Clinical practice guidelines for diagnosis and treatment of lumbar disc herniation in the elderly

doi:10.3877/cma.j.issn.2096-0263.2021.03.002

Abstract

Abstract:

Lumbar disc herniation is a common orthopaedic disease. With the coming of aging society, the incidence of lumbar disc herniation in the elderly increases gradually. As a special type of lumbar disc herniation, it is necessary to standardize the diagnosis and treatment procedures of lumbar disc herniation in the elderly. Based on the principle of evidence-based medicine, the guidelines were developed according to clinical guidelines of diagnosis and treatment of lumbar disc herniation with radiculopathy developed by North America Spine Society in 2013 and clinical practice guidelines for diagnosis and treatment of lumbar disc herniation by Chinese Orthopaedic Association of Spinal Surgery Group and Chinese Orthopaedic Association of Orthopaedic Rehabilitation Group in 2020. After expert working group development and clinical problem determination, Grading of Recommendations Assessment Development and Evaluation System was used to rate the quality of evidence and determined the strength of recommendations. After three rounds of discussions in expert work group, clinical guidelines for diagnosis and treatment of lumbar disc herniation in the elderly were finally developed. The guidelines defined the screening for definition, pathological characteristics, diagnosis, conservative treatment, surgical treatment, surgical complications, application of enhanced recovery after surgery in lumbar disc herniation in the elderly. The guidelines will provide a reliable clinical basis for the diagnosis and treatment in lumbar disc herniation in the elderly.

Key words: Lumbar disc herniation, Aged, Diagnosis, Enhanced recovery after surgery

Chinese Orthopaedic Association of Orthopaedic Rehabilitation Group, The Chinese Society for the Study of the Lumbar Spine CSSLS, Yan Wang, Hongfei Xiang, Yong Hai, Bohua Chen. Clinical practice guidelines for diagnosis and treatment of lumbar disc herniation in the elderly[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(03): 132-139.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlngkykfdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-0263.2021.03.002

