Category: Statistics

Zhonghua Yi Xue Za Zhi. 2023 Feb 21;103(7):520-525. doi: 10.3760/cma.j.cn112137-20221123-02478.

ABSTRACT

Objective: To compare the efficacy among stand-alone oblique lateral lumbar interbody fusion (OLIF-SA), OLIF combined with lateral screw internal fixation (OLIF-AF) and OLIF combined with posterior percutaneous pedicle screw internal fixation (OLIF-PF) in the treatment of degenerative lumbar diseases. Methods: The clinical data of patients with degenerative lumbar diseases who underwent OLIF-SA, OLIF-AF and OLIF-PF in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2017 to January 2021 were retrospectively analyzed. Patients’ visual analogue score (VAS) and Oswestry disability index (ODI) at 1 week and 12 months postoperatively were recorded, and efficacy of OLIF surgery with different internal fixation methods was evaluated by comparing clinical scores and imaging examinations at preoperative, postoperative and follow-up, and bony fusion and postoperative complications were recorded. Results: A total of 71 patients were included in the study, with 23 males and 48 females, aged (65±11) (34-88) years. There were 25 patients in the OLIF-SA group, 19 patients in the OLIF-AF group, and 27 patients in the OLIF-PF group. Compared with those of OLIF-PF group [(196±46) min and 50 (50, 60) ml], OLIF-SA and OLIF-AF groups had shorter operative time [(97±38) min and (118±48) min] and less intraoperative blood loss [20 (10, 50) ml and 40 (20, 50) ml] (both P<0.001). There was no statistically significant difference in the fusion rate among three groups (P>0.05). No statistically significant differences of VAS and ODI scores were observed among OLIF-SA, OLIF-AF and OLIF-PF groups during preoperative period [VAS: 5.0 (4.0, 6.0), 5.0 (4.0, 6.0) and 5.0 (4.0, 5.3); ODI: 44.0% (35.0%, 47.0%), 46.5% (43.3%, 46.5%) and 43.5% (35.8%, 46.0%)], and at one week postoperatively [VAS: 2.0 (2.0, 3.0), 3.0 (2.0, 3.0) and 2.0 (2.0, 3.0); ODI: 13.0% (12.0%, 18.0%), 21.0% (13.5%, 21.8%) and 16.5%(14.0%, 21.0%)] and final follow-up [VAS: 1.0 (0, 1.0), 1.0 (1.0, 2.0) and 1.0 (1.0, 2.0); ODI: 7.0% (5.0%, 11.0%), 10.0% (7.0%, 14.8%) and 8.0% (6.0%, 12.0%)], respectively (all P>0.05). Conclusion: Compared with OLIF-AF and OLIF-PF, OLIF-SA is a safe and effective surgical method with similar efficacy and fusion rates, decreases the cost of internal fixation, and reduces intraoperative time blood loss.

PMID:36800776 | DOI:10.3760/cma.j.cn112137-20221123-02478

Zhonghua Yi Xue Za Zhi. 2023 Feb 21;103(7):513-519. doi: 10.3760/cma.j.cn112137-20220906-01884.

ABSTRACT

Objective: To study the correlation between joint contact force and postoperative lower extremity alignment in Oxford unicompartmental knee arthroplasty (OUKA) and provide reference data for predicting the lower extremity alignment after OUKA. Methods: It was a retrospective case series study. A total of 78 patients (92 knees) who underwent OUKA surgery from January 2020 to January 2022 in the Department of Orthopedics and Joint Surgery of China-Japan Friendship Hospital were included in this study, including 29 males and 49 females, aged (68.8±6.9) years. A custom-designed force sensor was used to measure gap contact force in the medial gap of OUKA. The patients were divided into groups according to the varus degree of lower limb alignment after operation. Relationship between the gap contact force and the alignment of the lower limbs after operation was analyzed with Pearson correlation analysis, and the gap contact force was compared between patients with different lower limbs alignment correcting results. Results: The mean contact force measured during the operation at 0° of knee extension was 81.7 N±57.8 N, and it was 96.1 N±54.5 N at 20° of knee flexion. The average postoperative knee varus angle was 2.9°±2.7°. The gap contact force at the 0° and 20° positions of the knee joint was negatively correlated with the varus degree of the postoperative lower limb alignment (r=-0.493, -0.331, both P<0.001). The distribution of gap contact force at 0° was different in each group, the contact force [M (Q₁, Q₃)] of the neutral position group(n=24) was 117.4 N (31.7 N, 233.0 N), and it was 63.7 N (11.3 N, 209.0 N), 31.5 N (8.3 N, 87.7 N) in the mild varus group (n=51) and the significant varus group (n=17), respectively, and the difference was statistically significant (P<0.001); while at 20°, only the difference between the significant varus group and the neutral position group was statistically significant (P=0.040). The gap contact force of the alignment satisfactory group at 0° and 20° was greater than those in the significant varus group (both P<0.05). The gap contact force measured at 0° and 20° was significantly greater in patients with preoperative significant flexion deformity than in patients without flexion deformity (or mild flexion deformity) (both P<0.05). Conclusions: OUKA gap contact force is related to the degree of lower limb alignment correction after the operation. In patients with well-corrected lower limb alignment after surgery, the median intraoperative knee joint gap contact force at 0° and 20° is 117.4 N and 92.5 N, respectively.

