[Intradiscal interventional therapy for degenerative chronic discogenic low back pain with end-plate Modic changes].

OBJECTIVE: To observe the different efficacies of intradiscal interventional therapy for patients with degenerative chronic discogenic low back pain and end-plate Modic changes through different types of injection and to evaluate the potential therapeutic value of intradiscal injection treatment for degenerative chronic discogenic low back pain with different types of end-plate Modic changes by using appropriate injection. METHODS: Patients with single segmental degenerative chronic discogenic low back pain proved by discography were classified as Modic type I predominant change (including Modic Type I & Modic type I predominant mixed Type I/II) and Modic type II predominant change (including Modic Type II & Modic Type II predominant mixed Type II/I) according to the end-plate Modic changes on MRI. All received the intradiscal injection treatment. Patients were divided into three groups: (1) A group (control group): intradiscal injection of normal saline 3 ml; (2) B group (treatment group): intradiscal injection of diprospan (compound betamethasone) 3 ml; (3) C group (treatment group): interventional injection of diprospan (compound betamethasone) 1 ml + songmeile (cervus & cucumis polypeptide injection) 2 ml. Pain and function were evaluated by pain visual analogue scale (VAS) and Oswestry disability index (ODI). T-test was applied for efficacy comparison in each group at pre-operation, 3 months and 6 months post-operation. RESULTS: Sixty patients were included. There were 39 males and 21 females with a mean age of 41.6 years old (26 - 58). There were 10 patients in each group: A-Modic I, A-Modic II; B-Modic I, B-Modic II; C-Modic I, C-Modic II. There was no significant statistical difference in preoperative VAS and Oswestry scores among groups; VAS and Oswestry scores of B group and C group at 3 months and 6 months post-operation were significantly better than those pre-operative scores, and also better than that of control group (A group) at the same time. But there was no significant difference in scores between 3 months and 6 months in ether B group or C group, and there was also no significant difference in VAS and Oswestry scores between B group and C group at various time points. Various Modic types had no correlation with either VAS score or Oswestry score in each group at various time points. CONCLUSION: Intradiscal interventional therapy can relieve discogenic low back pain and improve Oswestry disability index score of function between 3 and 6 months post-operation. There is no significant difference in post-operative efficacy between Modic Type I and Modic Type II. Steroids are the major analgesic factor of intradiscal injection. But the synergistic application of songmeile (cervus & cucumis polypeptide injection) can maintain the analgesic effect and duration with a decreased dose of steroids.

[Efficacy and safety evaluation of glucosamine hydrochloride in the treatment of osteoarthritis].

OBJECTIVE: To evaluate the efficacy and safety of glucosamine hydrochloride for the treatment of osteoarthritis. METHODS: A multi-central, randomized, controlled clinical trial of glucosamine hydrochloride comparing glucosamine sulfate for the treatment of osteoarthritis was performed. One hundred and forty-three patients suffering from knee or hip osteoarthritis were randomized into study (glucosamine hydrochloride) or control (glucosamine sulfate) group. Patients in study group orally took glucosamine hydrochloride 2 times daily for 6 weeks, each time 1 capsule, and those in control group took glucosamine sulfate 3 times daily for 6 weeks also, each time 2 capsules. RESULTS: The symptomatic improvement of joint pain at walking, at rest and stiffness after 6 week treatment with glucosamine hydrochloride was better than those with glucosamine sulfate. The results had significant difference (P < 0.05). Total effective rates of patients with glucosamine hydrochloride was 75.4% and 60.6% with glucosamine sulfate, but no statistical difference. The results suggested both glucosamine had the considerable efficacy in the treatment of osteoarthritis. Three cases in study group and 2 in control group reported mild adverse events. No severe adverse events (SAE) was observed. CONCLUSION: Glucosamine hydrochloride is as effective and safe as glucosamine sulfate for the treatment of osteoarthritis.

[Analysis of the results of hemiarthroplasty in the treatment of proximal humeral fractures].

OBJECTIVES: To evaluate the clinical results of hemiarthroplasty in the treatment of severe proximal humeral fracture, and to analyze the influencing factors. METHODS: Forty-two cases with mean age of 63 years old were included. Mean follow-up duration was 29 months (12 - 48 months). Subjective satisfaction, ROM, muscle strength, stability, smoothness of motion were all evaluated. Radiographs of anterio-posterior view and axial view of shoulder were taken. Total-length radiographs of bilateral humerus were taken for 27 cases and CT for 15 cases. RESULTS: With Constant-Murley score 19 cases (45%) were excellent, 17 cases (40%) good, 6 cases (15%) poor, and the rate of total satisfactory was 85%. Post-operative active ROM, anterior flexion was (100 +/- 32) degrees , external rotation (16 +/- 11) degrees , external rotation and posterior extension to the level of L2. CONCLUSIONS: The reasons for the poor results include improper restoration of humeral length, over retroversion of prosthesis, poor fixation of tuberosity, malunion, absorption of greater tuberosity and heterotopic ossification.