https://zhlngkykfdzzz.cma-cmc.com.cn/EN/Y2021/V07/I03/132

References 105

54	Silvers HR, Lewis PJ, Asch HL, et al. Lumbar microdiscectomy in the elderly patient [J]. Br J Neurosurg, 1997, 11(1): 16-24.
55	Strömqvist F, Strömqvist B, Jönsson B, et al. Gender differences in the surgical treatment of lumbar disc herniation in elderly [J]. Eur Spine J, 2016, 25(11): 3528-3535.
56	Kherad M, Rosengren BE, Hasserius R, et al. Risk factors for low back pain and sciatica in elderly men-the MrOS Sweden study [J]. Age Ageing, 2017, 46(1): 64-71.
57	任晓冉，陈鸿芳，陈玉，等. 老年腰椎间盘突出症患者自我效能水平及其影响因素[J]. 中华老年多器官疾病杂志，2020，19(9)：661-665.
58	Ferreira ML, Mclachlan A. The challenges of treating sciatica pain in older adults [J]. Drugs Aging, 2016, 33(11): 779-785.
59	Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance [J]. JAMA, 2005, 294(6): 716-724.
60	American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons [J]. J Am Geriatr Soc, 2009, 57(8): 1331-1346.
61	Fine PG. Treatment guidelines for the pharmacological management of pain in older persons [J]. Pain Med, 2012, 13 Suppl 2(期缺失): S57-S66. URL
62	纪泉，易端，王建业，等. 老年患者慢性肌肉骨骼疼痛管理中国专家共识(2019) [J]. 中华老年医学杂志，2019，38(5)：500-507.
63	Enthoven WT, Roelofs PD, Deyo RA, et al. Non-steroidal anti-inflammatory drugs for chronic low back pain [J]. Cochrane Database Syst Rev, 2016, 2(2): CD012087.
64	Rasmussen-Barr E, Held U, Grooten W, et al. Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review [J]. Spine (Phila Pa 1976), 2017, 42(8): 586-594.
65	Gnjidic D, Blyth FM, Le Couteur DG, et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) in older People: prescribing patterns according to pain prevalence and adherence to clinical guidelines [J]. Pain, 2014, 155(9): 1814-1820. URL
66	Chou R, Gj F, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain [J]. J Pain, 2009, 10(2): 113-130. URL
67	Qaseem A, Wilt TJ, Mclean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American college of physicians [J]. Ann Intern Med, 2017, 166(7): 514-U142.
68	Nielsen SM, Tarp S, Christensen R, et al. The risk associated with spinal manipulation: an overview of reviews [J]. Syst Rev, 2017, 6(1): 64.
69	Rubinstein SM, De ZA, Van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials [J]. BMJ, 2019, 364: l689.
70	中华医学会骨质疏松和骨矿盐疾病分会. 男性骨质疏松症诊疗指南[J]. 中华骨质疏松和骨矿盐疾病杂志，2020，13(5)：381-395.
71	Larequi-Lauber T, Vader JP, Burnand B, et al. Appropriateness of indications for surgery of lumbar disc hernia and spinal stenosis [J]. Spine (Phila Pa 1976), 1997, 22(2): 203-209.
72	赵继荣，徐磊，张天太，等. 老年多节段腰椎间盘突出症的有限手术治疗探讨[J]. 颈腰痛杂志，2006，27(3)：195-196.
73	张高峰，张艳锋，王功臣，等. TESSYS技术与显微内镜下腰椎间盘切除术治疗老年腰椎间盘突出症患者的疗效比较[J]. 颈腰痛杂志，2020，41(2)：208-209+212.
74	时愔，王开化，田全良，等. 经皮椎间孔镜下行TESSYS技术治疗老年腰椎间盘突出的临床疗效[J]. 中国老年学杂志，2016，36(7)：1674-1675.
75	张愈峰，侍德. 显微镜下椎间盘切除术与显微内镜下椎间盘切除术治疗老年单节段腰椎间盘突出的疗效对比[J]. 中国老年学杂志，2016，36(3)：661-663.
76	Wang JC, Dailey AT, Mummaneni PV, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy [J]. J Neurosurg Spine, 2014, 21(1): 48-53. URL
77	Hareni N, Strömqvist F, Strömqvist B, et al. Predictors of satisfaction after lumbar disc herniation surgery in elderly [J]. BMC Musculoskelet Disord, 2019, 20(1): 594.
78	Chen CM, Sun LW, Tseng C, et al. Surgical outcomes of full endoscopic spinal surgery for lumbar disc herniation over a 10-year period: A retrospective study [J]. PLoS One, 2020, 15(11): e0241494.
79	Wang H, Zhang D, Ma L, et al. Factors predicting patient dissatisfaction 2 years after discectomy for lumbar disc herniation in a Chinese older cohort: a prospective study of 843 cases at a single institution [J]. Medicine (Baltimore), 2015, 94(40): e1584.
80	Martens F, Vajkoczy P, Jadik S, et al. Patients at the highest risk for reherniation following lumbar discectomy in a multicenter randomized controlled trial [J]. JB JS Open Access, 2018, 3(2): e0037.
81	Abdu RW, Abdu WA, Pearson AM, et al. Reoperation for recurrent intervertebral disc herniation in the spine patient outcomes research trial: analysis of rate, risk factors, and outcome [J]. Spine (Phila Pa 1976), 2017, 42(14): 1106-1114.
