Objective To investigate the clinical outcomes of subxiphoid video-assisted thoracoscopic thymectomy for myasthenia gravis. Methods The clinical data of the 85 patients undergoing video-assisted thoracoscopic thymectomy for myasthenia gravis in Department of Cardiothoracic Surgery, Huashan Hospital affiliated to Fudan University between January 2014 and July 2016 were studied. Subxiphoid approach video-assisted thoracoscopic thymectomy (SXVT) and through traditional unilateral approach video-assisted thymectomy (TVAT) were compared. The clinical outcomes of SXVT and TVAT were compared. Results There was no surgical death and no statistical difference between the two groups in drainage time, postoperative volume of drainage, postoperative hospital stay and bleeding volume during operation (P>0.05). However, the acute chest pain after surgery, as well as the postoperative chest pain, and operative time were less in the the SXVT group than that in the TVAT group (P<0.05). Conclusion SXVT for myasthenia gravis is safe and executable. It can alleviate intercostal neuralgia and abnormal chest wall feeling. And it should be considered in the treatment of myasthenia gravis.
Objective To investigate the effect of lateral retinacular release on the clinical outcomes after total knee arthroplasty (TKA) without resurfacing of the patella. Methods A prospective randomized controlled study was performed on 132 patients with unilateral degenerative knee arthritis undergoing TKA bewteen October 2012 and October 2014, who met the selection criteria. During TKA, lateral retinacular release was used in 66 cases (trial group) and was not used in 66 cases (control group). Two patients were excluded from the study due to missing the follow-up in trial group. Four patients were excluded from the study due to lateral retinacular release in control group. Finally, 64 patients and 62 patients were included in the trial group and in the control group. There was no significant difference in gender, age, body mass index, side, disease duration, preoperative patellar morphology, grading of patellofemoral arthritis, grade of patellar cartilage degeneration, patellar malposition, patellar maltracking, patellar score, and Knee Society Score (KSS) between 2 groups (P>0.05). The operation time, postoperative drainage volume, hospitalization time, postoperative complications, and patient satisfaction were recorded. Postoperative anterior knee pain was assessed by visual analogue scale (VAS), and the knee joint function was evaluated by KSS score and patellar score. The femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle were measured on the X-ray film for postoperative prosthetic alignment. The postoperative patellar tracking and patellar position, as well as the presence of osteolysis, prosthesis loosening, patellar fracture and patellar necrosis were observed. Results All patients were followed up for 24 months. There was no significant difference in operation time, postoperative drainage volume, hospitalization time, and patient satisfaction between 2 groups (P>0.05). The incidence of anterior knee pain in the trial group was better than that in the control group (P=0.033). KSS score and patellar score were significantly improved in both groups at 24 months after operation when compared with preoperative scores (P<0.05), but no significant difference was found between 2 groups (P>0.05). Complications included hematoma (2 cases in the trial group, and 1 case in the control group), mild wound dehiscence (2 cases in each group respectively), skin-edge necrosis (1 case in the trial group), and superficial wound infection (1 case in each group respectively), which were cured by conservative treatment. No patellar necrosis, patella fracture, or knee lateral pain occurred in 2 groups. There was no significant difference in complication rate between groups (P=0.392). Satisfactory implant alignment was observed in both groups during follow-up. There was no significant difference in femoral angle, tibial angle, femoral flexion angle, and tibial posterior slope angle between 2 groups (P>0.05). No radiolucent line at the bone-implant interface was seen around the tibial components and femoral components in both groups. The patellar maltracking was observed in 3 patients of the trial group and 5 patients of the control group, showing no significant difference (P=0.488). However, the incidence of patellar malposition in the trial group (18.8%) was significantly lower than that in the control group (35.5%) (χ2=0.173,P=0.034). Conclusion Lateral retinacular release during primary TKA without resurfacing of the patella can reduce postoperative knee pain without increasing complications.
Splanchnicectomy is a minimally invasive and effective method of treating chronic upper abdominal pain in cancer. It offers good, short-term pain relief, reduces morphine consumption, and improves patients' satisfaction. In the wake of developments in minimally invasive technology, the method has brought a number of new breakthroughs. We reviewed the effect of the success of splanchnicectomy.
