The Correlative Factors Affected The Clinical Efficacy Of Surgical Management Of Lumbar Disc Degeneration

In current study,we used cohort study to observe the patients who suffered from lumbar disc degeneration.We estimated their curative effects and analyzed the paramenters about preoperative,intraoperative, postoperative periods.On the basis of above,we discriminated the affectoies,investigated the causes of the failure and suggested the preventions.Chapter One The prospective study of the patients' early curative effectsObjective:To explore the correlative factors affected the early clinical efficacy of surgical management of lumbar disc degeneration.Method:150 patients who suffered from lumbar disc degeneration were recruited in our studies since December 2007.87 patients were male, others were femal.Mean age was 48.85±11.48.All patients had followed up for more than 3 months after operations.Some patients had followed up for more than 1 year.Recorded the details of the observations about their therapy,calculated the the JOA improved rate and divided the patients into two groups using the 25%improved rate as the benchmarker. Using the SPSS13.0 software to do statistical analysis.Discriminated the affectoies and calculate the odds ratios.Resulets:(1)Relying on the durgs during 3 months afer operations, disable to normal life and preoperative JOA score≥17 were the risk factors to the curative effect during the 3 months after operations.(2)The better preoperative reflex,resecting more amount of nucleus, postoperative JOA score≥25 and using DXM were the protective factors to the curative effect during 3 months after operations.(3)The fusion of spine,resecting more amount of nucleus,postoperative JOA score≥24 and using dehydraters in postoperative period were the protective factors to curative effect during 1 year after operations.Conclusions:(1)The preoperative JOA score≥17 was a hint to unfavourable prognosis.(2)The patients who had poorer curative effect were more relying to the drug and disable to normal life.(3)Resecting more amount of nucleus,better postoperative reflex,using DXM and dehydrater in postoperative period,and the fusion of spine were hints to better early curative effect.The resecting of nucleus was the most powerful risk factors.(4)The postoperative JOA score≥25 at 3 months and≥24 at one year after operations were hints to better early curative effects.Chapter Two The retrospective study of the patients' long term curative effectsObjective:To explore the correlative factors affected the long term clinical efficacy of surgical management of lumbar disc degeneration.Method:42 patients who suffered from lumbar disc degeneration were recruited in our studies from January 1999 to March 2007.26 patients were male,others were femal.Mean age was 47.88±11.03.All patients had been 2 years after operations.Some patients had been more than 5 years after operations.The observations and group standards were the same to the chapter one.Using the SPSS13.0 software to do statistical analysis too.Discriminated the affectoies and calculated the odds ratios.Resulets:(1)Resecting more amount of nucleus and postoperative JOA score≥25 were the protective factors to the prognosis during 2 years after operations.(2)The amount of resected nucleus,the pain and anaesthesia remained in 5 years,the degeneration appeared on the imaging and the JOA score at the five years after operations were statistical different in two groups.Conclusions:(1)Resecting more amount of nucleus was a hint to better long term curative effect.(2) Postoperative JOA score≥25 was a hit to better long term curative effect.