82	Leven D, Passias PG, Errico TJ, et al. Risk factors for reoperation in patients treated surgically for intervertebral disc herniation: a subanalysis of Eight-Year SPORT data [J]. J Bone Joint Surg Am, 2015, 97(16): 1316-1325.
83	Li Z, Yang H, Liu MZ, et al. Clinical characteristics and risk factors of recurrent lumbar disk herniation: a retrospective analysis of three hundred Twenty-One cases [J]. Spine (Phila Pa 1976), 2018, 43(21): 1463-1469.
84	Yurac R, Zamorano JJ, Lira F, et al. Risk factors for the need of surgical treatment of a first recurrent lumbar disc herniation [J]. Eur Spine J, 2016, 25(5): 1403-1408.
85	Yao Y, Liu H, Zhang H, et al. Risk factors for recurrent herniation after percutaneous endoscopic lumbar discectomy [J]. World Neurosurg, 2017, 100: 1-6.
86	Yin S, Du H, Yang W, et al. Prevalence of recurrent herniation following percutaneous endoscopic lumbar discectomy: a Meta-Analysis [J]. Pain Physician, 2018, 21(4): 337-350.
87	Yao Y, Liu H, Zhang H, et al. Risk factors for the recurrent herniation after microendoscopic discectomy [J]. World Neurosurg, 2016, 95: 451-455.
88	Kim CH, Chung CK, Choi Y, et al. The selection of open or percutaneous endoscopic lumbar discectomy according to an age cut-off point:nationwide cohort study [J]. Spine (Phila Pa 1976), 2015, 40(19): E1063-E1070.
89	Strömqvist F, Sigmundsson FG, Strömqvist B, et al. Incidental durotomy in degenerative lumbar spine surgery - a register study of 64,431 operations [J]. Spine J, 2019, 19(4): 624-630.
90	Hashimoto K, Aizawa T, Kanno H, et al. Adjacent segment degeneration after fusion spinal surgerya systematic review [J]. Int Orthop, 2019, 43(4, SI): 987-993.
91	Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: Review of the literature [J]. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
92	Wang T, Ding W. Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis [J]. J Orthop Surg Res, 2020, 15(1): 582.
93	Nie H, Jiang D, Ou Y, et al. Efficacy and safety of surgery for lumbar disc herniation in patients aged 80 and older [J]. Turk Neurosurg, 2011, 21(2): 172-176. URL
94	Aldecoa C, Bettelli G, Bilotta F, et al. European society of anaesthesiology evidence-based and consensus-based guideline on postoperative delirium [J]. Eur J Anaesthesiol, 2017, 34(4): 192-214.
95	Imagama S, Kawakami N, Tsuji T, et al. Perioperative complications and adverse events after lumbar spinal surgery: evaluation of 1012 operations at a single center [J]. J Orthop Sci, 2011, 16(5): 510-515.
96	Fineberg SJ, Nandyala SV, Marquez-Lara A, et al. Incidence and risk factors for postoperative delirium after lumbar spine surgery [J]. Spine (Phila Pa 1976), 2013, 38(20): 1790-1796.
97	Susano MJ, Scheetz SD, Grasfield RH, et al. Retrospective analysis of perioperative variables associated with postoperative delirium and other adverse outcomes in older patients after spine surgery [J]. J Neurosurg Anesthesiol, 2019, 31(4): 385-391.
98	Zhu C, Wang B, Yin J, et al. Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis [J]. Aging Clin Exp Res, 2020, 32(8): 1417-1434.
99	Brown C4, Laflam A, Max L, et al. Delirium after spine surgery in older adults: incidence, risk factors, and outcomes [J]. J Am Geriatr Soc, 2016, 64(10): 2101-2108.
100	胡文君. 快速康复外科理念对老年腰椎间盘突出症患者康复的影响[J]. 中国老年保健医学，2018，16(3)：150-152.
101	廖海英，宁宁，李佩芳，等. 基于加速康复外科的综合护理模式对腰椎间盘突出症老年患者术后谵妄发生的效果研究[J]. 华西医学，2017，32(9)：1355-1357.
102	黄道礼，朱冠楠，欧光信，等. 加速康复外科理念改善老年腰椎间盘突出患者术后认知功能的效果[J]. 中国当代医药，2019，26(5)：177-180.
1	Beard JR, Officer A, De Carvalho IA, et al. The world report on ageing and health: a policy framework for healthy ageing [J]. Lancet, 2016, 387(133): 2145-2154.
2	《中国老年骨质疏松症诊疗指南》(2018)工作组，中国老年学和老年医学学会骨质疏松分会，马远征，等. 中国老年骨质疏松症诊疗指南(2018)[J]. 中国骨质疏松杂志，2018，24(12)：1541-1567. DOI：10.3969/j.issn.1006-7108.2018.12.001.
3	中华医学会骨科学分会脊柱外科学组. 中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南[J]. 中华骨科杂志cn121113-2020，2020，40(08)：0402-00213.