ObjectivesTo systematically review the efficacy of yoga treatment for low back pain.MethodsWeb of Science, BBSCO Academic Source Complete, Elsevier ScienceDirect, Scopus, PubMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of yoga intervention for low back pain from inception to November 4th, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 14 RCTs involving 1 684 patients were included. The results of meta-analysis showed that: compared with conventional treatment, the RMDQ scores of yoga treatment for low back pain was statistically significant lower (MD=–1.86, 95%CI –2.39 to –1.33, P<0.000 01). The results of subgroup analysis showed that the exercise frequency, low back pain degree, low back pain cause, intervention period and sample size had not altered efficacy of yoga.ConclusionsCurrent evidence shows that yoga can achieve superior results in low back pain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
摘要:目的: 探讨深部痛点阻滞在治疗顽固性癌痛患者中的作用。 方法 : 将156例顽固性癌痛患者,随机分为深部痛点阻滞组及对照组,每组78例。深部痛点阻滞组根据疼痛部位,应用软组织外科学理论找出相应压痛点,给予痛点深部阻滞治疗;对照组找出压痛点但仅按三阶梯用药原则给予口服药物治疗。 结果 : 深部痛点阻滞组及对照组两组患者经治疗后疼痛控制均较理想(深部痛点阻滞组VAS13, 对照组VAS17),但是深部痛点阻滞组吗啡用量明显少于对照组(吗啡日平用量深部痛点阻滞组为335mg, 对照组为15287 mg)。便秘的发生率深部痛点阻滞组为5384%,对照组为7692%。 结论 : 深部痛点阻滞能较好的控制顽固性癌痛,同时可明显减少吗啡的用量,副作用相对发生要少。Abstract: Objective: To investigate the effect of the deeppressed pain points injection on the refractory cancer pain and provide reference for relieving the cancer pain. Methods : One hundred and fiftysix patients with refractory cancer pain were diagnosed by the soft tissue surgery,finding the pain point by pressing deeply,the patients with deeppressed pain points were divided into deeppressed pain points injection group and control group randomly, The patients in deeppressed pain points injection group were treated with deeppressed pain points injection; the patients in control group were treated with drugs according with the WHO analgesic ladder. Results : The patients in deeppressed pain points injection group got the same pain relief as those in control group (VAS 13 in deeppressed pain points injection group, 17 in control group ),but the daily dose of morphine in deeppressed pain points injection group was less than that incontrol group (morphine 335mg/day in deeppressed pain points injection group,15287mg/day in control group ) significantly. There was 5384% patients with constipation in deeppressed pain points injection group, 7692% in control group. Conclusion : The refractory cancer pain can be controlled effectively by the deeppressed pain point injection and the daily dose of morphine to control the cancer pain is decreased significantly. The side effect in deeppressed pain points injection group was less than that in control group.
Objective To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P＜0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P＞0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P＞0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P＜0.05). Conclusion Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.
ObjectiveTo explore the effect of selective exercise training technique combined with ultrasound therapy on patellofemoral pain syndrome. MethodsPatients who met the research criteria were assigned into treatment group and control group randomly between July 2011 and August 2012. Each group had 28 patients. There were no significant differences in gender, age and body mass index between the two groups (P>0.05). Patients in the treatment group received selective exercise therapy and ultrasound therapy, while patients in the control group received normal exercise treatment and ultrasound therapy. Knee numerical pain rating scale (NPRS) and knee functional obstruction assessment were performed on all the patients before treatment and 5 days after treatment (on the 6th day) for comparison. ResultsBefore treatment, the score of NPRS in the treatment group and the control group was 4.7±0.8 and 4.8±0.9, respectively, with no significant difference (P>0.05). The score of functional obstruction assessment was 11.2±2.2 and 12.2±2.7 in the two groups without significant difference (P>0.05). Five days after treatment, the NPRS score decreased to 2.1±0.5 in the treatment group and 4.2±1.0 in the control group, and the knee functional obstruction assessment score decreased to 6.4±1.9 and 11.1±2.6, respectively. Both groups improved significantly in NPRS score and knee functional obstruction assessment score (P＜0.05), while the treatment group exhibited more improvement in the two scores than the control group (P＜0.05). ConclusionSelective exercise training is effective for improving the pain and function of patients with patellofemoral syndrome.
