral approach, the endoscopic transnasal route is less invasive with earlier extubation and oral intake, shorter hospital/ICU stays and lower medical costs, which is conducive to enhanced recovery after surgery.

Background Among common findings in osteoporotic vertebral compression fractures (OVCFs), the intravertebral cleft (IVC) is usually considered a benign lesion. The current study was aimed to present a rare case of vertebral fracture caused by IVC-related spinal tuberculosis. Case presentation A 73-year-old female complained of back pain and weakness in lower limbs for 2 weeks. 3 months ago, after a minor trauma, she got back pain without weakness in lower limbs. Initially, she was diagnosed with a L1 compression fracture and accepted conservative treatment. After an asymptomatic period, she complained progressive pain at the fracture position with weakness of both lower limbs and was referred to our hospital with suspicion of Kümmell’s disease. The patient underwent posterior debridement and internal fixation for decompression and stabilization of the spine. Pathological examinations revealed the patient with spinal tuberculosis. Conclusions Although IVC is common in patients with OCVFs, there are some cases believed to be found in patients with spinal tuberculosis or infection. Further test, like CT-guided puncture biopsy, may be required before decisive treatment when an IVC is observed.

Background Many studies have demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), and some studies showed that the effect of ESWT was superior to LCI. We performed this meta-analysis to compare the clinical effects across the two therapies. Methods Relevant randomized controlled trials (RCTs) comparing ESWT and LCI for the treatment of CTS were searched in electronic database. The Cochrane risk bias tool was used for quality assessment. After data extraction and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were analyzed. The protocol for this systematic review was registered on INPLASY (202080025) and is available in full on the inplasy.com ( https://doi.org/10.37766/inplasy2020.8.0025 ) Results A total of 5 RCT studies with 204 patients were included from the electronic database. The meta-analysis results showed that two therapies were not significantly different in terms of visual analog scale (VAS) score ( P = 0.65), Boston Carpal Tunnel Questionnaire (BQ) score ( P = 0.14), sensory distal latency ( P = 0.66), and nerve conduction velocity (NCV) of the sensory nerve ( P = 0.06). There were significant differences between the results of motor distal latency ( P < 0.0001), compound muscle action potential (CMAP) amplitude ( P < 0.00001), and sensory nerve action potential (SNAP) amplitude ( P = 0.004). Conclusions In terms of pain relief and function improvement, the effects of ESWT and LCI are not significantly different. In terms of electrophysiological parameters, LCI has a stronger effect on shortening motor distal latency; ESWT is superior to LCI in improving action potential amplitude. ESWT is a noninvasive treatment with fewer complications and greater patient safety. In light of the heterogeneity and limitations, these conclusions require further research for definitive conclusions to be drawn.

Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% ( P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time ( P < 0.05), higher cost ( P > 0.05), and more injected cement volume ( P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage ( P < 0.05), while with no significant difference in adjacent-level fracture rates ( P > 0.05) . Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.

OBJECTIVE:To evaluate efficacy of platelet-rich plasma (PRP) injection in carpal tunnel syndrome (CTS), we conducted this meta-analysis, as well as proposed a protocol for its application in curative processes.METHODS:All randomized controlled trials (RCTs) of PRP for the management of mild or moderate CTS were included in this study. Database search was conducted from study inception to July 2020, including PubMed, Embase, Web of Science, and Cochrane Library. We used visual analogue scores (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) as evaluation tools for primary outcomes. Second outcomes comprised cross-sectional area (ΔCSA) and electrophysiological indexes including distal motor latency (DML), sensory peak latency (SPL), motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), compound muscle action potential (CMAP), and sensory nerve action potential (SNAP). The pooled data were analyzed using RevMan 5.3. Subgroup and sensitivity analyses were conducted with the evidence of heterogeneity. Egger' test was used to investigate publication bias.RESULTS:9 RCTs were finally screened out with 434 patients included. Control groups comprised corticosteroid injection in 5 trials, saline injection in 1 trial, and splint in 3 trials. At the 1st month after follow-up, only ΔCSA between the PRP group and the control group showed significant difference (P < 0.05). In the 3rd month, there were statistically significant differences in VAS, BCTQ, SPL, SNCV, and ΔCSA between two groups (P < 0.05), while no statistically significant differences were found in the remaining outcomes. In the 6th month, there were statistically significant differences at BCTQ (P < 0.05) in primary outcomes and ΔCSA (P < 0.05) in secondary outcomes between two groups. As to adverse events in PRP injection, only one study reported increased pain sensation within 48 h after injections.CONCLUSION:This systematic review and meta-analysis demonstrates that the PRP could be effective for mild to moderate CTS and superior to traditional conservative treatments in improving pain and function and reducing the swelling of the median nerve for a mid-long-term effect. To some extent, the electrophysiological indexes also improved after PRP injection compared with others conservative treatments.

