Clinical Application Of Acupotomy Intraspinal Release Under The Guidance Of Laminar Window Classification

Part I: Laminar window classification studyObjective: To classify the morphological features of the lower lumbar vertebral lamina of the Chinese people,and to standardize the puncture path and operation method of lumbar disc herniation(LDH)in the treatment of small needle knife spinal canal release.Methods:From January 2013 to December 2015,scan imaging data of 100 cases of(50 cases of male,female 50 cases),of the CT scan of the lumbar vertebrae L3~S1 in the Department of Radiology,Ningde Traditional Chinese Medicine Hospital of Fujian University of Traditional Chinese Medicine,using lamina the window zoning method is used to classify the L3~4,L4~5,and L5~S1 segments,observe the morphology distribution of each segment and each vertebral window,and analyze and analyze the transverse diameter of the spinal canal and the transverse vertebral window.Diameter and window diameter ratio.According to the characteristics of each laminar window,the puncture route and operation methods of each laminar window were designed.Results: The proportion of each type of laminar window in each segment: the proportion of each type of L3~4 segment is: type I 11%,type II 21%,type III 68%;L4~5 segment of each type the proportions are: type I 62%,type II 32%,type III 6%;L5~S1 segments account for the proportion of: type I 100%,type II 0%,type III 0%.Each section,each window of average diameter ratio measurement: typeⅠin L3~4 segment is 71.4%,in L4~5 segments is 70.9%,in L5~S1 segments is 98.5%;typeⅡin L3~4 segment is 60.5%,in L4~5 segments is 57.0%;type Ⅲ in L3~4 segment is 48.3%,in L4~5 segments is 44.6%.L5~S1 segments without typeⅡand type Ⅲ.In L3~4,L4~5 segments,the same window section average diameter ratio: typeⅠ> typeⅡ> type Ⅲ.Conclusion: The distribution pattern of various types of coronal lamina window is summarized.It is found that each type of puncture safety zone is designed with various puncture angles,which has guiding significance for acupotomy spinal canal puncture.Part Ⅱ: Confirmatory study of puncture under the guidance of laminar window classificationObjective: According to the acupotomy in the spinal canal puncture guided by the classification of the laminar window,observe whether the needle blade is located in a specific area of the spinal canal,that is,the inner lower edge of the superior vertebral body to verify the lamina.The rationality of window typing research.Methods:6 volunteers from the Department of Orthopaedics,Ningde Traditional Chinese Medicine Hospital of Fujian University of Traditional Chinese Medicine,from June 2017 to October 2017,who underwent acupotomy spinal canal dissection for lumbar disc herniation were selected.After the CT scan,according to the classification of the laminar window,the acupotomy was used to puncture the spinal canal,and the acupotomy was placed,and the CT scan was performed again.Results: A total of 6 acupotomy intraspinal puncture volunteers were conducted under the guidance of laminar window typing.Among them,1 volunteer withdrew from the experiment because he could not tolerate more than 10 minutes.After the remaining 5 patients were indwelling the acupotomy,the prone position CT plain scan was performed again,and the acupotomy blade were all in the specific area of the vertebral canal release,namely the lower edge of the lower articular process of the upper vertebral body.Conclusion: This study validated the rationality of the classification of the lamina window.In the laminar window classification,the acupotomy was inserted into the spinal canal.The position of the acupotomy blade was just in the specific region of the spinal canal.Part Ⅲ: Clinical study of intraspinal release with acupotomy under the guidance of laminar window classificationObjective: To investigate the puncture route and manipulation of intraspinal release of small needle scalpel guided by laminar window typing,and to observe whether intraspinal release of small needle scalpel guided by laminar window typing can improve the safety and clinical efficacy of release.Methods: 60 cases of patients with lumbar disc herniation who were admitted to department 1 of bone injury,Ningde Traditional Chinese Medicine Hospital of Fujian University of Traditional Chinese Medicine from December 2017 to December 2018 were selected.The experimental group(laminar window group)and the control group(traditional group)were randomly divided into 30 cases each.The experimental group was treated with intraspinal release of acupotomy under the guidance of laminar window classification.The control group was treated with intraspinal release of acupotomy in the traditional way.Collect and record two groups of patients with preoperative Visual Analogue Scale method(Visual Analogue Scale,VAS)score,the Japanese Orthopaedic Association to evaluate treatment Scores(Japanese Orthopaedic Association Scores,JOA)score,intra-operative puncture time,touch the excitation rate of nerve root,the straight leg-raising test to improve postoperative Angle,VAS score,JOA score,postoperative SIT value calculation,JOA period,statistical intraoperative and postoperative incidence of adverse events.Results: The difference of intraoperative puncture time between the two groups was statistically significant(P<0.05).The difference of intraoperative nerve root stimulation between the two groups was statistically significant(P<0.05).There was no significant difference in the improvement Angle of postoperative straight leg elevation test between the two groups(P>0.05).The difference in postoperative VAS score between the two groups was statistically significant(P<0.05).The difference in postoperative JOA score between the two groups was statistically significant(P<0.05).There was no statistically significant difference between the two groups in SIT efficacy evaluation 1 week after surgery(P>0.05).The difference in SIT efficacy evaluation between the two groups 1 month after surgery was statistically significant(P<0.05).The difference of JOA improvement rate 1 week after surgery between the two groups was statistically significant(P<0.05).The difference of JOA improvement rate 1 month after surgery between the two groups was statistically significant(P<0.05).No adverse events occurred during and after treatment in the experimental group.One patient in the control group had adverse events after treatment,with dizziness as the symptom,and the incidence of adverse events was 3.3%.Conclusion: Under the guidance of laminar window classification,the safety of intraspinal release with small needle knife is higher than that of traditional surgery.Intraspinal release with small needle knife under the guidance of laminar window classification for the treatment of lumbar intervertebral disc herniation has better efficacy than traditional surgery in terms of pain improvement and functional recovery.