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腰椎论坛»腰椎论坛 突友大家谈 翻译了一篇国外的关于手术治疗必要性的文章   『 交流腰椎间盘突出治疗方法,分享腰突症康复经验 』
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标题: 翻译了一篇国外的关于手术治疗必要性的文章

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2008-11-3
 楼主|发表于 2008-11-21 13:25 | 个人空间 | 显示全部楼层 | 收藏本帖
Studies question need for herniated-disk surgery
Posted 11/21/2006 10:30 PM ET
[地址=http://www.usatoday.com/news/health/2006-11-21-back-surgery_x.htm]E-mail | [地址=http://www.usatoday.com/news/health/2006-11-21-back-surgery_x.htm]Save | [地址=http://www.usatoday.com/news/health/2006-11-21-back-surgery_x.htm]Print | [地址=http://asp.usatoday.com/marketing/rss/rsstrans.aspx?ssts=news%7Chealth]
CHICAGO (AP) — Two big government-funded studies on back surgery for painful herniated disks show no clear-cut reason to choose an operation over other treatment. The pain and physical function of the patients, who were suffering from a condition called sciatica, improved significantly after two years whether or not they had surgery. However, neither strategy offered complete relief.
The results indicate patients should choose which treatment they get for the ailment, the researchers said.
"In back surgery for this particular condition, there's actually a choice," said lead author Dr. James Weinstein of Dartmouth Medical School. "If you don't want the risk of surgery, you can do watchful waiting" and still get well.
The condition involves disk cartilage bulging between vertebrae in the lower spine and pressing against a nerve. It can cause excruciating burning pain called sciatica, radiating from the lower back into the legs; patients often have difficulty walking.
About 250,000 Americans have disk surgery for sciatica each year, while another quarter-million instead choose physical therapy, painkillers or rest until they feel better. The surgery costs about $6,000, Weinstein said.
The findings, published in Wednesday's Journal of the American Medical Association, are the first from a big government-funded research project on spine surgery. Patients were treated at 13 spine centers in 11 states.
One study involved 472 patients aged 42 on average who were followed for two years after being randomly assigned to surgery or non-invasive treatment, which included education, physical therapy or painkillers. Surgery involved removing part of the bulging disc in a standard operation often done on an outpatient basis.
Patients in both groups had much improved scores on measures of pain, physical function and disability during periodic evaluations; differences between the groups weren't statistically significant.
Ninety-five percent of surgery patients had no complications, but 4% required a second surgery within a year.
In the other study, the researchers followed for two years 743 patients who chose surgery or other treatment. It found a clearer advantage to surgery, including quicker relief in the first months. After three months, 82% of surgery patients reported major improvement, compared with 48% of non-surgery patients. Those differences shrank over two years, however, and the researchers said the self-reported results should be interpreted cautiously.
In the randomized study, many patients didn't stay in their assigned group: Almost half those assigned to non-invasive treatment ultimately had surgery, and more than one-third of those assigned to surgery ended up choosing less invasive treatment instead.
That patient crossover makes drawing conclusions tricky and may account for surgery showing no superiority over other treatments, Weinstein said.
No one in either study developed a rare but feared disabling condition called cauda equina syndrome, which should ease the minds of patients and surgeons, said Dr. Eugene Carragee of Stanford University Medical Center.
