Infiltraciones de sangre autóloga y plasma enriquecido en plaquetas en el tratamiento de la epicondilitis. Una revisión sistemática / Infiltrations of autologous blood and platelet rich plasma in the treatment of epicondylitis. a systematic review

Objetivo. Evaluar la eficacia de la terapia con sangre autóloga o plasma enriquecido en plaquetas (PEP) en el tratamiento de la epicondilitis. Estrategia de búsqueda. Revisión sistemática de la literatura en las principales bases de datos. Artículos en español e inglés sin límite de tiempo. Palabras clave usadas: Epicondilitis y sangre autóloga; Epicondilitis y plasma enriquecido en plaquetas. Selección de los estudios. Ensayos clínicos aleatorizados y estudios de cohorte. Se seleccionaron un total de 11 artículos. Síntesis de resultados. La terapia con sangre autóloga o PEP es más efectiva para la disminución del dolor y mejora de la función que la infiltración con corticoides. Esta superioridad se muestra a medio y largo plazo. El PEP es superior a la sangre autóloga a medio plazo. El coste estimado de estos tratamientos es superior al uso de corticoides Conclusiones. Ambos tratamientos parecen superiores al patrón oro que podemos considerar la inyección de corticoides (AU)

Objective. To evaluate the efficacy of therapy with autologous blood or platelet rich plasma (PRP) in the treatment of epicondylitis. Research Strategy. A systematic revision of the literature in the main databases was performed of articles in Spanish and English without any time limits. Keywords used were: Epicondylitis and autologous blood; Epicondylitis and platelet-rich plasma. Study selection. Randomized clinical trials and cohort studies. A total of 11 articles were selected. Synthesis of results. Autologous blood therapy or PRP is more effective for pain reduction and function improvement than corticosteroid injections. This advantage is seen in both the mid and long term. PRP is superior to autologous blood in the mid term. The estimated cost of these treatments is higher than that of the use of corticosteroids. Conclusions. Both treatments seem superior to corticosteroid injections, which had been considered to be the gold standard (AU)

La sesión clínica basada en evidencias: proceso de evaluación y mejora / Evidence Based Medicine clinical session: a process of evaluation and improvement

Introducción y objetivo. Ya desde finales de los años noventa nuestro Servicio se interesa por la medicina basada en evidencias (MBE), que promueve la búsqueda y valoración crítica de la literatura médica para la resolución de dudas en el ámbito profesional. De esta forma, comenzamos a aplicar la MBE en las sesiones clínicas del Servicio, siguiendo el formato de los Critically Appraised Topic (CAT). Se realiza un análisis crítico de esta metodología, valorando las mejoras introducidas y las que están todavía pendientes. Material y métodos. Análisis descriptivo retrospectivo de las sesiones realizadas en formato tipo CAT desde el 24 de junio de 2003 hasta el 13 de febrero de 2007. Los datos recogidos fueron: tema de la sesión, tipo de análisis realizado (tratamiento, etiología, diagnóstico y pronóstico), aporte de pruebas complementarias, definición de la pregunta clínica, bases de datos utilizadas, artículos analizados y respuesta concluyente o no. Resultados. Se analizaron 83 sesiones clínicas. El tema más frecuente fue la patología musculoesquelética. Setenta y tres sesiones investigaron una medida terapéutica y 30 aportaron pruebas complementarias; la base de datos más utilizada fue Medline y los artículos más frecuentemente analizados fueron ensayos clínicos aleatorizados, con nivel de evidencia A, y la respuesta fue concluyente en 35 sesiones. Discusión. Se analiza la implantación de la sesión tipo CAT basada en la evidencia, detectando los errores y las mejoras aplicadas para aumentar su calidad. Seguimos proponiéndonos nuevos retos, como la aplicación del programa de lectura crítica CASPe (Critically Appraisal Skills Programme) y el uso de número necesario a tratar como instrumento de medida epidemiológica, todo ello en el proceso de evaluación y continua mejora de la sesión clínica tipo CAT

Introduction. By the end of the 1990¿s, the Rehabilitation Service in our hospital was already interested in Evidence Based Medicine (EBM), which promotes the search and critical evaluation of medical information for the solving of doubts in the professional setting. In this way, we began to apply EBM in the clinical sessions of the Service, using the Critically Appraised Topic format (CAT). A critical analysis of this methodology is made, evaluating the improvements introduced and those which are still pending. Material and methods. This article provides a descriptive and retrospective analysis of the clinical sessions in the Rehabilitation Service between 24/06/2003 to 13/02/2007. We analyze the subject of the session, type of analysis made (treatment, etiology, diagnosis, prognosis), if there were complementary tests, definition of the clinical question, what database were consulted, the kind of articles analyzed, and if the answer to the question was conclusive. Results. We analyzed 83 clinical sessions. The most treated subject was skeletal muscle pathology. A total of 73 sessions provided information on one kind of treatment, 30 sessions provided complementary diagnostic tests. The most consulted database was Medline. The articles analyzed most frequently were randomized clinical trials with evidence level A and the answer was conclusive in 35 sessions. Discussion. This article analyzes the introduction of the Critically Appraised Topic format in the clinical session in our service, detecting some mistakes and their solutions which have increased the quality of the clinical session. We continue to propose new challenges, such as the application of CASPe tools (Critically Appraisal Skills Programme) and the number needed to treat as an epidemiologic index, all of this within the clinical session improvement process