Objective To investigate the correlation between OPRM1 A118G gene polymorphism and Eysenck personality type and pain sensitivity. Methods The surgical patients who were transferred from Department of Emergency Medicine to Department of General Surgery of Luzhou People’s Hospital between January 2018 and December 2020 were selected. Before surgery, Eysenck Personality Questionnai (EPQ) was used to investigate the patient’s personality type, and the pain threshold and pain tolerance threshold were determined by electric stimulation instrument. The OPRM1 A118G genotype of peripheral venous blood was detected by polymerase chain reaction-restriction fragment length polymorphism analysis technique. Patients were divided into wild homozygous (A/A) group, mutant heterozygous (A/G) group and mutant homozygous (G/G) group according to the typing results. The general condition, pain sensitivity, EPQ score, difference of Eysenck personality type and correlation between Eysenck personality type and pain sensitivity were analyzed. Results A total of 356 patients were enrolled, including 174 in A/A group, 136 in A/G group and 46 in G/G group. The mutation rate of OPRM1 A118G gene was 32.00%. There were statistically significant differences in pain sensitivity (pain threshold, pain tolerance threshold) and scores of introverted and extraverted, neurotic and dissemble personality types among three groups (P<0.05). There were significant differences in introverted and extraverted and psychotic personality types among the three groups (P<0.05). There were significant differences in pain threshold and pain tolerance threshold among different introverted, extraverted and psychotropic personality types (P<0.05). Conclusion Both OPRM1 A118G gene polymorphism and Eysenck personality type have influence on pain sensitivity, and there is a correlation between them.
Objective To investigate the effects of altering the femoral offset after total hip arthroplasty on postoperative pain and function. Methods A total of 162 patients undergoing single total hip arthroplasty between March 2009 and December 2011 met the inclusion criteria. According to difference of femoral offset between operative side and contralateral side, the patients were divided into 3 groups: decreased offset group (lt; — 5 mm, 30 cases), normal offset group ( — 5-5 mm, 87 cases), and increased offset group (gt; 5 mm, 45 cases). There was no significant difference in gender, age, and disease duration among 3 groups (P gt; 0.05). The types of femoral stem and head prosthesis were compared among 3 groups. Short Form 12 Health Survey (SF-12) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, and Harris score were used to evaluate the clinical outcomes. Results Standard offset femoral prosthesis was most used, followed by increased offset femoral prosthesis, and decreased offset femoral prosthesis was least in 3 groups. The types of femoral stem and head prosthesis showed no significant difference among 3 groups (P gt; 0.05). The patients were followed up 12-33 months (mean, 25 months). There was no significant difference in SF-12 score among 3 groups at 1 year after operation (P gt; 0.05); there was no significant difference in WOMAC pain and stiffness scores among 3 groups (P gt; 0.05) except WOMAC body function score (P lt; 0.05). According to Harris scoring criteria, the results were excellent in 13 cases, good in 8 cases, fair in 7 cases, and poor in 2 cases in decreased offset group; the results were excellent in 42 cases, good in 34 cases, fair in 9 cases, and poor in 2 cases in normal offset group; the results were excellent in 31 cases, good in 12 cases, and fair in 2 cases in increased offset group; and significant difference was found among 3 groups (Z= — 3.152, P=0.008). Conclusion Increased offset is more conducive to joint functional recovery and pain relief; decreased offset may lead to joint function deterioration and pain aggravation.
Objective To conduct a systematic review of the construction methods, predictive factors, and model quality of risk prediction models for postoperative chronic pain in knee replacement surgery patients, providing evidence for the development of nursing-sensitive dynamic prediction models. Methods A systematic review of risk prediction models for postoperative chronic pain in knee replacement surgery patients was conducted by searching PubMed, Web of Science, Cochrane Library, CINAHL, SinoMed, CNKI, Wanfang Database, and VIP Database. The search period was from the establishment of the databases to February 28, 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies. Results A total of 10 studies involving 10 predictive models were included in this review. Among these, three models underwent internal validation, and one model underwent external validation. Commonly reported predictive factors included postoperative 24-hour Numerical Rating Scale scores, postoperative knee function scores, sleep disorders, preoperative depression, postoperative functional exercises, postoperative complications, preoperative pain, and postoperative C-reactive protein levels. All 10 studies had a high risk of bias and were generally applicable. Conclusions Existing risk prediction models generally rely on static indicators and lack dynamic monitoring of postoperative rehabilitation behaviors and psychosocial factors, with severe deficiencies in model validation. Future research should focus on developing nursing-led multidimensional dynamic models that incorporate functional exercise adherence data collected via wearable devices, standardize external model validation, and enhance clinical translation value.