4	Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy [J]. Spine J, 2014, 14(1): 180-191.
5	Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations [J]. AJNR Am J Neuroradiol, 2015, 36(4): 811-816.
6	Hangai M, Kaneoka K, Kuno S, et al. Factors associated with lumbar intervertebral disc degeneration in the elderly [J]. Spine J, 2008, 8(5): 732-740.
7	Ho-Pham LT, Lai TQ, Mai LD, et al. Prevalence and pattern of radiographic intervertebral disc degeneration in Vietnamese: a population-based study [J]. Calcif Tissue Int, 2015, 96(6): 510-517.
8	Teraguchi M, Yoshimura N, Hashizume H, et al. Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study [J]. Osteoarthritis Cartilage, 2014, 22(1): 104-110.
9	Lou C, Chen HL, Feng XZ, et al. Menopause is associated with lumbar disc degeneration: a review of 4230 intervertebral discs [J]. Climacteric, 2014, 17(6): 700-704. URL
10	Wang YX, Griffith JF, Ma HT, et al. Relationship between gender, bone mineral density, and disc degeneration in the lumbar spine: a study in elderly subjects using an eight-level MRI-based disc degeneration grading system [J]. Osteoporos Int, 2011, 22(1): 91-96.
11	Wang YX, Griffith JF. Effect of menopause on lumbar disk degeneration: potential etiology [J]. Radiology, 2010, 257(2): 318-320.
12	Wang YX, Griffith JF, Zeng XJ, et al. Prevalence and sex difference of lumbar disc space narrowing in elderly Chinese men and women: osteoporotic fractures in men (Hong Kong) and osteoporotic fractures in women (Hong Kong) studies [J]. Arthritis Rheum, 2013, 65(4): 1004-1010.
13	Wang YX. Postmenopausal Chinese women show accelerated lumbar disc degeneration compared with Chinese men [J]. J Orthop Translat, 2015, 3(4): 205-211.
14	Decandido P, Reinig JW, Dwyer AJ, et al. Magnetic resonance assessment of the distribution of lumbar spine disc degenerative changes [J]. J Spinal Disord, 1988, 1(1): 9-15.
15	Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation [J]. J Bone Joint Surg Am, 1990, 72(3): 403-408.
16	Spangfort EV. The lumbar disc herniation. A computer-aided analysis of 2,504 operations [J]. Acta Orthop Scand Suppl, 1972, 142: 1-95.
17	彭耀庆，张朝跃，詹瑞森，等. 老年性腰椎间盘突出症的临床分型与脊柱内窥镜手术疗效[J]. 湖南医科大学学报，2001，26(4)：345-346.
103	王润生，黄承军，苏晓静，等. 加速康复外科理念在老年单节段退行性腰椎疾病中应用研究[J]. 中国骨与关节杂志，2019，8(6)：454-458.
104	Wang P, Wang Q, Kong C, et al. Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion [J]. J Orthop Surg Res, 2020, 15(1): 299.
105	刘烨，解雅英. 老年骨科患者术后镇痛研究现状及新进展[J]. 中华老年骨科与康复电子杂志，2019，5(1)：58-61.
18	王国基，蒋清，张轶群，等. 老年人腰椎间盘突出症的特点及手术方法选择(附125例分析) [J]. 中国脊柱脊髓杂志，1999，1(1)：28-30.
19	王荣振，周秉文. 老年人腰椎间盘突出症7例报告[J]. 中国脊柱脊髓杂志，1992，2(3)：123-124.
20	Harada Y, Nakahara S. A pathologic study of lumbar disc herniation in the elderly [J]. Spine (Phila Pa 1976), 1989, 14(9): 1020-1024.
21	Matveeva N, Zivadinovik J, Zdravkovska M, et al. Histological composition of lumbar disc herniations related to the type of herniation and to the age [J]. Bratisl Lek Listy, 2012, 113(12): 712-717.
22	Tanaka M, Nakahara S, Inoue H. A pathologic study of discs in the elderly. Separation between the cartilaginous endplate and the vertebral body [J]. Spine (Phila Pa 1976), 1993, 18(11): 1456-1462.
23	Yasuma T, Makino E, Saito S, et al. Histological development of intervertebral disc herniation [J]. J Bone Joint Surg Am, 1986, 68(7): 1066-1072.
24	Autio RA, Karppinen J, Niinimäki J, et al. Determinants of spontaneous resorption of intervertebral disc herniations [J]. Spine (Phila Pa 1976), 2006, 31(11): 1247-1252.
25	Dammers R, Koehler PJ. Lumbar disc herniation: level increases with age [J]. Surg Neurol, 2002, 58(3/4): 209-212; discussion 212-3.
26	Strömqvist F, Strömqvist B, Jönsson B, et al. The outcome of lumbar disc herniation surgery is worse in old adults than in young adults [J]. Acta Orthop, 2016, 87(5): 516-521.
27	Aizawa T, Ozawa H, Kusakabe T, et al. Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population [J]. J Orthop Sci, 2012, 17(2): 107-113.
