BACKGROUND:Lumbar fusion surgery as an important and effective means of treating degenerative diseases is widely used in clinical application for almost a century. However, long-term clinical evidence showed that lumbar fusion also brought some problems, such as the loss of waist flexibility, complications of donor site, fusion segment motion loss and accelerating the adjacent segment degeneration. In recent years, the theory of spinal dynamic stabilization had spread widely, and a variety of non-fusion surgery is becoming more broadly used in treatment of lumbar degenerative disease. OBJECTIVE:To review the application of non-fusion surgery in the treatment of lumbar degenerative diseases and explain application perspectives and experiences. METHODS:Databases including PubMed and CNKI were retrieved to col ect clinical application and views about non-fusion internal fixation in the treatment of lumbar degenerative diseases from 2007 to 2016. The key words were“lumbar, non-fusion, bone fusion, dynamic stabilization, adjacent segment degeneration”. RESULTS AND CONCLUSION:Thirty papers were included in the final analysis after screening by two independent researchers. We summarized the lumbar non-fusion technology, including artificial nucleus replacement, total disc replacement and posterior lumbar dynamic stabilization device. The philosophy of these new technologies is to provide stability and physiological activity, reducing the abnormal stress that leads to adjacent segment degeneration. These methods can be applied to the step of treatment of lumbar degenerative diseases and to reduce the fusion of diseased segments. Simultaneously, it is needed to strictly grasp the indications for surgery, to identify the cause of the pain caused by low back pain and lumbar spine instability, and to select the most suitable non-fusion device for individual treatment.

Objective To investigate the clinical efficacy of extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis in elderly patients with knee osteoarthritis (KOA). Methods Fifty-six patients with KOA were randomized into the drug therapy group(n=28) receiving only traditional Chinese medicine iontophoresis therapy for four weeks and the combined treatment group(n= 28)receiving extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis therapy for four weeks.WOMAC score as an specific severity-of-illness score was used to evaluate knee joint function of patients before and four-week after treatment. Results WOMAC scores of all patients were significantly decreased which indicated states of an illness were improved after four-week treatment as compared with pre-treatment(all P< 0.05).The combined treatment group versus the drug therapy group showed markedly lower WOMAC scores,including pain score(3.17 ± 1.03 vs.5.27 ± 1.58,t= 7.316,P< 0.05),morning stiffness score(2.23 ± 0.91 vs.3.32 ± 1.14,t= 3.440,P< 0.05),activity restrict of daily living score(20.13 ± 6.46 vs.27.35 ± 13.28,t= 4.691,P< 0.05)and total score(28.37 ± 11.62 vs.40.16 ± 5.93,t=8.015,P<0.05). Conclusions Compared with single traditional Chinese medicine iontophoresis, the extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis therapy may significantly reduce the pain and morning stiffness degree,and enhance activities of daily living in elderly patients with KOA.

End-stage renal disease (ESRD) patients undergoing outpatient hemodialysis (HD) and home peritoneal dialysis (PD) are high risk population of severe and critical types caused by SARS-CoV-2 infection. In order to improve the quality of diagnosis and treatment in dialysis patients with SARS-CoV-2 infection, we wrote this recommendation for primary care clinicians. During the epidemic period of SARS-CoV-2 infection, all patients should be instructed to strengthen self-management. Once the SARS-CoV-2 infection was found in dialysis patients, early stratified management should be carried out within 72 hours after the first positive nucleic acid or antigen test results, which includes early antiviral therapy, early recognition, and transferring severe patients from community or primary hospital to a referral hospital promptly. Guidance for dietary and sports rehabilitation after SARS-CoV-2 infection should also be started as soon as possible.