Lumbar decompressive surgery is the gold standard treatment for lumbar spinal stenosis. Minimally invasive surgical techniques have been introduced with the aim of reducing the morbidity associated with open surgery. The purpose of the present study was to systematically search the literature and perform a meta-analysis of studies comparing the outcomes between biportal endoscopic technique and microscopic technique for lumbar canal stenosis decompression. A comprehensive search of the PubMed, Google Scholar, Web of Science, Embase and the Cochrane Library databases was performed to identify relevant articles up to 15th of December 2019. Eligible studies were retrieved, data were extracted by two authors independently and risks of bias were assessed. A total of six studies involving 438 patients were selected for review. The results of the pooled analysis indicated similar operative times [mean difference (MD),-3.41; 95% CI,-10.78-3.96; P<0.36], similar complications (MD, 0.70; 95% CI, 0.33-1.46; P=0.34), similar visual analogue scale scores for back and leg pain at the time of the final follow-up and similar Oswestry disability indexes (MD,-0.28; 95% CI,-1.25-0.69; P=0.58) for the two procedures. In conclusion, biportal endoscopic technique is a viable alternative to microscopic technique for lumbar canal stenosis decompression with similar operative time, clinical outcomes and complications.

Background Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision. Methods The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current recommended treatment (steroid injection) in people diagnosed with a refractory tennis elbow. Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints from 12 to 48 weeks. Results During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in visual analogue scale score (VAS) of pain, tenderness during palpation, pain-free grip strength (PFGS) and Nirschl staging than the corticosteroid group. Conclusions For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis. Trial registration: The National Health Commission announced the "ethical review measures for biomedical research involving people" in 2019, which was not mandatory in previous studies.

The aim of the present study was to evaluate the relative functional volume of bilateral lumbar multifidus (LM) muscles across different stages and ages of patients with lumbar disc herniation (LDH). The relative functional volumes of LM muscles in both non-affected and affected sides in the L4-L5 and L5-S1 segmental level were measured in a resting prone position, and visual analogue score (VAS) for pain and Japanese Orthopedic Association (JOA) scores were recorded. The correlation between changes in the relative net volume of LM muscles and times of onset, ages, VAS and JOA scores were analyzed. A total of 327 cases were selected. The affected sides of LM muscles could present a certain degree of atrophy in stages >3 weeks. During the duration of the course, all cases presented different degrees of LM muscle atrophy. In addition, the degree of LM muscle atrophy was positively correlated with its duration. Age could influence the degree of LM muscle atrophy. Patients with unilateral LDH had <10% asymmetry on relative functional volume in the youth group. At the L4-L5 segments, patients with unilateral LDH had >10% asymmetry within the course of 3 months in the elderly group. The reduced rate of the relative functional net LM muscle volume was positively correlated with VAS scores, age, duration and JOA scores. In conclusion, the reduced rate of relative functional net LM muscle volume was positively correlated with age, duration, VAS scores and JOA scores. Although these findings are unreliable markers of lumbar pathology in an individual level for use in clinical or research settings, there is a notable importance of early intervention in LM muscle atrophy.

Background Osteoporosis (OP) is a systemic bone disease characterized by decreased bone mass, destruction of the bone tissue microstructure, increased bone brittleness and an increased risk of fracture. OP has a high incidence rate and long disease course and is associated with serious complications. Yigu decoction (YGD) is a compound prescription in traditional Chinese medicine that is used to treat OP. However, its mechanism in OP is not clear. This study used a tandem mass tag (TMT)quantitative proteomics method to explore the potential bone-protective mechanism of YGD in an osteoporotic rat model. Materials and methods A rat model of OP was established by ovariectomy. Eighteen 12-week-old specific-pathogen-free female Wistar rats weighing 220 ± 10 g were selected. The eighteen rats were randomly divided into 3 groups (n = 6 in each group): the normal, model and YGD groups. The right femurs from each group were subjected to quantitative biological analysis. TMT quantitative proteomics was used to analyze the proteins extracted from the bone tissue of rats in the model and YGD groups, and the differentially expressed proteins after intervention with YGD were identified as biologically relevant proteins of interest. Functional annotation correlation analysis was also performed to explore the biological function and mechanism of YGD. Result Compared with the model group, the YGD group showed significant upregulation of 26 proteins (FC > 1.2, P < 0.05) and significant downregulation of 39 proteins (FC < 0.833, P < 0.05). Four important targets involved in OP and 5 important signaling pathways involved in bone metabolism were identified. Conclusions YGD can significantly increase the bone mineral density (BMD) of osteoporotic rats and may play a therapeutic role by regulating target proteins involved in multiple signaling pathways. Therefore, these results improve the understanding of the OP mechanism and provide an experimental basis for the clinical application of YGD in OP treatment.

Background: This study aims to evaluate the association between serum alkaline phosphatase (ALP), calcium (Ca) and phosphorus (P), C-reactive protein (CRP) and D-dimer (D-D), and hemoglobin (Hb) in postoperative and preoperative osteoporotic hip fracture elderly patients.Methods: A total of 32 operation patients with osteoporotic hip fracture over the age of 65 years old were admitted to the orthopedic unit and prospectively evaluated. All patients were treated according to specific protocols, according to the type of fracture. Fasting blood samples were taken, and serum ALP, Ca and P measurements were respectively performed in six periods: at the time of admission, post-operation, and at postoperative one week, two weeks, one month and three months. Hb, CRP and D-D were also analyzed, and the fracture healing was recorded.Results: Finally, 32 cases were selected for the present study. The analysis results revealed that the level of serum Ca and ALP slowly increased at two weeks after surgery, and slightly dropped back at three months after the operation. Furthermore, D-D and CRP had a significant effect at pre-and post-operation, and exhibited an obvious downward trend after postoperative one week. The fracture healing and recovery of activities were associated with the Hb levels. The serum levels of ALP, which were adjusted by Ca and P, were associated with Hb and CRP, but not with D-D.Conclusions: Interestingly, there was an association between CRP and D-D. These findings suggest that early control of inflammation and loss of Ca could play a positive role for the healing of osteoporotic hip fractures.