28	Mcgirt MJ, Parker SL, Hilibrand A, et al. Lumbar surgery in the elderly provides significant health benefit in the US health care system: Patient-Reported outcomes in 4370 patients from the N2QOD registry [J]. Neurosurgery, 2015, 77 Suppl 4: S125-S135.
29	Strömqvist F, Strömqvist B, Jönsson B, et al. Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients [J]. Spine J, 2017, 17(11): 1577-1585.
30	Ma D, Liang Y, Wang D, et al. Trend of the incidence of lumbar disc herniation: decreasing with aging in the elderly [J]. Clin Interv Aging, 2013, 8: 1047-1050. URL
31	Sanderson SP, Houten J, Errico T, et al. The unique characteristics of "upper" lumbar disc herniations [J]. Neurosurgery, 2004, 55(2): 385-389; discussion 389.
32	Lee DS, Park KS, Park MS. The comparative analysis of clinical characteristics and surgical results between the upper and lower lumbar disc herniations [J]. J Korean Neurosurg Soc, 2013, 54(5): 379-383.
33	Lurie JD, Faucett SC, Hanscom B, et al. Lumbar discectomy outcomes vary by herniation level in the Spine Patient Outcomes Research Trial [J]. J Bone Joint Surg Am, 2008, 90(9): 1811-1819.
34	Iwasaki M, Akino M, Hida K, et al. Clinical and radiographic characteristics of upper lumbar disc herniation: ten-year microsurgical experience [J]. Neurol Med Chir (Tokyo), 2011, 51(6): 423-426.
35	Karaaslan B, Aslan A, Börcek AÖ, et al. Clinical and surgical outcomes of upper lumbar disc herniations: a retrospective study [J]. Turk J Med Sci, 2017, 47(4): 1157-1160.
36	Werndle MC, Reza A, Wong K, et al. Acute disc herniation in the elderly [J]. Br J Neurosurg, 2012, 26(2): 255-257.
37	Tamir E, Anekshtein Y, Melamed E, et al. Clinical presentation and anatomic position of L3-L4 disc herniation: a prospective and comparative study [J]. J Spinal Disord Tech, 2004, 17(6): 467-469.
38	An HS, Vaccaro A, Fa, et al. Herniated lumbar disc in patients over the age of fifty [J]. J Spinal Disord, 1990, 3(2): 143-146.
39	Donaldson W3. Star MJ,thorne RP.surgical treatment for the far lateral herniated lumbar disc [J]. Spine (Phila Pa 1976), 1993, 18(10): 1263-1267.
40	Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results [J]. J Neurosurg, 1995, 83(4): 648-656.
41	Porchet F, Fankhauser H, De Tribolet N. Extreme lateral lumbar disc herniation: clinical presentation in 178 patients [J]. Acta Neurochir (Wien), 1994, 127(3/4): 203-209.
42	李放，张志成，赵广民，等. 极外侧腰椎间盘突出症的临床分型及手术方式选择[J]. 中华外科杂志，2009，47(20)：1553-1556.
43	马学晓，岳斌，相宏飞，等. 老年腰椎间盘突出症的手术疗效观察[J]. 中华老年多器官疾病杂志，2012，11(10)：724-730.
44	范伟杰，汤继文，徐雪梅，等. 老年腰椎间盘突出症与青中年椎间盘突出症的比较分析[J]. 颈腰痛杂志，2002，23(4)：294-295.
45	Gj B, Ardeshiri A, Miller LE, et al. Clinical performance of a bone-anchored annular closure device in older adults [J]. Clin Interv Aging, 2019, 14: 1085-1094.
46	Murphy ME, Gilder H, Maloney PR, et al. Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge [J]. J Neurosurg Spine, 2017, 26(3): 353-362.
47	Prabhu AV, Lieber B, Henry JK, et al. Early postoperative complications for elderly patients undergoing Single-Level decompression for lumbar disc herniation, ligamentous hypertrophy, or neuroforaminal stenosis [J]. Neurosurgery, 2017, 81(6): 1005-1010.
48	Rothoerl RD, Woertgen C, Holzschuh M, et al. Are there differences in the symptoms, signs and outcome after lumbar disc surgery in the elderly compared with younger patients? [J]. Br J Neurosurg, 1998, 12(3): 250-253.
49	梁智林，臧传义，杨波，等. 老年腰椎间盘突出症患者手术疗效的影响因素及对策[J]. 中华老年骨科与康复电子杂志，2019，5(3)：130-134.
50	Jönsson B, Strömqvist B. Influence of age on symptoms and signs in lumbar disc herniation [J]. Eur Spine J, 1995, 4(4): 202-205.
51	Gembun Y, Nakayama Y, Shirai Y, et al. Surgical results of lumbar disc herniation in the elderly [J]. J Nippon Med Sch, 2001, 68(1): 50-53.
52	Fujii K, Henmi T, Kanematsu Y, et al. Surgical treatment of lumbar disc herniation in elderly patients [J]. J Bone Joint Surg Br, 2003, 85(8): 1146-1150.
53	Deyo RA, Cherkin DC, Loeser JD, et al. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure [J]. J Bone Joint Surg Am, 1992, 74(4): 536-543.