PMID:36800775 | DOI:10.3760/cma.j.cn112137-20220906-01884

Zhonghua Yi Xue Za Zhi. 2023 Feb 21;103(7):500-505. doi: 10.3760/cma.j.cn112137-20220624-01391.

ABSTRACT

Objective: To investigate the efficacy and safety of pulsed radiofrequency of dorsal root ganglion combined with ozone injection on acute herpes zoster neuralgia in the neck and upper extremities. Methods: A total of 110 patients with acute phase herpes zoster neuralgia in the neck and upper extremities treated in the Department of Pain of Jiaxing First Hospital from January 2019 to February 2020 were retrospectively included. The patients were divided into two groups according to different treatment modalities: the pulsed radiofrequency group (group A, n=68) and the pulsed radiofrequency combined with ozone injection group (group B, n=42). In group A, there were 40 males and 28 females, aged (71.9±9.9) years, while group B consisted of 23 males and 19 females, aged (66.3±16.9) years. Patients were followed up, and numerical rating scale (NRS) score, dose of adjuvant gabapentin, incidence of clinically significant postherpetic neuralgia (PHN) and adverse effects were recorded preoperatively (T₀) and at 1 d (T₁), 3 d (T₂), 1 week (T₃), 1 month (T₄), 2 months (T₅), and 3 months (T₆) postoperatively. Results: The NRS score of patients [M (Q₁, Q₃)] in group A at time points T₀, T₁, T₂, T₃, T₄, T₅ and T₆ was 6 (6, 6), 2 (2, 2), 3 (3, 4), 3 (2, 3), 2 (2, 3), 2 (1, 3) , 1 (0, 2), respectively, while the NRS score at aforementioned time points in group B was 6 (6, 6), 2 (1, 2), 3 (3, 4), 3 (2, 3), 2 (2, 3), 2 (1, 3), 1 (0, 2), respectively. Compared with preoperative NRS scores, NRS scores decreased in both groups at all postoperative time points (all P<0.05). Compared with group A, the NRS scores of group B at time points T₃, T₄, T₅, and T₆ decreased more significantly, with statistically significant differences (all P<0.05). The dose of gabapentin in group A [M (Q₁, Q₃)] was 0.6 (0.6, 0.6), 0.3 (0.3, 0.6), 0.3 (0.0, 0.3) and 0.0 (0.0, 0.3) mg/d at time points T₀, T₄, T₅, and T₆, respectively, and 0.6 (0.6, 0.6), 0.3 (0.2, 0.3), 0.0 (0.0, 0.3) 0.0 (0.0, 0.0) mg/d in patients in group B, respectively. Compared with the preoperative period, the doses of gabapentin taken by patients in both groups reduced significantly at all postoperative time points (all P<0.05). Moreover, compared with group A, the gabapentin dose in group B decreased more significantly at time points T₄, T₅, and T₆, with statistically significant differences (all P<0.05). The incidence of clinically significant PHN was 25.0% (17/68) and 7.1% (3/42) in groups A and B, respectively, and the differences were statistically significant (P=0.018). No serious adverse effects such as pneumothorax, spinal cord injury and hematoma were observed during the treatment period in both groups. Conclusion: Pulsed radiofrequency of dorsal root ganglion combined with ozone injection is safer and more effective for the treatment of acute phase herpes zoster neuralgia in the neck and upper extremities, and it can reduce the incidence of clinically significant PHN, with high safety profile.

PMID:36800773 | DOI:10.3760/cma.j.cn112137-20220624-01391

Zhonghua Yi Xue Za Zhi. 2023 Feb 21;103(7):494-499. doi: 10.3760/cma.j.cn112137-20220808-01709.