[目的]比较一期前后路与单纯后路治疗颈椎后纵韧带骨化伴发育性椎管狭窄的临床疗效差异.[方法]回顾性分析本院2013年4月～2016年7月收治的颈椎后纵韧带骨化伴发育性椎管狭窄患者31例,根据手术方式不同为分2组,其中前后联合组16例采用一期后路单开门椎管扩大成型术联合前路椎体次全切植骨内固定术治疗,单纯后路组15例采用后路单开门椎管扩大成型术治疗.采用日本矫形外科学会(JOA)颈椎评分系统评估患者神经功能改善情况.行影像检查,测量Pavlov比值、脊髓缓冲空间、K-line阳性率.[结果]31例患者均顺利完成手术.两组患者手术并发症发生率差异无统计学意义(P＞0.05).前后联合组手术时间显著长于单纯后路组(P＜0.05);前后联合组术中平均出血量略多于单纯后路组,但差异无统计学意义(P＞0.05).随访(18.48±4.69)个月,两组患者的JOA评分均随时间推移而显著增加(P＜0.05).虽然术前两组间JOA评分的差异无统计学意义(P＞0.05),但术后6个月及末次随访时,前后联合组的JOA评分显著高于单纯后路组(P＜0.05).影像方面,两组患者末次随访时各节段(C3～7) Pavlov比值和脊髓缓冲空间均显著高于术前(P＜0.05);但相应时间点两组间各节段(C3～7)的Pavlov比值的差异均无统计学意义(P＞0.05),而末次随访前后联合组患者各节段(C3～7)脊髓缓冲空间均显著大于单纯后路组(P＜0.05).末次随访时两组患者K-line阳性率均较术前显著增加(P＜0.05).末次随访时前后联合组的K-line阳性率显著高于单纯后路组(P＜0.05).[结论]采用一期前后路手术较单纯后路手术治疗颈椎后纵韧带骨化伴发育性椎管狭窄能够获得更大减压效果,提高临床疗效.

Background Many studies have demonstrated the effectiveness of extracorporeal shock wave therapy (ESWT) and local corticosteroid injection (LCI) for the treatment of carpal tunnel syndrome (CTS), and some studies showed that the effect of ESWT was superior to LCI. We performed this meta-analysis to compare the clinical effects across the two therapies. Methods Relevant randomized controlled trials (RCTs) comparing ESWT and LCI for the treatment of CTS were searched in electronic database. The Cochrane risk bias tool was used for quality assessment. After data extraction and quality assessment of the included studies, a meta-analysis was performed using RevMan 5.3 software. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were analyzed. The protocol for this systematic review was registered on INPLASY (202080025) and is available in full on the inplasy.com ( 10.37766/inplasy2020.8.0025 ) Results A total of 5 RCT studies with 204 patients were included from the electronic database. The meta-analysis results showed that two therapies were not significantly different in terms of visual analog scale (VAS) score ( P = 0.65), Boston Carpal Tunnel Questionnaire (BQ) score ( P = 0.14), sensory distal latency ( P = 0.66), and nerve conduction velocity (NCV) of the sensory nerve ( P = 0.06). There were significant differences between the results of motor distal latency ( P < 0.0001), compound muscle action potential (CMAP) amplitude ( P < 0.00001), and sensory nerve action potential (SNAP) amplitude ( P = 0.004). Conclusions In terms of pain relief and function improvement, the effects of ESWT and LCI are not significantly different. In terms of electrophysiological parameters, LCI has a stronger effect on shortening motor distal latency; ESWT is superior to LCI in improving action potential amplitude. ESWT is a noninvasive treatment with fewer complications and greater patient safety. In light of the heterogeneity and limitations, these conclusions require further research for definitive conclusions to be drawn.