[1]	Shuihua Yang, Guidan He, Guican Qin, Mengfeng Liang, Yanhe Luo, Xueqin Li, Juansong Tang. Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1061-1067.
[2]	Heng Lyu, Licong Dong, Haiqin Xie, Zhuofei Zhao, Li Liu, Desheng Sun. CT-ultrasound comparison for evaluating missed diagnosis of focal liver lesions by ultrasound: a single-center cross-sectional quality control survey [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 712-716.
[3]	Honghua Dong, Genchun Guo, Lei Jiang, Xuefei Wu, Feixiang Ma, Haifeng Li. Application of integrated orthopedic rehabilitation pathway in rapid rehabilitation of ankle fracture [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 802-807.
[4]	Peijie Li, Yongjie Qiao, Haoqiang Zhang, Jiankang Zeng, Fei Tan, Jiahuan Li, Jing Wang, Shenghu Zhou. Progress in diagnosis and treatment of periprosthetic infection with negative bacterial culture [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 827-833.
[5]	Xu Peng, Yongfu Shao, Duo Li, Rui Zhou, Zhenming Xing. Diagnosis and surgical treatment of hepatocolon flexure [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 108-110.
[6]	Fengyi Li, Ruofan Li, Xu Gao, Chaofan Zhang. Effect of target-directed liquid intervention on postoperative hemodynamics and gastrointestinal function recovery in elderly patients with gastrointestinal tumors [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 29-32.
[7]	Qingyan Yan, Xiaomei Yong, Hong Luo, Min Du. Prognostic factors and survival analysis of multicenter elderly patients with metastatic breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 636-638.
[8]	Zhiming Li, Chenming Guo, Xiaochen Zhuang, Xueqin Hou, Junxi Gao. Comparative study of qualitative and quantitative indicators of contrast-enhanced ultrasound in early breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 639-643.
[9]	Xue Yang, Wei Zhang, Peizhong Shang, Chuangye Song, Dandan Shang, Wei Zhang. Cholecystoduodenal fistula with stone draining through it and spontaneously healing：a case report [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 707-708.
[10]	Dingwei Xu, Jiangyun Ma, Xincheng Li, Jie Huang. Alagille syndrome misdiagnosed as congenital biliary atresia: a case report and literature review [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 681-687.
[11]	Bing Lan, Huaiming Wang, Hui Wang, Bo Ma. Research progress on locally advanced colon cancer with bladder invasion [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 505-511.
[12]	Qiujie Shan, Lizhu Sun, Yiquan Xu, Zhixia Wang, Yan Xu, Hao Ma, Tiantian Liu. Construction and application of radiation-induced lung injury risk model for middle-aged and elderly patients with esophageal cancer during intensity modulated radiotherapy [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 388-393.
[13]	Xinxin Sun, Jun Liu, Chaowu Chen, Chao Sun. Application of endoscopic ultrasonography-guided fine needle aspiration in pancreatic space-occupying lesions [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 418-421.
[14]	Chunhua Qiu, Zhihong Zhang. Clinical diagnosis and examination strategy for small intestinal diseases: analysis of 1108 cases [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 948-954.
[15]	Tian Li, Hong Xu, Heliang Liu. Progress in research of pneumoconiosis [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 900-905.

Please choose a citation manager

Content to export