"Sometimes people with mild sciatica have elected to go ahead with the surgery in order to avoid a theoretical neurologic catastrophe," but now patients can avoid surgery with a realistic expectation that they'll feel better in a year or two, said Carragee, who was not involved in the research.
The study shows how tough it is to find scientific evidence that back surgery works better than other treatments.
For one thing, patients willing to be randomly assigned to surgery are probably different than most patients; their pain could be less, for example, making them more inclined to roll the dice and be assigned to treatment other than surgery.
Another problem: Most surgery studies have no placebo group to rule out the benefits that come with patients' faith in surgery.
Using sham surgery as a placebo, in which patients have incisions but no real treatment, raises ethical questions, but has been done in some research — and some patients say they feel better.
"It's critical that we evaluate the real role of surgery in people's lives," said Dr. David Flum of the University of Washington. "Studies like this that don't have a placebo arm make it very difficult to figure out how much of the effect is the operation versus the patients' and the surgeons' hopes for the operation."
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哎,刚刚大二,就请假回家一个月了,本来可以勉强坚持去学校,昨天去牵引试试,晚上就疼的不行,看来我是不适合牵引了,无论如何这个周末也要赶到学校去,昨天看到一篇文章,就翻译了下,也不知道有什么地方出错了没。大家将就着看看吧,还有一个完整介绍腰突的pdf,内容很多,看看有没有时间可以翻译下,希望有突友一起努力哈,毕竟一个月没去学校了,课程可能有些紧,也不是外语专业,我看的时候也挺累的,呵呵。
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芝加哥-两个政府资助的研究机构在椎间盘突出的后背手术上,无法清楚的显示病人挑选手术的原因。无论是否采取了手术,2年后忍受坐骨神经痛的病人,他们的疼痛和物理功能都有明显改善。
研究人员说,这个结果显示了病人应该根据自己的症状挑选治疗方法。
james医生说,对于这个特殊的情况的后背手术,事实上还有一个选择,你可以谨慎的等待直到好转为止。
这种状况包括了椎间盘膨出在脊椎上和压迫神经。它可能导致小腿下部疼痛,而且疼痛经常导致无法轻松的行走。
WEINSTEIN医生说,每年,大概 250,000 美国人由于坐骨神经痛采用了椎间盘的手术,其他25万的人选择了理疗,手术大概花费6000美元左右。
这个研究报告被发表在美国医药协会的星期三的日报上,是第一次在11个州的13个脊椎中心
472个平均年龄在42岁的病人被跟踪调查了两年,这些人是被随机指定手术,理疗和止痛药的,或者休息直到他们感觉好一些。手术包含用标准的开放性手术移除突出的椎间盘
两组病人都在疼痛上有所改善,在周期的统计上物理功能和无力都有一定的情况出现。
手术的人中百分之95的人没有并发症,%4的人在一年内需要二次手术。
在另一个研究中,调查者跟踪743个人在两年内,这些人选择了手术或者其他治疗方法。3个月后和没有手术的%48的人患者对比%82的手术患者报告了主要的症状改善,然而研究者说自我的报告还要应该被慎重的解释分析。
在随机的研究中,许多患者没有停留在他们被分配的小组中:很多人被分配到没有侵略性的治疗方法,那些被分配到手术的挑选了微小侵略性的治疗方法替代
病人的结论是值得人警惕的,说明了手术对比其他治疗方法是没有优势的。
在任何一个研究中没有一个人马尾神经失去功能,这个使患者和外科医生放松,斯坦福大学医学中心的Carregee说
有时候人们有一点点的坐骨神经痛,就直接选择去手术来避免神经损伤希望他们可以在一两年内感到好一些,Carragee说,他没有参与上面的研究。
这个研究显示发现手术比其他的治疗方法优秀的证据是多么困难。
对于另一件事上,愿意被随即分配到手术的患者是和大部分患者不同的,他们的疼痛可能轻微,使他们倾向于被分配除了手术的其他治疗方法
另一个问题是:大部分的手术研究对于想要采用手术的患者没有一个安慰剂。
用假的手术作为安慰剂,意思是在背部切成开口,并没有真正的采用治疗,但是这种方法又出现了伦理上的问题,可是确实可能使他们感到好一些。
我们在评价手术在人们生活中的角色是危险地,华盛顿大学的David医生说。(翻译的有点勉强。)
像这样的研究没有一个使人安慰的结论,使统计出多少可以达到手术和医生的希望的效果很困难。
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步步高 积分 + 1 感谢辛勤工作、无私奉献。 2008-11-21 14:04
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 楼主| 发表于 2008-11-21 13:27 | 个人空间 | 显示全部楼层

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 楼主| 发表于 2008-11-21 15:17 | 个人空间 | 显示全部楼层
我这里还有一份国外最新疗法,但是内容有10页左右,一个人可能翻不过来,有没有人一起和我尝试着翻一下?图文并茂的,还没看,乍一看很不错。


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热心突友

发表于 2008-11-21 15:55 | 个人空间 | 显示全部楼层
欢迎欢迎!你发一个倡议一起翻译的帖子,再把文章作为附件上传,我把帖子加亮。


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发表于 2009-7-2 15:47 | 个人空间 | 显示全部楼层
好长啊,看完也觉得手术不是第一选择


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发表于 2009-7-2 16:31 | 个人空间 | 显示全部楼层
感谢LZ,喜欢这种技术性的探讨。


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发表于 2009-7-2 23:53 | 个人空间 | 显示全部楼层

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康复突友

发表于 2010-8-26 10:47 | 个人空间 | 显示全部楼层
我跟你一起翻译!


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发表于 2010-8-26 11:05 | 个人空间 | 显示全部楼层

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发表于 2011-3-22 17:06 | 个人空间 | 显示全部楼层
用假的手术作为安慰剂,意思是在背部切成开口,并没有真正的采用治疗------有点意思,呵呵


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