ABSTRACT

Objective: To investigate the correlation between balloon volume and Meckel’s cave size during percutaneous puncture microballoon compression (PMC) for trigeminal neuralgia and the influence of the compression coefficient (the ratio of balloon volume/Meckel’s cave size) on the prognosis. Methods: Seventy-two patients (28 males and 44 females) aged (62±11) years who underwent PMC under general anesthesia for trigeminal neuralgia in the First Affiliated Hospital of Zhengzhou University from February 2018 to October 2020 were retrospectively collected. All patients underwent preoperative cranial magnetic resonance imaging (MRI) to measure Meckel’s cave size, intraoperative balloon volume was recorded, and the compression coefficient was calculated. Follow-up visits were performed preoperatively (T₀) and 1 d (T₁), 1 month (T₂), 3 months (T₃), and 6 months (T₄) postoperatively, either in the outpatient clinic or by telephone, and the Barrow Neurological Institute pain scale (BNI-P) score, the Barrow Neurological Institute facial numbness (BNI-N) score and the occurrence of complications were recorded and compared at each time point. Patients were divided into 3 groups according to different prognoses: patients in group A (n=48) were with no recurrence of pain and mild facial numbness, patients in group B (n=19) were with no recurrence of pain but severe facial numbness, while those in group C (n=5) had recurrence of pain. The differences in balloon volume, Meckel’s cave size, and compression coefficient were compared among the three groups, and the correlation between balloon volume and Meckel’s cave size in each group was analyzed by Pearson correlation. Results: The effective rate of PMC for trigeminal neuralgia was 93.1% (67/72). At time points from T₀ to T₄, patients had BNI-P scores [M (Q₁, Q₃)] of 4.5 (4.0, 5.0), 1.0 (1.0, 1.0), 1.0 (1.0, 1.0), 1.0 (1.0, 1.0) and 1.0 (1.0, 1.0), and BNI-N scores [M (Q₁, Q₃)] of 1.0 (1.0, 1.0), 4.0 (3.0, 4.0), 3.0 (3.0, 4.0), 3.0 (2.0, 4.0) and 2.0 (2.0, 3.0), respectively. Compared with those at T₀, patients had lower BNI-P scores and higher BNI-N scores from T₁ to T₄ (all P<0.05). In all patients, group A, group B, and group C, the balloon volume was (0.65±0.15), (0.67±0.15), (0.59±0.15) and (0.67±0.17) cm³, respectively, with no statistically significant difference (P>0.05), while the Meckel’s cave size was (0.42±0.12), (0.44±0.11), (0.32±0.07), and (0.57±0.11) cm³, with a statistically significant difference (P<0.001). The balloon volumes and Meckel’s cave sizes were all linearly and positively correlated (r=0.852, 0.924, 0.937 and 0.969, all P<0.05). The compression coefficient in group A, B and C was (1.54±0.14), (1.84±0.18) and (1.18±0.10), respectively, with a statistically significant difference (P<0.001). There were no serious intraoperative complications such as death, diplopia, arteriovenous fistula, cerebrospinal fluid leak, and subarachnoid hemorrhage. Conclusions: Intraoperative balloon volume during PMC for trigeminal neuralgia is linearly and positively correlated with the volume of the patient’s Meckel’s cave. The compression coefficient varies among patients with different prognoses and the compression coefficient may be a factor affecting the patient’s prognosis.

PMID:36800772 | DOI:10.3760/cma.j.cn112137-20220808-01709

Zhonghua Yi Xue Za Zhi. 2023 Feb 21;103(7):488-493. doi: 10.3760/cma.j.cn112137-20220727-01640.

