| Aim: To explore the short-term clinical efficacy of posterior micro endoscopic discectomy(MED)in treating lumbar disc herniation and reasons of complications in perioperative period.Methods: 69 patients with lumbar disc herniation undergoing posterior MED(MED group)and 35 patients with the same symptom undergoing posterior mini-incision discectomy(open group)from September 2015 to February 2017 are selected.For the two groups,collect patents' elemental information,operation time,operation bleeding amount,complications in perioperative period,hospital stay on average,reoccurrence rate,JOA and VAS scores of pre-operation,and 1 week,1 month,3months,6 months,9 months and 12 months after operation;and evaluate Mac Nab effect of 6 months and 12 months after operation.Results: For intervertebral disc herniation gap of MED group,L2-3: 1case,L3-4 :2case,L4-5 : 31 cases,L5-S1: 35 cases.Herniation in the left side: 42cases;herniation in the right side: 27 cases.For intervertebral disc herniation gap of open group,L3-4: 2cases,L4-5: 19 cases,L5-S1: 14 caes.Herniation in the left side: 19cases;herniation in the right side: 16 cases.There are no statistical difference in age,sex,and course between the two groups(P>0.05).Two groups were both followed up.The follow-up time of MED group is 15.90±2.44 M,and that of open group is16.09±2.63 M.There are no statistical difference in follow-up time between two groups.For MED group,Operation time is 53.91±6.69 min on average,and for open group,that is 51.43±9.28 min on average.There is no statistical difference between two groups.For MED group,bleeding amount is 40.14±9.66 ml on average,and for open group,that is 59.71±10.50 ml on average.Compared open group,the average bleeding amount of MED group decreased obviously,and there is significant difference(P>0.05).for MED group,hospital stay is 5.10±2.18 d on average,and for open group,that is 9.03±1.76 d,hospital stay of MED group shortened obviously.For MED group,low back pain after operation eased up obviously compared pre-operation,and VAS scores was becoming better in 6 months after operation.Pre-operation VAS score is 7.83±0.91,and VAS score of 12 months after operation is0.51±0.58.The difference is significant(P>0.05).Leg pain after operation eased up obviously compared pre-operation,and VAS score is becoming better in 6 months after operation.Pre-operation VAS score is 7.87±1.07,and VAS score of 12 months after operation is 0.48±0.58.The difference is significant(P>0.05).For open group,low back pain eased up obviously compared pre-operation.Pre-operation VAS score is 8.03±0.66,and VAS score of 12 months after operation is 0.60±0.73.The difference is significant(P>0.05).Leg pain eased up obviously compared pre-operation.Pre-operation VAS is 7.77±0.81,and that of 12 months after operation is 0.66±0.54.The difference is significant(P>0.05).There are no statistical difference in VAS scores of pre-operation and 12 months after operation between the two groups.For MED group,JOA is improved compared pre-operation.JOA score before operation is10.04±3.62,and JOA score of 12 months after operation is 25.30±1.81.The difference is significant(P>0.05).For open group,JOA score is improved compared pre-operation.JOA score before operation is 10.66±1.51,JOA score of 12 months after operation is 25.57±1.52.The difference is significant(P>0.05).There are no significant difference in JOA scores of pre-operation and 12 months after operation between two groups.6 months after operation,for MED group,Mac Nab acceptance is 88.4%,and for open group,Mac Nab acceptance is 82.9%.By rank sum test,there are no significant between the two groups(P>0.05).1 year after operation,for MED group,Mac Nab acceptance is 92.8%,and for open group,Mac Nab acceptance is88.6%.By rank sum test,there are no significant between the two groups(P>0.05).For MED group,there is no significance in Mac Nab acceptance between 6 months after operation and 1 year after operation.For MED group,there are 7 cases of complication in perioperative period with the rate of 10.14%,among which there is 5case of neurologic damage,1 case of spinal dura mater fracture,and 1 case of leftover of nucleus pulposus textus.For open group,there is no complication.And there are no significant difference between two groups.(P>0.05)For MED group,there is 4 cases of reoccurrence of the nucleus pulposus herniation,with the rate of 5.80%.For open group,there is no reoccurrence.And there is no significant difference in reoccurrence(P>0.05)Conclusion:1.There are such advantage S of mini trauma,small amont of bleeding,fast recover when using MED to cure lumbar disc herniation.However,it is difficult to operate,and the rate of complication and recurrence is high.It is necessary to select strictly adaptation symptom and try to lower the rate of complication.2.Using MED to cure lumbar disc herniation,low back pain and leg pain can be eased up immediately after operation,and in the6 months the effect is becoming better and steadier. |
PDF Full Text Request