12. Pang Jinlei, Department of Pain, Anzhen Hospital, Beijing, China, Central Targeted Infusion System Implantation
1>Introduction
Through minimally invasive surgery, an intelligent metal analgesic pump with drug storage and flow rate adjustment outside the body can be implanted into the patient’s body. Through a small and soft intraspinal/ intrathecal catheter, the drug delivery program is prepared according to the patient’s pain level, and analgesic drugs such as morphine are directly delivered into the cerebrospinal fluid in the subarachnoid space of the spinal cord, which is the target center of pain, to achieve the purpose of pain relief.
2>Indications
1)Intractable pain caused by sympathetic nerve dysfunction and peripheral vascular lesions.
2)Large range of low back pain and peripheral nerve pain.
3)Pain of residual limb, phantom limb pain and pain after spinal cord injury
4)Complex local syndrome pain.
5)Post herpes zoster neuralgia.
6)Pain of malignant tumor with local or systemic metastasis
(Photo from Gezhouba Central Hospital Qian Chao)
13.Extracorporeal shock wave therapy
1>Principle
Shock wave is a kind of energy and momentum transfer process, divided into mechanical and electromagnetic waves, which is generated by the sudden release of shock wave energy, acting on local tissues and achieving therapeutic effects.
Currently, Extracorporeal Shock Wave Therapy (ESWT) has been used for 10 orthopedic diseases in Western European countries, and ESWT has become a new treatment for specific sports system diseases. In recent years, this therapy is also being carried out in China one after another.
2>Indications
The principle of shock wave is applied to the human body musculoskeletal viscera and other tissue lesions for the pathological reversal of a therapy, in the medical aspects of the main applications are: the systemic system of tumor and cancer shock therapy; skeletal system of frozen shoulder, tennis elbow, patellar tendonitis, achalasia, etc.; urinary system of extracorporeal shock wave lithotripsy treatment, etc..
3>The advantages of extracorporeal shock wave are
(1) minor injuries, can replace some surgical treatments.
2) simple or no anesthesia is generally used.
3) short treatment time, low risk, and can be performed on an outpatient basis.
4) No special post-operative treatment is required and recovery is faster.
5) The treatment cost is much lower than that of open surgery.
14.Percutaneous vertebroplasty
1>Overview
Percutaneous vertebroplasty (PVP) was invented by Frenchmen Deramond and Galibert in 1984 as a method of injecting bone cement (Polymethylmethacrylate, PMMA) into the diseased vertebral body through percutaneous puncture under imaging surveillance. PMMA) into the diseased vertebral body via percutaneous puncture.
It was initially used for cervical invasive hemangioma, and was subsequently used for osteoporotic vertebral compression fractures (OVCF), primary or metastatic tumors of the vertebral body, and invasive hemangioma of the vertebral body.
2>Principles
It is generally accepted that the injection of bone cement fixes the microfracture of the vertebral body, thus restoring the normal line of force in the spine, increasing the stability of the spine and helping to relieve pain, and that the high heat generated by the polymerization of the bone cement and its own chemical properties can destroy the sensory nerve endings of the vertebral body.
3>Indications
Osteoporotic vertebral compression fractures (OVCF), primary or metastatic tumors of the vertebral body, and invasive hemangiomas of the vertebral body.
With so many minimally invasive techniques, how exactly do you choose? Actually, it is a matter for doctors and an academic question.
First of all, no matter which technology has certain merits, the technology that the doctors in the hospital are skilled in is the best technology; secondly, the choice of indications, there is a clear difference in the choice of inclusive protrusion and prolapse, as if fighting a war, knife, robbery and gun can kill the enemy, it is right to choose the most suitable weapon under what circumstances.