ABSTRACT

Objective: To explore the efficacy and safety of coblation and pulsed radiofrequency on cervicogenic headache (CEH). Methods: A total of 118 patients with CEH who underwent coblation or pulsed radiofrequency in the Department of Pain Management at Xuanwu Hospital, Capital Medical University from August 2018 to June 2020 was retrospectively collected. Patients were divided into the coblation group (n=64) and the pulsed radiofrequency group (n=54) according to different surgical methods. In the coblation group, there were 14 males and 50 females, aged 29-65 (49.8±10.2) years, while in the pulse radiofrequency group, there were 24 males and 30 females, aged 18-65 (41.7±14.8) years. Visual analogue scale (VAS) score, postoperative numbness in the affected areas and other complications were recorded and compared between the two groups at preoperative 3 d, and 1 month, 3 months and 6 months postoperatively. Results: The VAS score of the coblation group was (7.16±0.91), (3.67±1.13), (1.59±0.91), (1.66±0.84) and (1.56±0.90) before operation, and 3 days, 1 month, 3 months and 6 months after surgery. Likewise, the VAS score of the pulsed radiofrequency group was (7.01±0.78), (1.58±0.88), (1.57±0.94), (3.71±1.08) and (6.92±0.83) at the aforementioned time points. There were statistically significant differences of VAS scores between the coblation group and the pulsed radiofrequency group at 3 days, 3 months and 6 months postoperatively (all P<0.001). Intra-group comparison revealed that VAS scores in the coblation group were significantly lower than those before surgery at all time points after surgery (all P<0.001), while VAS scores in the pulsed radiofrequency group were significantly decreased at 3 days, 1 month and 3 months after surgery (P<0.001). The incidence of numbness was 72% (46/64), 61% (39/64), 6% (4/64) and 3% (2/62) in the coblation group and 7% (4/54), 7% (4/54), 2% (1/54) and 0 (0/54) in the pulsed radiofrequency group, respectively. At 3 days and 1 month after surgery, the incidence of numbness in the coblation group was higher than those in the pulsed radiofrequency group (both P<0.001). In the coblation group, one patient developed pharyngeal discomfort 3 days after surgery, which disappeared spontaneously 1 week after surgery without special treatment. One patient developed vertigo after getting up in the morning at 3 days postoperatively, and the possibility of transient cerebral ischemia was considered. In the pulsed radiofrequency group, one patient developed nausea and vomiting after operation, but spontaneous remission was observed after one hour without special treatment. Conclusions: Both coblation and pulsed radiofrequency are effective and safe in the treatment of CEH. But the VAS scores at 3 and 6 months after coblation is significantly lower than those of pulsed radiofrequency ablation group, and the efficacy is better in those undergoing coblation.

PMID:36800771 | DOI:10.3760/cma.j.cn112137-20220727-01640

Zhonghua Yi Xue Za Zhi. 2023 Feb 21;103(7):483-487. doi: 10.3760/cma.j.cn112137-20220519-01105.

ABSTRACT

Objective: To investigate the efficacy and safety of CT-guided radiofrequency ablation of posterior root of spinal nerve in the treatment of postherpetic neuralgia (PHN). Methods: A total of 102 PHN patients (42 males and 60 females) aged (69.7±9.4) years who underwent CT-guided radiofrequency ablation of posterior root of spinal nerve in the Department of Pain Medicine of the Affiliated Hospital of Jiaxing University from January 2017 to April 2020 were retrospectively included. Patients were followed up, and numerical rating scale (NRS) score, Pittsburgh sleep quality index (PSQI), satisfaction score and complications before surgery (T₀) and at 1 d (T₁), 3 months (T₂), 6 months (T₃), 9 months (T₄) and 12 months (T₅) after surgery were recorded. Results: The NRS score of PHN patients at T₀, T₁, T₂, T₃, T₄, and T₅ [M(Q₁, Q₃)] was 6(6, 7), 2(2, 3), 3(2, 4), 3(2, 4), 2(1, 4), 2(1, 4), respectively. Likewise, the PSQI score [M(Q₁, Q₃)] at aforementioned time points was 14(13, 16), 4(3, 6), 6(4, 8), 5(4, 6), 4(2, 8), 4(2, 9), respectively. Compared with T₀, the NRS and PSQI scores at all time points from T₁ to T₅ were lower, with statistically significant differences (all P<0.001). The overall effective rate of surgery at 1 year postoperatively was 71.6% (73/102) with a satisfaction score of 8(5, 9), and the recurrence rate was 14.7% (15/102) with a recurrence time of (7.5±0.8) months. The main postoperative complication was numbness, with an incidence of 86.0% (88/102), and the degree of numbness gradually decreased with time. Conclusion: CT-guided radiofrequency ablation of posterior root of spinal nerve for PHN has a high effective rate and a low recurrence rate, with high safety profile, and may be a feasible surgical option for the treatment of PHN.

PMID:36800770 | DOI:10.3760/cma.j.cn112137-20220519-01105

J Pak Med Assoc. 2023 Feb;73(2):381-383. doi: 10.47391/JPMA.4410.

ABSTRACT

A cross sectional analytical study was conducted from September 26 to December 28 2018 at Shifa Tameer-e-Millat University Islamabad with 111 undergraduate students aged 17-26 years as participants. The aim of the study was to establish the normative values of cervical joint positioning error (CJPE) and its association with cervical spine mechanics. Neck discomfort was measured using the neck portion of the “student specific Cornell Musculoskeletal Discomfort Questionnaire” (ssCMDQ) and CJPE was measured via cervico-cephalic relocation test using a goniometer. Non-parametric tests of significance were used because the data was not normally distributed in terms of normality testing. Normative values of CJPE were noted to be highest in flexion (9o±9o), rotation towards left (9o±6o) and right (8o±7o), extension (6o±8o), and lastly lateral flexion towards left (5o±7o) and right (5o±5o). Higher CJPE in all movements was observed among females; however, no significant statistical differences were observed (p>0.05). In terms of correlation, important trends included significantly positive correlation of neck discomfort with CJPE in extension, and of CJPE in lateral flexion towards the left with CJPE in lateral flexion towards the right and flexion (p<0.05).