[Related factors with the failed surgery of herniated lumbar disc]. / Factores relacionados con la cirugía fallida de hernia discal lumbar

INTRODUCTION: The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. MATERIAL AND METHODS: A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. For the statistical analysis of the results, we used the program SPSS 11.01. RESULTS: In a sample in which the proportion between both sexes was 1/1, and the middle age was over 45 years [35-54], in which the most frequent clinical symptom was right sciatica, lasting more than 6 months, correlated to disc herniation at L5-S1 level, 37.9% of the patients presented FBSS. Although there were a few patients with reoperation in our study, the incidence of FBSS in these patients was higher (52.9%) than in patients who suffered this surgery for first time (32%). The predictive clinical factors of an unfavourable result in patients operated on for first time were bilateral sciatica, the presence of stenosis associated to herniated disc and comorbidity factors. On the other hand the sociolabor factors identified were a low culture level and those working as drivers, building and service sectors. Return to work occurred in the 64% of the active workers before surgery. Only around 10% of patients were dissatisfied with surgical result and there was a significant relationship between this and the physical function, pain, vitality and emotional status in the SF-36 with the FBSS. CONCLUSIONS: One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labour and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life.

Factores relacionados con la cirugía fallida de hernia discal lumbar / Related factors with the failed surgery of herniated lumbar disc

Introducción. La cirugía descompresiva de herniadiscal es la intervención quirúrgica más frecuente a nivel de la columna lumbar. La cirugía fallida oscila entre un 10 y un 40% de los casos, constituyendo el denominado Síndrome de la Cirugía Raquídea Fracasada (SCRF). La reincorporación laboral a medio plazo tras la cirugía se sitúa en torno al 70-85%, y existen pocos estudios que analicen la calidad de vida tras la intervención. Los objetivos de este estudio son conocerla incidencia de cirugía fallida de hernia discal lumbar en nuestro medio, identificando aquellos factores que puedan influir en su aparición; y estudiar factores ambientales como la reincorporación laboral y la calidad de vida a medio plazo tras esta cirugía, así como su relación con el éxito o fracaso quirúrgico. Material y métodos. Estudio descriptivo transversal de 117 pacientes intervenidos de hernia discal lumbar durante el primer semestre del 2003 en nuestro hospital. Para valorar la incidencia de cirugía fallida y factores relacionados se han recogido datos clínicos de la Historia Clínica de los pacientes de la muestra. Y, asimismo, se ha entrevistado telefónicamente a 91 de ellos -los que contestaron- para valorar factores no clínicos relacionados con el SCRF, tales como reincorporación laboral, satisfacción con la cirugía, realización de tratamiento rehabilitador y calidad de vida a través del Cuestionario de Salud SF-36. Para el análisis de resultados se ha empleado el programa estadístico SPSS 11.01. Resultados. En una muestra en la que la proporción ente ambos sexos es de 1/1 y la edad media de 45 [35-54]años, con una clínica más frecuente de ciática derecha, de más de 6 meses de evolución, correlacionada con el hallazgo radiológico de hernia L5-S1, un 37,9% ha presentado el SCRF. Aunque es escaso el número de pacientes que en nuestra serie afrontan una reintervención, se ha observado en ellos una incidencia del SCRF notablemente superior (52,2%) a los que se someten a una primera cirugía (32%). Los factores clínicos predictivos de resultados desfavorables en pacientes sometidos a primera cirugía han sido la clínica precirugía de ciática bilateral, el hallazgo de estenosis de canal asociada a hernia discal y la comorbilidad; mientras que los sociolaborales han sido pacientes sin estudios y aquellos que trabajan en los sectores de la conducción, construcción y hostelería. La reincorporación laboral se produjo en el 64 % de los trabajadores activos previamente. Sólo entorno al 10% se encuentran insatisfechos con la opción quirúrgica, relacionándose significativamente tanto estocomo las dimensiones de función física, dolor, vitalidad y rol emocional en el SF-36 con el SCRF. Conclusiones. Uno de cada 3 pacientes intervenidos de hernia discal lumbar en nuestro medio presenta cirugía fallida, reincorporándose laboralmente 2 de cada 3pacientes previamente activos. El paciente con cirugía fallida se encuentra afectado por dolor, hasta el punto de repercutir y limitar las actividades del hogar y las laborales. Además presenta frecuentemente sensación de cansancio o agotamiento, y problemas emocionales que interfieren tanto en las actividades de la vida diaria como en el trabajo

Introduction. The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. Material and methods. A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. For the statistical analysis of the results, we used the program SPSS 11.01. Results. In a sample in which the proportion between both sexes was 1/1, and the middle age was over 45 years [35-54], in which the most frequent clinical symptom was right sciatica, lasting more than 6 months, correlated to disc herniation at L5-S1 level, 37'9% of the patients presented FBSS. Although there were a few patients with reoperation in our study, the incidence of FBSS in these patients was higher (52,9%) than in patients who suffered this surgery for first time (32%). The predictive clinical factors of an unfavourable result in patients operated on for first time were bilateral sciatica, the presence of stenosis associated to herniated disc and comorbidity factors. On the other hand the socio-labor factors identified were a low culture level and those working as drivers, building and service sectors. Return to work occurred in the 64% of the active workers before surgery. Only around 10% of patients were dissatisfied with surgical result and there was a significant relationship between this and the physical function, pain, vitality and emotional status in the SF-36 with the FBSS. Conclusions. One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labor and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life (AU)