PMID:36800731 | DOI:10.47391/JPMA.4410

J Pak Med Assoc. 2023 Feb;73(2):366-369. doi: 10.47391/JPMA.5234.

ABSTRACT

The objective of the endeavour was to study the clinical presentation, diagnosis, and management of paediatric patients suffering from congenital adrenal hyperplasia and understand the issue in the light of available published data on the disease in Pakistan through a systematic analysis of researches. From an analysis of five-year retrospective data on congenital adrenal hyperplasia in patients of paediatric age group from a tertiary care centre in the capital of Pakistan and the available published Pakistani literature on CAH, it was concluded that the resultant deficiency of cortisol, aldosterone, and a rise in adrenal androgens is responsible for the symptomatology observed in the disease. Particularly, the presence of ambiguous genitalia makes the disease a difficult problem to tackle, especially in complex social conditions such as in Pakistan. The country not only lacks statistical data on the disease but also the diagnostic machinery making the problem two fold. It is only through maintaining an efficient disease registry and the introduction of neonatal screening programme that we might start grappling the crux of the issue.

PMID:36800727 | DOI:10.47391/JPMA.5234

J Pak Med Assoc. 2023 Feb;73(2):328-332. doi: 10.47391/JPMA.6477.

ABSTRACT

OBJECTIVE: To measure the perception of medical students regarding different methods of active learning, and its association with the year of study.

METHODS: The analytical cross-sectional study was conducted at Shalamar Medical and Dental College, Lahore, Pakistan, from May to September 2020, and comprised medical students of either gender from first to final year of studies. Data was collected using an online questionnaire regarding different methods of active learning and e-learning. Perceptions and their association with the year of study were worked out. Data was analysed using SPSS 16.

RESULTS: Of the 270 subjects, 155(57.4%) were females and 115(42.5%) were males. Overall, 39(14.4%) students were from the first year of studies, 32(11.9%) second, 47(17.4%) third, 120(44.4%) fourth and 32(11.9%) were from the final year of medical studies. Most students preferred class lectures as the teaching method of choice 240(89%), followed by small group discussions 156(58%). Students showed positive perception of different learning methods except e-learning 78(28.89%). The association between perceptions and the year of study was statistically significant (p< 0.05).

CONCLUSIONS: Students apparently enjoyed using different interactive methods, but were apprehensive about online learning.

PMID:36800720 | DOI:10.47391/JPMA.6477

J Pak Med Assoc. 2023 Feb;73(2):290-293. doi: 10.47391/JPMA.5623.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of bleomycin in the treatment of lymphatic malformations, and the concordance between photographic and radiological assessments of the outcome.

METHODS: The retrospective study was conducted at the Vascular Anomalies Centre of Indus Hospital, Karachi, and comprised data of patients enrolled with diagnosis of macrocystic or mixed lymphatic malformations from January 2017 to November 2019. All patients had been treated with injection bleomycin 0.6-1mg/kg/session. Size and location of lesions, ultrasonographic findings, photographic documentation and post-procedure complications were reviewed. Photographic and radiographical assessment outcomes were categorised as excellent, good or poor, and compared for concordance. Data was analysed using Stata 14.

RESULTS: Of the 31 children, 22(68.8%) were boys. Mean age at presentation was 54.2±44 months (range: 2 months to 15.7 years). There were 32 lymphatic malformations; 29(90.6) macrocystic and 3(9.4%) mixed. Head and neck region was mostly involved 19(59.4%). Most lesions 23(71.9%) presented during the first year of life, and 29(90.6%) lesions were purely macrocystic. Excellent, good and poor response was seen in 16(50%), 15(46.9%) and 1(3.1%) lesions on photographic assessment, and 21(65.6%), 11(34.4%) and 0(0.0%) lesions on radiological assessment, respectively. Concordance in photographic and radiological outcomes was 22(69%). No complications were seen and no statistically significant difference was observed for photographic and radiographic assessment with respect to gender, malformation type, region involved, and number of sessions (p>0.05).

CONCLUSIONS: Intralesional bleomycin sclerotherapy was found to be effective in the treatment of lymphatic malformations. Clinical observation was reliable in assessing progress on routine follow-up, with additional radiology done when management decisions needed to be reviewed.

PMID:36800712 | DOI:10.47391/JPMA.5623